Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.

Objective: Eye drops may contain certain preservatives, and there is concern in patients who use them on a daily basis for the treatment of diseases, including corneal epithelial disorder and glaucoma. PF eye drops (Rohto Nitten Co., Ltd.) are used widely; however, their usability may be difficult in patients prescribed these medications for the first time. Therefore, fact-finding was performed on the usability of PF eye drops, particularly the difficulty in squeezing out these eye drops. Methods: The squeezing forces for various eye drops in 11 different shapes were determined. A sensuality evaluation examination on “the easiness of pushing out the eye drops” was performed in addition to a questionnaire survey targeting patients who used eye drops at a community pharmacy. Results: The squeezing forces ranged from 2.0 to 17.1 N. This study showed that the squeezing force tended to increase as the drop got closer to the opening of the container. Significant differences in the sensuality examination scores were found: 3.09 points for Santen Pharmaceutical Co., Ltd.; 3.07 points for Senju Pharmaceutical Co., Ltd.; 2.47 points for Sawai Pharmaceutical Co., Ltd.; and 1.37 points for PF eye drops for any place other than Santen and Senju (p<0.001). Conclusion: When eye drops were prescribed for an elderly individual, the pharmacist considered it necessary to suggest an alternative agent to the doctor depending on body function. In addition, it is important to explain to the patient that an additional squeezing force is required to push out the drop as it gets closer to the opening of the container.