Joseph S. Alpert    Prof of Medcn; Head， Department of Medcn. 

    <International Circulation>: How common is polypharmacy in elderly patients and is that a problem?

  《国际循环》：在老年人中多种药物合用有多常见？这有问题吗？

    prof Alpert: It is a huge problem. It’s a huge problem from a number of points of view. The first problem is that we don’t even know what the drug interactions are when patients are on this many drugs. All we can tell is that it is not a good idea. There are differences in drug metabolism， differences in drug clearances and when they interact like that you can have frightening problems in terms of adverse reactions. It is very common for the elderly to be on multiple drugs because very often they have two or three different doctors – maybe they are going to their primary care doctor who has them on several drugs; then they maybe see a cardiologist; then they are having some indigestion so they see a gastroenterologist. Each time these doctors prescribe a couple of drugs in their area but after a while the elderly collect a huge number of drugs. Also from an economic point of view， the cost to these individuals is huge. When I was an intern， I was on rounds one day with Dr Bernard Lown who is a famous pioneering cardiologist， the first person to do defibrillation， the first person to put in a pacemaker and so forth， and Dr Lown used to have private patients coming to see him from all over the world. The residents would go in with the Doctor when he went to see his private patients and one of these patients was on twenty different drugs. Dr Lown talked to the patient， examined the patient and then turned to me as the intern and said， “I want you to stop sixteen of this patient’s twenty drugs”. I asked， “Which sixteen Doctor?” He replied， “Any sixteen”. I think the point is very well taken. There are so many drugs in that case it is impossible to know what is worthwhile for that patient and very often a patient might be on two forms of the same drug. Of course， some elderly patients save the drugs from previous experiences so sometimes， if you have a sense that the patient is taking way too many， it can be a good idea to tell them to take a paper bag and bring in all of their medicines  – some will be out-dated， some will be contraindicated in interactions with other drugs – and although it doesn’t happen that often， I will throw out the ones I don’t want them to take and mark with a red circle the ones I do want them to take.

    Alpert教授：这是一个严重问题。从许多观点来看它都是一个严重问题。第一个问题是，当患者在接受如此多药物治疗时，我们甚至不知道它们之间的相互作用是什么。我们只能说这不是一个好主意。药物的代谢和清除存在差异且当他们像这样相互时，就不良反应而言可能会出现可怕的问题。对老年患者，接受多种药物治疗是很常见的，因为他们往往有2个或3个不同的医生——可能患者就诊于他们的主治医生，医生会让他们接受数种药物治疗；然后他们可能去看一位心脏病医生；由于消化不良，他们可能去看一位消化科医生。每次这些医生处方他们领域中的几种药物，然后老年患者就收到大量的药物。从经济角度来看，这些个体的花费也是巨大的。当我还是实习医师时，有一天我和著名的先驱心脏病学专家Dr Bernard Lown（除颤第一人，植入起搏器第一人）一起巡查病房， Dr Lown过去常常有来自世界各地找他就诊的私人患者。当他去看他的私人患者时，住院医生会与他一起进去，其中一例患者在接受20种不同的药物。Dr Lown与患者进行交谈，并进行检查，然后转向作为实习医师的我说，“我想让你停用这位患者20种药物中的16种”。我问，“哪16种，医生？”他回答道，“任意16种”。我认为这种做法非常好。在这个病例中，有如此多的药物，不可能知道对这个患者来说什么是值得的，而且患者往往可能在应用两种不同形式的同种药物。当然，一些老年患者从既往经历中保留了药物，因此，有时候如果你感觉患者在服用太多药物，告诉他们用一个纸袋将所有的药物带来可能是一个好主意——其中一些可能是过期的，一些在与其他药物的相互作用上将会是禁忌的——尽管并不太经常发生，但我会去掉那些我不想让他们服用的药物，并用红圈标记我想要他们服用的药物。