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Medikamentöse Interaktionen in der Rheumatologie

Drug-drug interactions in antirheumatic treatment

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Zusammenfassung

Medikamentöse Interaktionen stellen einen wichtigen Grund für gefährliche Nebenwirkungen und stationäre Einweisungen dar. Auch in der Rheumatologie bilden sie ein Problem, das im Praxisalltag evtl. nicht ausreichend wahrgenommen wird. Sie sind für die meisten hier verwendeten Medikamente beschrieben; nicht immer ist ihre praktische Relevanz klar. Zu den Antirheumatika mit häufigeren und praktisch wichtigen Interaktionsproblemen zählen nichtsteroidale Antiphlogistika (NSAR), Methotrexat, Azathioprin, Mycophenolat-Mofetil und insbesondere Cyclosporin A. Für alle anderen Substanzen sind einzelne Wechselwirkungen beschrieben, die meist nicht mit gefährlichen Folgen verbunden sind. Die wichtigsten Einzelinteraktionen mit potenziell lebensbedrohlichen Konsequenzen resultieren aus der gleichzeitigen Verabreichung von Methotrexat und Cotrimoxazol sowie Azathioprin und Allopurinol. Bei Multimedikation sollte grundsätzlich an Interaktionen gedacht werden. Ältere Patienten sind diesem Risiko besonders ausgesetzt.

Abstract

Clinically relevant drug-drug interactions contribute considerably to potentially dangerous drug side-effects and are frequently the reason for hospitalization. Nevertheless they are often overlooked in daily practice. For most antirheumatic drugs a vast number of interactions have been described but only a minority with clinical relevance. Several potentially important drug interactions exist for non-steroidal anti-inflammatory drugs (NSAIDs), methotrexate, azathioprine, mycophenolate-mofetil and especially for cyclosporin A. Most importantly co-medication with methotrexate and sulfmethoxazole trimethoprim as well as azathioprine and allopurinol carries the risk of severe, sometimes life-threatening consequences. Nevertheless, besides these well-known high-risk combinations in each case of polypharmacy with antirheumatic drugs it is necessary to bear in mind the possibility of drug interactions. As polypharmacy is a common therapeutic practice in older patients with rheumatic diseases, they are at special risk.

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  1. Rheumatologisches Praxiszentrum, St.-Bonifatius-Str. 5, 81541, München, Deutschland

    K. Krüger

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  1. K. Krüger
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Krüger, K. Medikamentöse Interaktionen in der Rheumatologie. Z. Rheumatol. 71, 209–216 (2012). https://doi.org/10.1007/s00393-012-0973-0

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  • DOI: https://doi.org/10.1007/s00393-012-0973-0

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