社團法人臺灣臨床藥學會

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【原著】口服抗癌藥品之交互作用處方評估
Evaluation of oral anticancer prescriptions and drug interactions
口服抗癌藥品、藥物交互作用、電腦警示系統、oral anticancer drugs, drug interaction, computer warning system
王芙容Fu-Jung Wang1 、王銘崇Ming-Chung Wang2 、溫燕霞Yen-Hsia Wen3 、林凱逸Kai-Yi Lin3 、李炳鈺Ping-Yu Lee1 、戴慶玲Ching-Ling Tai1 、吳信昇Shihn-Sheng Wue*3
1高雄長庚紀念醫院 藥劑科 、2高雄長庚紀念醫院 血液腫瘤科 、3高雄醫學大學 藥學系
目的:本研究目的在分析臨床上使用口服抗癌藥物的癌症,常見的潛在藥物交互作用發生率、型態和藥物交互作用電腦警示系統的成效。
方法:本研究為回溯性觀察性研究,研究材料取自台灣南部某醫學中心2007年1-12月份門診健保行政申報光碟。口服抗癌藥品之潛在藥物交互作用資料庫是依據Drug Interaction Facts software, version 4.0。在處方型態分析上,利用健保給付藥品ATC (Anatomical Therapeutic Chemical)代碼對照檔與國際疾病傷害及死因分類標準ICD-9CM (International Classification of Diseases, 9 th version, Clinical Modification)及SPSS統計軟體來篩選及分析。
結果:使用口服抗癌藥品的門診癌症病患有2,482人,處方之口服抗癌藥品共19,066筆,其中有937筆發生潛在藥物交互作用,發生率為4.9%。潛在藥物交互作用的顯著性級數第1級、第2級和第4級。產生反應的時間大部分是延遲型。顯著性級數第1級的藥物交互作用,最常見為MTX的交互作用,但臨床影響不顯著。而顯著性級數第2級和第4級的潛在藥物交互作用反而較有臨床意義,雖不屬於電腦警示範圍,卻值得我們注意。電腦警示系統的偵測率為89.7%。
結論:有些抗癌藥物的交互作用雖不屬於顯著性第1級,未被列入電腦警示項目,但可能導致抗癌療效下降或增加藥物毒性,而危及病患生命。因為口服抗癌藥物交互作用的文獻不多,我們的研究是希望能獲得更多藥學先進對口服抗癌藥物交互作用和目前電腦警示系統效能的注意,以增進病患用藥安全。

Introduction: 
The purpose of our research was to analyze the clinical use of oral anticancer treatment of cancer, the incidence and type of frequently of potential drug-drug interactions, and the effectiveness of computer generated warnings in screening drug-drug interactions. 
Methods: 
This study is a retrospective cohort study based on the outpatient administrative claims data from the medical center in southern Taiwan from the period between January 2007 and December 2007. Information regarding potential drug interactions for oral anticancer drugs was sourced from “Drug Interaction Facts software, version 4.0”. In the drug utilization, the Anatomical Therapeutic Chemical (ATC) digit coding system, International Classification of Diseases, 9 th version, Clinical Modification (ICD9-CM) codes and SPSS software were used for extracting and analyzing the pharmaceutical claims data. 
Results: 
From a total of 2,482 cancer outpatients, 19,066 prescriptions for oral anticancer drugs were recorded. 937 potential drug interactions were identified at an incidence of 4.9%. The incidence of potential interactions was classified according to significance level 1, 2 and 4. The type of onset time most frequently classified was the delayed type. The most common potential drug interaction in significance level 1 was from methotrexate (MTX), but no significant clinical impact. However, Significant level 2 and level 4 of the drug interactions but more clinical significance, although not part of computer alarm items, but worthy of our attention. The detection rate of drug interaction warning system was found to be 89.7%.
Conclusion: 
Although some drug interactions of anticancer drugs not as significance level 1 and not including in computer alarm items, but possibly result in decreased the anticancer efficacy and increased drug toxicity, and may threaten patient life. To date the literature for oral anticancer drugs are limited, Our research is hoping to get more attention from pharmacy profession to drug interactions of anticancer drugs and the efficacy of current computer warming system, to enhance patient medication safety.
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