BackgroundPharmaceutical intervention enables safe and effective pharmacotherapy by avoiding of adverse drug reactions (ADRs) and efficacy attenuations. Many prescriptions require optimization, and pharmaceutical interventions are inextricably associated with the prevention of potential drug-related problems (DRPs). Although the analysis and understanding of pharmaceutical interventions can lead to improvement in prescription, the analysis of routine pharmaceutical interventions in Japan in insufficient. Thus, we conducted this study to understand potential DRPs by analyzing routine pharmaceutical interventions made by pharmacists in Japan.MethodsPharmacists register the details of pharmaceutical interventions (excluding personal patient information) in a web-based database. We classified data of pharmaceutical interventions into 13 DRP types, 43 DRP subtypes, and 10 intervention categories (e.g., avoidance of serious ADRs and renal dosing recommendations). These data were analyzed with a focus on renal dysfunction and polypharmacy.ResultsDuring the study period, 2376 pharmaceutical interventions were performed. Overall, 68.2% of pharmaceutical interventions were for patients aged over 65 years. The most frequently detected potential DRP was overdosage, followed by omission of prescription, contraindications, and duplication of a drug with similar effect. The main cause of contraindication and overdosage was renal function deterioration, and that of polypharmacy was duplication of a drug with similar effect. Using our original evidence-based approach, we found that 2376 pharmaceutical interventions prevented ADRs for 1678 drugs, with potential cost savings of up to USD 2,657,820.ConclusionsOur results indicate that the analysis of routine pharmaceutical interventions is beneficial for detecting potential DRPs. Our findings also show that, in an aging society, pharmacists have an important role in providing medication safety, with potential cost savings.

Ulcerative colitis (UC) involves chronic inflammation of the large intestine. Several agents are used to treat UC, but adverse side effects are remaining problems. We examined the effect of tropisetron as a new type of drug for UC using a dextran sulfate sodium (DSS)-induced model of colitis in mice. We developed a DSS-induced model of colitis and calculated the Disease Activity Index and colon length. We measured myeloperoxidase activity and determined the protein level and mRNA level of cytokines in the colon. DSS-induced colitis was ameliorated by administration of tropisetron and PNU282987. Pre-administration of methyllycaconitine diminished the suppressive effect of tropisetron upon DSS-induced colitis. These findings suggested that α7 nicotinic acetylcholine receptors (α7 nAChRs) were related to the suppressive effect of tropisetron on DSS-induced colitis. Additionally, stimulation of α7 nAChRs decreased the colon level of interleukin-6 and interferon-γ upon DSS administration. Furthermore, stimulation of α7 nAChRs decreased macrophage infiltration, with expression of α7 nAChR increased by DSS administration. These results suggest that the underlying mechanism of this suppressive effect on DSS-induced colitis is via stimulation of α7 nAChRs and involves suppression of expression of pro-inflammatory cytokines. Tropisetron could be a new type of therapeutic agent for UC.

These results suggest the importance of pharmaceutical interventions by both community and hospital pharmacists in reducing increasing medical expenses and contributing to safety and effectiveness of medication. They also suggest that community and hospital pharmacists have different roles.