藥物交互作用之影響

Outcomes Influenced by Drug Interactions

10.6317/LTC.201112_15(3).0003

王婷瑩(Ting-Ying Wang)

藥物交互作用 ； 老年藥學 ； 用藥安全 ； drug interaction ； geriatric pharmacy ； drug safety

長期照護雜誌

15卷3期（2011 / 12 / 01）

195 - 204

繁體中文

老年人因罹患的慢性病多，長期用藥的種類也多，使得老年人成為發生藥物交互作用的高危險群。在老人用藥照護上，交互作用是不能不注意的一環。交互作用的類型很多，除了藥動學與藥效學上的藥物－藥物交互作用之外，還有藥物－營養、藥物－中草藥，以及藥物－疾病交互作用等。藥物-藥物交互作用中很重要的是經由影響CYP450代謝酵素系統，而增加或抑制某一藥物代謝的交互作用；因生理自我調節機能下降，藥效學方面的交互作用在老年人身上更為敏感。除西藥間的交互作用，中藥與西藥的交互作用也不可忽略，例如warfarin併用人參、銀杏等中藥會增加出血的風險。使用有抗膽鹼作用的藥物也都要特別注意，可能因藥物－疾病交互作用而導致惡化前列腺肥大、失智症之症狀。在老年人的藥物治療，應秉持用藥品項數保持在最低必要品項，並定期監測及評估藥物的療效及毒性等原則。可藉由跨專業團隊照護間的合作，來預防老年人藥物交互作用的發生。

Older adults are at high risk of having drug interactions because of more chronic diseases and multiple medication usage. Drug interaction is an important issue that can not be ignored when caring for elderly patients. There are several types of drug interaction: pharmacokinetic drug-drug interaction, pharmacodynamic drug-drug interaction, drug-nutrition interaction, drug-herb interaction, and drug-disease interaction. Interactions which increase or inhibit drug metabolism via effect CYP450 system are very important, and elderly patients are more sensitive topharmacodynamic interactions because their self-modulate mechanism decreased. The combination of warfarin and herbal medicine such as gingseng, gingo may increase risk of bleeding. Symptom exacerbation of prostate hypertrophy and dementia should be considered when using medication with anticholinergic effects. The principles of pharmacotherapy in older adults are to keep the number of drugs in lowest items, monitor and assess effectiveness and toxicity of drugs periodically. Besides, multidisciplinary team work approach can help to prevent drug interactions in elderly people.