Tương tác Thuốc Có Hại với Thuốc Kháng Viêm Không Steroid (NSAIDs)

Drug Safety - Tập 8 - Trang 99-127 - 2012
Anthony G. Johnson1,2,3, Peter Seideman1,2,3, Richard O. Day1,2,3
1Department of Clinical Pharmacology and Toxicology, St Vincents’s Hospital, Darlinghurst, Australia
2School of Physiology and Pharmacology, University of New South Wales, Sydney, Australia
3Karolinska Institute, Department of Rheumatology, Danderyd Hospital, Danderyd, Sweden

Tóm tắt

Tỷ lệ phổ biến và tỷ lệ mắc của các tương tác thuốc có hại liên quan đến thuốc kháng viêm không steroid (NSAIDs) vẫn chưa được xác định. Để xác định những tương tác thuốc có ảnh hưởng lâm sàng lớn nhất, việc tập trung vào các tương tác giữa các loại thuốc thường được sử dụng và/hoặc thường được kê đơn đồng thời là điều thích hợp, mặt khác, các tương tác mà có nhiều báo cáo trường hợp được tài liệu hóa trong các tạp chí uy tín, các tương tác đã được chứng minh bởi các nghiên cứu trên người thiết kế tốt và những tương tác ảnh hưởng đến các loại thuốc có nguy cơ cao và/hoặc bệnh nhân có nguy cơ cao. Trong khi hầu hết các tương tác giữa NSAIDs và các thuốc khác là dược động học, các tương tác dược lực học liên quan đến NSAIDs có thể quan trọng hơn nhiều trong bối cảnh lâm sàng, và sự thiếu hiểu biết của người kê đơn có khả năng là yếu tố quyết định chính của nhiều tương tác thuốc có hại. Việc kê đơn NSAIDs được chống chỉ định tương đối cho bệnh nhân đang dùng thuốc chống đông đường uống do nguy cơ chảy máu, và cho bệnh nhân sử dụng methotrexate liều cao do những nguy cơ độc tính tủy xương, suy thận và rối loạn chức năng gan. Việc điều trị kết hợp NSAID không thể biện minh được vì độc tính có thể gia tăng mà không có bất kỳ cải thiện nào về hiệu quả. Khi lithium hoặc thuốc chống tăng huyết áp được kê đơn đồng thời với NSAIDs, việc theo dõi cẩn thận là bắt buộc để phát hiện độc tính của lithium và tăng huyết áp, và aspirin (acid acetylsalicylic) hoặc sulindac được ưu tiên. Phenytoin hoặc các tác nhân hạ đường huyết uống có thể được sử dụng cùng với NSAIDs khác ngoài pyrazoles và salicylates với điều kiện bệnh nhân được theo dõi cẩn thận khi bắt đầu và ngừng điều trị NSAID. Digoxin, aminoglycosides và probenecid có thể được kê đơn đồng thời với NSAIDs, nhưng việc theo dõi cẩn thận là cần thiết, đặc biệt đối với bệnh nhân có nguy cơ cao như người cao tuổi. Indomethacin và triamterene nên được tránh do nguy cơ suy thận. Aspirin liều cao nên được thay thế bằng naproxen cho bệnh nhân sử dụng acid valproic (sodium Valproate) và cần cẩn thận khi corticosteroids được dùng cho bệnh nhân sử dụng salicylates liều cao trong thời gian dài. Các tương tác giữa NSAIDs và thuốc chống acid hoặc cholestyramine thường có thể tránh được. Các tương tác thuốc có hại liên quan đến NSAIDs có thể được hạn chế bằng cách kê đơn hợp lý và theo dõi cẩn thận, đặc biệt là đối với bệnh nhân, thuốc và thời gian điều trị có nguy cơ cao.

Từ khóa

#NSAIDs #tương tác thuốc #dược động học #dược lực học #kê đơn hợp lý #bệnh nhân có nguy cơ cao

Tài liệu tham khảo

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