心臟衰竭病患治療藥物之交互作用研究

A Study of Drug Interactions in Prescriptions for Patients with Heart Failure

李秀月(Hsiu-Yueh Lee) ； 廖培湖(Pei-Hu Liao) ； 林明忠(Min-Jon Lin) ； 林瑞生(Ruey-Hseng Lin)

《中山醫學雜誌》 17卷1期 (2006/06) Pp. 71-83

https://doi.org/10.30096/CSMJ.200606.0008

摘要

心臟衰竭乃心臟的輸出不敷全身需要的疾病，為高致死率的疾病，症狀愈嚴重者，致死率越高。心臟衰竭病患多為老年病患且合併多種疾病，故除digoxin外常併用多種其他藥物，所以含digoxin處方之藥物交互作用，值得加以探討。Digoxin與其他藥物之交互作用已於“含digoxin處方其藥物交互作用之研究（一）”探討，本篇主要是探討digoxin除外之藥物交互作用發生率。
本研究收集台灣中部某醫學中心92年1月間所有服用digoxin的病患，共計440人次，逐一探討具有藥物交互作用處方，並統計其藥物交互作用的發生率。結果顯示藥物交互作用的總發生率為43.96%。若只估計具臨床意義的交互作用（一到三級）則有28.97%。Digoxin除外之藥物交互作用發生率為20.51%，若只估計具臨床意義的第一級到第三級的交互作用則有15.00%。其中具高危險性之一級交互作用發生率為1.33%，二級藥物交互作用則最多，發生率為12.43%。一級藥物交互作用以抗凝血劑和抑制血小板凝集劑之交互作用最多。二級藥物交互作用則以去鉀利尿劑和ACEIs之交互作用為最多。在本文中對各藥物交互作用的機轉和如何預防和減少藥物交互作用所帶來的不良反應做深入討論，以期提高醫療品質。

關鍵字

心臟衰竭 ； 治療藥物 ； 藥物交互作用

並列摘要

This study is based on 440 prescriptions for digoxin that were collected during the period 1/1/2003 to 1/31/2003. We have already investigated the drug interactions of digoxin in a previous study and in the present study we use these prescriptions to explore the drug interactions that do not involve digoxin. The incidence of the total drug interactions was 43.96%. Of these, 28.97% were clinically significant (severity 1 to 3). The incidence of drug interactions (excluding digoxin) was 20.51% of which 15% were clinically significant (severity 1 to 3).
Of the drug interactions, 1.33% of them were classified as being of severity 1 with the largest number of interactions occurring between anticoagulants and antiplatelet agents. Interactions classified as severity 2 constituted 12.43% of the total, with potassium wasting diuretics and ACEIs having the largest number of drug interactions. The mechanism of drug interaction and suggestions on how to alleviate the adverse effects of drug interactions are also discussed.

並列關鍵字

heart failure ； prescriptions ； drug interactions