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Der Anaesthesist

, Volume 66, Issue 11, pp 829–839 | Cite as

Differenzialindikation von Opioiden in der Schmerztherapie

  • J. Heyn
  • S. C. Azad
Leitthema

Zusammenfassung

Aufgrund ihrer hohen analgetischen Potenz haben Opioide bis zum heutigen Tag einen großen Stellenwert in der Behandlung von akuten und insbesondere tumorbedingten chronischen Schmerzen. Da sich die einzelnen Opioide mitunter erheblich in ihren pharmakokinetischen und physikochemischen Eigenschaften unterscheiden, können sie nicht alle bei jedem Patienten gleichermaßen eingesetzt werden. Insbesondere bei Patienten mit Organfunktionsstörungen ist Vorsicht geboten. Darüber hinaus kann der Abbau der Opioide oder die Entstehung aktiver Metabolite durch genetische Faktoren oder Medikamenteninteraktionen maßgeblich beeinflusst werden. Die Kenntnis der Abbauwege sowie der pharmakologischen Besonderheiten einzelner Opioide kann daher helfen, Komplikationen zu vermeiden. Dieser Artikel widmet sich Pharmakologie, Anwendungsgebieten und Abbauwegen von Opioiden, die einen hohen Stellenwert in der Schmerztherapie haben.

Schlüsselwörter

Opioide Leberinsuffizienz Niereninsuffizienz Analgesie Pharmakokinetik 

Differential indications of opioids in pain therapy

Abstract

Due to their strong analgesic potency opioids are highly effective in the therapy of acute and particularly cancer-induced chronic pain; however, the individual opioids differ considerably with respect to their pharmacokinetic and physicochemical properties and may therefore not be equally applicable for every patient. Caution should be taken especially in patients with impaired organ function. Furthermore, the metabolism of opioids leads to active or inactive metabolites. This process can be substantially influenced by genetic polymorphisms or drug interactions. Knowledge of all these factors for individual opioids, which influence the efficacy and side effects, is therefore crucial. In this review the pharmacology, clinical applications, metabolism and genetic factors of the most important opioids used for pain management are discussed.

Keywords

Opioids Renal failure Hepatic failure Analgesia Pharmacology 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Heyn und S.C. Azad geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Anaesthesiologie, Interdisziplinäre Schmerzambulanz und TagesklinikLudwig-Maximilians Universität München (LMU)MünchenDeutschland

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