Caraci Filippo, Sultana Janet, Drago Filippo, Spina Edoardo
Department of Drug Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Italy.
CNS Neurol Disord Drug Targets. 2017;16(4):501-513. doi: 10.2174/1871527316666170303144817.
The aging world population had led to an increase in the prevalence of Alzheimer's disease (AD). The drugs used to slow down the onset of AD, galantamine, donepezil, rivastigmine and memantine, are generally well-tolerated. However, drug interactions between these drugs and other drugs are an important aspect of patient safety that should be borne in mind, particularly given the high burden of polypharmacy in the elderly. The aim of this review is to provide an updated review of clinically significant drug-drug interactions concerning drugs approved for AD.
PubMed was searched for relevant keywords. No time limit was imposed but only articles in English published in peer-reviewed journals were selected. Relevant literature was also identified from the references of identified articles. Further information was obtained from drug summary of product characteristics.
The major pharmacokinetic interactions identified concerned fluoxetine, paroxetine and ketoconazole when used with galantamine or donepezil. On the other hand, the major potential pharmacodynamic interactions concerned anti-dementia drugs and general anesthesia agents, anti-cholinergic drugs, conventional antipsychotics and bradycardia-inducing drugs. In clinical practice memantine shows a lower potential for pharmacodynamic drug-drug interactions (DDIs) compared to other drug classes.
The concomitant use of anti-dementia drugs with other drugs can have variable clinical effects, making appropriate prescribing of these drugs very challenging. A simple and coherent way of presenting evidence on complex drug interaction information from heterogenous sources to clinicians is needed in order for the voluminous data available to have an impact on clinical practice.
全球人口老龄化导致阿尔茨海默病（AD）患病率上升。用于延缓AD发病的药物，如加兰他敏、多奈哌齐、卡巴拉汀和美金刚，通常耐受性良好。然而，这些药物与其他药物之间的相互作用是患者安全的一个重要方面，应予以关注，尤其是考虑到老年人多重用药负担较重的情况。本综述的目的是对已批准用于AD的药物之间具有临床意义的药物相互作用进行更新综述。
在PubMed上搜索相关关键词。未设定时间限制，但仅选择在同行评审期刊上发表的英文文章。还从已识别文章的参考文献中识别相关文献。进一步的信息从产品特性的药物总结中获取。
确定的主要药代动力学相互作用涉及氟西汀、帕罗西汀和酮康唑与加兰他敏或多奈哌齐合用时。另一方面，主要的潜在药效学相互作用涉及抗痴呆药物与全身麻醉剂、抗胆碱能药物、传统抗精神病药物和致心动过缓药物。在临床实践中，与其他药物类别相比，美金刚发生药效学药物相互作用（DDIs）的可能性较低。
抗痴呆药物与其他药物联合使用可能产生不同的临床效果，这使得合理开具这些药物极具挑战性。需要一种简单连贯的方式，将来自不同来源的复杂药物相互作用信息呈现给临床医生，以便现有的大量数据能够对临床实践产生影响。
