Metabolische unerwünschte Arzneimittelwirkungen von Psychopharmaka

Maximilian Gahr

doi:10.1055/a-2539-1129

Diabetes aktuell, Table of Contents

Diabetes aktuell 2025; 23(02): 79-87
DOI: 10.1055/a-2539-1129

Schwerpunkt

Metabolische unerwünschte Arzneimittelwirkungen von Psychopharmaka

Maximilian Gahr

Krankenhaus für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Schloss Werneck, Werneck, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Metabolische unterwünschte Arzneimittelwirkungen (mUAW) von Psychopharmaka haben erhebliche gesundheitsbezogene und ökonomische Relevanz. Zu den mUAW gehören Gewichtszunahme, gestörte Glukosetoleranz, Diabetes mellitus und Dyslipidämie. Fast alle Antipsychotika (AP) und viele Antidepressiva (AD) sowie Stimmungsstabilisatoren können zu mUAW, insbesondere Gewichtszunahme führen. Die Gewichtsentwicklung in den ersten Wochen bis Monaten nach Initialisierung einer Therapie ist der stärkste Prädiktor für Gewichtszunahme assoziiert mit AP und AD. Die wichtigsten Risikofaktoren für mUAW sind antagonistische Effekte an H₁-, 5-HT_2C- und M₃-Rezeptoren sowie antidopaminerge Effekte, wobei die Beeinflussung zahlreicher weiterer Systeme relevant ist. Ein systematisches Monitoring metabolischer Parameter sollte bei Therapie mit allen Substanzen durchgeführt werden, die mit einem erhöhten Risiko für mUAW assoziiert sind. Lebensstilverändernde und diätetische Maßnahmen, Bewegungstherapie, Dosisreduktion, Umstellung und Beendigung der Medikation sowie eine zusätzliche Therapie mit Metformin und Topiramat sind evidenzbasierte Therapieoptionen bei AP-assoziierter Gewichtszunahme, wobei auch die GLP-1-Rezeptoragonisten wie Liraglutid vielversprechend sind.

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References

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