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Kardiovaskuläre Pharmakotherapie

Risiken und Nebenwirkungen

Cardiovascular pharmacotherapy

Risks and adverse effects

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Zusammenfassung

Arzneimittelnebenwirkungen (UAW) sind ein häufig unterschätztes Problem der modernen Medizin. In dieser Übersicht fassen wir häufige Nebenwirkungen der kardiovaskulären Pharmakotherapie zusammen. Dabei werden insbesondere Faktoren hervorgehoben, die das Auftreten von Nebenwirkungen begünstigen. So werden gerade bei älteren Patienten aufgrund einer verminderten hepatischen oder renalen Elimination häufig Dosisanpassungen notwendig. Außerdem können Arzneimittelinteraktionen sowohl auf pharmakodynamischer als auch auf pharmakokinetischer (Cytochrom-P450-System, P-Glykoprotein) Ebene auftreten und zu einer Wirkverstärkung oder Abschwächung führen, wodurch das Risiko von UAW steigt. Die wichtigsten kardialen Nebenwirkungen umfassen Rhythmusstörungen (z. B. AV-Blockierungen, Long-QT-Syndrom, Torsade-de-Pointes-Arrhythmien) oder Minderung der Kontraktionskraft. Extrakardiale Nebenwirkungen werden gesondert nach Substanzgruppen dargestellt, wobei gruppenspezifische Nebenwirkungen hervorgehoben werden. Insgesamt sollte die systematische Aufklärung über Risiken und Nebenwirkungen der Arzneimitteltherapie dazu beitragen, die durch UAW bedingte Mortalität und Morbidität zu verringern.

Abstract

Adverse side effects of drugs are a significantly underestimated problem in modern medicine. In this review article, we summarize common adverse side effects of cardiovascular drugs. In particular, we highlight the factors promoting these adverse side effects in patients, including reduced hepatic or renal clearance in elderly patients that often requires dosage adjustment. Pharmacodynamic and pharmacokinetic interactions between drugs (e.g. through the cytochrome P450 system or P-glycoproteins) can modify the plasma concentration of many compounds, thereby also increasing the likelihood of unwanted side effects. The most prominent cardiac side effects include arrhythmias, e.g. atrioventricular (AV) block, drug-induced long-QT syndrome and torsade de pointes and altered inotropy. Non-cardiac side effects are subsequently discussed grouped by drug class. A better understanding of the risks and side effects of cardiovascular drugs is expected to reduce the mortality and morbidity associated with adverse side effects.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. N. Voigt, J. Heijman und D. Dobrev geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Pharmakologie, Medizinische Fakultät, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    N. Voigt, J. Heijman &  D. Dobrev

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  1. N. Voigt
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  2. J. Heijman
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  3. D. Dobrev
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Correspondence to D. Dobrev.

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Voigt, N., Heijman, J. & Dobrev, D. Kardiovaskuläre Pharmakotherapie. Herz 39, 227–240 (2014). https://doi.org/10.1007/s00059-014-4066-5

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