臨床常用科學中藥與西藥交互作用之評估

鮑力恆
國防大學國防醫學院
目前國內在全民健康保險醫療下及在目前國人的就醫習慣上，民眾常以同時服用中醫及西醫的藥物作為治療疾病方式，同時也因缺乏相關的交互作用資訊，中醫與西醫的疾病診治過程中，用藥安全上常常無法兼顧，此可能造成許多藥物不良反應或是中西藥物交互作用，可導致藥物預期的療效降低，或是影響藥物代謝及排泄而產生毒性反應，造成病人用藥安全的顧慮。因此本研究的目的即在於建立臨床常使用的科學中藥與西藥交互作用資料平台，以供醫藥相關人員臨床實用上對於中西藥交互作用發生風險評之參考，以期能減少可能因中西交互作用而產生的不良反應或副作用，以適時提供醫療團隊或病人相關資訊，更提昇醫療品質。此計劃的執行是以目前三軍總醫院使用的科學中藥為篩選標的進行針對人的肝臟微粒體(human liver microsomes)的CYP3A酵素的活性進行研究，以評估科學中藥在臨床使用上對西藥可能產生的中西藥交互作用，並建立基本交互作用相關資料。以目前治療藥物的代謝主要途徑而言即使不以CYP3A當作首要的代謝酵素，亦有50﹪~70%經由CYP3A代謝，因此交互作用之評估是以臨床使用之科學中藥對於人的肝臟微粒體(human liver microsomes)的CYP3A酵素的活性影響為主。此是為期兩年的計畫，以人類肝微粒體(human liver microsomes)進行科學中藥對最常引起臨床藥物交互作用的CYP3A酵素活性進行評估，預計於前兩年計劃階段分別完成臨床常用五十種單方及五十種複方科學中藥可能交互作用的篩選評估；此兩年篩選結果中呈現顯著及潛在可能引起交互作用的科學中藥有助於日後進行活體動物試驗及臨床上交互作用研究之指標參考，以進一步確認交互作用的可能影響程度。
關鍵字：中藥；中藥-西藥交互作用；人肝微粒體；細胞色素3A

Evaluation of Chinese medicine extracts-drug interactions

Li-Heng Pao
School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, R.O.C
Under the national social health care systems and coustums of medicine use in Taiwan, coadministration of herbal medicines and drugs is not unsual for patients taken the medicine. The information of systemic herb-drug interactions is still far form practical applications. Therefore, herb-drug interactions might result in a loss of therapeutic efficacy or toxic effects of drug therapy. The purpose of this project is to study the herb extracts and drug interactions systemically to build up the interactions data bank. These herb-drug interactions data may provide useful information for medical professional stuffs in prescription and consultation to reduce the chance of advers effects and impove the quality of medical care. Herb extracts used in Tri-Service General Hospital are used for screening the herb-drug interactions. CYP3A is estimated to metabolize between 50% and 70% of currently administered drugs, although not always as the primary metabolic enzymes. Therefore, human liver CYP3A activity is used for evaluation of herb-drug interactions. This is a two-year project which includes in vitro screening. The first will conduct 50 single herb exteacts product in vitro. The second year then studies 50 compound herb extracts prodruct in vitro. These herb-drug interactions data base will be very useful in identifing the potential interaction cases for further in vivo animal or clinical interaction study in the future.
關鍵字：Herbal；Herbal extract-durg interations；human liver microsomes；CYP3A