Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan最新文献

Active vitamin D3 (VDRAs) can cause drug-induced hypercalcemia and acute renal failure. Eldecalcitol (ELD), a VDRA, promotes bone formation more strongly than other VDRAs, such as alfacalcidol (ALF), but whether or not ELD affects serum Ca levels and renal function more significantly than other VDRAs is unclear. In Japan, the supply of ALF was temporarily stopped in 2021, and patients at Fukuoka University Hospital who were taking ALF were either switched to ELD or discontinued ALF. We retrospectively investigated how these prescription changes affected serum Ca levels and renal function. Sixty-seven adult patients who were admitted to our hospital for at least 5 days between September 2021 and March 2022 and were taking ALF at the time of admission were divided into 3 groups: 36 patients who continued ALF (ALF-C), 12 who were switched to ELD (ELD-S), and 19 who discontinued VDRAs (DC). The changes in weekly serum Ca levels and renal function during hospitalization were compared between the groups. At the second week of observation, the change in the serum Ca level was 0.01 mg/dL in the ALF-C group, +0.45 mg/dL in the ELD-S group, and -0.37 mg/dL in the DC group, showing a significant difference among these groups. In addition, serum Ca levels were increased in all patients in the ELD-S group at Week 2. The estimated glomerular filtration rate didn't change significantly in any group during hospitalization. These results suggest that serum Ca levels should be measured by Week 2 when ELD is newly started or changed.

Comprehensive exploratory surveys of pharmacist involvement with perioperative patients were conducted to identify the current issues and challenges. In the first survey, patients who underwent surgery under general anesthesia during the weekday day shift at Sapporo Higashi Tokushukai Hospital between April 1 and September 30, 2022, were included. Patient backgrounds, surgery-related information, and initial preoperative pharmacist interviews were investigated. In the second survey, the questionnaire was administered to anesthesiologists and operating room nurses at our hospital between March 1 and March 31, 2023. Of the patients who underwent surgery during the weekday day shift, the initial preoperative pharmacist interview was not conducted for approximately 1 in 10 cases. Patients who were not interviewed were more likely to be hospitalized on weekends, holidays, or at night and were more commonly trauma patients. Both anesthesiologists and operating room nurses indicated that the work of operating room pharmacists "supported their work," "improved the quality of care," and "improved medical safety."

Under the Food Sanitation Law, standards for the production and specifications of food ingredients for distribution may be established. Food that does not meet these standards is prohibited from being distributed. For pesticide residues in food, maximum residue limits (MRLs) are set for each pesticide and food type. Even pesticides without specific MRLs must comply with a uniform limit of 0.01 ppm. Thus, the positive list system controls pesticide residues in food in Japan. The MRLs for the pesticides were established based on current international agreements and concepts, and are calculated from crop residue trials for registered usage methods where maximum residue concentrations are expected. MRLs are determined if the dietary intake, when draft MRLs are adopted, does not exceed the acceptable daily intake (ADI) and acute reference dose (ARfD) as evaluated by the Food Safety Commission. The residue definition for MRL setting may be selected from the pesticide components themselves but also their metabolites and degradates, determined by considering the feasibility of analytical methods. Exposure to pesticides via food is estimated using monitoring data from quarantine stations and local governments, as well as market basket surveys. Currently, this exposure level is considered tolerable.

In recent years, functional foods have attracted increasing attention due to growing health consciousness. When functional food ingredients are poorly water-soluble, they largely fail to be absorbed due to their low solubility in the digestive tract, limiting their ability to exert their functions. To develop poorly water-soluble compounds into viable functional food ingredients, it is important to increase their gastrointestinal absorption so that they can fully exert their functions, and to ensure their safety and efficacy through ADMET research. β-Carotene exerts physiological activities including antioxidant effects, and functions as a source of vitamin A, but it is completely insoluble in water, so it is poorly absorbed from the digestive tract, rendering it difficult to use efficiently as a functional food ingredient. To overcome this problem, we are conducting research on drug delivery system to improve β-carotene solubility and thereby improve its digestive absorption by applying our unique amorphous solid dispersion production technology. To date, we have produced amorphous solid dispersions with dramatically improved water solubility by adding polymers and emulsifiers to β-carotene and kneading these mixtures under heat. The resultant amorphous solid dispersion showed unprecedentedly high gastrointestinal absorption, enhanced inhibition of allergic dermatitis, and enhanced amelioration of cognitive impairment. No major safety issues associated with long-term continuous administration were observed. In this paper, we introduce our efforts to effectively deliver poorly water-soluble compounds such as β-carotene in functional foods.

Pemetrexed is a folate analog inhibitor for the treatment of non-small-cell lung cancer (NSCLC). Prophylactic supplementation with vitamin B₁₂ and folic acid reduces hematotoxicity associated with pemetrexed. Metformin, the antidiabetic agent, has been associated with the potential side effect of vitamin B₁₂ deficiency. This retrospective observational study aimed to evaluate the effect of concomitant metformin use on hematologic adverse events in patients with NSCLC undergoing pemetrexed-based chemotherapy using the Medical Data Vision Database. Patients with stage III or higher NSCLC who received pemetrexed from April 2008 to May 2021 were categorized into metformin-treated (MTF) and non-metformin-treated (non-MTF) groups. The primary outcome was the proportion of granulocyte colony-stimulating factor (G-CSF) administration during cycle (C) 1 to C2 or C2 to C3 of pemetrexed therapy. Propensity score matching (PSM) was used to balance the baseline characteristics between the groups. A total of 1174 patients met the inclusion criteria (54 in MTF and 1120 in non-MTF). After PSM, 52 patients were included in each group. The median metformin dosage in the MTF group was 500 mg/d before and 625 mg/d after PSM. There were no significant differences between the MTF and non-MTF groups in G-CSF administration (15.4 vs. 21.2%, p=0.446). Multivariate logistic regression analysis also showed that metformin use did not significantly affect hematologic toxicity (odds ratio: 1.208, 95% CI: 0.554-2.634). This suggests that the concomitant use of a relatively low dose of metformin is unlikely to significantly increase the risk of hematotoxicity in Japanese patients with NSCLC receiving pemetrexed-based chemotherapy.

Introduction: This study examines current OTC pharmaceuticals in Japan categorized as potential substances for abuse and discusses future initiatives for drug abuse prevention.

Methods: The Pharmaceuticals and Medical Devices Agency package inserts search function was used to identify OTC pharmaceuticals containing substances prone to abuse. Subsequently, the corresponding OTC pharmaceuticals containing the designated ingredients were investigated, analyzing their therapeutic and risk categories.

Results: In total, 1427 (13.9%) OTC pharmaceuticals contained the designated ingredients, with those containing methylephedrine and dihydrocodeine accounting for the majority (1245/1427, 87.2%). Among the therapeutic categories, oral cold medicines were predominant at 564, followed by antitussives and expectorants at 213, and oral rhinitis medicines at 100. Regarding risk categories, designated schedule II pharmaceuticals predominated in 9 out of 11 therapeutic category classifications.

Conclusion: Designated schedule II pharmaceuticals, such as oral cold medicines, antitussives and expectorants, and oral rhinitis medicines, pose a high risk of drug abuse. Addressing this challenge necessitates collaboration between pharmacists and registered sales clerks to implement preventive measures aligned with current trends in drug abuse.

Tumor-specific active drug release from macromolecular antitumor drugs after tumor delivery is critical to achieve efficient cellular uptake of the active drug, thereby ensuring therapeutic efficacy. Upon reaching the tumor tissue, protease-facilitated depegylation of pegylated zinc protoporphyrin with ester bonds between PEG and ZnPP (esPEG-ZnPP) occurs, leading to a faster cellular uptake and superior antitumor efficacy compared to PEG-ZnPP with ether bonds (etPEG-ZnPP). This finding provides a viable strategy for achieving efficient tumor-specific drug release by utilizing an ester linkage between PEG and antitumor drugs. Another strategy involves using styrene-maleic acid copolymer (SMA), an amphiphilic polymer. Drug-encapsulating SMA aggregates disintegrate upon interaction with cell membrane components, releasing the encapsulated active drug. The author has demonstrated an improvement in the tumor accumulation of SMA-based macromolecular drugs by conjugating pirarubicin (THP), an anthracycline antitumor drug, with SMA. Furthermore, by conjugating various molecular weights of N-(2-hydroxypropyl)methacrylamide (HPMA) to THP via a hydrazone bond (P-THP, DP-THP, and SP-THP), the author has established a positive correlation between HPMA molecular weight and therapeutic efficacy as well as toxicity. Notably, P-THPs release THP under acidic conditions within tumor tissue; however, this release occurs solely outside tumor cells due to HPMA-mediated inhibition of cellular uptake. The author is currently developing macromolecular anticancer drugs using albumin for the tumor-targeted release of anticancer agents both intra- and extracellularly. The strategic development of tumor-targeting macromolecular antitumor drugs based on a comprehensive understanding of polymer characteristics and the tumor-specific environment is imperative for effective cancer therapy.

Pesticides, veterinary drugs, and feed additives (hereinafter referred to as "pesticides") can remain in foods when used in agricultural and livestock products. Since consuming a variety of foods every day can result in ingesting trace amounts of these pesticides, which may be harmful to health, risk management for residual pesticides in foods is necessary to prevent adverse effects. Based on the Food Sanitation Act, the Ministry of Health, Labour and Welfare (MHLW) has established maximum residue limits (MRLs) for each pesticide and each food type. Currently, approximately 770 pesticides have MRLs set. Since May 2006, Japan has implemented a positive list system, prohibiting the distribution of food containing residual pesticides exceeding the MRLs or uniform limit of 0.01 ppm for pesticides without established MRLs. Appropriate analytical methods are required to determine whether pesticides exceed the MRLs or uniform limit. Currently, MHLW has notified ten simultaneous analytical methods and approximately 350 individual analytical methods. However, many pesticides still lack developed analytical methods. These methods should be simple, quick, and accurate, but developing them is challenging. The National Institute of Health Sciences, in cooperation with local health institutes, registered conformity assessment bodies, and universities, is working on developing these analytical methods. This lecture introduces an overview and the challenges of analytical methods for detecting residual pesticides.

Mycotoxins, toxic secondary metabolites produced by fungi, are present in food and feed worldwide. Acute and chronic dietary exposures can induce adverse health effects in humans and animals. Among the various mycotoxins, aflatoxins pose significant health concerns to the general public. In the early 1960s, a total of more than 100000 turkey poults died from an unknown turkey "X" disease in England. The disease was associated with Brazilian groundnut meal contaminated by Aspergillus flavus, from which aflatoxins were first isolated from the fungal culture broth. Subsequent studies revealed that aflatoxin B₁ (AFB₁) is the most potent carcinogen among all aflatoxins, affecting both humans and various animal species. The International Agency for Research on Cancer has classified AFB₁ as a Group 1 human carcinogen. Aflatoxins are present in a wide variety of food items, including cereals, nuts, fruits, and spices. A survey conducted in Japan between 2004 and 2006 revealed that peanut products, cacao products, peppers, and Job's tears were contaminated with aflatoxins. To reduce exposure, Japan has set a regulatory limit of 10 µg/kg for total aflatoxins [sum of AFB₁, aflatoxin B₂ (AFB₂), aflatoxin G₁ (AFG₁), and aflatoxin G₂ (AFG₂)] for all food items. The National Institute of Health Sciences has developed official analytical methods for determining aflatoxins in foods which are used for quarantine inspection of imported foods. In this symposium, the regulations and analytical methods for aflatoxins are introduced.

Many anticancer drugs, including anthracycline drugs, pose a risk of cardiovascular damage as an adverse reaction. This can detrimentally impact the prognosis and quality of life of patients, potentially leading to the interruption of cancer chemotherapy and compromising cancer treatment. Recently, onco-cardiology (or cardio-oncology) has developed as a new interdisciplinary field that focuses on the prevention and treatment of cardiovascular toxicity of anticancer drugs. In this review, we explore the mechanism underlying the cardiotoxicity of anthracyclines and examine pharmacological agents that safeguard the heart from anthracycline-induced damage. Anthracycline-induced cardiotoxicity primarily involves oxidative stress, characterized by radical production in mitochondria and subsequent apoptosis in cardiomyocytes. While various antioxidant agents, such as resveratrol, vitamin E, and melatonin have demonstrated efficacy in reducing anthracycline-induced cardiotoxicity in animal models, their clinical effectiveness remains inconclusive. Alternatively, dexrazoxane, an intracellular iron chelator, along with standard heart failure medications, such as β-blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, reduce anthracycline cardiotoxicity and prevent subsequent heart failure in both animal and human studies. Additionally, statins [hydroxymethylglutaryl (HMG)-CoA reductase inhibitors] and ranolazine have emerged as potential candidates for attenuating anthracycline-induced cardiotoxicity in clinical settings. Notably, recent in vitro findings suggest that everolimus, an autophagy/mitophagy-inducing antitumor drug, may protect cardiomyocytes from anthracycline-induced toxicity without reducing the antitumor effects of anthracycline. Although promising, further clinical research is warranted to validate the potential of everolimus as a safer and more effective anthracycline chemotherapeutic strategy.