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Fortschr Neurol Psychiatr 2017; 85(03): 139-145
DOI: 10.1055/s-0043-100762
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Update Opipramol

Update Opipramol
Maximilian Gahr
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
Christoph Hiemke
2   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Mainz
,
Bernhard J. Connemann
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

Publication Date:
20 March 2017 (online)

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Zusammenfassung

Opipramol ist eine in den 1960er Jahren initial als Antidepressivum entwickelte Substanz, die chemisch Ähnlichkeiten mit den trizyklischen Antidepressiva aufweist. Die Pharmakodynamik mit fehlender Wiederaufnahmehemmung von Serotonin und Noradrenalin sowie Agonismus an Sigma-Rezeptoren unterscheidet Opipramol jedoch von den Trizyklika. Zudem ist die antidepressive Wirkung geringer als die anxiolytische. Die Wirkungsweise der Substanz ist derzeit nicht ausreichend verstanden. Agonistische Effekt an Sigma-Rezeptoren werden mit den therapeutischen Effekten assoziiert. Die exzessive hepatische Metabolisierung (in erster Linie über CYP2D6) sollte insbesondere bei eingeschränkter Leberfunktion und Polypharmazie berücksichtigt werden. Die vorliegenden klinischen Daten legen nahe, dass die Substanz eine gute Verträglichkeit und Sicherheit im zugelassenen Dosisbereich aufweist. Es können vornehmlich milde Formen von Vigilanzstörungen sowie anticholinerge Nebenwirkungen auftreten. Opipramol ist in Deutschland zur Behandlung somatoformer Störungen und der generalisierten Angststörung zugelassen, und es gibt für eine Wirksamkeit von Opipramol bei diesen Störungen suffiziente Evidenz. Die Substanz wird in Deutschland weiterhin sehr häufig verordnet, spielt im klinischen und wissenschaftlichen Bereich der Psychiatrie gegenwärtig jedoch eine geringe Rolle. Vor dem Hintergrund der eingeschränkten Verfügbarkeit (pharmakologischer) therapeutischer Optionen bei der generalisierten Angststörung und insbesondere bei den somatoformen Störungen sollte Opipramol zur Therapie dieser Entitäten erwogen werden.

Abstract

Opipramol was developed in the 1960s as an antidepressant and has chemical similarities with tricyclic antidepressants. Pharmacodynamic properties with absent reuptake inhibition of serotonin and noradrenaline and agonism at sigma receptors distinguish opipramol from tricyclics. Furthermore, antidepressive effects are smaller than the anxiolytic ones. The mechanism of action of opipramol is currently not sufficiently understood. Agonistic effects at sigma receptors have been linked with therapeutic effects. Excessive hepatic metabolism (primarily via CYP2D6) should be considered, particularly in patients with impaired hepatic function and polypharmacy. The available clinical data suggest good tolerability and safety within the approved dose range. Mild disturbances of vigilance and anticholinergic adverse events are the predominant side effects. In Germany, opipramol is approved for the treatment of somatoform disorders and generalized anxiety disorder, and there is sufficient evidence for the efficacy of opipramol in these disorders. The agent is still prescribed very often in Germany, yet plays a minor role in the clinical as well as scientific setting. In view of the limited availability of (pharmacologic) treatment options for generalized anxiety disorder and particularly somatoform disorders, opipramol should be considered in the treatment of these entities.

Schlüsselwörter

Antidepressivum - Anxiolytikum - Insidon - somatoforme Störungen

Key words

antidepressant - anxiolytic - insidon - somatoform disorders
 

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