Johnson A G, Day R O
St Vincents Hospital, Sydney, NSW, Australia.
Drugs Aging. 1991 May;1(3):212-27. doi: 10.2165/00002512-199101030-00005.
The elderly are most susceptible to pharmacokinetic drug interactions between various NSAIDs and anticoagulants, sulphonylurea hypoglycaemic agents, certain anticonvulsants, methotrexate, digoxin, aminoglycosides and lithium. Pharmacodynamic interactions between some NSAIDs and antihypertensive drugs, anticoagulants, sulphonylurea agents and other NSAIDs are also potentially significant in the elderly. Despite the finding that mean therapeutic responses of large groups of patients have been generally equivalent for the wide range of NSAIDs studied thus far, it is also apparent that marked variability exists in the response of individual patients to different NSAIDs. Subsequent dosage increments may predispose 'nonresponders' and some less sensitive 'responders' to toxicity from NSAIDs. This interindividual variability in response to NSAIDs may be contributed to by the differing physicochemical properties of NSAIDs, physician prescribing habits and patient expectations, variations in NSAID pharmacokinetics, and the differing effects of NSAIDs other than their common ability to inhibit prostaglandin synthesis. The principles for drug prescribing in the elderly are no different from those that should be applied to the prescribing of medication in any patient. The clinician should strive to make a diagnosis and should avoid treating symptoms in isolation. Critical assessment of the indication for prescribing NSAID therapy must include consideration of the available effective and safe alternatives. If an NSAID is commenced the lowest effective dose should be the desired goal, but after an appropriate trial it is acceptable clinical practice to employ an alternative NSAID. There is no justification for combination NSAID therapy. The progress of each patient must be carefully monitored, particularly during the first few months of treatment, while periodic review of the ongoing need for the NSAID is essential.
老年人最易受到各种非甾体抗炎药（NSAIDs）与抗凝剂、磺酰脲类降糖药、某些抗惊厥药、甲氨蝶呤、地高辛、氨基糖苷类药物和锂之间的药代动力学药物相互作用的影响。一些NSAIDs与抗高血压药物、抗凝剂、磺酰脲类药物和其他NSAIDs之间的药效学相互作用在老年人中也可能具有重要意义。尽管有研究发现，到目前为止所研究的广泛的NSAIDs对大量患者的平均治疗反应总体上是相当的，但很明显，个体患者对不同NSAIDs的反应存在显著差异。随后增加剂量可能会使“无反应者”和一些不太敏感的“反应者”更容易受到NSAIDs毒性的影响。个体对NSAIDs反应的这种变异性可能是由NSAIDs不同的物理化学性质、医生的处方习惯和患者的期望、NSAIDs药代动力学的变化以及NSAIDs除了其抑制前列腺素合成的共同能力之外的不同作用所导致的。老年人用药的原则与适用于任何患者用药的原则并无不同。临床医生应努力做出诊断，避免孤立地治疗症状。对开具NSAID治疗指征的严格评估必须包括考虑现有的有效且安全的替代药物。如果开始使用NSAID，最低有效剂量应是期望的目标，但经过适当的试验后，使用另一种NSAID是可接受的临床实践。联合使用NSAID治疗没有依据。必须仔细监测每位患者的病情进展，尤其是在治疗的最初几个月，同时定期复查是否持续需要使用NSAID至关重要。
