6 ．薬物相互作用と現実的な対応

抄録

In recent years, many excellent drugs with few side effects have been introduced into treatment and contribute to improving prognosis, but elderly people often have multiple diseases and take many drugs in combination. As a result, the existence of drug interactions has become more important as a risk factor for the occurrence of adverse drug reactions（ADRs）. In Japan as well, the importance of drug interactions has been recognized since the Sorivudine incident in 1993, in which sorivudine, a therapeutic drug for herpes zoster, caused death due to serious myelosuppressive side effects when used in combination with 5-FU anticancer drugs, and cautions have been issued such as the revision of the description procedure in the package insert. In addition, efforts are being made by various parties concerned in the drug development process. In 2018, the Ministry of Health, Labor and Welfare issued the “Guideline on drug interaction for drug development and appropriate provision of information” regarding the method of examining drug interactions and the provision of information.

On the other hand, looking at the medical field, although some side effects of individual drugs and interactions between the two drugs are described in the package insert, it is impossible to grasp all of them. In addition, even if the drug therapy is recommended in the treatment guidelines for a certain disease, if the drug is complicated with another disease, the drug interaction with the recommended drug for those diseases may become a problem. A meta-analysis of prospective studies on the incidence of drug-induced ADRs in inpatients published by the United States in 1998 estimated that 106,000 people die annually from ADRs. Healthcare professionals are required to work harder than ever to prevent ADRs. Even now, medications are checked by pharmacists, but it is hard to say that they are fully prepared for drug interactions.

In this session, I would like to describe what can be done and what kind of knowledge should be learned to prevent serious drug interactions. Based on that, I would like to think about what points should be emphasized and dealt with in the actual medical field.