Zusammenfassung.
Onkologische Schmerzpatienten erhalten häufig eine Vielzahl von Arzneistoffen mit hohem Interaktionspotential. Bei einer Therapie mit antipyretischen Analgetika sind vor allem Wechselwirkungen mit ACE-Hemmern, blutgerinnungshemmenden Arzneistoffen, blutzuckersenkenden Arzneistoffen relevant. Besondere Aufmerksamkeit gebührt der Hochdosis-Methotrexattherapie, die bei gleichzeitiger Gabe von antipyretischen Analgetika infolge erhöhter MTX-Spiegel schwere Überdosierungserscheinungen hervorrufen kann. Opioidanalgetika zeigen relevante Interaktionen besonders im Zusammenhang mit dem Abbau über mikrosomale Leberenzyme. Eine Enzyminduktion beispielsweise durch Antikonvulsiva oder Rifampicin kann eine deutlich verminderte Analgesie bewirken. Carbamazepin bewirkt ebenfalls eine Vielzahl von Interaktionen, die auf die Beeinflussung mikrosomaler Leberenzyme zurückgeführt werden. Zum einen reduziert Carbamazepin als Enzyminduktor die Wirksamkeit vieler Arzneistoffe beispielsweise von Steroidhormonen, zum anderen kann das Hinzufügen eines Enzymhemmers wie Erythromycin zu neurotoxischen Überdosierungserscheinungen von Carbamazepin führen.
Relevant Interactions of (Co-) Analgesics with other Substances Frequently Employed in Oncology.
Patients in oncology are often treated with lots of drugs with a high risk for drug-drug interactions. Antipyretic analgetics often interact with ACE inhibitors, anticoagulants, and antidiabetic drugs. A special focus has to be put on high dose methotrexat therapy that might cause overdosage in combination with antipyretic analgetics because of increased serum methotrexat concentration. On the other hand opioid analgetics might be involved in relevant drug interactions because of metabolic reactions of microsomal liver enzymes. For example an enzyme induction caused by anticonvulsants or rifampicine reduces the analgetic potential. A very complex modus of interactions shows carbamazepine which influences microsomal liver enzymes; on the other hand carbamazepine is able to reduce efficacy of drugs by means of enzyme induction, for example the efficacy of steroidhormones. On the other hand it might cause neurotoxic overdosage in combination with an enzyme inhibitor like erythromycin.
Schlüsselwörter:
Arzneimittelinteraktionen - antipyretische Analgetika - Opioide - Carbamazepin
Key words:
drug interactions - antipyretic analgesics - opiate analgesics - carbamazepine
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45122 Essen
