Bedarfsmedikation als Behandlung von Off-Phasen bei Parkinson-Patienten

Zusammenfassung

Off-Phasen bei Parkinson-Patienten mit Levodopa-Wirkungsschwankungen kennzeichnen sich dadurch, dass die gewünschte Wirkung von Levodopa-Dosen nachlässt oder ausbleibt und motorische Symptome und/oder nicht-motorische Symptome wieder auftreten oder sich verschlimmern. Off-Phasen bleiben eine Herausforderung trotz Kombination von Levodopa mit Dopaminagonisten, COMT- und MAO-B-Hemmern sowie dem Einsatz von geräteunterstützten Verfahren wie die tiefe Hirnstimulation. Bedarfsmedikationen (on-demand, rescue-medication) ermöglichen eine schnelle Symptomkontrolle und reduzieren die Wartezeit auf das On. Lösliches Levodopa wird dafür seit langem eingesetzt und von aktuellen Leitlinien empfohlen. Apomorphin, zunächst subkutan im Pen-System zugelassen, war das erste spezifische Medikament für Off-Phasen. Seit 2022 und 2024 erweitern inhalatives Levodopa und sublinguales Apomorphin in einigen EU-Ländern die Optionen. Diese neuen Darreichungsformen umgehen den Magen-Darm-Trakt und ermöglichen eine schnelle Resorption sowie mehr Flexibilität den Patienten. Diese Übersicht vergleicht die verfügbaren bedarfsorientierten Therapieoptionen und hebt die Bedeutung des bedarfsweisen Managements von Off-Phasen hervor.

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