Seeland Ute, Regitz-Zagrosek Vera
Institute of Gender in Medicine, Universitaetsmedizin Berlin Charité, Berlin, Germany.
Handb Exp Pharmacol. 2012(214):211-36. doi: 10.1007/978-3-642-30726-3_11.
This chapter outlines sex differences in pharmacokinetics and pharmacodynamics of the most frequently used drugs in cardiovascular diseases, e.g., coronary artery disease, hypertension, heart failure. Retrospective analysis of previously published drug trials revealed marked sex differences in efficacy and adverse effects in a number of cardiovascular drugs. This includes a higher mortality among women taking digoxin for heart failure, more torsade de pointes arrhythmia in QT prolonging drugs and more cough with ACE inhibitors. Trends towards a greater benefit for women and/or female animals have been observed in some studies for endothelin receptor antagonists, the calcium channel blocker amlodipine, the ACE-inhibitor ramipril and the aldosterone antagonist eplerenone. However, reproduction of these results in independent studies and solid statistical evidence is still lacking. Some drugs require a particularly careful dose adaptation in women: the beta-blocker metoprolol, the calcium channel blocker verapamil, loop-, and thiazide diuretics. In conclusion, sex differences in pharmacokinetics and pharmacodynamics have to be taken into account for cardiovascular drug therapy in women.
本章概述了心血管疾病（如冠状动脉疾病、高血压、心力衰竭）中最常用药物的药代动力学和药效学方面的性别差异。对先前发表的药物试验进行回顾性分析发现，许多心血管药物在疗效和不良反应方面存在显著的性别差异。这包括服用地高辛治疗心力衰竭的女性死亡率更高，服用延长QT间期药物时发生尖端扭转型室性心动过速心律失常的情况更多，以及使用血管紧张素转换酶抑制剂时咳嗽更多。在一些研究中，对于内皮素受体拮抗剂、钙通道阻滞剂氨氯地平、血管紧张素转换酶抑制剂雷米普利和醛固酮拮抗剂依普利酮，已观察到对女性和/或雌性动物有更大益处的趋势。然而，在独立研究中重现这些结果并缺乏确凿的统计证据。一些药物在女性中需要特别谨慎地调整剂量：β受体阻滞剂美托洛尔、钙通道阻滞剂维拉帕米、袢利尿剂和噻嗪类利尿剂。总之，在女性心血管药物治疗中必须考虑药代动力学和药效学方面的性别差异。
