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Unerwünschte Arzneimittelwirkungen

Diagnostik und Bewertung

Adverse drugs reactions: diagnosis and assessment

  • Schwerpunkt: Iatrogene Pathologie
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Zusammenfassung

Mit unerwünschte Arzneimittelwirkungen (UAW) ist bei etwa 5% aller medikamentösen Behandlungen zu rechnen. Mehrere Tausend Patienten versterben jährlich in Deutschland an UAW. Die auslösenden Arzneimittel sind überwiegend nichtsteroidale Antirheumatika, Antikoagulanzien und Acetylsalicylsäure, gefolgt von Herz-Kreislauf-Medikamenten. Das UAW-Spektrum beinhaltet daher zum großen Teil Blutungen (im Gastrointestinaltrakt) und kardiovaskuläre Störungen. Andererseits gibt es jedes Jahr mehr oder weniger spektakuläre Marktrücknahmen von Arzneimitteln wegen UAW, in jüngster Zeit Coxibe, davor Cisaprid und Cerivastatin. Diese Marktrücknahmen beruhen meist auf eher seltenen UAW, deren Diagnostik nicht immer einfach ist. Ärzte sind laut Musterberufsordnung verpflichtet, UAW zu melden. Häufig wird dies unterlassen, weil die UAW entweder zu bekannt oder die Diagnose nicht gesichert ist. Bei einigen UAW ist der histopathologische Befund ausschlaggebend dafür, ob es sich um eine UAW oder eine Erkrankung handelt. Daher sollte bei der Übersendung des Materials an die Pathologie die Medikation im Verdachtsfall genannt werden, damit diese Information in die Beurteilung des Präparates einfließen kann.

Abstract

Adverse drug reactions (ADR) occur in about 5% of all pharmacologically treated patients. Between 2% and 20% of all hospital admissions are caused by ADR, and approximately 10% of all hospitalized patients experience ADR during their hospital stay. Several thousand patients die due to ADR in Germany each year. ADR-associated drugs come predominantly from the class of non-steroidal antiinflammatory drugs, anticoagulants, acetysalicylic acid and cardiovascular drugs. Most ADR cases present as gastrointestinal bleeding and adverse cardiovascular effects. Apart from this, one or more drugs are withdrawn from the market each year because of unwanted but mostly rare side effects. In recent years the most prominent cases were rofecoxib, cisapride and cerivastatin. Physicians in Germany are obliged to report ADR. A substantial proportion of ADR, however, is not reported because it is deemed to be either too well known or the association between the drug and the adverse effect is too doubtful. In some cases, histopathological findings are needed to determine the diagnosis of ADR. Accordingly, physicians should inform the pathologist whether an ADR is suspected and which drugs may be responsible.

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  1. Philipp-Klee-Institut für Klinische Pharmakologie, HELIOS Klinikum Wuppertal, Universität Witten/Herdecke

    P. A. Thürmann

  2. Philipp-Klee-Institut für Klinische Pharmakologie, HELIOS Klinikum Wuppertal, Heusnerstraße 40, 42283 , Wuppertal

    P. A. Thürmann

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Thürmann, P.A. Unerwünschte Arzneimittelwirkungen. Pathologe 27, 6–12 (2006). https://doi.org/10.1007/s00292-005-0805-y

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