Metabolische unerwünschte Arzneimittelwirkungen von Psychopharmaka

Zusammenfassung

Metabolische unterwünschte Arzneimittelwirkungen (mUAW) von Psychopharmaka haben erhebliche gesundheitsbezogene und ökonomische Relevanz. Zu den mUAW gehören Gewichtszunahme, gestörte Glukosetoleranz, Diabetes mellitus und Dyslipidämie. Fast alle Antipsychotika (AP) und viele Antidepressiva (AD) sowie Stimmungsstabilisatoren können zu mUAW, insbesondere Gewichtszunahme führen. Die Gewichtsentwicklung in den ersten Wochen bis Monaten nach Initialisierung einer Therapie ist der stärkste Prädiktor für Gewichtszunahme assoziiert mit AP und AD. Die wichtigsten Risikofaktoren für mUAW sind antagonistische Effekte an H₁-, 5-HT_2C- und M₃-Rezeptoren sowie antidopaminerge Effekte, wobei die Beeinflussung zahlreicher weiterer Systeme relevant ist. Ein systematisches Monitoring metabolischer Parameter sollte bei Therapie mit allen Substanzen durchgeführt werden, die mit einem erhöhten Risiko für mUAW assoziiert sind. Lebensstilverändernde und diätetische Maßnahmen, Bewegungstherapie, Dosisreduktion, Umstellung und Beendigung der Medikation sowie eine zusätzliche Therapie mit Metformin und Topiramat sind evidenzbasierte Therapieoptionen bei AP-assoziierter Gewichtszunahme, wobei auch die GLP-1-Rezeptoragonisten wie Liraglutid vielversprechend sind.

Abstract

Metabolic adverse drug reactions (mADR) related to psychotropic drugs have significant health-related effects including weight gain, impaired glucose tolerance, diabetes mellitus and dyslipidemia as well as economic relevance. Nearly all antipsychotics (AP) and many antidepressants (AD) and mood stabilisers may induce weight gain. Weight development in the first weeks or months after the beginning of the therapy is the strongest predictor for weight gain related to AP and AD. The most important risk factors for mADR are antagonistic effects at H₁-, 5-HT_2C- und M₃-receptors and antidopaminergic effects. However, several other systems are also relevant. Systematic monitoring of metabolic parameters is recommended in all patients treated with substances that are associated with an increased risk of mADR. Lifestyle modification, dietary measures, exercise therapy, dose reduction, change and discontinuation of the substance, and additional treatment with metformin and topiramate are evidence-based treatment options for AP-associated weight gain. GLP-1 receptor agonists such as liraglutide are also promising.

Schlüsselwörter

Gewichtszunahme - Antipsychotika - Antidepressiva - Metformin - Topiramat

Keywords

weight gain - antipsychotics - antidepressants - metformin - topiramate

Publication History

Received: 21 April 2024

Accepted after revision: 26 August 2024

Article published online:
23 September 2024

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