Journal of Pharmaceutical Health Care and Sciences最新文献

Background: Nano-liposomal irinotecan (nal-IRI) combined with 5-fluorouracil (5-FU) and levofolinate has been reported to extend the survival of patients with pancreatic cancer and represents an effective second-line treatment. Nal-IRI encapsulates IRI in liposomes modified with polyethylene glycol (PEGylation), which can lead to infusion reactions. Hypersensitivity reactions (HSR) to chemotherapeutic agents include both allergic and infusion reactions, which are difficult to distinguish. Severe HSR can be fatal; however, discontinuation of the suspected drug directly affects the treatment strategy. We report a case of severe HSR during the first nal-IRI administration, in which treatment was successfully continued with supportive management.

Case presentation: A woman in her early 80s with metastatic pancreatic cancer received nal-IRI + 5-FU + levofolinate as second-line treatment. Five minutes after the initiation of the first nal-IRI infusion, the patient developed a tightening sensation in the head, respiratory distress, convulsions, and loss of consciousness, with percutaneous oxygen saturation dropping to the 80% range. The nal-IRI infusion was immediately discontinued, and emergency management was initiated with intravenous infusion of hydrocortisone, famotidine, d-chlorpheniramine maleate, and oxygen administration, resulting in symptom improvement. Given the limited treatment options for metastatic pancreatic cancer and the patient's strong desire to continue therapy, we decided to re-administer the regimen with intensified management, increasing dexamethasone to 19.8 mg and adding famotidine 20 mg and d-chlorpheniramine maleate 5 mg. Furthermore, we adopted a three-step dose-escalation method. The infusion was started at one-third of the standard rate, increased to two-thirds after 30 min, and finally adjusted to the full rate after another 30 min, after confirming the absence of HSR symptoms. Consequently, the patient did not exhibit any signs of HSR, and the same administration method was continued for 11 cycles until disease progression.

Conclusions: The novelty of this report lies in presenting, for the first time, the detailed course and process by which treatment was successfully continued in a patient experiencing severe HSR upon initial nal-IRI administration, through enhanced supportive care tailored to the characteristics of the drug and stepwise dose adjustment.

Background: The implementation of local formularies in Japan began in November 2018 in the Sakata area of Yamagata Prefecture. A local formulary is a regional list of recommended pharmaceuticals selected based on comprehensive criteria, including efficacy, safety, and economic considerations. However, the economic impact of these formulations has not yet been clearly demonstrated. This retrospective observational study aimed to verify their effectiveness by analyzing real-world data.

Methods: Prescription and outpatient data from the National Database were extracted for October 2018, 2019, and 2020, covering both the Sakata area and the rest of Yamagata Prefecture. The number of prescriptions and cost per prescription were calculated for four therapeutic classes: proton pump inhibitors/potassium-competitive acid blockers, angiotensin receptor blockers, α-glucosidase inhibitors, and statins.

Results: In 2020, the formulary adherence rate in Sakata exceeded that in the rest of Yamagata Prefecture across all therapeutic classes. Although the cost per prescription annually decreased in Sakata, some therapeutic classes showed increased costs in the remainder of the prefecture from 2019 to 2020. In contrast, formulary adherence to outpatient medical prescriptions was lower in Sakata, and no clear impact of the local formulary was observed. Applying the rate of cost reduction observed in Sakata to the rest of the prefecture, the estimated monthly savings reached approximately 35 million JPY after 1 year and 15 million JPY after 2 years. Furthermore, although no prior measures existed to control the use of originator drugs without generics, Sakata showed a trend of reduced usage compared with the rest of the prefecture, suggesting the influence of the local formulary.

Conclusions: Local formularies can contribute to the sustainability of Japan's healthcare financing systems.

Background: In 2021, the Education and Training Committee of the Japanese Society for Pharmaceutical Palliative Care and Sciences established an educational training program for pharmacists in palliative care, named Palliative care-Situational Motivating Interactive Learning and Education (pSMILE), based on web-based and face-to-face workshops. The program aims to enhance pharmacists' knowledge of palliative care and develop communication and cooperation skills.

Methods: We constructed a web-based pSMILE training program, which was later adapted for face-to-face workshops. This program consisted of two sessions, with the first half at a hospital and the second half at a clinic or community pharmacy. The participants could choose from three learning scenarios. A post-survey (within 1 week of the workshop) assessed usefulness, difficulty, length, and satisfaction. Participants also completed a web-based survey on behavioral changes related to daily palliative care following the workshop. Nine items on behavioral changes were assessed before and 1 month after the workshop, which was held from April 2021 to March 2024.

Results: Twelve pSMILE workshops were held during this period (10 web-based and two face-to-face). A total of 296 pharmacists participated, 152 (51.4%) of whom were Board Certified Pharmacist in Palliative Pharmacy, and 292 (98.6%) responded to the before/after workshop survey. Usefulness ratings were 4.39 for Session I and 4.20 for Session II. Satisfaction ratings were high (≥ 4.5), with no significant differences based on affiliation, training format, or certification. All confidence scores of nine daily palliative care behaviors (symptom assessment; multidisciplinary information sharing; proposing pharmacotherapy; polypharmacy intervention; palliative pharmacotherapy with awareness of pharmacokinetics; explanation of delirium; response in the discharge conference; information sharing between hospitals, clinics, and community pharmacies; and pharmacotherapy suggestions in view of the post-discharge) improved significantly post-workshop (p < 0.01), across both web-based and face-to-face workshops. Certified participants had higher confidence scores both before and after the workshop, and each group showed a significant improvement.

Conclusions: These results suggest that either web-based or face-to-face pSMILE workshops improve the quality of pharmacists' contribution in daily palliative care. This is the first report on the effectiveness of an academically approved web-based educational program for palliative care pharmacists, comparable to face-to-face workshops.

Background: Shift workers experience regular changes in their waking hours due to fluctuating work schedules. The timing of their medication intake differs depending on whether they are working a day or night shift. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are prescribed once a day and are often taken before or after breakfast. However, studies on the optimal dosing times for the effective treatment of shift workers are lacking. In this study, we investigated whether the effects were different by the pattern of SGLT2 inhibitor intake for shift workers with diabetes.

Methods: Seven shift workers with diabetes who were taking an SGLT2 inhibitor were analyzed. All participants took the medication upon waking for 14 days, followed by administration at a fixed time for another 14 days. Glucose levels were measured over 14 days when the drug was administered either upon waking or at a fixed time of day. The time in range (TIR), which indicates the percentage of time during which the glucose level is within the range of 70-180 mg/dL, was used as the main evaluation index.

Results: The mean HbA1c of the participants was 7.1%. The TIR was 88.5% in the administration upon waking group and 84.9% in the administration at a fixed time group. No significant difference in TIR values was observed between the two administration groups.

Conclusion: A TIR of 70% or higher is recommended to prevent the onset of diabetic complications. Consistent intake of SGLT2 inhibitors, regardless of whether it is during the day or night shift, may help stabilize blood glucose levels in shift workers throughout the day and night, thereby preventing the development of complications.

Background: Hypertension is a major global health problem that often develops without noticeable symptoms. Current treatments and complementary approaches focus on improving endothelial function and enhancing nitric oxide (NO) production to promote vasodilation and lower blood pressure. Isosakuranetin, a flavanone found in Chromolaena odorata leaves, has shown potential antihypertensive properties. This study aimed to investigate the effects of isosakuranetin on L-N^G-Nitroarginine methyl ester (L-NAME)-induced hypertension, focusing on its ability to enhance NO production and reduce oxidative stress.

Methods: This study investigated the antihypertensive effects of the flavanone isosakuranetin in male Wistar rats (n = 8 per group). Hypertension was induced by L-NAME, a nitric oxide synthase inhibitor, for four weeks, followed by treatment with isosakuranetin (10, 20, or 40 mg/kg) or enalapril (10 mg/kg) for an additional two weeks. Systolic blood pressure (SBP), heart rate, and body weight were monitored weekly. After six weeks, the effects of isosakuranetin on NO level and oxidative stress were assessed using the Griess reaction, 2',7'-dichlorofluorescein diacetate (DCF-DA), and superoxide dismutase (SOD) activity assays.

Results: The results demonstrated that the SBP was significantly reduced in the isosakuranetin treatment group when compared to the hypertensive group. Additionally, isosakuranetin treatment significantly restored plasma nitrate/nitrite levels and showed the potential to reduced oxidative stress, as indicated by the decrease in reactive oxygen species (ROS) levels and a significant increase in SOD activity.

Conclusion: These findings suggest that isosakuranetin is a promising natural compound for managing hypertension, demonstrating its potential for clinical application.