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Arzneimittelinteraktionen

Drug interactions

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Zusammenfassung

Arzneimittelwechselwirkungen sind in vielen Fällen erwünscht und erhöhen die Effektivität von Kombinationstherapien, andererseits sind sie auch häufige Ursache unerwünschter Arzneimittelwirkungen. Abhängig vom Entstehungsmechanismus werden pharmakokinetische von pharmakodynamischen Arzneimittelinteraktionen unterschieden. Pharmakokinetische Wechselwirkungen führen zu Änderungen der Konzentrations-Zeit-Profile der Begleitsubstanz und damit verbunden zu Änderungen konzentrationsabhängiger Wirkungen. Dabei können alle Ebenen der Pharmakokinetik (Liberation, Absorption, Verteilung, Metabolismus, Exkretion) betroffen sein. Cytochrom-P450-Enzyme und Arzneimitteltransporter, z. B. ABC-Transporter, sind entscheidend für die Clearance vieler Arzneimittel. Pharmakodynamische Wechselwirkungen führen zu Wirkungsänderungen der Begleitsubstanz, ohne dass die Konzentration verändert wird. Die Beachtung von Arzneimittelwechselwirkungen mit daraus resultierender entsprechender Dosisanpassung ist zunehmend ein Kriterium für gute Arzneimittelverordnungspraxis.

Abstract

Drug-drug interactions can be used to enhance effectiveness but they are also a significant cause of adverse drug reactions. Alterations in liberation, absorption, distribution, metabolism, and excretion may all affect the pharmacokinetics of a drug. Cytochrome P450 enzymes and drug transporters like ABC-transporters determine the clearance of many drugs leading to alterations in therapeutic effect. In contrast pharmacodynamic drug interactions will alter drug effects in the absence of concentration changes of the co-administered drug. Alterations of a drug effect may require changes in dose to maintain the therapeutic effect.

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Abbreviations

ABC:

ATP-binding Cassette

AIDS:

Acquired Immunodeficiency Syndrome

Al:

Aluminium

Ca:

Kalzium

cGMP:

Zyklisches Guanosinmonophosphat

COMT:

Katechol-O-Methyltransferase

COX:

Cyclooxygenase

CYP:

Cytochrom-P450-Enzyme

Fab:

Fragment Antigen Binding

Fe:

Eisen

MDR1:

Multidrug Resistance Protein 1

Mg:

Magnesium

NSAR:

Nichtsteroidale Antirheumatika

OATP1B1:

Organic Anionic Transporting Polypeptide 1B1

PG:

Prostaglandin

PPI:

Protonenpumpeninhibitor

SSRI:

Selektiver Serotonin-Reuptake-Inhibitor

UAW:

Unerwünschte Arzneimittelwirkung

WHO:

World Health Organization

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Authors and Affiliations

  1. Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universität Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    V. Hafner, B. Grün, C. Markert, D. Czock, G. Mikus &  W.E. Haefeli

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  1. V. Hafner
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  2. B. Grün
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  3. C. Markert
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  4. D. Czock
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  5. G. Mikus
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  6. W.E. Haefeli
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Correspondence to W.E. Haefeli.

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Hafner, V., Grün, B., Markert, C. et al. Arzneimittelinteraktionen. Internist 51, 359–370 (2010). https://doi.org/10.1007/s00108-009-2553-1

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