Blaufarb I, Pfeifer T M, Frishman W H
Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Drug Saf. 1995 Dec;13(6):359-70. doi: 10.2165/00002018-199513060-00005.
The clinician prescribing beta-blockers for his or her patients is faced with an often difficult situation. There are many beta-blockers, each with its own pharmacological profile. Patients are often taking multiple medications, thus increasing the risk of both anticipated and unexpected drug interactions. Reports of drug interactions are frequently anecdotal. The prescriber may not be aware of the patient's other medications or lifestyle habits. Pharmacokinetic and pharmacodynamic drug interactions involving beta-blockers are documented in the literature, but these studies often examine small numbers of patients. For these reasons, it is difficult for the practitioner to distill guidelines for the administration of beta-blockers in conjunction with other medication. In general, beta-blockers are well tolerated, and symptomatic drug interactions are relatively infrequent. It is incumbent upon the clinical practitioner to have knowledge of his or her patient's drug profile and to be aware of the various drug interactions as well as each patient's unique pathophysiological profile when prescribing any medication, including beta-blockers. beta-Blockers may interact with a large number of commonly prescribed drugs, including antihypertensive and antianginal drugs, inotropic agents, anti-arrhythmics, NSAIDs, psychotropic drugs, anti-ulcer medications, anaesthetics, HMG-CoA reductase inhibitors, warfarin, oral hypoglycaemics and rifampicin (rifampin).
临床医生为患者开具β受体阻滞剂时常常面临困境。β受体阻滞剂种类繁多,每种都有其独特的药理特性。患者通常同时服用多种药物,这就增加了预期和意外药物相互作用的风险。药物相互作用的报告往往多为轶事性的。开处方者可能并不了解患者的其他用药情况或生活习惯。文献中记载了涉及β受体阻滞剂的药代动力学和药效学药物相互作用,但这些研究通常只涉及少数患者。由于这些原因,从业者很难提炼出β受体阻滞剂与其他药物联合使用的给药指南。一般来说,β受体阻滞剂耐受性良好,有症状的药物相互作用相对较少。临床医生有责任了解患者的用药情况,并在开具任何药物(包括β受体阻滞剂)时,了解各种药物相互作用以及每个患者独特的病理生理特征。β受体阻滞剂可能与大量常用药物相互作用,包括抗高血压药、抗心绞痛药、正性肌力药、抗心律失常药、非甾体抗炎药、精神药物、抗溃疡药、麻醉药、HMG-CoA还原酶抑制剂、华法林、口服降糖药和利福平。