rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-5-603-609rpcardio-1343Research ArticleCURRENT QUESTIONS OF CLINICAL PHARMACOLOGYАКТУАЛЬНЫЕ ВОПРОСЫ КЛИНИЧЕСКОЙ ФАРМАКОЛОГИИAntiarrhythmic Drugs Use in Elderly Patients. Vaughan Williams Class III and IV DrugsПрименение антиаритмических средств у пожилых пациентов. Препараты III и IV классов по классификации Вогана-ВильямсаУшкаловаЕ. А.UshkalovaE. A.

д.м.н., профессор кафедры общей и клинической фармакологии РУДН

MD, PhD, Professor of Chair of the General and Clinical Pharmacology, People's Friendship University of Russia

eushk@yandex.ruЗыряновС. К.ZyryanovS. K.

д.м.н., заведующий кафедрой общей и клинической фармакологии РУДН

MD, PhD, Head of Chair of the General and Clinical Pharmacology, People's Friendship University of Russia

ЗатолочинаК. Э.ZatolochinaK. E.

к.м.н., ассистент кафедры общей и клинической фармакологии РУДН

MD, PhD, Teaching Assistant of Chair of the General and Clinical Pharmacology, People's Friendship University of Russia

ПереверзевА. П.PereverzevA. P.

к.м.н., доцент кафедры общей и клинической фармакологии РУДН

MD, PhD, Associate Professor of Chair of the General and Clinical Pharmacology, People's Friendship University of Russia

ЧухареваН. А.ChukharevaN. A.

м.н.с. терапевтического отделения, Научный центр акушерства, гинекологии и перинаталогии им. академика В.И. Кулакова

MD, Junior Researcher, Internal Medicine Department, Scientific Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Российский университет дружбы народов. Россия, 117198, Москва, ул. Миклухо-Маклая, 6РоссияPeople's Friendship University of Russia. Miklukho-Maklaya ul. 6, Moscow, 117198 RussiaRussian FederationНаучный центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова Россия 117997, Москва, ул. Опарина, 4РоссияScientific Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov. Academika Oparina ul. 4, Moscow, 117997 RussiaRussian Federation201607112016125603609Copyright © Ushkalova E.A., Zyryanov S.K., Zatolochina K.E., Pereverzev A.P., Chukhareva N.A., 20162016Ушкалова Е.А., Зырянов С.К., Затолочина К.Э., Переверзев А.П., Чухарева Н.А.Ushkalova E.A., Zyryanov S.K., Zatolochina K.E., Pereverzev A.P., Chukhareva N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1343

The effectiveness of antiarrhythmic drugs in the elderly is similar to that in younger patients. However data for «the very elderly» are lacking. Elderly patients are more vulnerable to adverse drug reactions (ADRs) because of age-related changes of pharmacokinetics, co-morbidity and drug interactions. Аmioadarone is not considered as the drug of choice in elderly patients because of the high risk of serious ADRs. Other class III drugs should be prescribed to the elderly with great caution under close monitoring of the treatment. Diltiazem and verapamil should not be used in elderly patients with NYHA class III-IV heart failure and should not be combined with β-blockers.

Эффективность антиаритмических препаратов у пожилых аналогична таковой у более молодых пациентов. Однако данные в отношении «очень пожилых» пациентов крайне ограничены. Вследствие возрастных изменений фармакокинетики, наличия сопутствующих заболеваний и лекарственных взаимодействий пожилые пациенты более уязвимы в отношении нежелательных реакций антиаритмических препаратов. Амиодарон в связи с высоким риском несердечных побочных эффектов не является препаратом выбора у пожилых пациентов. Другие препараты III класса следует назначать пожилым с большой осторожностью при тщательном наблюдении за лечением. Дилтиазем и верапамил не следует применять у лиц пожилого возраста с хронической сердечной недостаточностью III-IV класса по Нью-Йоркской классификации, а также одновременно с β-адреноблокаторами.

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The authors declare that there are no conflicts of interest present.