Riechelmann Rachel P, Tannock Ian F, Wang Lisa, Saad Everardo D, Taback Nathan A, Krzyzanowska Monika K
Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
J Natl Cancer Inst. 2007 Apr 18;99(8):592-600. doi: 10.1093/jnci/djk130.
Cancer patients receive numerous medications, including antineoplastic agents, drugs for supportive care, and medications for comorbid illnesses. Therefore, they are at risk for drug interactions and duplicate prescribing.
A questionnaire eliciting information on demographics and medications taken in the previous 4 weeks was given to adult outpatients receiving systemic anticancer therapy for solid tumors. The Drug Interaction Facts software, version 4.0, was used to identify potential drug interactions and to classify them by level of severity (major, moderate, or minor) and the strength of scientific evidence for them (using categories [1-5] of decreasing certainty). Summary statistics and logistic regression were used to analyze the data. All statistical tests were two-sided.
The survey was completed by 405 patients. We observed 276 potential drug interactions, and at least one potential interaction was identified in 109 patients (27%; 95% confidence interval [CI] = 23% to 31%). Of the potential interactions, 25 (9%) were classified as major and 211 (77%) as moderate. Nearly half (49%) of potential interactions were supported by level 1 or 2 scientific evidence. Most potential drug interactions (87%) involved non-anticancer agents such as warfarin, antihypertensive drugs, corticosteroids, and anticonvulsants, but some (n = 36, 13%) involved antineoplastic agents. In multivariable analysis, increased risk of receiving drug combinations in which there were potential drug interactions was associated with receipt of increasing numbers of drugs (odds ratio [OR] = 1.4 per additional drug, 95% CI = 1.26 to 1.58, P<.001 from the Wald chi-square test), type of medication (drugs to treat comorbid conditions versus supportive care medications only; OR = 8.6, 95% CI = 2.9 to 25, P<.001), and the presence of brain tumors. Thirty-two (8%) patients were exposed to duplicate medications, most often corticosteroids, proton pump inhibitors, or benzodiazepines.
Potential drug interactions were common among cancer patients and most often involved medications to treat comorbid conditions. Duplicate medications were infrequent.
癌症患者会使用多种药物，包括抗肿瘤药物、支持性治疗药物以及用于治疗合并症的药物。因此，他们存在药物相互作用和重复用药的风险。
向接受实体瘤全身抗癌治疗的成年门诊患者发放一份问卷，收集其人口统计学信息以及过去4周内服用的药物信息。使用Drug Interaction Facts软件4.0版来识别潜在的药物相互作用，并根据严重程度（主要、中度或轻度）以及相关科学证据的强度（使用确定性递减的[1 - 5]类）对其进行分类。采用汇总统计和逻辑回归分析数据。所有统计检验均为双侧检验。
405名患者完成了调查。我们观察到276种潜在的药物相互作用，109名患者（27%；95%置信区间[CI]=23%至31%）中至少发现了一种潜在相互作用。在潜在相互作用中，25种（9%）被归类为主要相互作用，211种（77%）为中度相互作用。近一半（49%）的潜在相互作用有1级或2级科学证据支持。大多数潜在药物相互作用（87%）涉及非抗癌药物，如华法林、抗高血压药物、皮质类固醇和抗惊厥药物，但也有一些（n = 36，13%）涉及抗肿瘤药物。在多变量分析中，接受存在潜在药物相互作用的药物组合的风险增加与所服用药物数量的增加相关（比值比[OR]=每增加一种药物为1.4，95%CI = 1.26至1.58，来自Wald卡方检验的P<.001）、药物类型（用于治疗合并症的药物与仅用于支持性治疗的药物；OR = 8.6，95%CI = 2.9至25，P<.001）以及是否存在脑肿瘤有关。32名（8%）患者存在重复用药情况，最常见的是皮质类固醇、质子泵抑制剂或苯二氮䓬类药物。
潜在药物相互作用在癌症患者中很常见，且大多涉及用于治疗合并症的药物。重复用药情况并不常见。
