Objectives: At present, the dose conversion ratio for a continuous intravenous infusion of fentanyl (CIV) and fentanyl transdermal patches (TP), which are widely used in Japan, is not based on the results of clinical studies in Japanese patients. Studies comparing serum fentanyl concentrations in patients with cancer pain treated by TP showed large differences between Japanese patients and those in other countries. We therefore studied the dose conversion ratio in Japanese patients. Methods: From October 2003 through October 2008, we extracted information on all patients with gastrointestinal cancer who underwent rotation from CIV to TP in the gastrointestinal ward of Kitasato University East Hospital. We selected patients in whom the daily dose of CIV or TP (i.e., the basic dose) was unchanged for 10 days after rotation and the difference in the number of rescue doses (per day) as compared with immediately before rotation was 1 or less on at least 3 consecutive days. All TP preparations used in this study were reservoir-type. Regression lines were plotted on the basis of the relation of “the basic released dose of TP” to “the basic prescribed dose of CIV,” and the dose conversion ratio was calculated. Results: 47 patients underwent opioid rotation, and 11 of them satisfied the eligibility criteria. Eleven patients were studied. The following regression equation was obtained: Y=1.0227X+1.0103, r²=0.9188, indicating a strong correlation. The dose conversion ratio of CIV to TP (released dose) derived by regression analysis was 1:1. Conclusions: Our results obtained in Japanese patients will allow dose conversion at the time of opioid rotation from CIV to TP to be more appropriately performed.

We conducted a cross-sectional survey of pharmacists in clinical settings to assess the status and extent of challenges experienced by pharmacists in providing drug information to pregnant and breastfeeding women. The survey was completed anonymously via the internet using a structured questionnaire. The survey items included basic respondent characteristics, their experiences, attitude toward providing information to pregnant and breastfeeding women, and efforts toward obtaining relevant knowledge. Out of the 1,000 participating pharmacists, 96.8% received inquiries about pregnancy and breastfeeding. However, 92.5% of them recognized that the consultations they provided to pregnant and breastfeeding patients were not sufficient. The reasons for the sentiment were as follows: a lack of basic knowledge regarding pregnancy and breastfeeding and the effects of medications on pregnancy and breastfeeding (37.9% and 37.7%, respectively), a feeling that it is difficult to select appropriate information to share with patients (32.1%), lack of detailed information in the drug package insert (26.0%), lack of opportunities to learn about drug treatment during pregnancy and breastfeeding (20.9%), and the notion that pregnancy and breastfeeding are delicate and difficult topics to discuss (19.8%). While most pharmacists provided consultations regarding pregnancy and breastfeeding, only 7.5% felt that they provided sufficient consultations on this topic. Some pharmacists were concerned about their limited knowledge of pregnancy and breastfeeding. They also had difficulty addressing pregnancy and breastfeeding-related subjects, and communicating with pregnant and breastfeeding women. Pharmacists should advance their education by including elements regarding informed choice and make use of appropriate sources of information.