A Patient with Cancer Pain Developing Serotonin Syndrome and Concomitant Acute Dyskinesia Associated with Tramadol Hydrochloride

A 68-year-old man with a diagnosis of transformation to undifferentiated carcinoma of the left thyroid who was being treated with Lenvatinib presented with swelling and pain around the left clavicle, and tramadol was started. Two days later, he developed diarrhea, sweating, disorientation, and myoclonus, leading to a diagnosis of serotonin syndrome. He also exhibited dyskinesia including involuntary movements of the arms and legs and squirming movements of the trunk. Tramadol was thus discontinued. His myoclonus and dyskinesia resolved within half a day and had disappeared the day after tramadol discontinuation. These symptoms were attributed to tramadol because there was a reasonable temporal relationship between drug administration and the adverse event. Tramadol inhibits serotonin reuptake, and thus has the potential to cause serotonin syndrome. However, there have been relatively few reports describing the occurrence of this syndrome, and there have been none showing concomitant dyskinesia. Clinicians should be aware that tramadol can cause serotonin syndrome accompanied by dyskinesia.

<b>The Present Situation Regarding Kampo Medicine Use and Kampo Education in Three Hokkaido H</b><b>ospitals </b> / 日本東洋医学雑誌

<p>Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.</p>

The large gap between customer expectations and actual explanations of supplements by pharmacists / 日本プライマリ・ケア連合学会誌

<b><i>Abstract</i></b><br><b>Objective</b> : In this study, we conducted a survey on both the use of supplements by customers and information provided by pharmacists, to clarify customer understanding. We also sought to ascertain the actual current state of information provided by pharmacists to customers, as well as investigating both how, and to what extent, pharmacists should be involved in customers 'use of supplements.<br><b>Methodology</b> : During regular pharmacy visits, pharmacists used a questionnaire to interview 1,253 customers, in 14 community pharmacies, in Tokyo and Hokkaido, respectively. A different questionnaire, designed for pharmacists, was also given to 289 pharmacists who were either working in those same pharmacies, or who attended the Conference on Pharmaceutical Sciences in Hokkaido (2011, Sapporo).<br><b>Results</b> : The results of the survey showed that approximately 50％ of consumers greatly desired the provision of safety and efficacy information about supplements by pharmacists. However, few pharmacists answered customers' questions satisfactorily (only 7.3％ of total responses).<br> The results also indicated that only 30％ of pharmacists actively gathered information about supplements, despite the fact that 67.5％ of pharmacists were aware that they were expected to do so by customers, in their roles as primary information providers regarding such treatments. Furthermore, even those pharmacists who checked information regarding supplements depended mostly on information acquired from the Internet.<br><b>Conclusion</b> : There is a large gap between customers' expectations for explanation of supplements and the reality of such explanations, and the information actually provided by pharmacists. In order to live up to their customers' expectations, pharmacists should foster both wider dissemination and better understanding of evidence-based information about supplements. Pharmacists should also provide integrated management of drugs and supplements for patients.