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DOI: 10.1055/s-2006-956291
© Georg Thieme Verlag KG Stuttgart · New York
Duloxetin: Eine neue Behandlungsoption für Schmerzen im Rahmen der diabetischen Polyneuropathie
Duloxetine, a new therapeutic option for diabetic peripheral neuropathic painPublikationsverlauf
eingereicht: 4.7.2006
akzeptiert: 24.9.2006
Publikationsdatum:
30. November 2006 (online)

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