Medication Wastage in a University Hospital in Japan.

Medication wastage is a global issue; however, there are few reports in Japanese hospitals. The purpose of this study was to clarify the situation of medication wastage at our university hospital. We investigated the numbers, costs, reasons, occurrence departments, and involvement of high-priced medications of medication wastage for two years. We analyzed 6730 cases and the total cost was 22782027 Japanese yen (JPY). The most common reasons for medication wastage were change or discontinuation of medication after preparation and breakage or contamination due to dropping. The highest cost was expired medications. The department with the highest number of cases was the hospital wards; however, the hospital pharmacy department accounted for the majority of the costs and most of the reasons were expired medications. Medication wastage of 50000 JPY or more per case was only 1.3% of the total but accounted for 70.7% of the cost and medication wastage of 100000 JPY or more per case was only 0.7% of the total but accounted for 58.6% of the cost. These findings indicate that expired medications in the hospital pharmacy department have the largest impact on medication wastage from the viewpoint of economic loss, and suggest the need for efforts on medication management focusing on high-priced medications. The challenge of minimizing medication wastage should be addressed from the perspectives of both hospital management and the effective use of resources.

[Efficacy and Safety of THP-COP for Diffuse Large B-Cell Lymphoma].

PURPOSE: We studied the efficacy and safety of THP-COP(pirarubicin, cyclophosphamide, vincristine, and prednisolone)for elderly patients with diffuse large B-cell lymphoma(DLBCL). METHODS: We retrospectively investigated the efficacy and adverse events of THP-COP in previously untreated patients with DLBCL who completed THP-COP as first-line chemotherapy between December 2009 and December 2014. RESULTS: The study included 32 previously untreated DLBCL patients aged 67- 85 years(median, 77 years). The median number of treatment courses was 6, and 30 patients completed the treatment (93.8%). The response rate(CR/CRu/PR)was 81.3%, and 21 patients(65.6%)achieved a complete response(CR). The 1- year overall survival rate for all patients was 96.3%(95%CI: 76.5-99.5%). The most common grade 3-4 adverse events were neutropenia, leukocytopenia, infection, and febrile neutropenia. Grade 1-2 adverse events included thrombocytopenia, anemia, peripheral neuropathy, and constipation. Dose reduction was required in 19 patients. The median relative dose intensities (RDI)were 80.8%, 80.2%, and 68.0% for pirarubicin, cyclophosphamide, and vincristine, respectively. CONCLUSION: Our results suggest that THP-COP is safe and effective for elderly patients with DLBCL.

[Formation of oxalate in oxaliplatin injection diluted with infusion solutions].

Oxaliplatin use can cause acute peripheral neuropathy characterized by sensory paresthesias, which are markedly exacerbated by exposure to cold temperatures, and is a dose-limiting factor in the treatment of colorectal cancer.Oxalate is eliminated in a series of nonenzymatic conversions of oxaliplatin in infusion solutions or biological fluids.Elimination of oxalate from oxaliplatin has been suggested as one of the reasons for the development of acute neuropathy.In this study, we developed a high-performance liquid chromatography(HPLC)-based method to detect oxalate formation, and investigated the time dependent formation of oxalate in oxaliplatin diluted with infusion solutions.The results obtained showed that the amount of oxalate in the solution corresponded to 1.6% of oxaliplatin 8 h after oxaliplatin dilution with a 5% glucose solution. On the other hand, oxalate formation from oxaliplatin diluted with a saline solution was ten-fold higher than that from oxaliplatin diluted with the 5% glucose solution.Most patients who were intravenously injected with oxaliplatin experienced venous pain.As a preventive measure against venous pain, dexamethasone was added to the oxaliplatin injection.We measured the amount of oxalate formed in the dexamethasone-containing oxaliplatin injection diluted with a 5% glucose solution.The amount of oxalate formed when dexamethasone was added did not differ significantly from that formed when dexamethasone was not added.Thus, there are no clinical problems associated with the stability of oxaliplatin solutions.

Determination of paroxetine in serum treated with simple pretreatment by pre-column high-performance liquid chromatography using 4-(5,6-dimethoxy-2-phthalimidinyl)-2-methoxyphenylsulfonyl chloride as a fluorescent labeling reagent.

The therapeutic drug monitoring of paroxetine could be used to optimize the pharmacological treatment of depressed patients. A simple and sensitive high-performance liquid chromatography procedure was developed for the determination of paroxetine in serum. After simple pretreatment of serum (50 µL) with acetonitrile and o-phthalaldehyde, paroxetine was derivatized with 4-(5,6-dimethoxy-2-phthalimidinyl)-2-methoxyphenylsulfonyl chloride at 70°C for 20 min in borate buffer (0.1 mol/L, pH 8.0) to produce a fluorescent product. The derivative was separated on a reversed-phase column at 40°C for stepwise elution with (A) acetic acid (10 mmol/L) and (B) acetonitrile. The flow rate was 1.0 mL/min. The fluorescence intensity was monitored at excitation and emission wavelengths of 320 and 400 nm, respectively. The within-day and day-to-day relative standard deviations were 3.0-3.4 and 2.7-8.3%, respectively. The detection limit of paroxetine was 8.3 fmol at a signal-to-noise ratio of 3. As the proposed method that only requires a small quantity of serum (50 µL) is simple, sensitive and reproducible, it would be useful for clinical and biochemical research as well as drug monitoring.

[Evaluation of palonosetron for the prevention of nausea and vomiting induced by colon cancer chemotherapy].

Chemotherapy-induced nausea and vomiting(CINV)is one of the side effects causing significant psychological and physical suffering in patients receiving chemotherapy. First-generation 5-HT3 receptor antagonists(ondansetron, granisetron and ramosetron)are available, but some patients are still not treated adequately. Palonosetron is a second-generation 5-HT3 receptor antagonist with a prolonged duration of action and a higher receptor binding affinity than first-generation agents. In the present study, we aimed to compare the antiemetic efficacy of palonosetron vs. ramosetron in preventing acute and delayed CINV. Patients received palonosetron followed by ramosetron, and the antiemetic effects were evaluated by the Multinational Association of Supportive Care in Cancer Antiemesis Tool(MAT). A total of 22 patients with colon cancer receiving chemotherapy were included in the efficacy analyses. Nine patients were observed with acute nausea, and 11 patients with delayed nausea. Relief of symptoms was observed in 3 patients with acute nausea and 4 patients with delayed nausea by switching from ramosetron to palonosetron. There was no significant difference of improvement in the acute phase, there was significantly suppressed in the delayed phase.

[Comparison of hypersensitivity to branded and generic paclitaxel injections in rats].

The use of injectable generic antineoplastic agents has been increasing. Few studies have compared the quality and adverse reactions of generic and branded antineoplastic agents; and therefore, generic agents have not gained wide acceptance. Paclitaxel injections, which are used for treating solid cancers, are being marketed by some companies in Japan. The degree of hypersensitive reactions to these drugs may vary because of the differences in chemical properties of the polyoxyethylene castor oil that is used as a solvent in the paclitaxel preparations. Therefore, we investigated the incidence of pulmonary edema occurring as a hypersensitive reaction in rats administered branded and generic paclitaxel injections. Moreover, we compared the chemical properties of these preparations. We found that the pH of branded and generic paclitaxel preparations diluted with saline was different. This difference in pH may be attributed to a difference in chemical properties from the additive. We observed no significant differences in pulmonary vascular permeability, arterial partial pressure of oxygen, or leakage of protein in the pulmonary alveolus, between paclitaxel preparations administered to rats. These results suggest that both paclitaxel preparations induced pulmonary edema of a similar level in rats, irrespective of the differences in their chemical properties.

[Management system of cancer chemotherapy regimens].

Cancer chemotherapy regimens which had been used at a ward and outpatient chemotherapy in various departments were collected and made available to everybody in October, 2003. However, it was difficult to manage cancer chemotherapy regimens in real time, from the viewpoint of risk management. Then, the Cancer Chemotherapy Center took the leading part and established a chemotherapy exploratory committee, which consists of 4 doctors, 2 nurses and 2 pharmacists, in June, 2006. The department of pharmacy could control all cancer chemotherapy regimens by this system, and lead the proper use of increasing anticancer agents. Inquiries on prescription by the pharmacist contributed to proper medical treatment. The role of the cancer chemotherapy exploratory committee and its outcome are described for the purpose of the prevention of medical accidents in this paper.

[Out-patient treatment for cancer patients at cancer chemotherapy centers in university hospitals].

At present, one-third of people die of cancer and the number is still increasing in Japan. A safe and effective treatment system is critically required. Recently, the discovery of new drugs and the development of medical oncology promotes out-patient treatment for cancer patients. Out-patient treatment in the cancer chemotherapy center of the University of Occupational and Environmental Health Hospital has been started, and many chemotherapy regimens were verified in this center. Not only different organ-specific chemotherapies but also summarizing the oncology team are necessary for performance of the mission. We describe in this review the characteristics of the cancer chemotherapy center.