Background
The increasing cost of anticancer drugs is now being recognised as a global problem, and measures against drug wastage are among the most important cost containment strategies for anticancer drugs.
Objective
When blood examination results or changes to a patient's condition necessitate dose reduction or discontinuation of anticancer drugs after their preparation, the compounded anticancer drugs are discarded. To reduce anticancer drug wastage after preparation, we developed a protocol that set the eligibility, start of treatment, dose reduction and discontinuation criteria for injectable anticancer drugs and assessed the effect of pharmacists' checks of these criteria based on the present protocol prior to preparation of injectable anticancer drugs.
Method
Observations before and after introduction of the protocol were conducted at Gifu University Hospital. We recorded the number, type and cost of anticancer drugs discarded after preparation and the reason for discarding these drugs in our dedicated database.
Results
Checking the criteria for anticancer drug administration before preparation significantly reduced the rate at which anticancer drugs within a chemotherapy cycle were discarded after preparation compared with that prior to the protocol's introduction (0.367% [18/4909] vs 0.032% [2/6248], P < .001). Additionally, the total cost of anticancer drugs discarded after preparation was reduced from JPY 2 041 786 (USD 18 562) to JPY 398 414 (USD 3622).
Conclusion
Pharmacists' checks of the eligibility, start of treatment, dose reduction and discontinuation criteria for anticancer drugs based on the present protocol prior to preparation of injectable anticancer drugs was useful for reducing drug wastage after preparation.
We describe a presumed case of drug-induced gastric perforation arising during treatment of rheumatoid arthritis in an outpatient. A 48-year-old male was given diclofenac sodium and misoprostol at the University Hospital. However, the patient also took two non-prescription drugs produced in Taiwan without the consent of his doctors or pharmacists for about three months . The patient was then admitted to another hospital due to upper abdominal pain. A diagnosis of peritonitis due to perforation of the digestive tract was made by thoracic and abdominal radiography , and extended gastrectomy was carried out.We detected indometacin and prednisolone from one non-prescription drug . From the findings, it was considered that the perforated gastric ulcer in this patient was induced by the concomitant use of a corticosteroid and NSAIDs. In this case, the adverse reaction might have been prevented by sufficient patient counseling about the medication. For high-quality and appropriate pharmaceutical care, the pharmacist must provide patient counseling about non-prescription as well as prescrintion drugs .
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