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Geriatrie up2date 2019; 1(02): 151-163
DOI: 10.1055/a-0892-0286
Allgemeine Geriatrie
Georg Thieme Verlag KG Stuttgart · New York

Arzneimittelinteraktionen, die man kennen muss!

Niels Voigt
,
Katharina Ort
,
Samuel Sossalla
Further Information

Publication History

Publication Date:
23 July 2019 (online)

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Arzneimittelinteraktionen (AMI) sind ein häufig unterschätztes Problem der modernen Medizin. Die Zahl älterer, multimorbider Patienten, die mehrere Wirkstoffe gleichzeitig einnehmen, nimmt stetig zu – der damit verbundene exponentielle Anstieg möglicher AMI ist fast unüberschaubar. Diese Übersicht stellt häufige, relevante AMI anhand von Beispielen dar und zeigt Strategien auf, wie sie in der Praxis frühzeitig erkannt und vermieden werden können.
Kernaussagen

  • 1 – 5% aller Krankenhauseinweisungen sind auf Arzneimittelinteraktionen (AMI) zurückzuführen oder stehen mit diesen in Zusammenhang.

  • Pharmakodynamische AMI können die Auftretenswahrscheinlichkeit sonst kaum beobachteter unerwünschter Arzneimittelwirkungen derart erhöhen, dass diese klinische Relevanz erhalten.

  • Lediglich für die Kombination zweier AM mit „bekanntem Risiko“ für TdP-Arrhythmien konnte eine additive Wirkung auf die QT-Zeit-Verlängerung nachgewiesen werden.

  • Pharmakokinetische Interaktionen umfassen Wechselwirkungen, welche die Resorption, Verteilung, Metabolisierung und Elimination beeinflussen und die Konzentration am Wirkort verändern.

  • P-Glykoprotein und Cytochrom-P450-Enzyme spielen eine wichtige Rolle bei pharmakokinetischen Interaktionen.

Schlüsselwörter

Arzneimittelinteraktionen - Cytochrom P450 - Polypharmazie - Pharmakokinetik - Pharmakodynamik
 

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