Stellenwert der fixen Kombination aus Acetylsalicylsäure, Paracetamol und Koffein in der Therapie primärer Kopfschmerzen

Zusammenfassung

Essenzieller Bestandteil der Selbstmedikation primärer Kopfschmerzerkrankungen sind Kombinationsanalgetika, die Acetylsalicylsäure, Paracetamol und Koffein enthalten. Sie sind den Monosubstanzen Acetylsalicylsäure, Paracetamol, Ibuprofen und Sumatriptan in ihrer Wirksamkeit überlegen. Durch die Kombination mehrerer Wirkstoffe und des Koffeins als Adjuvans erklärt sich die Erhöhung der Ansprechrate, der Ansprechwahrscheinlichkeit, der Konsistenz und des Ausmaßes sowie der Dauer der Symptomverbesserung. Durch die Dosisreduktion der Einzelsubstanzen wird eine Verbesserung des Sicherheits- und Verträglichkeitsprofils erreicht. Bedenken, dass Kombinationsanalgetika eine Analgetikanephropathie induzieren oder unterhalten würden, sind widerlegt und konnten ursächlich dem Phenacetin zugeordnet werden, das in Westeuropa verboten ist. Für ein höheres Risiko der Entwicklung eines Medikamentenübergebrauchkopfschmerzes bzw. eines nicht bestimmungsgemäßen Mehr- oder Vielgebrauchs durch Koffein ergibt sich aus den Studien keine wissenschaftliche Evidenz.

Summary

Combination analgesics containing acetylsalicylic acid, paracetamol and caffeine are an essential component of the self-medication of primary headache disorders. They are superior to the mono-substances acetylsalicylic acid, paracetamol and to ibuprofen and sumatriptan in terms of efficacy. The increased response rate and response probability as well as the increased consistency, extent, and duration of symptom improvement can be explained by the combination of several active ingredients and of caffeine as an adjuvant. Through the dose reduction of the individual substances, an improvement of the safety and tolerability profile is achieved. Concerns that combination analgesics might induce or maintain an analgesic nephropathy have been disproved and have been causally attributed to phenacetin, which has long been banned in Western Europe. The available studies have found no evidence of a higher risk of developing medication overuse headache or an improperly frequent use by caffeine.

Schlüsselwörter

Kombinationsanalgetika - Acetylsalicylsäure - Paracetamol - Koffein - Kopfschmerzen

Keywords

Combination analgesics - acetylsalicylic acid - paracetamol (acetaminophen) - caffeine - headache

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