Kenichi Sagawa

Disopyramide concentrations in human plasma and saliva: Comparison of disopyramide concentrations in saliva and plasma unbound concentrations

AbstractObjective: This study was performed to investigate whether it is possible to use saliva instead of blood usually used for therapeutic drug monitoring (TDM) of disopyramide. Methods: Six healthy male volunteers ingested 200 mg of disopyramide base, and the disopyramide concentrations in saliva and plasma (total and unbound) were determined by the HPLC. Results: Disopyramide concentration-time profiles for the saliva were nearly equal to those for the plasma unbound concentrations. A large variation for absorption time of the drug was observed among the subjects. Disopyramide concentrations (Cs) in saliva did not correlated well with plasma total concentrations (Cp), r = 0.799, but did well with unbound concentrations (Cpu), r = 0.969, for the 3–12 h period on the elimination phase. The mean ratio of disopyramide concentrations in the saliva against the plasma unbound concentrations was almost constant (1.02(0.10), CV = 9.7%) for the period. The pharmacokinetic parameters (tmax, t1/2, AUC, AUMC and MRT values) for disopyramide calculated from the saliva data were nearly equal to those from the unbound data. Conclusion: Disopyramide concentrations in saliva correlated well with plasma unbound concentrations on the elimination phase.

Survey on the Actual Status of Use of Antiseptics in Our Hospital

Prevention of nosocomial infections is an important task for any medical institution. Although it is important to administer antibiotics prophylactically during the perioperative period, the proper use of antiseptics should have top priority. We carried out a survey to show the actual status of antiseptic use in our hospital in order to determine their proper use. The survey was carried out considering two aspects: the expense situation on the basis of the order slips and the status of use in each department and ward. It was conducted by questionnaire, and the pharmacist of each department asked questions to the nursing staff there. It was found that disinfectants and antiseptics are used almost correctly in our hospital. However, some improper uses were also found. In the future, on the basis of the findings of this study by questionnaire, we would like to give instructions from the standpoint of the pharmacist in the proper use of disinfectants and antiseptics and in the control of nosocomial infections.

Current State of Drug Information Services in Japan. Based on a Hospital Survey in Kanagawa Prefecture.

The rapid growth of pharmaceutical care in Japan has resulted in the need for a new clinical support system for drug information (DI) services. The DI committee of the Kanagawa Society of Hospital Pharmacists conducted a survey of hospitals in 1997-1998. The purpose of the survey was to determine such things as the number of pharmacists actually working in DI, the number of hospitals publishing a DI newsletter and also the number of hospitals utilizing computer automation in their DI programs. The survey consisted of 16 questions that were mailed to 353 hospital pharmacies, out of which 155 responses were returned. The results of the survey were compared to the findings of a similar study performed in 1996. One hundred-two of the 155 pharmacies (66%) indicated that they had a DI-room within their facility. Eighty-five percent of the facilities had their own hospital formulary. In addition many (56.8%) of the DI-rooms had a computer system, but on the other hand only 11.0% of all institutions used it for computer communication and literature seachs such as for MEDLINE. As changes occur in the medical environment, the DI related job should respond accordingly. An average citizen can now access much DI through the Internet, but the qualify of that information may be suspect. The problem today is how to encourage the hospital pharmacies to also access the Internet and both use and evaluate the huge amount of DI that is to be found there.

Determination of Serum Mexiletine Concentrations and its Protein Binding by High-performance Liquid Chromatography.

A new method to determine serum mexiletine (MX) concentrations using high-performance liquid chromatography (HPLC) was established.This method could reduce a sample volume to 100μ1 of serum and could shorten the pretreatment time to less than 10 minutes by using Chem Elut minicolumn. The results obtained by this method (n=28) correlated well with those obtained by gas chromatography method (r=0.997).Moreover, this method had a good recovery and reproducibility, suggesting that it is an excellent method for determining serum MX concentrations.Using this HPLC method, serum protein binding of MX was studied in healthy subjects and patients with chronic renal failure (CRF). The protein binding of MX was 60.83±4.37% in healthy subjects (n=6) and 52.45±6.22% in CRF (n=9).The protein binding of MX in CRF was significantly decreased, compared with healthy subjects, indicating an apparent elevation of free drug concentrations.In general, dose adjustment of MX in CRF is considered to be unnecessary. However, free drug concentrations may participate in the appearance of effects and adverse reactions. The possibility of enhanced pharmacological effects and increased adverse reactions due to such variations of protein binding in CRF should be also considered.