International journal of clinical pharmacology and therapeutics最新文献

{"title":"Label-discordant prescribing of proton pump inhibitor in elderly outpatients: Prevalence and associated factors.","authors":"Zichao Ji, Xin Wang, Jiawei Wang","doi":"10.5414/CP205013","DOIUrl":"10.5414/CP205013","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the rationality of proton pump inhibitor (PPI) prescription in elderly outpatients aged ≥ 65 years, characterize inappropriate prescription patterns, and identify the factors associated with label-discordant prescription.</p><p><strong>Materials and methods: </strong>A retrospective single-center study was conducted at Beijing Tongren Hospital. Data were extracted for outpatients aged ≥ 65 years who received PPIs between November 2024 and October 2025. Only the first visit of each patient was included (n = 3,038) to avoid non-independence. Prescription rationality was assessed using the Clinical Application Guidelines for Proton Pump Inhibitors (2020 Edition) and package inserts. Two binary outcomes were defined: any label-discordant prescription (composite of inappropriate indication, dose, drug interaction, or label-discordant frequency) and pure excessive frequency (twice-daily dosing without other discordance). Logistic regression analysis was conducted to identify the associated factors.</p><p><strong>Results: </strong>Among 3,038 first-visit patients, 281 (9.25%) had label-discordant prescriptions (rational use rate: 90.75%). Excessive frequency (twice-daily dosing) was the most common type of label-discordant prescription (206 patients, 73.31% of discordant cases), of whom 204 exhibited no other discordance (pure excessive frequency). Inappropriate drug interactions were observed in 34 patients (12.10%), inappropriate indications were detected in 19 (6.76%) patients, and inappropriate single-dose was found in 13 (4.63%) patients. Multivariable analysis showed that male sex (OR = 0.681), having ≥ 5 diagnoses (OR = 0.721), and non-gastroenterology department (OR = 0.235) were associated with lower odds of label-discordant prescription, while senior physician title (OR = 1.628) was associated with higher odds of label-discordant prescription. Age ≥ 75 years did not show a significant association (p = 0.981). Results for pure excessive frequency were directionally consistent.</p><p><strong>Conclusion: </strong>In this sample of elderly outpatients, the label-discordant prescription rate of PPI was 9.25%, with excessive frequency representing the predominant type. Male sex, a higher number of diagnoses, and non-gastroenterology departments were associated with lower odds, whereas a senior physician title was associated with higher odds. Given the exclusion of prophylactic use and single-center design, these findings should not be generalized to all PPI prescription practices. Future studies should include prophylactic prescriptions and disease severity measures.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical antimicrobial TDM (PAT) of vancomycin in Japanese emergency and critical care units: Concentration overestimation and correction using scaling factors.","authors":"Koki Takeda, Naoki Yoshikawa, Hidehiko Koreeda, Shuhei Urata, Yuki Matsusaki, Tsubasa Yokota, Akira Okada, Ayane Higuchi, Rin Taguchi, Asako Nishimura, Nobuhito Shibata, Ryota Tanaka, Hiroki Itoh, Ryuji Ikeda","doi":"10.5414/CP205029","DOIUrl":"10.5414/CP205029","url":null,"abstract":"<p><strong>Objectives: </strong>i) To improve the accuracy of initial dosing design in vancomycin therapeutic drug monitoring (TDM) using a free web application of practical antimicrobial TDM (PAT) for vancomycin, ii) to identify patient subgroups in emergency and critical care settings with overestimated predicted population mean serum vancomycin concentrations (PRED), and iii) to calculate appropriate PRED scaling factors.</p><p><strong>Materials and methods: </strong>Vancomycin serum concentrations in patients treated at the Emergency and Critical Care Centers of the University of Miyazaki Hospital, Japan, were simulated using a population pharmacokinetic model. Patients were classified based on the ratio of observed-to-predicted serum vancomycin concentrations (OBS/PRED). Those with a ratio < 0.67 were assigned to the low-trough group, while those with values ≥ 0.67 were the control group. Changes in patient data in the period from admission to immediately before vancomycin administration were analyzed, and scaling factors minimizing the mean squared error (MSE) between PRED and OBS were determined for subgroups more common in the lowtrough group. MSE and root mean squared error (RMSE) values before and after PRED scaling were compared.</p><p><strong>Results: </strong>A total of 47 patients were analyzed, of which 23 were assigned to the low-trough group and 24 to the control group. The low-trough group showed a significantly higher prevalence of patients with creatinine clearance (CCR) < 15 mL/min, albumin < -0.5 g/dL, and trauma. For these subgroups, PRED scaling factors ranged from 0.53 to 0.64. The optimal scaling factor was 0.53 for ΔCCR > 15 mL/min, reducing the RMSE from 5.1 to 4.0 (μg/mL).</p><p><strong>Conclusion: </strong>PRED scaling factors were derived to potentially improve the accuracy of initial vancomycin dosing using PAT, and ΔCCR > 15 mL/min, ΔALB < -0.5 g/dL, and trauma were identified as key factors.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged cholinergic toxidrome with markedly low cholinesterase activity after exposure to emamectin benzoate emulsion: A case report.","authors":"Hideo Chubachi, Noritaka Kitazume, Kenji Momo, Haruka Kamagata","doi":"10.5414/CP204994","DOIUrl":"10.5414/CP204994","url":null,"abstract":"<p><p>Emamectin benzoate emulsion is a macrocyclic lactone insecticide that is not classified as an organophosphate or carbamate. We report the case of a man in his 80s with chronic kidney disease and cardiovascular comorbidities who ingested emamectin benzoate emulsion. On day 2, he presented with abdominal pain, diarrhea, and marked sialorrhea; his vital signs were stable; however, his serum cholinesterase (ChE) had markedly declined (18 U/L). The patient was discharged with supportive care. From day 3, watery diarrhea recurred and neurobehavioral symptoms progressed. On day 5, he presented with pinhole miosis and further ChE suppression (2 U/L). Therefore, atropine was administered, and the patient was transferred for close monitoring. After discharge (day 8), miosis and sialorrhea persisted, and ChE remained low for weeks. Findings suggestive of tubular injury were observed during follow-up. The patients' symptoms resolved gradually, with ChE partially recovering by days 75 - 95. This case underscores the need for serial reassessment and structured follow-up after pesticide exposure, even when the patient appears stable at the initial presentation.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"482-486"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic evaluation of two oral formulations of chlorpromazine in healthy subjects.","authors":"Hyo-Jin Min, Jun Gi Hwang, Young-Sim Choi, Min Kyu Park","doi":"10.5414/CP204934","DOIUrl":"10.5414/CP204934","url":null,"abstract":"<p><p>Chlorpromazine is a first-generation antipsychotic agent that exerts its therapeutic effects primarily by antagonizing dopamine D2 receptors. This randomized, open-label, single-dose, two-period, two-sequence crossover study was conducted to evaluate the pharmacokinetic bioequivalence of two oral formulations of chlorpromazine 100 mg: Neomazine tablets (Whan In Pharmaceutical Co., Ltd.) and Chlorpromazine HCl tablets (Myung In Pharmaceutical Co., Ltd.). A total of 70 subjects were randomized, and 61 completed both treatment periods. Blood samples were collected at predefined intervals up to 72 hours post dose to assess pharmacokinetic parameters, including maximum plasma concentration (C_max) and the area under the plasma concentration-time curve to the last measurable concentration (AUC_last). Safety was assessed through monitoring of adverse events (AEs), clinical laboratory tests, vital signs, physical examinations, and 12-lead electrocardiograms. The geometric mean ratios (90% confidence intervals) for C_max and AUC_last were 1.0490 (0.9534 - 1.1542) and 0.9941 (0.9261 - 1.0671), respectively, falling within the accepted bioequivalence range of 0.80 - 1.25. Among the 70 subjects who received at least 1 dose, 116 AEs were reported in 48 individuals; all were mild in intensity and resolved without sequelae, and no serious AEs occurred. These findings confirm the pharmacokinetic bioequivalence and favorable tolerability of the two formulations under fasting conditions in healthy adults and support the use of Neomazine as a therapeutically equivalent and clinically interchangeable alternative to Chlorpromazine HCl.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"498-504"},"PeriodicalIF":0.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palonosetron-induced anaphylaxis during general anesthesia in a patient with multiple drug hypersensitivity.","authors":"Meiyi Shi, Zhefeng Quan","doi":"10.5414/CP205049","DOIUrl":"https://doi.org/10.5414/CP205049","url":null,"abstract":"<p><strong>Background: </strong>Palonosetron, a second-generation 5-HT3 receptor antagonist, is widely used for postoperative nausea and vomiting (PONV) prophylaxis. Anaphylaxis induced by palonosetron during general anesthesia is extremely rare, and the risk of severe anaphylaxis upon re-exposure in polysensitized atopic patients is inadequately recognized.</p><p><strong>Case report: </strong>A 50-year-old female underwent an uneventful hepatectomy, receiving palonosetron without adverse reaction. Ten weeks later, during pre-induction for laparoscopic rectal cancer surgery, she received oxycodone, palonosetron, and penehyclidine hydrochloride. One minute after completion, she developed generalized rash (> 60% body surface area), hypotension (81/50 mmHg), and tachycardia (125 bpm), requiring vasopressor support; surgery was cancelled. Subsequent skin testing was positive for ondansetron (++), cisatracurium (+), and propofol (+), while negative for chlorhexidine, rocuronium, and etomidate.</p><p><strong>Conclusion: </strong>Prior uneventful exposure to palonosetron does not guarantee future safety. Atopic patients with polysensitization are at significantly increased risk of severe anaphylaxis upon re-exposure. Positive ondansetron skin testing provides indirect evidence identifying palonosetron as the culprit. All 5-HT3 receptor antagonists should permanently be avoided in such patients, and alternative antiemetics (e.g., dexamethasone, droperidol, NK1 antagonists) should be selected.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel intravenous human IVIG in patients with secondary immunodeficiency: Interim analysis of a multicenter, prospective, non-interventional study.","authors":"Artur Bauhofer, Silke Aigner, Stephan Borte","doi":"10.5414/CP204975","DOIUrl":"10.5414/CP204975","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness, safety, and tolerability of Yimmug, a novel, highly purified, 10% human plasma-based intravenous immunoglobulin (IVIG) preparation, in patients with secondary immunodeficiency (SID) under real-world conditions.</p><p><strong>Materials and methods: </strong>This interim analysis is based on data from a multicenter, prospective, non-interventional study conducted with out-patients in Germany. Effectiveness was assessed by changes in (i) serum IgG levels, (ii) severe infection rates, (iii) clinical symptoms, and (iv) patient-reported quality of life (QoL) at three treatment intervals (after 3, 12, and 24 IVIG infusions) compared to baseline. Safety was evaluated through documentation of adverse events (AEs), including adverse drug reactions (ADRs), while tolerability was assessed by investigators.</p><p><strong>Results: </strong>A total of 119 SID patients received 726 IVIG infusions at a median (IQR) dose of 0.3 (0.2 - 0.3) g/kg over a median (IQR) duration of 1.4 (0.4 - 2.9) years, with a median interval of 30.1 days between infusions. Serum IgG trough levels increased, with the proportion of patients achieving IgG ≥ 6 g/L rising from 30.3% at baseline to 66.7% after both 12 and 24 infusions. The mean annual rate of infections requiring antibiotics decreased from 2.3 at baseline to 0.0 after 3 and 12, and to 0.4 after 24 infusions, respectively. The new IVIG was well tolerated, and patients' clinical symptoms and QoL improved during treatment. AEs were reported in 20 (16.8%) patients, with 41 events in total, while ADRs occurred in 9 (7.6%) patients, with 16 events. Serious AEs (SAEs) occurred in 4 (3.4%) patients, involving 5 events, but no serious ADRs (SADRs) were reported.</p><p><strong>Conclusion: </strong>This interim analysis shows that the risks are minor compared to the benefits of this novel IVIG preparation in the management of SID.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"416-427"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute arsenic poisoning from realgar water: Case series from Guilin, China.","authors":"Yong-Fei Fu, Hong-Zhen Xu, Xin Long, Qian-Qian Liao, Hai-Ling Huang, Kun Deng, Yan-Juan Jiang, Guo-Rong Tang, Shu-Ping Tang, Jian Tang, Dong Qin","doi":"10.5414/CP204830","DOIUrl":"10.5414/CP204830","url":null,"abstract":"<p><strong>Background: </strong>The inappropriate use of Traditional Chinese Medicine (TCM) poses significant health risks. Realgar (As₄S₄), an arsenic-containing mineral traditionally consumed during China's Dragon Boat Festival, may induce acute toxicity following ingestion.</p><p><strong>Materials and methods: </strong>This case series describes 8 patients (age: 1 - 80 years), including 2 children, with clinically confirmed acute arsenic poisoning subsequent to Dragon Boat Festival ingestion of realgar-containing water. We systematically evaluated clinical manifestations, laboratory parameters, and environmental arsenic concentrations. Urinary arsenic quantification was performed in all cases, with intravenous 2,3-dimercaptopropane sulfonic acid (DMPS) sodium salt initiated as chelation therapy.</p><p><strong>Results: </strong>All patients developed gastrointestinal manifestations (nausea, vomiting, and diarrhea) within 5 - 14 days post exposure, accompanied by biochemical evidence of hepatic dysfunction. Laboratory analyses confirmed elevated urinary arsenic concentrations (> 0.032 mg/L) and identified arsenic contamination in drinking water (> 0.01 mg/L), with both measures exceeding established safety thresholds. Multi-organ dysfunction syndrome (MODS) was observed in 3 patients. All cases demonstrated a favorable clinical response to intravenous DMPS sodium salt chelation therapy, achieving clinical improvements and subsequent discharge.</p><p><strong>Conclusion: </strong>This case series documented acute arsenic toxicity secondary to realgar consumption in both adults and children. The findings underscore the critical need for targeted public health education initiatives and enhanced regulatory oversight regarding traditional medicinal practices, particularly during cultural festivals. Furthermore, they emphasize the necessity for heightened clinical vigilance in the prompt diagnosis and management of arsenic poisoning associated with traditional cultural practices.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"312-317"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iodixanol-induced acute kidney injury and multi-organ complications via alternative excretion: A case report and mechanism exploration.","authors":"Le Li, Lifang Yang, Huifeng Wu, Lin Chen, Zhouqian Jiang","doi":"10.5414/CP204941","DOIUrl":"10.5414/CP204941","url":null,"abstract":"<p><strong>Objective: </strong>To report a rare case of vicarious contrast material excretion (VCME) following iodixanol administration, leading to acute kidney injury (AKI) and multi-organ complications, and to explore the underlying mechanisms.</p><p><strong>Case presentation: </strong>A 71-year-old female underwent lower limb venography with intravenous iodixanol. Post-procedure, she developed AKI, followed by acute pancreatitis, hepatic hemorrhage, and hemoperitoneum. Imaging revealed contrast accumulation in the gallbladder and biliary tract, consistent with VCME.</p><p><strong>Intervention and outcome: </strong>The patient was managed with hemodialysis, octreotide, transfusion, and supportive care. Laboratory and imaging improvements were observed by day 22, with successful discharge.</p><p><strong>Conclusion: </strong>This case highlights the potential for iodixanol to induce VCME and subsequent multi-organ injury in the setting of AKI. Enhanced preoperative risk assessment, postoperative monitoring, and multidisciplinary management are essential for mitigating such rare but severe complications.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"318-323"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147270977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can tiotropium add-on inhalation revolutionize therapy in elderly asthmatic patients? A treatable traits approach towards successful aging.","authors":"Yoshihisa Ishiura, Shosaku Nomura, Noriyuki Ohkura, Johsuke Hara, Masaki Fujimura, Tomoki Ito","doi":"10.5414/CP204911","DOIUrl":"10.5414/CP204911","url":null,"abstract":"<p><strong>Background: </strong>The population of elderly patients with asthma is increasing, resulting in serious health problems because of hospitalization and high mortality rate. Furthermore, several recent studies have shown that progressive airflow limitation may worsen cognitive dysfunction and contribute to poor asthma control. Maintaining good respiratory function is therefore important in the elderly in order to achieve a satisfactory quality of life.</p><p><strong>Materials and methods: </strong>A 12-week, open-label, cross-over study was conducted in elderly patients with asthma to investigate the effect of 5 μg/day tiotropium bromide (TIO) add-on therapy administered using a soft mist inhaler (SMI), in addition to a dosage of 500/20 µg/day fluticasone propionate/formoterol fumarate (FP/FM) treatment and to compare the effects of treatment with those following the administration of 500/20 µg/day FP/FM alone. The trial design thus entailed a 4-week run-in period and two 4-week treatment periods.</p><p><strong>Results: </strong>A total of 21 patients aged over 65 years with stable bronchial asthma were recruited in the study. Forced expiratory volume in 1 second values after the treatment period with FP/FM and TIO add-on therapy were significantly higher than those after the run-in period (p < 0.01).</p><p><strong>Conclusion: </strong>TIO add-on therapy FP/FM treatment using an SMI in elderly patients with asthma improved lung function parameters demonstrating, the value of TIO add-on therapy as a treatable traits option for improving quality of life and achieving successful aging in this population.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"296-303"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative infusion of dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing lung surgery: A randomized controlled trial.","authors":"Fujing Li, Weizhou Zhang, Jian Huo, Liming Cheng, Rui Zhao","doi":"10.5414/CP204731","DOIUrl":"10.5414/CP204731","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effect of intravenous (IV) patient-controlled anesthesia (PCA) combined with dexmedetomidine (DEX) injections on reducing the risk of postoperative delirium (POD) in elderly patients undergoing thoracoscopic lung surgery, hypothesizing a potential risk reduction.</p><p><strong>Materials and methods: </strong>Patients aged 65 years and older who underwent thoracoscopic lung surgery were assessed for eligibility. The participants were randomly assigned to either the test or control group. The test group received DEX through an IV PCA pump, consisting of 3 μg×kg^-1 sufentanil and 3 μg×kg^-1 DEX, while the control group received 3 μg×kg^-1 sufentanil. PCA parameters were standardized, including a total volume of 150 mL, a 2-mL bolus dose with a 15-minute lock-out period, and a background infusion rate of 2 mL/h. The primary outcome was the incidence of POD, which was evaluated twice daily for 7 days after surgery. The secondary outcomes included duration of POD, incidence of postoperative nausea and vomiting (PONV), postoperative hospitalization duration, pain assessment, and adverse events.</p><p><strong>Results: </strong>A total of 287 patients were recruited. The incidence of POD in the control group was significantly higher (15.28 vs. 4.9%, p = 0.006). There were no significant differences in POD duration, PONV, or the length of hospital stay after operation between the two groups. The incidence of hypertension in the test group was significantly lower (p < 0.001), and no differences were found for other adverse events.</p><p><strong>Conclusion: </strong>IV patient-controlled DEX injections after major thoracoscopic lung surgery can reduce postoperative delirium.</p>","PeriodicalId":13963,"journal":{"name":"International journal of clinical pharmacology and therapeutics","volume":" ","pages":"289-295"},"PeriodicalIF":0.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}