The Safety Using Ritodrine for Long-Term Tocolysis / 医薬品情報学

Objective: Ritodrine, a β agonist, is a uterine tocolytic agent used to suppress preterm labor. In 2013, the European Medicines Agency (EMA) recommended that short-acting β agonists should be used for a maximum of 48 h. However, in Japan, they are widely used for long-term therapy (＞48 h). The EMA recommendation was informed to physicians by pharmacists. We retrospectively evaluated the safety of ritodrine by comparing outcomes before and after the provision of drug information (DI). We investigated whether the physicians' knowledge of the DI of ritodrine influenced performance, and affected the dose administered and the number of side effects reported.Methods: Women administered ritodrine for preterm labor between November 2011 and December 2015 were included in this single-centered retrospective study, which comprised two groups: before (Pre, from November 2011 to November 2013) and after (Post, from December 2013 to December 2015) DI provision. The frequency of cardiovascular side effects was the primary endpoint and the rate of long-term use was the secondary endpoint. The chi-squared test was used for statistical comparison and p＜0.05 was considered to indicate a significant difference.Results: The study comprised 91 patients administered ritodrine for preterm labor: 43 in the Post and 48 in the Pre. The frequency of cardiovascular side effects was 48.8 and 45.8 % in the Post and Pre, respectively (p＝0.64). The rate of long-term use was 65.1 and 79.2 % in the Post and Pre, respectively (p＝0.13).Conclusion: The DI provided by pharmacists increased physicians’ awareness of ritodrine use, which may have improved the safety of the drug. Thus, the provision of DI by pharmacists may enhance patient safety by promoting behavioral change in physicians.

Effects of Information Provided by Pharmacists on Pharmacotherapy / 医薬品情報学

<b>Objective: </b>There are only a few studies evaluating the effects of drug information services on pharmacotherapy.  We, therefore, studied the effects of providing drug information such as the effectiveness and safety of aliskiren on its pharmacotherapeutic efficacy by comparing before versus after drug information provision.<br><b>Methods: </b>Pharmacists provided drug information such as the effectiveness and safety of aliskiren coadministered with either ACE-I (angiotensin converting enzyme inhibitor) or ARB (angiotensin receptor blocker) to physicians and other healthcare professionals.  We compared the number of patients for whom aliskiren was prescribed, the proportion of diabetic patients taking both aliskiren and ACE-I (or ARB), the proportion of patients with low eGFR (estimated glomerular filtration rate), and the proportion of patients with hyperkalemia and related conditions, before versus after providing the drug information to the healthcare professionals.<br><b>Results: </b>The number of patients for whom aliskiren was prescribed decreased.  The proportion of patients taking both aliskiren and ACE-I (or ARB) decreased significantly after providing the drug information (<i>p</i>=0.007).  The proportion of diabetic patients taking both aliskiren and ACE-I (or ARB), the proportion of patients with low eGFR, and the proportion of patients with hyperkalemia also decreased, after providing the drug information.<br><b>Conclusion: </b>This study showed the drug information service to be clinically beneficial, achieving better pharmacotherapy.  Pharmacists should evaluate and provide information on the effectiveness and safety of drugs announced by authorities in a timely manner to achieve optimal patient care.

Unilateral oculomotor nerve palsy, ataxia and Parinaud’s syndrome caused by ventral midbrain hemorrhage

We report a patient with unilateral midbrain hemorrhage which caused ipsilateral complete oculomotor nerve palsy with pupillary involvement, contralateral upgaze paresis, contralateral limb ataxia and Parinaud’s syndrome. CT scan and MRI brain demonstrated a hemorrhage in the left paramedian midbrain probably involving the oculomotor fascicles; extension of the hemorrhage to the most rostral midbrain may have involved the pupillary fi bers. It was previously thought that a lesion in the superior colliculus, surrounding nuclei (Darkschewitsch and Cajal nuclei), and the posterior commissure (i.e. dorsal midbrain) were responsible for clinical fi ndings similar to those found in our patient, but our patient showed a hemorrhagic lesion in the left ventral midbrain which did not extend to dorsal midbrain. We propose that the responsible lesion in our patient might involve the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).