Zusammenfassung
Appetitlosigkeit und Kachexie sind häufige, aber bis zum heutigen Tag nur wenig beeinflussbare Symptome in der Palliativmedizin, die bei vielen Patienten zu einer deutlichen Beeinträchtigung der Lebensqualität führen. Die Ursachen und die Pathophysiologie von Anorexie und Kachexie sind komplex. Vor einer medikamentösen Therapie müssen Ursachen erfasst und behandelt werden. Die pharmakologische symptomatische Behandlung zielt auf die Beeinflussung der metabolischen, neuroendokrinen und katabolen Veränderungen ab. Neben dem Einsatz von Prokinetika, Kortikosteroiden und Gestagenen werden in letzter Zeit auch Cannabinoide auf ihre Eignung zur Appetitsteigerung und Gewichtszunahme untersucht. Bei Tumorpatienten waren Cannabinoide deutlich effektiver als Placebo, aber eher schwächer als Gestagene. Bei Patienten mit AIDS oder Morbus Alzheimer konnte im Vergleich zu Placebo ebenfalls eine höhere Effektivität nachgewiesen werden. Nebenwirkungen wie Schwindel, Müdigkeit und Benommenheit führten bei einem Teil der Patienten zum Abbruch der Cannabinoidtherapie.
Abstract
Loss of appetite and cachexia are frequent symptoms in palliative care patients. However, therapeutic regimens often prove ineffective, and the quality of life of many patients is significantly impaired by these symptoms. Causes and pathophysiology of anorexia and cachexia are complex and must be identified and treated. Symptomatic pharmacological therapy aims at metabolic, neuroendocrinological and catabolic changes. Prokinetic drugs, corticosteroids and gestagenes are used for symptomatic therapy. Recently, the use of cannabinoids for treatment of loss of appetite and cachexia has become the focus of interest. In cancer patients, cannabinoids proved more effective than placebo but less than gestagenes. Compared to placebo, higher efficacy of cannabinoids could be demonstrated in patients with AIDS as well as in patients with Morbus Alzheimer. However, side effects, such as dizziness, tiredness and daze led to discontinuation of the cannabinoid therapy in some patients.
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Nauck, F., Klaschik, E. Cannabinoide in der Palliativtherapie des Anorexie-Kachexie-Syndroms. Schmerz 18, 197–202 (2004). https://doi.org/10.1007/s00482-003-0277-z
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DOI: https://doi.org/10.1007/s00482-003-0277-z