Zusammenfassung
Diabetiker leiden langfristig an zahlreichen Folgeerkrankungen, darunter auch sensible
Polyneuropathien. Im Rahmen der diabetischen Polyneuropathie (DPNP) treten häufig
Schmerzen unterschiedlichster Art, Ausprägung und Dauer auf. Zur Therapie dieser Beschwerden
gibt es zahlreiche pharmakotherapeutische Angriffspunkte, auch Antidepressiva sind
von Bedeutung. Ein neuer Wirkstoff, der selektive Serotonin- und Noradrenalin-Wiederaufnahmehemmer
Duloxetin, scheint in der Schmerzbehandlung ähnlich wirksam zu sein wie etablierte
Substanzen. Duloxetin (60 mg einmal oder 60 mg zweimal täglich) reduzierte im Vergleich
zu Plazebo ab der ersten Behandlungswoche signifikant die Schmerzen bei DPNP. Die
am häufigsten beobachteten Nebenwirkungen waren Übelkeit, Schläfrigkeit, Schwindel,
Obstipation und Müdigkeit. Es zeigte sich im Mittel keine klinisch relevante Erhöhung
von Blutdruck und Puls sowie keine Gewichtszunahme. Duloxetin bietet damit eine neue
Therapieoption bei DPNP. Im Therapiealgorithmus sollen die einzelnen Substanzen individuell,
auch unter Berücksichtigiung ihres Nebenwirkungsprofils, eingesetzt werden. Zur Unterstützung
der Schmerzbewältigung dienen supportive psychologische Therapieverfahren.
Summary
Diabetics develop numerous chronic associated diseases, among them sensory polyneuropathy.
Diabetic polyneuropathy (DPN) often causes pain of various kinds, degree and duration.
There are many pharmacological approaches: antidepressants are also important. Duloxetine
is a recently approved dual action serotonin and noradrenaline re-uptake inhibitor
that in its analgesic efficacy is comparable to established drugs. Duloxetine, in
a dosage of 60 mg x 1 or x 2 daily, significantly reduces, from the first week of
administration, the pain of DPN, when compared with a placebo. The most commonly observed
side effects have been nausea, sleepiness, constipation and fatigue. On average duloxetine
has not shown any clinically relevant increase in blood pressure, pulse rate and
weight. It thus offers a new option as part of the treatment of pain caused by DPN.
The various drugs should be considered individually in any treatment algorithm, also
taking into account their side effects. Psychotherapeutic methods serve to support
the overcoming of pain.
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Prof. Dr. Dan Ziegler
Deutsches Diabetes-Zentrum, Heinrich-Heine-Universität Düsseldorf
Auf’m Hennekamp 65
40225 Düsseldorf
Email: dan.ziegler@ddz.uni-duesseldorf.de
