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Fortschr Neurol Psychiatr 2000; 68(12): 546-556
DOI: 10.1055/s-2000-10037
ORIGINALARBEIT
Georg Thieme Verlag Stuttgart · New York

Gewichtszunahme bei Gabe von atypischen Neuroleptika - eine unterschätzte Nebenwirkung?

T. Wetterling
  • Klinik für Psychiatrie und Psychotherapie I, Johann Wolfgang Goethe-Universität, Frankfurt/M. (Direktor: Prof. Dr. K. Maurer)
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung:

Bei einigen so genannten „atypischen Neuroleptika” ist nach ihrer Markteinführung in der klinischen Praxis gehäuft eine deutliche Gewichtszunahme beobachtet worden. In dieser Übersicht werden die Häufigkeit, das Ausmaß und die Bedingungen einer Gewichtssteigerung während der Therapie mit „atypischen Neuroleptika” dargestellt. Ein Vergleich ist durch teilweise erhebliche Unterschiede im Design der Studien sowie in den untersuchten Stichproben nur eingeschränkt möglich. Die publizierten Studienergebnisse zeigen, dass eine ausgeprägte Gewichtszunahme insbesondere bei Patienten, die mit Clozapin und Olanzapin behandelt wurden, zu beobachten ist. Die wenigen verfügbaren Daten zeigen, dass auch bei Quetiapin und Zotepin häufig eine deutliche Gewichtssteigerung auffällt. Risperidon und wahrscheinlich auch Amisulprid verursachen nur eine geringe Gewichtszunahme, während Ziprasidon nur eine klinisch nicht relevante Gewichtssteigerung zu induzieren scheint. Am häufigsten tritt eine Zunahme des Gewichts in den ersten 12 Behandlungswochen, besonders bei Untergewichtigen, auf. Die der Gewichtszunahme zugrunde liegenden Pathomechanismen sind noch nicht hinreichend geklärt. Ein niedriger Quotient der 5-HT2 (Serotonin)/D2 (Dopamin)-Rezeptoraffinität scheint ebenso wie eine hohe Affinität zum Histamin H1-Rezeptor eine wesentliche Voraussetzung für eine gewichtsinduzierende Wirkung zu sein. Neuere Studien zeigen, dass wahrscheinlich einer durch „atypische” Neuroleptika gesteigerten Sekretion von Leptin eine wichtige Rolle zukommt. Obwohl wichtige pathogenetische Fragen noch nicht zufriedenstellend geklärt sind, sollte einer Gewichtszunahme als häufiger Nebenwirkung von „atypischen” Neuroleptika mehr Aufmerksamkeit geschenkt werden, denn sie kann die Compliance in der Langzeitbehandlung beeinflussen und zu schwerwiegenden Komplikationen führen.

Weight Gain in the Treatment with „Atypical Neuroleptics” - an Underestimated Side-Effect?

After the introduction of the so-called „atypical neuroleptics” in the clinical experience a marked weight gain was frequently observed in patients treated with some of these agents. In this review the frequency, amount and conditions of weight gain during the medication with ‚atypical’ neuroleptics were evaluated. A comparison is limited by the different designs and recruitment procedures of the reviewed studies. The available data show that the frequency as well as the amount of weight gain is particularly high in patients treated with clozapine, olanzapine, and likely also quetiapine and zotepine. Moderate changes of weight have been observed in the treatment with risperidone and probably also with amisulpride, while ziprasidone seems to induce only clinically irrelevant weight changes. Weight gain most frequently occurs in the first weeks of treatment. Underweighted patients are at highest risk to gain weight. The underlying pathomechanism still remains widely unclear. The relative receptor affinities of the atypical antipsychotics for histamine H1 as well as their quotient of 5-HT2/D2 receptor affinity appear to be a correlate of weight gain. Furthermore, the induction of leptin secrection may have an important impact on weight gain in subjects treated with atypical neuroleptics. Although many questions concerning the conditions of weight gain remain unsolved, this side-effect has to be considered in the medication with many atypical neuroleptics, particularly in view of compliance in long-term treatment and possible medical complications.

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Prof. Dr T Wetterling

Klinik für Psychiatrie und Psychotherapie IJohann Wolfgang Goethe-Universität

Heinrich-Hoffmann-Str. 1060258 Frankfurt/Main

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