Mallet Louise, Spinewine Anne, Huang Allen
Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada; Department of Pharmacy, McGill University Health Centre, Montreal, QC, Canada; McGill University, Montreal, Quebec, Canada.
Centre for Clinical Pharmacy, School of Pharmacy, Université catholique de Louvain, Brussels, Belgium.
Lancet. 2007 Jul 14;370(9582):185-191. doi: 10.1016/S0140-6736(07)61092-7.
Drug therapy is essential when caring for elderly patients, but clearly it is a double-edged sword. Elderly patients are at high risk of having drug interactions, but the prevalence of these interactions is not well documented. Several types of interactions exist: drug-drug, drug-disease, drug-food, drug-alcohol, drug-herbal products, and drug-nutritional status. Factors such as age-related changes in pharmacokinetics and pharmacodynamics, frailty, interindividual variability, reduced homoeostatic mechanisms, and psychosocial issues need to be considered when drug interactions are assessed. Software can help clinicians to detect drug interactions, but many programmes have not been updated with the evolving knowledge of these interactions, and do not take into consideration important factors needed to optimise drug treatment in elderly patients. Any generated recommendations have to be tempered by a holistic, geriatric, multiprofessional approach that is team-based. This second paper in a series of two on prescribing in elderly people proposes an approach to categorise drug interactions, along with strategies to assist in their detection, management, and prevention.
药物治疗在照顾老年患者时至关重要，但显然它是一把双刃剑。老年患者发生药物相互作用的风险很高，但这些相互作用的发生率尚无充分记录。存在几种类型的相互作用：药物-药物、药物-疾病、药物-食物、药物-酒精、药物-草药产品以及药物-营养状况。在评估药物相互作用时，需要考虑诸如药代动力学和药效学中与年龄相关的变化、虚弱、个体间差异、体内稳态机制降低以及社会心理问题等因素。软件可以帮助临床医生检测药物相互作用，但许多程序并未随着对这些相互作用的不断发展的认识而更新，并且没有考虑到优化老年患者药物治疗所需的重要因素。任何生成的建议都必须通过基于团队的整体、老年医学、多专业方法来加以权衡。这是关于老年人用药的两篇系列文章中的第二篇，提出了一种对药物相互作用进行分类的方法，以及协助检测、管理和预防药物相互作用的策略。
