Medikamentöse Rhythmuskontrolle und orale Antikoagulation bei Patienten mit Vorhofflimmern: Bedeutung pharmakokinetischer Interaktionen für die klinische Praxis

T. Klingenheben; J. Ruef; C. Hammerstingl

doi:10.1055/s-0035-1545811

Aktuelle Kardiologie, Inhaltsverzeichnis

Aktuelle Kardiologie 2015; 4(2): 114-119
DOI: 10.1055/s-0035-1545811

Übersichtsarbeit

Georg Thieme Verlag KG Stuttgart · New York

Medikamentöse Rhythmuskontrolle und orale Antikoagulation bei Patienten mit Vorhofflimmern: Bedeutung pharmakokinetischer Interaktionen für die klinische Praxis

Pharmacological Rhythm Control and Oral Anticoagulation in Patients with Atrial Fibrillation: Relevance of Pharmacokinetic Interactions for Clinical Practice

T. Klingenheben

¹Praxis für Kardiologie/Ambulante Herzkatheterkooperation Bonn, Bonn

,

J. Ruef

²Kardiocentrum Frankfurt, Klinik Rotes Kreuz, Frankfurt am Main, Deutschland

,

C. Hammerstingl

³Medizinische Klinik II, Universitätsklinikum Bonn, Deutschland

› Institutsangaben

Abstract

Zusammenfassung

Neben der Katheterablation/Pulmonalvenenisolation hat auch die pharmakologische Therapie des Vorhofflimmerns in den letzten Jahren erhebliche Fortschritte erfahren. Einerseits ist die orale Antikoagulation durch Einführung der direkten oralen Antikoagulanzien (DOAKs) bereichert worden. Andererseits ist durch die Zulassung von Dronedaron das Arsenal der spezifisch-antiarrhythmischen Pharmakotherapie erstmals seit über 25 Jahren durch eine neuartige Substanz erweitert worden. Bei der Kombination der „modernisierten“ Therapieoptionen sind allerdings Wechselwirkungen und Kontraindikationen zu beachten. Die vorliegende Arbeit fasst die pharmakokinetischen Besonderheiten der potenziell für Interaktionen infrage kommenden Substanzen zusammen und versucht, Empfehlungen für die klinische Anwendung zu geben.

Abstract

Recently, progress has been achieved with regard to pharmacologic management of atrial fibrillation. First, oral anticoagulation has become a sophisticated therapeutic field with the advent of new direct oral anticoagulants (DOACs). Secondly, dronedarone has been approved as the first new antiarrhythmic drug in Europe for more than 25 years. However, with combination therapy including “modernised” therapeutic options important drug-drug interactions call for awareness. The present review summarizes the pharmacologic properties of the new drugs and tries to give recommendations with regard to clinically useful drug-drug combinations.

Schlüsselwörter

Vorhofflimmern - DOAKs - Antiarrhythmika - Interaktionen - P-Glykoprotein - CYP3A4

Key words

Atrial fibrillation - direct oral anticoagulants (DOAC) - antiarrhythmic drugs - drug–drug interactions - P-glycoproteine - CYP3A4

Volltext

Referenzen

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