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Background Interferon and ribavirin have been used as therapeutic agents for chronic hepatitis C infection or C-compensated cirrhosis in the conventional treatment. Hepatitis C virus (HCV) -specific direct-acting antiviral agents that directly inhibit the growth process of HCV have been approved since 2011. However, in the early post-marketing vigilance phase of ledipasvir acetonate/sofosbuvir (LDV/SOF), there were reports of interstitial lung disease in 4 out of 32,700 cases with death in 1 case; the onset mechanism is unknown. Case presentation Treatment for hepatitis C was deemed to be necessary, and the patient was referred to our hospital. Oral administration of LDV/SOF was started. On day 8 of administration, a fever of 38–39 °C and coughing were observed followed by the gradual appearance of shortness of breath. As there was no improvement, the patient visited her primary care physician on day 16 of administration and the patient was brought urgently to our hospital on the same day. Blood tests and imaging tests were conducted at our hospital on the day of emergency transport; inflammatory response markers showed abnormal values, and sialylated carbohydrate antigen Krebs von den Lungen-6 was within the normal value range at 303 U/mL. Because the possibility of infection was low based on results of imaging and bronchoalveolar lavage, drug-induced lung disease was suspected, LDV/SOF administration was discontinued, and steroid administration was started. Following steroid pulse therapy, treatment with oral prednisolone tablets was gradually tapered. The patient’s symptoms were relieved and she was discharged. Conclusions The patient’s medication history in this case indicated that there were no drugs taken before or after administration of LDV/SOF until the adverse reaction occurred, and there were no supplements or dietary supplements taken. Therefore, LDV/SOF has been proposed as the cause of the suspected adverse effect. Pharmacists should try to collect adverse effect reports to identify adverse effects early.

We investigated the effects of a Chinese herbal medicine, Gosha-jinki-gan (GJG), on the regulation of insulin levels in rats fed a sucrose-rich diet (SRD). Normal Wistar rats in the SRD group were fed an SRD for 4 weeks. Increased dietary sucrose did not alter plasma glucose levels but it increased plasma insulin levels at 2 and 4 weeks in the SRD-fed rats relative to control rats that were fed standard chow. GJG treatment significantly suppressed the SRD-induced elevation in plasma insulin levels. These results suggest that GJG improves hyperinsulinemia caused by an SRD.

Few studies have reported the changes in the peptide YY (PYY) levels in the intestinal tissue of rats with ulcerative colitis (UC) following oral administration of mesalazine and prednisolone. We investigated the effects of these drugs on the intestinal mucosal PYY levels in a rat model of UC. We confirmed that the PYY levels in the rat intestinal mucosal tissue were high in the lower intestinal tract. The leukocyte count and hemoglobin levels approached the normal values after administering mesalazine or prednisolone to rats treated with 3% dextran sulfate sodium (DSS). The PYY levels in the caecum and colon decreased significantly after administering DSS but increased when mesalazine was administered in a tissue-specific manner. Unlike mesalazine, the PYY levels increased in the ileum in addition to the colon and rectum after administering prednisolone. However, neither of the drugs induced any changes in the plasma PYY levels. These findings indicate that changes in the intestinal tissue PYY levels may be partially involved in the improvement of DSS-induced UC in rats following the administration of these drugs.

We investigated the ability of eicosapentaenoic acid (EPA) to prevent high-fat diet (HFD)-induced obesity and non-alcoholic fatty liver disease (NAFLD). Male C57BL/6J mice were fed standard chow (5.3% fat content), an HFD (32.0% fat content) or an HFD + EPA (1 g/kg/day EPA for the last 6 weeks) for 12 weeks. Serum total cholesterol, hepatic triglyceride and total cholesterol levels were significantly increased in the HFD group, in comparison with those of normal mice (p

At the Municipal Ikeda Hospital, a system in which pharmacists stationed in one ward pharmacy dispense drugs to be administered by injection and injectable preparations delivered to patients' bedsides was introduced in April 2000. This system was aimed at minimizing risks related to injections. Initially, however, on holidays, nurses played the roles of pharmacists in terms of the injections, and there were concerns over a possible rise in the incidence of errors (adverse events/near-misses) related to injections on these days compared with weekdays. Later, when planning to introduce a new holiday work system in the ward pharmacy, we took into account such factors as the number of pharmacists needed on holidays, their duties on holidays and the influence on weekday pharmacy activity of compensatory days-off taken by such pharmacists. In May 2004, the new holiday work system was introduced in the ward pharmacy. Under the new system, 5 pharmacists work at the ward pharmacy on holidays. After this system was put into operation, the number of injections dispensed at the ward pharmacy averaged 230 per day, and 177 per holiday. To evaluate the validity of this system, we recently conducted a questionnaire survey of nurses at our hospital. The survey involved 139 nurses. Of these nurses, 69.1% responded that the number of incidents (adverse events/near-misses) related to dispensing injections on holidays had decreased. Furthermore, 65.4% of the nurses reported a decrease in incidents related to the delivery and administration of injectable preparations. More than half of the nurses answered that the new system had made it easier for them to collect information on medicines and helped them provide better nursing services. When the nurses were asked to make a general assessment of the new system, 90% rated the system as "good." The results of this survey indicate that keeping the ward pharmacy open on holidays contributes to the promotion of the proper use of medicines, reduction of risks related to injections and improvement in the quality of medical care.

The system of intravenous injections (i.v.) being mixed by pharmacists is necessary to prevent contamination and dispensing errors. Such a system was started at the Municipal Ikeda Hospital on April 2000. The dispensing of injections consists of five steps, including the labeling, dispensing, setting and mixing, and the application of check systems. Dispensing errors that induced serious medical complications were examined over a 4-month period (2000.10. 1-2001. 1.31). In addition, resource management during dispensing errors were researched, and countermeasures against dispensing errors were developed. Dispensing errors involving i.v. mixing, which were identified after the preparation had been taken to the ward by nurses, were also surveyed for a 4-month period (2001. 6. 1-9.30). There were 9, 611 i.v. mixing by pharmacists in a 4-month period (2000.10. 1-2001. 1.31). There were 214 dispensing errors (2.23%) during those 4 months, those discovered in the final check comprised 0.28% (27cases), while those involving i.v. mixing taken to the ward by nurses was 0.04% (4 cases). The percentage of serious dispensing errors was 0.01 % (1 case). Fortunately, these mixed i.v. preparations were not administered to patients. In the second survey, there were 10, 478 i.v. mixings by pharmacists in a 4-month period (2001. 6. 1-9.30). There was only 1 case (0.01 %) of a dispensing error involving i.v. mixing identified after being taken to the ward by nurses. There were no cases involving serious dispensing errors. These erroneous instances of i.v. mixing were not administered to patients. When these two surveys are compared, no significant difference was observed, but the number of errors decreased after the establishment of countermeasures to reduce dispensing errors. As a result, it became clear that dispensing errors could occur at any step, but they were preventable by both making several checks and by developing countermeasures against dispensing errors at each step.

A system that included both images and voice using a personal computer was developed to provide pharmaceutical instructions for outpatients at the medication counter. A touch panel was adopted for easy use by a wide range of age groups. The system consisted of such items as the “usage of externally applied drug”, “information on disease”, “patient education” and comprised eight items over all. A survey of 105 patients was conducted and almost all patients (95%) understood the drug-related information provided. This system was found to be an effective method for providing patients with easily understood drug-related information and most patients actually enjoyed using this system which led to an improved dissemination of important medication related information.

To facilitate mutual understanding between doctors and nurses, prevent errors, and assure quality control in the mixing intravenous drip solutions at Ikeda Municipal Hospital, the Department of Pharmacy manages changes in the mixing of solutions and provides appropriate information for drug use. We mix solutions for intravenous injection under uniform standards and also set up a satellite pharmacy to perform these functions in April 2000. This satellite pharmacy accepts prescriptions for manual intravenous injections and manages two laminar air follow cabinets and a laminar flow biological safety cabinet. A ward trial was started in April, another ward was added in June and all wards were included in October 2000. We mix solutions for intravenous injection from Monday till Friday, based on prescriptions received the previous day, from four divisions. The hours of operation are from 10 : 00 Am to 8 : 00 Pm excluding weekends and holidays. The preparation of anticancer and narcotic drugs is not performed by the satellite pharmacy. We mixed 60 to 70 bottles of intravenous injections per day, over a six-month period. Of the intravenous injections mixed, about 70 percent were mixed by the Department of Pharmacy. 95.3 percent were used, 1.8 percent diverted, 2.9 percent were not used.

One of the side effects of cancer chemotherapy is the occurrence of stomatitis. Many studies have shown the effectiveness of a 0.1% allopurinol gargle for treating such stomatitis. Allopurinol gargle develops crystalline deposition a few days after preparation, and therefore it should befreshly prepared each time before use.We developed a prescription that delays crystalline deposition by adding glycerin to allopurinol gargle.Sterile allopurinol gargle (sterile ALT) was prepared by crushing allopurinol tablets, and then glycerin was added at various concentrations.The dissolved amount after 30 days was 0.65±0.05 mg/mL in sterile ALT without glycerin (sterile G0-ALT), 0.75±0.01 mg/mL in sterile ALT containing 1% glycerin (sterile G1-ALT), 0.79±0.03 mg/mL in sterile ALT containing 3% glycerin (sterile G 3-ALT), 0.89±0.06 mg/mL in sterile ALT containing 5% glycerin (sterile G 5-ALT), and 0.98±0.01 mg/mL in sterile ALT containing 10% glycerin (sterile G 10-ALT). The dissolved amount increased with the glycerin concentration.Allopurinol crystal deposition was observed after 2 days in sterile G 0-ALT, after 3 days in sterile G 1-ALT, after 6 days in sterile G 3-ALT, and after 10 days in sterile G 5-ALT, but could not be detected even after 30 days in sterile G 10-ALT.In tests of the sensation tastes during use in normal subjects, similar results were obtained between sterile G 10-ALT and sterile G 0-ALT. The xanthine oxidase (XOD) inhibitory activity was also similar between the two gargles.These results show that sterile G 10-ALT can be preserved for 30 days at 25°C, and its effects and sensation during use are similar to those of a prescription not containing glycerin.

Obesity contributes to the development of insulin resistance and the subsequent incidence of Type 2 Diabetes Mellitus (T2DM). The effects of co-administration of sitagliptin (dipeptidylpeptidase-4 inhibitor) and pitavastatin (lipid-lowering drug) on hyperinsulinemia and fatty liver damage accompanied by obesity in the preclinical stages of T2DM have not yet been investigated. We aimed to evaluate the additive effects of co-administration of sitagliptin and pitavastatin on hyperinsulinemia and fatty liver damage in obese ob/ob mice. Normal male C57BL/6J mice and obese ob/ob mice were divided into four groups, each receiving different drugs: standard mice chow, n = 8 (Normal); ob/ob mice with vehicle, n = 8 (Control); sitagliptin, n=8 (SG); pitavastatin+ sitagliptin, n = 8 (SG + PS). At the end of the study period (8 weeks), blood samples were drawn from all mice to determine Glycated Hemoglobin (HbA1c), serum glucose, insulin, triglyceride, total cholesterol, High-Density Lipoprotein (HDL) cholesterol, Aspartate-Aminotransferase (AST), Alanine Aminotransferase (ALT) and leptin levels. The SG+PS group had significantly (P < 0.05) lower levels of HbA1c, serum insulin, total cholesterol, AST, and ALT, and liver weight ratio, than did the Control group. And also, the SG+PS group had significantly (P < 0.05) higher levels of leptin than did the Control group. Body weight and serum glucose levels in the SG+PS group did not significantly decrease compared to those in the Control group. Serum triglyceride and HDL-cholesterol levels were unchanged among the four groups. These results suggest that combination treatment with sitagliptin plus pitavastatin may be a promising therapeutic approach in the management of T2DM because it has a beneficial effect on the pathophysiological processes of obesity.

The Chinese herbal medicine, Goshajinki-gan (GJ) (Niu-Che-Sen-Qi-Wan), has been widely used for treating patients with melalgia, lower back pain, numbness, and diabetic neuropathy. We investigated the effects of GJ on the regulation of serum insulin and triglyceride levels in obese Zucker fatty rats (fa/fa; ZFR). We administrated GJ to 6-week-old ZFR and non-obese lean rats (LR) for 12 weeks. Body weight and serum glucose, insulin, total cholesterol, and triglyceride levels were significantly increased at 18 weeks in ZFR as compared to the LR. GJ treatment in ZFR significantly suppressed elevation in serum glucose, insulin, and triglyceride levels, but no significant differences were observed in body weight and serum cholesterol levels in the ZFR group with GJ treatment compared to the ZFR group without GJ treatment. These results suggest that GJ may improve hyperinsulinemia and hypertriglyceridemia in ZFR and that GJ may be useful for preventing or delaying the onset of diabetes mellitus in a pre-diabetic state.

To prescribe drugs or check a prescription, it is very important to understand the contraindications. We developed an original drug information system utilizing commercialy available application software. On the base of this system, we made a list of drugs sequenced due to each contraindication and a list of drugs contraindicated due to drug interactions for combination use. Thus, this list enables us to save times in our searching for the information.