Zusammenfassung
Mit zunehmendem Alter steigt nicht nur die Zahl der Erkrankungen, sondern auch
die Menge der durchschnittlich eingenommenen Medikamente pro Patient. Darüber
hinaus liegt im Alter eine Minderung der Clearance der wichtigsten Eliminationsorgane
des menschlichen Organismus - der Nieren und der Leber - vor. Somit prädestinieren
Multimorbidität, konsekutive Multimedikation (bis hin zur Polypragmasie) und eine
reduzierte Clearanceleistung von Leber und Nieren für die Entstehung von Arzneimittelinteraktionen
bei alten Menschen. Aber nicht alle Arzneimittelinteraktionen resultieren in schwerwiegenden
Komplikationen, wie die des Lipidsenkers Cerivastatin (Rhabdomyolysen) und des
T-Kanal-Blockers Mibefradil (rhythmologische Komplikationen, Rhabdomyolysen).
Ein großer Teil der Medikamenteninteraktionen löst nur unspezifische Symptome
aus, die bei vielen Patienten übersehen und zum Teil auf das fortgeschrittene
Alter der Patienten geschoben werden. Dazu zählen Verwirrtheit, Apathie, Ohnmacht,
Stürze und Inkontinenz. Die Kenntnis typischer Arzneimittelinteraktionen und der
zugrunde liegenden Mechanismen sowie die aufmerksame Beobachtung des Patienten
bei Umstellung der Medikation ist daher wichtig, um vermeidbare Komplikationen
einer Behandlung mit mehreren Arzneimitteln zu verhindern.
Summary
With increasing age not only the number of comorbid diseases, but also the amount
of drugs that are prescribed on average per patient is growing. Furthermore there
is a age related reduction regarding the clearance for the elimination of drugs
of the most important organs - namely the kidney and liver. Therefore multimorbidity,
consecutive multimedication (polypragmasia) and a reduced clearance of liver and
kidneys accounts for drug-drug interactions in the elderly. But not all drug-drug
interactions result in severe complications as the ones that led to the withdrawal
of the lipid lowering agent Cerivastatin (rhabdomyolysis) and the T-channel blocker
Mibefradil (arrhythmias, rhabdomyolysis). A substantial proportion of drug-drug
interactions evokes more unspecific symptoms which are overlooked in many
patients and are often ascribed to the age of the patient. These symptoms are
confusion, apathy, dizzy spells, falls and incontinence. The knowledge of typical
drug-drug interactions and of the underlying mechanisms as well as the closed
observation of symptoms in patients with a change in drug prescription is therefore
important to alleviate preventable complications of treatment with several drugs.
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Dr. med. Peter Bramlage
Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität
Dresden
Fiedlerstraße 27
01307 Dresden
Phone: 0351/4582815
Fax: 0351/4584341
Email: peter.bramlage@mailbox.tu-dresden.de
