The dangers of mixing drugs - Céline Valéry

譯者: Lilian Chiu 審譯者: SF Huang

Which of these three people is doing something risky?

這三個人當中，誰的行為有風險？

Is it the one who takes their cholesterol medication with grapefruit juice?

是服用降膽固醇藥物 配葡萄柚汁的那個人嗎？

The one who takes Acetaminophen pain relievers

還是因為腳踝酸痛 吃乙醯氨酚止痛藥，

for a sore ankle before going out for drinks?

然後外出喝酒的那個人？

Or the one who’s on a blood-thinning medication

或者吃抗凝血藥物同時

and takes an aspirin for a headache?

也因為頭痛吃阿斯匹靈的那個人？

Actually, all of them are.

其實，他們的行為都有風險。

Each has inadvertently created a drug interaction that could, in extreme cases,

他們都不經意造成了藥物交互作用，

在極端的狀況下， 可能會造成腎臟衰竭、

lead to kidney failure; liver damage;

肝臟損傷或內出血。

or internal bleeding.

Drug interactions happen

發生藥物交互作用，

when the combination of a drug with another substance

是因為將一種藥物 與另一種物質結合，

causes different effects than either would individually.

造成了兩者單獨服用時 不會發生的藥效。

Foods, herbal supplements, legal drugs, and illicit substances

食物、草藥營養品、 合法藥物和禁藥

can all cause drug interactions.

都有可能造成藥物交互作用。

Most drug interactions fall into two categories.

大部分的藥物交互作用 都可歸為兩大類。

Some take place when two substances’ effects influence each other directly.

有些交互作用發生，是因為 兩種物質的作用會直接影響彼此。

In other cases, one substance effects how the body processes another,

其他情況則是一種物質會影響 身體如何處理另一種物質，

like how it is absorbed, metabolized, or transported around the body.

比如影響該物質如何被吸收、 代謝或在體內運輸。

Blood thinners and aspirin, for example,

比如，抗凝血藥物和阿斯匹靈

have similar effects that become dangerous when combined.

有類似的作用，所以 一起服用就會有危險。

Both prevent blood clots from forming—

兩者都會預防血栓的形成——

blood thinners by preventing the formation of the clotting factors

抗凝血藥物的方式是

防止栓塞因子的形成，

that hold clots together,

and aspirin by preventing blood cells from clumping into groups

阿斯匹靈則是預防血細胞

群聚一起變成栓塞。

that become clots.

Individually, these effects are usually safe,

單獨使用時，兩者的作用 通常都是安全的，

but taken together, they can prevent blood clotting to a dangerous extent,

但若同時服用，就會把預防 凝血帶到了極危險的程度，

possibly causing internal bleeding.

有可能會造成內出血。

While blood thinners and aspirin are generally harmless

雖然通常抗凝血藥物和阿斯匹靈 在單獨使用時都是無害的，

when taken individually,

interactions where one substance exacerbates the effects of another

但一種物質加劇了另一種 物質效用的這種交互作用，

can also take place between drugs that are independently harmful.

也有可能發生在單獨使用時 就有害的兩種藥物之間。

Cocaine and heroin are each dangerous,

古柯鹼和海洛英單獨使用就很危險，

and those dangers compound when the two drugs are combined—

當兩種藥物結合起來， 那些危險就會加乘——

even though their behavioral effects may feel like they cancel each other out.

雖然感覺起來似乎它們的行為作用 會互相抵消，但並不會。

Cocaine is a stimulant, and many of its effects, like increased heart rate,

古柯鹼是一種刺激物，

它的許多作用，如增加心跳，

cause the body to need more oxygen.

會讓身體需要更多的氧氣。

But heroin, a depressant, slows breathing—

但海洛英是種鎮靜劑， 會讓呼吸緩和下來——

reducing the body’s oxygen supply just when it needs more.

當身體需要更多氧氣 供應時，卻出現供氧短缺。

This combination strains the organs and can cause respiratory failure and death.

這種組合會讓器官負擔很大，

可能會造成呼吸衰竭和死亡。

The interaction between grapefruit juice and certain medications

葡萄柚汁和施德丁類的 降低膽固醇藥物

in class of cholesterol-lowering drugs called statins,

之間也會產生交互作用，

has to do with drug metabolism.

會對藥物的代謝產生影響。

The liver produces enzymes, molecules that facilitate the breakdown of substances

肝臟會產生酵素，

這種分子有助於 將進入體內的物質分解。

that enter the body.

Enzymes can both activate drugs,

酵素可以活化藥物，

by breaking them down into their therapeutic ingredients

因為它會將藥物從更複雜的分子分解

from more complex molecules, and deactivate them,

成為有療效的成分， 同時也對藥物有鈍化作用，

by breaking harmful compounds down into harmless metabolites.

因為可以將有害的複合物 分解成為無害的代謝物。

There are many, many different enzymes,

有各式各樣不同種類的酵素，

each of which has a binding site that fits a specific molecule.

每種酵素都有一個適合 特定分子的結合位點。

Grapefruit binds to the same enzyme as statins,

葡萄柚和施德丁會和同一種酵素結合，

making less of that enzyme available to break down statins.

讓分解施德丁的酵素變少。

So combining the two means that a greater concentration of the drug

所以，將兩者結合就表示 該藥物的濃度會變高，

stays in the bloodstream for a longer period of time,

且會留在血液中更長的時間，

potentially causing kidney failure.

有可能會造成腎臟衰竭。

Alcohol can also alter the function of the enzyme that breaks down Acetaminophen,

酒精也有可能改變酵素 分解乙醯氨酚的功能，

the active ingredient in pain relievers like Tylenol and paracetamol.

也就是止痛藥如泰諾 和撲熱息痛中的活性成分。

When someone takes Acetaminophen, some of it is converted into a toxic substance.

服用乙醯氨酚時，

有一部分會被轉換成有毒物質。

At the recommended dose,

如果依建議的劑量服用，通常這種 有毒的副產品不足以造成傷害。

there isn’t usually enough of this toxic byproduct to cause harm.

But heavy drinking can alter enzyme activity

但大量飲酒會改變酵素活性，

so more of that byproduct is produced,

導致產生更多有毒的副產品，

potentially causing liver damage

有可能會傷害到肝臟，

even with what’s usually a safe dose of acetominophen.

即使只是服用一般 安全劑量的乙醯氨酚也會有危險。

Meanwhile, the herbal remedy Saint John’s Wort increases the liver’s production

此外，像貫葉連翹這種藥草類藥物

會增加肝臟某特定酵素的數量。

of a particular enzyme.

That means the drugs this enzyme is responsible for breaking down

也就是由這種酵素來分解的藥物

get metabolized faster—

會更快被代謝掉——

sometimes too fast, before they can have their therapeutic effects.

有時會太快，快到藥物 還來不及發揮療效。

In spite of the dizzying number of possible interactions,

儘管可能發生的交互作用 多到讓人眼花繚亂，

most of the dangerous interactions with commonly used drugs are well known.

大部分和常用藥物有關的 危險交互作用都是眾所周知的。

And new developments in science are helping us keep better track

且科學的新發展也在協助我們

對藥物交互作用的追蹤做到最好。

of drug interactions than ever.

Some researchers are developing AI programs that can predict the side effects

有些研究者正在開發人工智慧程式，

在藥物交互作用產生 副作用之前就能預測到，

of drug interactions before they occur,

using information about the landscape of protein interactions within your body.

只要用你體內蛋白質交互作用的 資訊就可以預測出來。

For the new drugs that are being developed all the time,

因為新的藥物不斷地研發出來，

supercomputers are being used to find potential interactions

在這些藥物還在研發階段時，

就可以用超級電腦 找出可能的交互作用。

while those drugs are still in development.