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№2' 2018
CLINICAL PHARMACOLOGYInternational Medical Journal, Vol. 24., Iss. 2, 2018, P. 84−88.
HOW TO REDUCE THE RISKS OF MULTICOMPONENT DRUG THERAPY
N. A. Lopatkin Research Institute of Urology and Interventional Radiology, Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, D. D. Pletnev City Clinical Hospital, Department of Health of Moscow, Russian Federation
The majority of patients receive combinations of medications. On the one hand, this is due to the presence of several diseases in the patient, since with the population aging the problem of comorbidity becomes more urgent, on the other hand, monotherapy of many diseases is significantly inferior in effectiveness to multicomponent treatment regimens. The effects of concomitant medications can be added, and can be potentiated, that is, strengthen each other's action. Potentiating the effects often underlies successful and time−stable multicomponent therapy protocols. However, not only desirable effects, but also undesirable side effects, can develop and become potentiated. With this purpose, potentially unsafe variants of multicomponent drug therapy were analyzed, the main risks and ways to minimize them were reflected. Simultaneous use of two drugs of one group, as a rule, does not solve the problem of low effectiveness of therapy, but very easily gives severe overdoses or potentiates side effects. Administration of two drugs with unidirectional toxicity often leads to the realization of this risk, in spite of carefully calculated and justified doses of each of the medicines individually. The use of a drug that has toxicity to the affected organ is accompanied by a high risk of adverse effects, even if the failure of the function is moderate, completely compensated and does not determine the general condition of the patient, being an accompanying or background condition in relation to the underlying disease. It is undesirable that the preparations have unidirectional side effects associated with undesirable pharmacological effects (not with toxicity). This rule is not strict, as the risks are usually low and their implementation is not always accompanied by a threat to the life of the patient. It is advisable, if possible, to avoid a combination of drugs that compete with each other for metabolic systems. The combination of a narrow therapeutic interval and hepatic metabolism at least in one of the drugs included in the therapy protocol leads to a huge number of drug interactions, which greatly complicates the real use of the drug and increases the risk of adverse effects. Drugs should not have a multidirectional effect. Unequivocally, it is impossible to combine direct antagonists, for example, β−adrenoblockers and β−adrenomimetics. However, in the case of drugs with opposite effects, but different mechanisms of action, the ban is not rigid. The use of the presented indicators by the attending physician in everyday work does not obscure the shortcomings in order to complicate the work of the expert, but eliminates these shortcomings, increasing the quality of drug therapy.
Key words: multicomponent drug therapy, drug toxicity, side effects of drugs.