Unerwünschte Arzneimittelwirkungen am Harntrakt – der Wittener Harntrakt-Nebenwirkungs-Score

Zusammenfassung

Obwohl der Harntrakt mit Restharnbildung, Harnverhaltung, Pollakisurie, Polyurie, Nykturie, Detrusorstimulation, Detrusorhemmung, Hämaturie, Dysurie und anderen Erscheinungen häufig den Schauplatz unerwünschter Arzneimittelwirkungen darstellt, fehlt es an einer Gesamtübersicht an Substanzen, die eine solche Harntraktnebenwirkung auslösen können und eine entsprechende Bewertung. Vorhandene Listen „potenziell inadäquater Medikation“ fokussieren entweder auf eine pharmakologische Gruppe von Nebenwirkungen („anticholinergic burden score“), eine Gruppe von Medikamenten bestimmter Indikation (LUTS-Forta) oder auf eine selektionierte Gruppe von Patienten (PRISKUS-Liste, beers-Liste).

Mit dem folgenden interdisziplinären Projekt aus der Arbeitsgruppe Uro-Geriatrie der Universität Witten/Herdecke sollte diese Lücke geschlossen werden. Es erfolgte eine Identifikation von Substanzen, die eine Harntraktnebenwirkung lt. diverser Datenbanken prinzipiell auslösen können, eine Kategorisierung der hierzu vorhandenen Literatur (Kasuistik, Fallsammlung, RCT, Metaanalyse) und eine strukturierte Bewertung des Risikos durch 33 Experten. Das Ergebnis stellt eine Liste von 235 Substanzen dar, die zu verschiedenen Harntraktnebenwirkungen führen können. Diese Liste enthält einen die Nennung in Datenbanken bzw. deren Korrelat in der Literatur darstellenden „theroretischen“ Punktwert, einen die klinische Realität abbildenden „praktischen“ Punktwert, der die Expertenbewertung darstellt, und einen Summenscore – geordnet nach der Systematik der „Roten Liste“.

Erstmals wäre damit sowohl bei der Neuverordnung einer Substanz vor dem Hintergrund bestehender patientenseitiger Risiken eine Einschätzung dieses Wirkstoffes im Hinblick auf Harntraktnebenwirkungen möglich; andersherum könnte die Durchsicht des Medikationsplanes bei Vorhandensein einer Harntraktfunktionsstörung die Frage klären, ob diese medikamentös (mit-) verursacht ist. Die Entwicklung des „Harntraktnebenwirkungs-Rechners“ als „App“ ist geplant.

Abstract

The urinary tract is the site of many adverse drug reactions, including the formation of residual urine, urinary retention, pollakisuria, polyuria, nycturia, detrusor stimulation, detrusor inhibition, haematuria, dysuria and other symptoms. Nevertheless, there is no general overview or evaluation of the substances that can trigger these adverse drug reactions. The available lists of “potential inadequate medication“ either focus on a pharmacological group of adverse reactions (“anticholinergic burden score”), a group of drugs for a specific indication (LUTS-Forta) or on a selected group of patients (PRISKUS List, Beers List).

The following interdisciplinary project has been processed by the group for urogeriatrics in the University of Witten/Herdecke and is intended to fill this gap. We have identified substances which can in principle trigger adverse reactions in the urinary tract – according to a variety of databases. We also categorise the available literature (case reports, case series, RCT, meta-analysis) and present a structured analysis of the risk by 33 experts. This results in a list of 235 substances that can lead to various different adverse reactions of the urinary tract. This list includes a “theoretical“ score from the reports in the databases or the corresponding literature, a “practical“ score based on an expert evaluation of clinical reality and a cumulative score, classified in accordance with the Rote Liste“.

It is now possible to classify the extent to which newly prescribed drugs may pose a risk of adverse reactions in different patients. Conversely, this may also help to clarify whether a functional disorder of the urinary tract is fully or partially linked to treatment with a specific drug. We plan to develop an app to assess adverse drug reactions in the urinary tract.

Schlüsselwörter

Polypharmazie - geriatrischer Patient - Harntrakt - Urogeriatrie - unerwünschte Arzneimittelwirkungen

Keywords

polypharmacy - geriatric patient - urinary tract - geriatric urology - inappropriate medication

Publication History

Article published online:
31 May 2021

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