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Pre-avoid activities of pharmacy pharmacists

pharmacy pharmacist preavoid

​Preavoid is a coined word based on the words "prevent and avoid the adverse drug reaction". The Tsuruha Group collects case studies of avoiding or mitigating adverse effects for patients, such as side effects, drug interactions, and inadequate therapeutic effects, through pharmaceutical intervention by pharmacists, and shares best practices with each pharmacy. increase.

case study

We will introduce initiatives at pharmacies through cases where pharmacists prevented adverse events.

Prescription drugs are prescribed by doctors according to the medical conditions of individual patients. The information provided on this site is individual cases, and we do not recommend making medical decisions or changing medications based on these. If there is anything you do not understand, be sure to consult with your doctor, pharmacist, or nurse.


Case 01 Checking medicine according to constitutionCase 02 Inquiring about patient concerns about test values and making a proposal to a doctorCase 03 Suggesting the optimal drinking method according to the lifestyle rhythm within the usage and dosageCase 04 Suggesting medicines that match the patient's living situationCase 05 Discovering the possibility of side effects from the timing and symptoms of taking medicine

Case 01 Checking medicine according to constitution

A case of avoiding drugs containing excipients that may not suit the patient's constitution


  • [Prescription contents]
  • Fluticasone propionate/formoterol fumarate hydrate inhaler 125 aerosol 56 for inhalation (medicine used to treat bronchial asthma)
  • 2 inhalations once 2 times a day administration

I am continuing treatment for bronchial asthma, but from this time I changed to inhalation medicine for the first time. Since this medicine contains "anhydrous ethanol" as an additive, the pharmacist confirmed that the patient was allergic to alcohol, and found that the patient had severe hypersensitivity to alcohol.

Pre-pharmaceutical intervention

Fluticasone propionate/formoterol fumarate hydrate 125 inhalants 56 for inhalation (contains absolute ethanol as an additive)

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After pharmacological intervention

Budesonide/Formoterol Fumarate Hydrate Inhaler 60 Inhalation


Fluticasone Propionate/Formoterol Fumarate Hydrate 125 Inhaler 56 Absolute ethanol is used as an additive for inhalation. The content has changed. Inhalers come in various shapes, and additives are included for the purpose of making it easier to inhale according to each shape.

Initiatives at pharmacies

After inquiring about the patient's physical constitution, we will check not only the main ingredients of the medicine, but also additives, for ingredients that are expected to be unsuitable for the patient's body.

Case 02 Inquiring about patient concerns about test values and making a proposal to a doctor

A case where the test value for diabetes worsened after changing the medicine


  • [Prescription contents]
  • Anagliptin/Metformin Hydrochloride Combination Tablets HD (Drugs that lower blood sugar levels)
  • 1 tablet at a time, twice a day, after breakfast and dinner

The patient said, "It's been a while since I changed my medicine, but the test results seem to be getting worse than before. I think it suits you better." After obtaining the patient's consent, we made a document and handed it to the doctor.

Pre-pharmaceutical intervention

Anagliptin/Metformin Hydrochloride Combination Tablets HD

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After pharmacological intervention

back to previous medication


The day after I sent the document, the doctor contacted me and said, ``I thought I'd wait a little longer, but if it doesn't suit the person's psychology, I'll change the medicine. It would be helpful if you could help me, so I would like to continue to ask for it.", and the medicine was changed.

Initiatives at pharmacies

If it is thought that the patient's feelings are not being conveyed well in the busy medical care, we will send a document summarizing the patient's situation (tracing report) to help the patient continue treatment. I support you.

Case 03 Suggesting the optimal drinking method according to the lifestyle rhythm within the usage and dosage

Example of suggesting how to take medicine considering the patient's meal time


  • [Prescription contents]
  • Cabozantinib tablet 20mg (medicine used for cancer treatment)
  • 2 tablets once daily 1 hour before breakfast

I started taking the medicine a week ago for a new treatment, but I found that there were cases where I had breakfast about 30 minutes after taking the medicine because I didn't have time to spare in the morning.

Pre-pharmaceutical intervention

Cabozantinib tablet 20mg 2 tablets once a day 1 hour before breakfast

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After pharmacological intervention

Cabozantinib tablet 20mg 2 tablets once a day 2 hours after breakfast


If cabozantinib tablets are taken between 1 hour before and 2 hours after meals, the effects of the medicine may become stronger, and pharmacists who thought there was a risk of side effects I confirmed with the patient the possible timing. The patient said, "I think you can drink it two hours after you eat breakfast," so I called the doctor and suggested changing from one hour before breakfast to two hours after breakfast.

Initiatives at pharmacies

For medicines that are affected by food, we will check if the timing of taking the medicine is difficult in light of your lifestyle and propose the best timing.

Case 04 Suggesting medicines that match the patient's living situation

A case of suggesting a change from a once-a-week bone medicine to a once-every-four-weeks medicine


  • [Prescription contents]
  • Alendronic acid tablet 35mg (medicine to treat osteoporosis)
  • 1 tablet once a week Take this medicine with about 180 mL of water when you wake up in the morning, and avoid lying down and eating and drinking for at least 30 minutes.

An 87-year-old patient who often lies down during the day was prescribed a drug that required him to avoid lying down for 30 minutes once a week. In addition, this patient suffered from rheumatoid arthritis (a disease that causes pain and swelling in the joints due to immune disorders), and the joints were particularly stiff immediately after waking up, and waking up seemed to be painful. If this continues, it is thought that continuing the drug will become a burden on the patient.

Pre-pharmaceutical intervention

Alendronate Tablets 35mg 1 tablet Once a week, when you wake up in the morning, take with about 180mL of water.Do not lie down and avoid eating and drinking for at least 30 minutes.

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After pharmacological intervention

Minodronic acid tablet 50mg 1 tablet Once every 4 weeks, take with about 180mL of water when you wake up in the morning, do not lie down for at least 30 minutes, and avoid eating and drinking.


Therefore, the pharmacist suggested that instead of taking the medicine once a week, we should change to a medicine that can be taken once every four weeks, which can reduce the frequency, or an injection medicine. At the next prescription, it was changed to a drug to be taken once every four weeks, and the patient was able to continue taking the drug.

Initiatives at pharmacies

Taking into consideration the patient's medical condition and lifestyle, we propose the medicine that will cause the least burden.

Case 05 Discovering the possibility of side effects from the timing and symptoms of taking medicine

A case where side effects were suspected due to swollen gums and pain caused by drugs that lower blood pressure


  • [Prescription contents]
  • Amlodipine tablet 2.5mg (medicine to lower blood pressure)
  • 1 tablet once a day after breakfast

A patient who has been taking blood pressure-lowering medicine for about a month has been prescribed the same medicine again this time and came to our pharmacy. When the pharmacist asked if there was any swelling or pain in the gums, he confirmed that since he started taking the medicine, his gums had become uncomfortable, and now he is going to the dentist because his dentures no longer fit.

Pre-pharmaceutical intervention

Amlodipine tablet 2.5mg (calcium receptor antagonist)

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After pharmacological intervention

Azilsartan Tablets 20mg (angiotensin II receptor blocker)


After taking it for one month, I thought it was highly likely that the discomfort in my gums was due to the drug, so I contacted my doctor and was changed to another drug that does not cause swelling of the gums.

Initiatives at pharmacies

Depending on the medicine, the time at which side effects appear varies, and they may not appear immediately after taking them. While taking the medicine, the pharmacist will check whether there are any changes in your physical condition that you are concerned about.
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