Köhler G I, Bode-Böger S M, Busse R, Hoopmann M, Welte T, Böger R H
Institute of Clinical Pharmacology, Medical School, Hannover, Germany.
Int J Clin Pharmacol Ther. 2000 Nov;38(11):504-13. doi: 10.5414/cpp38504.
Adverse drug reactions (ADRs) are a major cause of hospital admissions, thereby leading to significant medical and economical problems. Drug interactions contribute to a major part of ADRs, especially in elderly patients and in patients under polymedication. As a peculiarity of the German health care system the general practitioner is less involved in patient care during hospital stay than in other countries. Consequently, changes in medication at the transition point from out-patient to in-patient care and back may contribute to drug-related problems.
In the present study we investigated potential interactions in 169 consecutive patients with the diagnosis CHD (coronary heart disease) or COLD (chronic obstructive lung disease) who were admitted to the University Hospitals of Hannover and Magdeburg.
For each patient, potential interactions between prescribed drugs at admission, at discharge, and 3 months after discharge were assessed by using drug interaction data bases.
We found that the number of drugs taken per patient as well as the number of interactions per patient are higher during hospitalization than before admission (pre-admission), and fall back after the hospital stay (post-discharge), but not to the pre-admission level. The number of potential interactions was significantly correlated in a polynomial manner to the number of drugs taken by each patient. The number of patients without a potential interaction was 44.4% pre-admission, 39.6% at discharge, and 39.1% post-discharge. Patients with potential interactions had a mean of 2.8, 2.7, and 2.4 interactions at each of the time points. Drug classes mainly involved with potential interactions were kaliuretic diuretics (recorded by 43.3% at discharge), ACE inhibitors (30.3%), anticoagulants and aggregation inhibitors (20.4%) and digitalis glycosides (14.7%). Regarding the frequency of the interaction categories, 68-70% of the potential interactions demand clinical attention, while 1-2% are life-threatening. 17-19% may result in therapeutic benefit; 10-12% are without clinical relevance.
The risk of drug interactions increases exponentially with the number of drugs given to a patient. Although we have no data on the fraction of interactions that became clinically manifest, our study indicates that prescribing fewer drugs can reduce the risk of suffering from sickness secondary to drug interactions. Taking this risk into account may help to improve the quality of drug treatment and to save costs.
药物不良反应（ADR）是导致患者住院的主要原因，进而引发重大的医疗和经济问题。药物相互作用在很大程度上导致了药物不良反应，尤其是在老年患者和接受多种药物治疗的患者中。德国医疗保健系统的一个特点是，与其他国家相比，全科医生在患者住院期间较少参与患者护理。因此，在从门诊到住院护理以及再回到门诊的过渡阶段，药物治疗的变化可能会导致与药物相关的问题。
在本研究中，我们调查了汉诺威和马格德堡大学医院收治的169例连续诊断为冠心病（CHD）或慢性阻塞性肺疾病（COLD）患者中的潜在药物相互作用情况。
对于每位患者，通过使用药物相互作用数据库评估入院时、出院时以及出院后3个月所开药物之间的潜在相互作用。
我们发现，每位患者在住院期间服用的药物数量以及每位患者的相互作用数量均高于入院前（入院前），且在住院后（出院后）有所下降，但未降至入院前水平。潜在相互作用的数量与每位患者服用的药物数量呈显著的多项式相关。无潜在相互作用的患者比例在入院前为44.4%，出院时为39.6%，出院后为39.1%。有潜在相互作用的患者在每个时间点的平均相互作用次数分别为2.8次、2.7次和2.4次。主要涉及潜在相互作用的药物类别为排钾利尿剂（出院时记录为43.3%）、血管紧张素转换酶抑制剂（30.3%）、抗凝剂和聚集抑制剂（20.4%）以及洋地黄苷（14.7%）。关于相互作用类别的频率，68 - 70%的潜在相互作用需要临床关注，而1 - 2%具有生命危险。17 - 19%可能产生治疗益处；10 - 12%无临床相关性。
给予患者药物的数量越多，药物相互作用的风险呈指数级增加。尽管我们没有关于已在临床上显现的相互作用比例的数据，但我们的研究表明，减少用药可以降低因药物相互作用而引发疾病的风险。考虑到这种风险可能有助于提高药物治疗质量并节省成本。
