cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2021-3031cardiovascular-3031Research ArticleМЕЖЛЕКАРСТВЕННОЕ ВЗАИМОДЕЙСТВИЕОсновные принципы комбинированной медикаментозной терапии – фокус на межлекарственное взаимодействиеBasic principles of combination therapy: focus on drug-drug interactionhttps://orcid.org/0000-0002-7717-4362МарцевичС. Ю.MartsevichS. Yu.

Марцевич Сергей Юрьевич — доктор медицинских наук, профессор, руководитель отдела профилактической фармакотерапии

Москва

Moscow

sergeymartsevich@mail.ruhttps://orcid.org/0000-0001-8252-3099ЛукинаЮ. В.LukinaYu. V.

Лукина Юлия Владимировна — кандидат медицинских наук, ведущий научный сотрудник отдела профилактической фармакотерапии

Москва

 

Moscow

yuvlu@mail.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана Михайловна — доктор медицинских наук, профессор, член-корреспондент РАН, главный специалист-терапевт Минздрава России, директор

Москва

Moscow

drapkina@bk.ruФГБУ “Национальный медицинский исследовательский центр терапии и профилактической медицины” Минздрава РоссииNational Medical Research Center for Therapy and Preventive Medicine20211711202120730313031Copyright © Марцевич С.Ю., Лукина Ю.В., Драпкина О.М., 20212021Марцевич С.Ю., Лукина Ю.В., Драпкина О.М.Martsevich S.Y., Lukina Y.V., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/3031

Статья посвящена проблеме межлекарственных взаимодействий при комбинированном назначении лекарственных препаратов. На сегодняшний день, когда медикаментозная терапия является ведущим методом лечения больных хроническими неинфекционными заболеваниями, а старение населения планеты приводит к повышению количества пациентов с  выраженной коморбидностью и  вынужденной полипрагмазией, проблема межлекарственного взаимодействия стоит особенно остро. В  статье рассмотрены основные виды взаимодействий лекарств  — фармакокинетическое (связанное с  абсорбцией, распределением, метаболизмом и  элиминацией лекарственных препаратов) и  фармакодинамическое, приводящее к  синергии или антагонизму фармакологических эффектов назначаемых лекарственных средств. Последствия взаимодействия различных препаратов могут быть желательными и нежелательными, последние встречаются значительно чаще, и  именно на профилактику таких взаимодействий должно быть направлено внимание врачей разных специальностей. Также на примере сведений из специальных шкал и  перечней (критерии Beers, START/ STOPP критерии), применяемых, преимущественно в  гериатрической практике, кратко описаны варианты различных неблагоприятных межлекарственных взаимодействий. Кроме того, в статье приводятся ссылки на ряд Интернет-ресурсов, позволяющих оценить риск межлекарственного взаимодействия при назначении комбинированной фармакотерапии.

The article is devoted to the issue of drug interactions in the combination regimens. Today, when drug therapy is the first-line approach for patients with noncommunicable diseases, and the world population ageing leads to an increase in the number of patients with severe comorbidity and polypharmacy, the problem of drug-drug interaction is especially relevant. The article discusses the main types of drug interactions  — pharmacokinetic (related to absorption, distribution, metabolism and excretion of drugs) and pharmacodynamic ones, leading to synergy or antagonism of the pharmacological effects. The consequences of drug interactions can be desirable and undesirable, while the latter are much more common. Attention should be directed precisely to preventing such interactions. Also, using data from special scales and lists (Beers criteria, STOPP/START criteria), the options for various adverse drugdrug interactions are briefly described. In addition, the article provides a number of Internet resources that allow assessing the drug interaction risk when prescribing combination therapy.

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The authors declare that there are no conflicts of interest present.