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Kitagawa K, Uekusa S, Hanai Y, Kimura I, Tsukahara M, Kagawa A, Sasaoka K, Sakishiro Y, Miyake A, Watanabe Y, Baba D, Kodama M, Kishi Y, Yamada N, Yoshio T, Matsuo K. Changes in psychopharmacotherapy for patients with schizophrenia in a psychiatric institution in Japan: A 12-year prescription survey pre- and post-introduction of clozapine. Asian J Psychiatr 2024; 96:104047. [PMID: 38640549 DOI: 10.1016/j.ajp.2024.104047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
Psychopharmacotherapy for patients with schizophrenia in Japan has a long history of polypharmacy, which is rare worldwide but remains a critical problem. One reason for this is that clozapine was not available in Japan until 2009. We aimed to investigate the changes in psychopharmacotherapy in patients with schizophrenia over 12 years pre- and post-introduction of clozapine to clarify how psychopharmacotherapy for patients with schizophrenia has changed with the introduction of clozapine. We retrospectively collected data from the medical records of inpatients diagnosed with schizophrenia at the Okayama Psychiatric Medical Center. Chlorpromazine equivalent (CP-eq) decreased from 1276.6 mg/day in 2009 to 613.9 mg/day in 2020. The prescribed daily dose/defined daily dose (PDD/DDD) decreased from 3.0 in 2009 to 1.2 in 2020. The monotherapy rate increased from 24.4 % in 2009 to 74.6 % in 2020. Our institution began using clozapine in 2010, and the prescription rate for clozapine increased to 37.3 % in 2020. The prescription rate for more than three antipsychotics decreased from 27.8 % in 2009 to 0.8 % in 2020. The increase in clozapine prescription has contributed to an increased rate of antipsychotic monotherapy and a decreased rate of polypharmacy, promoting the optimization of schizophrenia medication. Clozapine therapy should be further promoted in Japan to reduce treatment-resistant schizophrenia due to polypharmacy as much as possible.
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Affiliation(s)
- Kohei Kitagawa
- Department of Clinical Research, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan.
| | - Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | - Itsuki Kimura
- Department of Pharmacy, Toho University Omori Medical Center, Ota, Japan
| | - Masaru Tsukahara
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Azusa Kagawa
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Kenji Sasaoka
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Yui Sakishiro
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Ayaka Miyake
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Yuki Watanabe
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Daiki Baba
- Department of Pharmacy, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Masafumi Kodama
- Department of Clinical Research, Okayama Psychiatric Medical Center, Okayama, Japan; Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Yoshiki Kishi
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Takashi Yoshio
- Sumiyoshikaiseikai Sumiyoshi Hospital Yamanashi, Japan; Department of Hospital Pharmaceutics, Faculty of Pharmaceutical Sciences, Showa University, Shinagawa, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
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Hanai Y, Ueda T, Hamada Y, Oda K, Takahashi Y, Nakajima K, Miyazaki Y, Kiriyama M, Uekusa S, Matsuo K, Matsumoto K, Kimura T, Takesue Y. Optimal timing for therapeutic drug monitoring of voriconazole to prevent adverse effects in Japanese patients. Mycoses 2023; 66:1035-1044. [PMID: 37584173 DOI: 10.1111/myc.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The optimal timing for therapeutic drug monitoring (TDM) of voriconazole in Asians, who have higher rates of poor metabolisers than non-Asians, is unclear. This can cause unexpectedly high concentrations and delays in reaching steady-state levels. OBJECTIVES To determine the appropriate timing of TDM in Japanese patients receiving voriconazole. PATIENTS/METHODS Trough levels (Cmin ) were measured on days 3-5 (recommended timing, RT) and days 6-14 (delayed timing, DT) after starting voriconazole in patients receiving an appropriate dosage. Considering bioavailability, Cmin was only compared in patients receiving oral voriconazole. RESULTS A total of 289 and 186 patients were included in the safety and pharmacokinetic analyses, respectively. There was a significant difference in Cmin measured no later than and after day 5 (3.59 ± 2.12 [RT] vs. 4.77 ± 3.88 μg/mL [DT], p = .023), whereas no significant difference was observed on cutoff day 6 (3.91 ± 2.60 vs. 4.40 ± 3.94 μg/mL, p = .465), suggesting that Cmin close to the steady-state was achieved after day 5. DT causes a delay in achieving the therapeutic range. The hepatotoxicity rates were 21.5% and 36.8% in the RT and DT groups, respectively (p = .004); DT was an independent risk factor for hepatotoxicity. CONCLUSION Although steady-state concentrations may not be achieved by day 5, early dose optimisation using RT can prevent hepatotoxicity in Japanese patients. TDM should be performed on days 3-5 to ensure safety. However, subsequent TDM may be necessary due to a possible further increase in Cmin .
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Affiliation(s)
- Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mone Kiriyama
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
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Uekusa S, Nemoto M, Hanai Y, Nakashin M, Miyagawa A, Yanagino S, Arita Y, Matsumoto T, Nishizawa K, Nagai H, Higai K, Matsuo K. Risk Factors for Lenvatinib-Induced High-Grade Hypothyroidism in Patients with Hepatocellular Carcinoma: A Retrospective Study. Pharmacology 2023; 108:460-468. [PMID: 37591220 DOI: 10.1159/000531881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/26/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Lenvatinib mesylate (LEN) is an orally administered tyrosine kinase inhibitor used for the treatment of various cancers, including hepatocellular carcinoma (HCC). HCC treatment with LEN is associated with a very high incidence of adverse events, especially hypothyroidism. This study investigated the incidence of hypothyroidism due to LEN and the relationships between hypothyroidism incidence and patient demographics by analyzing clinical laboratory data from HCC patients treated with LEN. METHODS This was a single-center, retrospective study of HCC patients who received LEN between April 19, 2018, and September 30, 2020. The observation period was from 1 week before the start of LEN administration to 1 month after the end of administration. RESULTS In total, 61 patients with HCC were enrolled. High-grade hypothyroidism (CTCAE Grade 2-3) was found in 36.1% (22/61 patients). In high-grade hypothyroidism, eosinophil (EOSINO) count was significantly low (p = 0.029). The cutoff value of EOSINO count was estimated to be approximately 150/µL. The adjusted odds ratios of high-grade hypothyroidism for current smoking and EOSINO count <150/µL were 0.237 (95% confidence interval: 0.063-0.893) and 4.219 (95% confidence interval: 1.119-15.92), respectively. CONCLUSION The results showed that noncurrent smoking and EOSINO count <150/µL are risk factors for LEN-induced high-grade hypothyroidism.
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Affiliation(s)
- Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Maho Nemoto
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Misaki Nakashin
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | | | | | | | | | | | - Hidenari Nagai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Koji Higai
- Laboratory of Medical Biochemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
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Uekusa S, Hanai Y, Hirayama S, Yokoo T, Hasegawa T, Shimoyama K, Kusano A, Nishizawa K, Matsumoto T, Matsuo K. Vancomycin Hydrochloride as a Risk Factor for Acute Kidney Injury: A Retrospective Study. Pharmacology 2023; 108:444-450. [PMID: 37531935 DOI: 10.1159/000531511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/30/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The incidence of acute kidney injury (AKI) caused by vancomycin hydrochloride (VCM) was reported to be 5-43%. VCM-induced AKI was reported to be more likely to occur 4-17 days after initiating VCM treatment; however, it may occur earlier. The aim of this study was therefore to investigate risk factors for the development of AKI within two (AKI2days) and seven (AKI7days) days of VCM administration. METHODS This was a single-center, retrospective study including patients who underwent VCM therapy between April 1, 2013, and December 31, 2019. AKI was evaluated based on the Kidney Disease: Improving Global Outcomes criteria. RESULTS In total, 287 patients were enrolled. The incidence of VCM-induced AKI within 7 days was 10.8% (31/286 cases), and the incidence of AKI within 2 days was 5.9% (15/252 cases). Serum VCM trough concentrations and tazobactam-piperacillin (TZP) were shown to be a risk factor for VCM-induced AKI. The serum VCM trough concentration was 12.67 μg/mL within the 48 h threshold (AKI2days) and 19.03 μg/mL within the 7-day threshold (AKI7days). CONCLUSION Our study demonstrated that high serum VCM trough concentrations and the combination of VCM and TZP were independent risk factors for VCM-induced AKI. Avoiding the concomitant use of TZP, or thorough monitoring of renal function with the concomitant use of TZP, may be helpful in reducing the occurrence of AKI. Furthermore, monitoring serum VCM trough concentrations within 2 days may effectively reduce the incidence of AKI.
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Affiliation(s)
- Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | - Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | | | - Takuya Yokoo
- Toho University Omori Medical Center, Tokyo, Japan
| | | | | | - Ayumu Kusano
- Toho University Omori Medical Center, Tokyo, Japan
| | | | | | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
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Uekusa S, Onozato M, Umino M, Sakamoto T, Ichiba H, Tsujino N, Funatogawa T, Tagata H, Nemoto T, Mizuno M, Fukushima T. Increased inosine levels in drug-free individuals with at-risk mental state: A serum metabolomics study. Early Interv Psychiatry 2022; 16:247-255. [PMID: 33779047 DOI: 10.1111/eip.13148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
AIM At-risk mental state (ARMS) has been recently attracting attention with respect to the improvement of the management and outcome of psychiatric diseases, such as schizophrenia. Since only a few studies have reported on biological alterations in ARMS, serum metabolomics was carried out in ARMS subjects and healthy controls using liquid chromatography with high-resolution mass spectrometry. METHODS Serum samples were collected from ARMS subjects (n = 24; male: 12; female 12) and age- and sex-matched healthy controls (n = 23 male: 11, female: 12). After serum pre-treatment, liquid chromatography with high-resolution mass spectrometry was performed. Multivariate analyses, such as orthogonal partial least-squares discriminant and volcano plot analyses, were performed. RESULTS Serum inosine, lactate, taurine, 2,3-dihydroxypropanoate and glutamate levels differed between the two groups. A significant increase in inosine levels was detected in the positive- and negative-ion modes; however, significant differences were not observed in the levels of other purine-related metabolites (hypoxanthine, xanthine and urate) between the two groups. CONCLUSION Increased inosine levels may serve as biological markers for ARMS, in addition to alterations in the levels of lactate and certain amino acids.
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Affiliation(s)
- Shusuke Uekusa
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan.,Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Mayu Onozato
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Maho Umino
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Tatsuya Sakamoto
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Hideaki Ichiba
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Naohisa Tsujino
- Department of Psychiatry, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.,Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Tomoyuki Funatogawa
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takeshi Fukushima
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
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Hanai Y, Yoshizawa S, Matsuo K, Uekusa S, Miyazaki T, Nishimura K, Mabuchi T, Ohashi H, Ishii Y, Tateda K, Yoshio T, Nishizawa K. Evaluation of risk factors for uric acid elevation in COVID-19 patients treated with favipiravir. Diagn Microbiol Infect Dis 2022; 102:115640. [PMID: 35193798 PMCID: PMC8782729 DOI: 10.1016/j.diagmicrobio.2022.115640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/20/2021] [Accepted: 01/16/2022] [Indexed: 11/24/2022]
Abstract
The objective of this retrospective study was to identify the clinical risk factor associated with uric acid elevation in coronavirus disease (COVID-19) patients treated with favipiravir. Uric acid elevation was defined as an unexplained increase of ≥1.5 times in the patient's uric acid level from baseline. Twenty-nine COVID-19 patients were included in the study. Uric acid elevation developed during favipiravir therapy in 12 (41.4%) patients and the median onset time was 4.5 days after starting favipiravir. In multiple logistic regression analysis, the favipiravir dosage (adjusted OR = 1.69 [1.02–2.81], P = 0.044) and younger patient age (adjusted OR = 0.91 [0.83–0.99], P = 0.040) were significant clinical risk factors for uric acid elevation. No significant between-group difference was noted in the uric acid elevation and non-elevation groups in the clinical recovery after favipiravir therapy. The uric acid levels of patients administered with favipiravir should be monitored closely.
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Azuma K, Matsuo K, Nemoto M, Uekusa S, Yokoyama M, Terui Y, Hama T, Yoshio T. Occurrence of Infusion-Related Reactions due to Obinutuzumab Therapy for Follicular Lymphoma. Gan To Kagaku Ryoho 2021; 48:1369-1373. [PMID: 34795129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Obinutuzumab is used to treat follicular lymphoma in Japan. Its characteristic adverse event is infusion- related reactions(IRRs). Although interruption of administration improves many IRRs, serious symptoms can occur; thus, timing the interruption to correspond with the onset of these symptoms is necessary. However, the specific symptoms and timing of IRRs caused by obinutuzumab remain unclear. Therefore, the purpose of this study was to clarify the specific symptoms and timing of the onset of IRRs with obinutuzumab treatment. METHODS Thirty patients were administered obinutuzumab for one year from October 2018 to September 2019. The frequency of IRRs, expression time, severity, symptoms, and correspondence were investigated. RESULTS IRRs occurred in 13 patients(43.3%), and all occurred after the first dosing. In 9 of 13 cases(69.2%), IRRs occurred within 90 min of the first dosage. Grade 3 symptoms were expressed in 1 of 13 cases (7.7%). The symptoms of IRRs were throat discomfort, breathing difficulty, skin rash, chills, and fever. CONCLUSIONS Most IRRs due to obinutuzumab occurred within 90 min of the first dosage. They were mostly Grade 2 or lower, and the frequency of serious IRRs was low. Thus, careful observation of symptoms during treatment with obinutuzumab is necessary.
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Affiliation(s)
- Keiichi Azuma
- Dept. of Pharmacy, Cancer Institute Hospital, Japanese Foundation for Cancer Research
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Onozato M, Uekusa S, Sakamoto T, Umino M, Ichiba H, Fukushima T. Separation of vigabatrin enantiomers using mixed-mode chromatography and its application to determine the vigabatrin enantiomer levels in rat plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1179:122866. [PMID: 34348203 DOI: 10.1016/j.jchromb.2021.122866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022]
Abstract
Mixed-mode chromatography-comprising a mixed phase with reversed and ionic phases, enabling hydrophobic and ion-exchange interactions simultaneously-was applied to identify vigabatrin enantiomers by HPLC with pre-column fluorescence derivatization with 2,5-dioxopyrrolidin-1-yl (4-(((2-nitrophenyl)sulfonyl)oxy)-6-(3-oxomorpholino)quinoline-2-carbonyl)prolinate (Ns-MOK-(S)-Pro-OSu). The MOK-(S)-Pro-vigabatrin enantiomers were efficiently separated within 12 min (total analysis time per sample: 28 min, including washing and equilibrium time for the column). The mobile phase was H2O/CH3OH/10 mM ammonium formate (pH 2.0) (20/20/60, v/v/v). Column temperature was maintained at 60℃. The proposed HPLC method could successfully monitor plasma vigabatrin enantiomer levels in rats administered (±)-vigabatrin (50 mg/kg, p.o.).
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Affiliation(s)
- Mayu Onozato
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Shusuke Uekusa
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan; Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Tatsuya Sakamoto
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Maho Umino
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Hideaki Ichiba
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Takeshi Fukushima
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan.
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Sakamoto T, Onozato M, Uekusa S, Ichiba H, Umino M, Shirao M, Fukushima T. Development of derivatization reagents bearing chiral 4-imidazolidinone for distinguishing primary amines from other amino acids and application to the liquid chromatography-tandem mass spectrometric analysis of miso. J Chromatogr A 2021; 1652:462341. [PMID: 34192611 DOI: 10.1016/j.chroma.2021.462341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
We designed and synthesized three novel derivatization reagents bearing chiral 4-imidazolidinone, namely succinimidyl 2-(3-((benzyloxy)carbonyl)-1-methyl, ethyl, and -phenyl-5-oxoimidazolidin-4-yl)acetates (CIMs), for use in liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The CIMs were able to discriminate primary amines from other compounds such as secondary amines and phenols, based on their unique m/z reduction of precursor ion to form product ion in MS/MS. As amino acid derivatization reagents, the CIMs were compared in terms of enantioseparation of amino acid and detection sensitivity. CIMa-OSu with 1-methyl-5-oxoimidazolidinone moiety gave the best optical resolution and detection sensitivity among the CIM reagents. Next, we applied (R)-CIMa-OSu to determine amino acids in miso by LC-triple-quadrupole MS. The proposed method achieved simultaneous determination of 20 l-amino acids and two d-amino acids (d-alanine and d-serine) in the sample with a high sensitivity (limits of detection 5-238 fmol, signal-to-noise ratio 3.3). After derivatization with CIMa-OSu, it was possible to determine whether each peak in the chromatogram was a component of primary amine or not, by using a high-resolution orbitrap MS instrument.
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Affiliation(s)
- Tatsuya Sakamoto
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Mayu Onozato
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Shusuke Uekusa
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Hideaki Ichiba
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Maho Umino
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan
| | - Mika Shirao
- Department of Food and Health Sciences, Jissen Women's University, 4-1-1 Osakaue, Hino, Tokyo 191-8510, Japan
| | - Takeshi Fukushima
- Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi-shi, Chiba 274-8510, Japan.
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Kitagawa K, Uekusa S, Matsuo K, Moriyama K, Yamamoto T, Yada Y, Kodama M, Kishi Y, Yoshio T. Risk factors for clozapine-induced central nervous system abnormalities in Japanese patients with treatment-resistant schizophrenia. Asian J Psychiatr 2021; 60:102652. [PMID: 33866283 DOI: 10.1016/j.ajp.2021.102652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/13/2021] [Accepted: 04/05/2021] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to assess the risk factors for clozapine-induced central nervous system (CNS) abnormalities (i.e., electroencephalogram [EEG] abnormalities, myoclonus, and seizures). We retrospectively analyzed data from 106 patients with schizophrenia who received clozapine treatment through our hospital. A review of the EEG recordings showed that 71 of these patients (67.0 %) developed CNS abnormalities after initiating clozapine treatment. EEG abnormalities, myoclonus, and seizures occurred in 53.8 %, 38.7 %, and 8.5 % of the patients, respectively. Multivariate logistic regression analysis showed that the risk factors for clozapine-induced CNS abnormalities were concomitant lithium usage (odds ratio, 4.560; 95 % confidence interval, 1.750-11.900) and shorter illness durations before clozapine initiation (odds ratio, 0.796; 95 % confidence interval, 0.649-0.976). However, plasma clozapine levels and the usage of antiepileptics did not exhibit associations with the risks of CNS abnormalities. Clinicians should monitor their patients for incident CNS abnormalities when administering lithium in combination with clozapine regardless of plasma clozapine levels or the usage of antiepileptics. This is especially true for patients with short illness durations.
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Affiliation(s)
- Kohei Kitagawa
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan.
| | - Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
| | - Kei Moriyama
- School of Pharmacy, Shujitsu University, Okayama, Japan
| | - Tatsuro Yamamoto
- Department of Pharmacy, Tottori University Hospital, Tottori, Japan
| | - Yuji Yada
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Masafumi Kodama
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Yoshiki Kishi
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Takashi Yoshio
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan
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Uekusa S, Onozato M, Sakamoto T, Umino M, Ichiba H, Fukushima T. Fluorimetric determination of the enantiomers of vigabatrin, an antiepileptic drug, by reversed-phase HPLC with a novel diastereomer derivatization reagent. Biomed Chromatogr 2021; 35:e5060. [PMID: 33377241 DOI: 10.1002/bmc.5060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 01/16/2023]
Abstract
Herein, determination of an antiepileptic drug, (±)-vigabatrin (VB), was performed by reversed-phase HPLC with fluorimetric detection using a newly designed and synthesized fluorescence derivatization reagent, 2,5-dioxopyrrolidin-1-yl (4-{[(2-nitrophenyl)sulfonyl]oxy}-6-(3-oxomorpholino)quinoline-2-carbonyl)prolinate [Ns-MOK-(R)- or (S)-Pro-OSu]. During the derivatization of VB with Ns-MOK-(R)-Pro-OSu at 60°C, the nosyl (Ns) group, which was introduced to protect a phenolic hydroxy group, was released within 30 min to produce MOK-(R)-Pro-VB, which was detected fluorimetrically at 448 nm with an excitation wavelength of 333 nm. The VB enantiomers were separated on an octadecylsilica (ODS) column with a resolution value of 5.57, because Ns-MOK-(R)-Pro-OSu bears an optically active D-proline structure. A complete separation of MOK-(R)-Pro-(R)- and -(S)-VB enantiomers was achieved on the ODS column within 40 min using stepwise gradient elution, and the detection limits were ~0.80 and 0.37 pmol on the column, respectively. The proposed HPLC with fluorimetric detection method was successfully used for determining VB enantiomers in VB-spiked human serum following solid-phase extraction with an anion-exchange cartridge.
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Affiliation(s)
- Shusuke Uekusa
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan.,Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Mayu Onozato
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Tatsuya Sakamoto
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Maho Umino
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Hideaki Ichiba
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Takeshi Fukushima
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
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Akagi Y, Chiba T, Uekusa S, Kato H, Yamamura S, Aoki Y, Enoki M, Ogawara Y, Kasahara T, Kimura Y, Shimizu T, Takeishi A, Nakajima Y, Kobayashi H, Sugi K. Retrospective cohort study of the efficacy and safety of dabigatran: real-life dabigatran use including very low-dose 75 mg twice daily administration. J Pharm Health Care Sci 2019; 5:17. [PMID: 31388437 PMCID: PMC6670142 DOI: 10.1186/s40780-019-0145-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Dabigatran is a direct thrombin inhibitor and an anticoagulant that is prescribed to prevent ischemic stroke and systemic embolism in non-valvular atrial fibrillation. Dabigatran (150 mg twice daily) is non-inferior to warfarin for the prevention of stroke and systemic embolism. A dose reduction to 110 mg twice daily should be considered for patients with decreased renal function, elderly patients, and those with a history of gastrointestinal bleeding. A small number of patients are prescribed 75 mg twice daily; however, excessive dose reduction below that indicated on the package insert may decrease the effectiveness of dabigatran. In this study, we investigated the incidence of thromboembolic events and hemorrhagic complications in patients receiving different doses of dabigatran, including patients receiving the very low-dose of 75 mg twice daily. Methods Five hospitals in Meguro and Setagaya areas of Tokyo were included in this study. The subjects were patients receiving dabigatran in the hospitals from March 2011 to February 2014. Thromboembolic events (stroke, systemic embolism, and transient cerebral ischemic attack) and hemorrhagic complications occurring before December 2014 were retrospectively evaluated. Results A total of 701 subjects received dabigatran during the study period: 187 patients (26.7%) received 150 mg twice daily (normal dose), 488 patients (69.6%) received 110 mg twice daily (low-dose), and 26 patients (3.7%) received 75 mg twice daily (very low-dose). Thromboembolism occurred in 4 (2.1%), 11 (2.3%), and 3 patients (11.5%), in the normal dose, low-dose, and very low-dose groups, respectively. The odds ratio of the 75 mg dose to the 150 and 110 mg doses was 5.73 (95% CI, 1.55–21.2; p = 0.009), and the incidence with the 75 mg dose was higher than that with the other doses. Although the number of events was limited, it should be noted that 3 patients in the very low-dose group had thromboembolic events. Conclusions The results suggest that sufficient anticoagulation efficacy may not be maintained when the dabigatran dose is excessively reduced to 75 mg twice daily.
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Affiliation(s)
- Yuuki Akagi
- 1Department of Pharmacy, National Hospital Organization, Yokohama Medical Center, 3-60-2 Harajuku, Totsuka, Yokohama, Kanagawa 245-8575 Japan
| | - Tatsuo Chiba
- 2Department of Pharmacy, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro, Tokyo, 153-8515 Japan
| | - Shusuke Uekusa
- 2Department of Pharmacy, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro, Tokyo, 153-8515 Japan
| | - Hiroyoshi Kato
- 3Faculty of Pharmaceutical Sciences, Toho University, 2-2-1 Miyama, Funabashi, Chiba, 274-8510 Japan
| | - Shigeo Yamamura
- 4Faculty of Pharmaceutical Sciences, Josai International University, 1 Gumyo, Togane, Chiba, 283-8555 Japan
| | - Yukiko Aoki
- 5Department of Pharmacy, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo, 152-8902 Japan
| | - Mizuho Enoki
- Department of Pharmacy, Tamagawa Hospital, 4-8-1 Seta, Setagaya, Tokyo, 158-0095 Japan
| | - Yuka Ogawara
- Department of Pharmacy, Tamagawa Hospital, 4-8-1 Seta, Setagaya, Tokyo, 158-0095 Japan
| | - Takanori Kasahara
- 5Department of Pharmacy, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo, 152-8902 Japan
| | - Yuki Kimura
- 5Department of Pharmacy, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo, 152-8902 Japan
| | - Tadahiro Shimizu
- Department of Pharmacy, Mishuku Hospital, 5-33-12 Kami-meguro, Meguro, Tokyo, 153-0051 Japan
| | - Aiko Takeishi
- 2Department of Pharmacy, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro, Tokyo, 153-8515 Japan
| | - Yuko Nakajima
- Department of Pharmacy, Kohsei Chuo General Hospital, 1-11-7 Mita, Meguro, Tokyo, 153-8581 Japan
| | - Hideki Kobayashi
- 2Department of Pharmacy, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro, Tokyo, 153-8515 Japan
| | - Kaoru Sugi
- Department of Cardiovascular Medicine, Odawara Cardiovascular Hospital, 6-1-14 Yahagi, Odawara, Kanagawa 250-0873 Japan
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Sawada M, Katsumata H, Tomokuni Y, Uekusa S. Structural and electrical properties of Co-doped β-FeSi2 thin films prepared by RF magnetron sputtering. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.phpro.2012.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yamada H, Katsumata H, Yuasa D, Uekusa S, Ishiyama M, Souma H, Azumaya I. Structural and electrical properties of β-FeSi2 bulk materials for thermoelectric applications. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.phpro.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
ABSTRACTOptical direct and indirect excitation of erbium (Er) ions in silicon substrates was performed in order to investigate the high efficiency of Er3+− related 1.54µm emission (4I13/2→4I15/2) for direct excitation that is not concerned with the indirect band gap and low quantum efficiency of a Si host. The samples were prepared by ion-implantation or thermal diffusion methods. In each sample, photoluminescence (PL) showed the peaks originating from 4I13/2→4I15/2 of Er3+ ions.In Er thermally diffused samples, optical excitation for energy level 4I11/2 of Er3+ ions was successfully effected by photoluminescence excitation spectroscopy (PLE). The PLE spectra consisted six peaks (963. lnm, 965.Onm, 976.lnm, 978.9nm and 980.9nm) which were caused by direct excitation (4I15/2→4I11/2) of Er3+ ions. The emission directly excited is about 2 times more intense than the indirectly excited emission. The six peaks originating from the splitting of the 4I11/2 levels meant that Er3+ ions were in the sites of noncubic symmetry. The samples prepared by Er ion-implantation did not show the effect.
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