Objective: Tamoxifen is a drug that is frequently administered for 5 years to treat hormone receptor-positive breast cancer in premenopausal women.  Metabolism of tamoxifen by cytochrome P450 enzymes such as CYP3A4 and CYP2D6 is required for drug efficacy.  However, reports suggest that the effect of tamoxifen is attenuated in the presence of CYP2D6 inhibitors.  In this study, I evaluated drug-drug interactions that may attenuate tamoxifen action for improved pharmaceutical management.
Data Source: Potential interactions were evaluated by using the tamoxifen package insert, Kyoto Encyclopedia of Genes and Genomes (KEGG), Pharmaceuticals and Medical Devices Agency (PubMed), and Lexicomp Online.  We have searched the paper using the PubMed and JDream III.
The Choice of Research: The paper about the interaction related CYP2D6 and 3A4 of tamoxifen.
Results and Conclusion: The use of tamoxifen is often long term; however, adverse effects such as hot flashes, can cause poor regimen adherence.  Although selective serotonin reuptake inhibitors (SSRIs) can effectively treat menopausal hot flashes, many SSRIs inhibit CYP2D6.  In particular, paroxetine has been reported to adversely affect tamoxifen metabolism.  There are 31 drugs and 843 compounds that inhibit CYP2D6.  Thus, it is necessary to avoid these combinations.  In addition, there are many CYP2D6 gene polymorphisms that have been identified in Japanese patients, and some reports indicate that they affect tamoxifen efficacy.  Therefore, in order to continue use of these medications without attenuating the effect of tamoxifen, development of medical database which can be updated daily is required to avoid CYP-related interactions.

Objective: Pharmacotherapy for patients with breast cancer is now administered in an ambulatory setting, and we assume that patients would benefit if clinical pharmacists perform all stages of pharmacological intervention up to prescription in an ambulatory setting as well, especially for medicines requiring chronic administration and those that affect the patient’s life, such as hormonal therapy.  A thorough understanding of guidelines and the clinical reports is paramount for effective pharmacological intervention.  Since ambulatory care clinical pharmacists are involved in the treatment of a large number of patients, effective utilization of evidence outlined in guidelines and clinical reports is difficult.  Therefore, we developed a system for utilizing evidence as outlined in guidelines and clinical reports with a focus on hormonal therapy for patients with breast cancer.
Methods: A database based on the 2013 version of the clinical practice guidelines for breast cancer and clinical reports was constructed using Microsoft® Access 2010.
Result: Clicking on a guideline algorithm according to the disease stage of the patient results in a clinical question being displayed, and the ambulatory care clinical pharmacist is immediately able to determine suitable medications based on clinical reports that are run through the database.
Conclusion: With the use of this database, which includes information required for pharmacological intervention, ambulatory care clinical pharmacists could care for a large number of patients.

To evaluate the effects of acupuncture on the immune system, the leukocyte, monocytes, lymphocyte and lymphocyte surface markers, CD2, CD4, CD8, CD11b, CD16, CD19 and CD56 in the peripheral blood of seventeen healthy volunteers were counted. The leukocyte above CD⁺ cell counts significantly increased after acupuncture. The results indicate that acupuncture may regulate the immune system and can increase the activity of cellular and humoral immunity and NK cell.
According to the percentage of lymphocytes or granulocytes, volunteers were divided into two types, those with more than 70% of granulocyte were recognized as G type and those with more than 40% of lymphocyte were divided into L type. Interestingly, before and after the treatment of acupuncture, the number of granulocytes and lymphocytes had a negative relationships. Namely we found an increase in the lymphocytes as well as a decrease in the granulocytes in the G type. On the other hand in the L type, we found an increase in the granulocytes and a decrease in the lymphocytes. Therefore we suggest that acupuncture can enhance the activity that maintains the balance of the immune function.

We have simultaneously proved that cell populations taking charge of immunity in human peripheral blood can be regulated quantitatively by acupuncture. Now we investigated the effect of acupuncture qualitatively on cytokine production by lymphocyte cells in human peripheral blood.
The number of IL-1β, IL-4 and IFN-γ containing cells, which are closely associated with macrophage, humoral immunity and cellular immunity respectively, were measured by FACScan. We found a significant increase in IFN-γ containing cells after acupuncture. According to this result together with previous results, the enhancement of CD4⁺ and CD56⁺ cell counts, the treatment of acupuncture can promote the activity of cellular immunity as well as NK cell.