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Pharmakologische Behandlung der Obstipation

Pharmacological treatment of constipation

  • Arzneimitteltherapie
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Zusammenfassung

Die chronische Obstipation tritt häufig auf und verlangt oft eine pharmakologische Behandlung. Auf dem Markt sind diverse Abführmittel erhältlich, die sehr unterschiedlichen pharmakologischen Gruppen angehören. Deren wichtigste Vertreter sind unter den älteren Laxanzien die osmotischen Salze, Zucker und Zuckeralkohole, Macrogol, Anthrachinone und die diphenolischen Laxanzien (Bisacodyl und Natriumpicosulfat), unter den neueren Laxanzien Prucaloprid und Linaclotid. Die Wirksamkeit aller genannten Substanzen wurde in klinischen Studien belegt. Bei korrekter Dosierung kommt es nicht wie oft befürchtet zu Elektrolytstörungen (mit seltenen Ausnahmen bei salinischen Laxanzien). Die älteren Substanzen sind auch hinsichtlich Schwangerschaft und Stillzeit sicher; für die neueren Präparate fehlen noch entsprechende Daten. Unklar ist, ob die neueren Substanzen gegenüber den älteren Vorteile bieten. Vergleichsstudien gibt es nicht. Bei opiatinduzierter Obstipation kommen neben Laxanzien auch bestimmte Opiatantagonisten infrage.

Abstract

Chronic constipation is a frequent condition often requiring pharmacological treatment. A number of laxatives that belong to very different pharmacological groups are available. Most relevant are the older representatives osmotic salts, sugars and sugar alcohols, macrogol, anthraquinones, diphenolic laxatives (bisacodyl and sodium picosulphate), and the newer compounds prucalopride and linaclotide. For all of these laxatives, efficacy has been shown in controlled trials. Electrolyte problems do not occur when laxatives are given in therapeutic doses (rare exceptions with salinic laxatives). The older laxatives are also safe regarding teratogenicity, abortion, and lactation; for the newer compounds no respective data are available as yet. It is questionable whether the newer laxatives offer advantages over the older ones. Unfortunately, comparative trials are lacking. Opiate-induced constipation may also be treated with laxatives or certain opiate antagonists.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: S. Müller-Lissner hat als Referent, Advisory-Board-Mitglied oder Berater von folgenden Firmen Honorare erhalten: Almirall, Boehringer Ingelheim, Mundipharma GmbH, Shire-Movetis.

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Müller-Lissner, S. Pharmakologische Behandlung der Obstipation. Internist 54, 498–504 (2013). https://doi.org/10.1007/s00108-013-3245-4

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