Psychopharmakotherapie und metabolische Nebenwirkungen

Zusammenfassung

Gegenstand und Ziel

Metabolische unerwünschte Arzneimittelwirkungen (UAW) unter Psychopharmakotherapie besitzen in Hinblick auf Morbidität, Mortalität und Therapieadhärenz eine erhebliche klinische Relevanz. Die vorliegende Übersichtsarbeit gibt einen Überblick über epidemiologische Aspekte, prädiktive Faktoren, die Pathophysiologie sowie über Monitoring und mögliche therapeutische Ansätze hinsichtlich metabolischer Nebenwirkungen von Psychopharmaka. Zudem wird das Risiko für metabolische UAW von häufig verordneten Substanzen anhand von Informationen aus Fachinformationen dargestellt.

Material und Methoden

Es wurde eine narrative Übersichtsarbeit erstellt. Die Literaturrecherche wurde in der bibliografischen Datenbank MEDLINE durchgeführt.

Ergebnisse

Die Pathomechanismen, die psychopharmakotherapieassoziierten metabolischen UAW zugrunde liegen, sind unvollständig verstanden; genetische Faktoren und die Modulation zahlreicher Neurotransmittersystem (insbesondere das histaminerge und dopaminerge System) scheinen relevant zu sein. Vor allem Antipsychotika, Antidepressiva und Phasenprophylaktika sind mit einem Risiko für metabolische Nebenwirkungen assoziiert, wobei innerhalb der Indikationsgruppen Unterschiede zwischen einzelnen Substanzen hinsichtlich des Risikos für metabolische UAW bestehen. Gegenwärtig gibt es nur bei antipsychotikaassoziierten metabolischen UAW Evidenz für die Wirksamkeit und Verträglichkeit pharmakologischer und/oder nicht pharmakologischer Behandlungsoptionen. Hinsichtlich der therapeutischen Ansätze stehen sowohl nicht pharmakologische Interventionen (Verhaltensänderungen und diätetische Maßnahmen) als auch medikamentöse Ansätze (Metformin zur Behandlung von antipsychotikaassoziierter Gewichtszunahme oder Wechsel zu einem Präparat mit geringerem Risiko für metabolische UAW) zur Verfügung.

Schlussfolgerungen

Metabolische UAW haben erhebliche klinische Relevanz. Bei Verordnung eines Präparates, das mit dem Risiko metabolischer Nebenwirkungen verbunden ist, sollte stets eine ausführliche Aufklärung und adäquates Monitoring erfolgen.

Summary

Objective

Metabolic adverse drug reactions (ADR) have considerable clinical relevance regarding morbidity, mortality and adherence to treatment. The present review article provides an overview of epidemiological aspects, predictive factors, pathophysiology, monitoring and possible therapeutic approaches for the treatment of metabolic ADR related to psychopharmacotherapy. In addition, the risk of metabolic ADR related to frequently prescribed agents based on data derived from summaries of product characteristics is presented.

Material and methods

A narrative review article was created. Literature search was performed in the bibliographic database of MEDLINE.

Results

The pathomechanisms underlying metabolic ADR related to psychotropic drugs are insufficiently understood. Genetic factors and the modulation of neurotransmitter systems (particularly the histaminergic and dopaminergic system) seem to be of relevance. Especially antipsychotics, antidepressants and mood stabilizers are associated with the risk of metabolic ADR; however, within these indication groups there are differences between single substances regarding the risk for metabolic ADR. Currently, the evidence for the efficacy and tolerability of pharmalogical and/or non-pharmacological treatment approaches is limited to antipsychotics-related metabolic ADR. There are both non-pharmacological (behavioral weight loss interventions or dietary measures) and pharmacological (e.g. metformin or switching of anitpsychotic medication to a drug with lower risk) approaches.

Conclusion

Metabolic ADR are of significant relevance. Prescription of an agent associated with the risk of metabolic ADRs should always be accompanied by thorough patient education and adequate monitoring.

Schlüsselwörter

Psychopharmaka - metabolische Nebenwirkungen - Gewichtszunahme - Antipsychotika - Antidepressiva - Phasenprophylaktika

Keywords

Psychotropic drugs - metabolic side effects - weight gain - antipsychotic drugs - antidepressive drugs - mood stabilizers

Die Tabellen sowie Teile des Inhalts dieser Arbeit wurden bereits publiziert (Zeiss R, Connemann BJ, Gahr M. Metabolische Nebenwirkungen von Psychopharmaka – Teil 1: Epidemiologische und pathophysiologische Aspekte. DNP – Der Neurologe & Psychiater 2017; 18: 42–48; und Zeiss R, Connemann BJ, Gahr M. Metabolische Nebenwirkungen von Psychopharmaka- Teil 2: Substanzspezifische Betrachtung und therapeutische Möglichkeiten. DNP – Der Neurologe & Psychiater 2017; 18: 42–51)

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