Oxcarbazepin in der Behandlung affektiver und schizoaffektiver Erkrankungen

Zusammenfassung

Antikonvulsiva wie Carbamazepin und Valproat werden erfolgreich in der Behandlung der Manien und zur Prophylaxe affektiver und schizoaffektiver Erkrankungen eingesetzt. Auch Oxcarbazepin, ein Ketoderivat des Carbamazepins, zeigte sich bereits in den frühen 80er-Jahren bei diesen Erkrankungen als antimanisch wirksam. Im Vergleich zu Carbamazepin weist Oxcarbazepin zudem eine bessere Verträglichkeit auf. Trotz dieses Vorteils fand Oxcarbazepin jedoch bei der Behandlung psychiatrischer Erkrankungen kaum Beachtung. In diesem Beitrag werden die bisherigen Studien zur Behandlung affektiver und schizoaffektiver Psychosen mit Oxcarbazepin dargestellt und zusammenfassend bewertet: Oxcarbazepin scheint in der Behandlung akuter Manien effektiv zu sein und bei adjuvanter Therapie affektiver und schizoaffektiver Störungen eine Reduzierung der notwendigen Neuroleptikadosis bei gleicher klinischer Wirkung zu erlauben. Außerdem weist Oxcarbazepin durch eine deutlich geringere Interaktion mit dem Cytochrom-P450-System eine bessere Verträglichkeit bei der in der Pharmakopsychiatrie oft üblichen Kombinationsbehandlung auf. Die Befunde sprechen dafür, dass im Rahmen größerer Studien die antimanische Wirkung von Oxcarbazepin validiert und weitere mögliche pharmakopsychiatrische Indikationsgebiete evaluiert werden sollten.

Abstract

The therapeutic value of anticonvulsants in affective and schizoaffective disorders was documented in several clinical trials. Oxcarbazepine (OXC), a keto-derivative of carbamazepine, which appears to have a preferable side effect profile compared to carbamazepine, has also shown antimanic efficacy in affective and schizoaffective disorders in clinical studies since the early 80's, but was not further investigated regarding these indications. Therefore, the value of OXC in the treatment of affective and schizoaffective disorders requires evaluation. Literature was reviewed with regard to pharmacokinetic and pharmacodynamic characteristics of OXC, drug-drug interactions relevant in pharmacopsychiatry, and clinical effects in these disorders. According to the literature OXC is regarded effective in acute mania and appears to allow reduction of the neuroleptic medication required for the treatment of affective and schizoaffective disorders. In addition, it has a preferable pharmacokinetic profile with less severe side effects compared to other anticonvulsants and neuroleptics. Furthermore, it appears to be well tolerated if augmented to neuroleptics or antidepressants, since OXC does not interact substantially with the cytochrome P450-enzyme-system. However, despite promising effects of OXC, few clinical studies have been published in the last 16 years. We conclude that further studies should validate the antimanic efficacy of OXC and evaluate possible pharmacopsychiatric indications as well as limitations of this psychotropic compound.

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