台灣地區高風險藥物與中藥併用之藥物流行病學研究

林香汶
中國醫藥大學
由於國人多元的看病習慣、中草藥使用之盛行、以及全民健保的給付等種種因素，導致有相當比率的患者同時服用西藥和中草藥，包括一些高危險的病人，如老年人、癌症病人或慢性病人等。然而，有關中西藥交互作用的結果與機轉已陸續被報導；事實上，因為中西藥併用而造成病人不適或嚴重不良反應的案例也時有所聞。因此，確實有必要建立一套本土之中西藥交互作用實證資料庫，更迫切性需要進行國人中西藥併用及發生潛在交互作用之藥物流行病學。尤其是針對容易因交互作用而產生不良反應的高風險藥物，如抗凝血藥物、抗血小板藥物及digoxin等。 
本計畫的首要目標是希望補足中西藥交互作用相關之資訊差距並找出台灣實際發生的問題。依此，本計畫規劃有一年二階段: 包括(1)實證建立階段及(2)藥物流行病學階段。本計畫主要分析探討之中藥將先針對具/或為毒性及文獻指出與高風險西藥有交互作用之中藥，先利用結構性文獻搜尋的步驟，建立潛在交互作用之實證資料庫，然後再利用健保資料庫進行族群回顧性資料分析及相關藥物流行病學。
藉由本計畫之實施，希望能建立高風險藥物和中藥潛在交互作用之先驅實證資料庫、找出台灣地區高風險藥物與中藥併用之使用情形及其相關影響因子。本研究結果將集結成冊，以作為進一步研究或未來醫療人員提供病患照護及相關單位決定醫藥衛生政策之參考。
關鍵字：高風險藥物、中草藥、交互作用、藥物流行病學、機轉探討

Pharmacoepidemiology Research on Concurrent Use of High Risk Medications with Traditional Chinese Medicines

Hsiang-Wen Lin
In Taiwan, given the insufficient gatekeeper referral system and easiness to access medical specialists upon the provision of National Health Insurance (NHI), a higher proportion of patients, including the elderly, cancer patients and those with chronic illnesses, tend to take Western Medicine (WM) with Traditional Chinese Medicine (TCM) either for same disease(s) or otherwise. It raises the concerns of safety and waste of medical care resources. In fact, studies or case reports about the benefits or risks of medication use along with TCM were being reported in literature or the newspapers from time to time. As such, it is crucial to prepare an evidence database regarding concurrent use or interactions between the WM and TCM and to examine the use patterns, interaction mechanisms, especially for those higher risk medications which have narrow therapeutic indexes.
The aim of this study is to make up the information gap between both types of medications (WM and TCM) in order to explore the real situations of use in Taiwan and to bridge the population use experience and outcomes with the basic science on particular use of WM with TCM. Therefore, this one-year study was divided into two phases, including 1) development of an evidence-based database, and 2) conducting the pharmacoepidemiology study. This study will focus on those concurrent uses or interactions between higher risk of WM and TCM, which are either more toxic or have documented interactions with WM in the literature. The retrospective population database analysis will be performed using the NHI databases. 
This is one of the studies to examine the actual use patterns of WM and TCM on the population base in Taiwan. Ideally, it is expected to establish a stronger evidence-based database and summarize the research information to come up with a more practical information about the safe use of WM with TCM for clinical practitioners in Taiwan and the findings will be used for further or next phase research.
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