Lékové interakce - rizika u pacientů s polypragmazií

Polypharmacy, a phenomenon of today's medicine, brings a great risk of drug interactions. Some of them can lead to serious side effects or treatment failure, knowledge in this field is dramatically developing. Pharmacokinetic drug interactions can occur not only when drugs are metabolized by the cytochrome P450 isoenzyme system, but also at the level of transporters, a number of which have already been described. In order to assess their clinical significance, it is necessary to orient oneself in the pharmacodynamics and pharmacokinetics of drugs, but also to consider other factors that will influence the impact of drug interactions. The physician should be familiar with commonly prescribed drugs with a high interaction potential, be aware of strong inducers and inhibitors of CYP450, as well as the possible influence of genetic polymorphism of some of its isoforms. However, one should not rely on the interpretation of drug interactions only using available interaction databases. No software is yet capable of evaluating interactions comprehensively and in the context of a specific patient, their health status and comorbidities. Also, the information available from clinical studies and observations needs to be properly understood and translated into real practice. Nowadays, it is a great advantage a doctor can consult with a clinical pharmacist or pharmacologist on the issue of drug interactions in a specific patient. This article summarizes the issue of drug interactions, focusing on the less intuitive ones, with examples from practice.