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Gewichtsveränderungen unter Antiepileptikagabe

Antiepileptic drug-induced weight changes

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Zusammenfassung

Antiepileptika („antiepileptic drugs“, AED) werden in der Regel über mindestens einige Jahre als Dauertherapie eingenommen. Daher ist die Langzeitverträglichkeit eines AED von großer Bedeutung für dessen Auswahl. Gewichtsänderungen stellen eine bedeutsame Nebenwirkung dar, da sowohl eine relevante Gewichtszunahme als auch -abnahme mit einer erhöhten Morbidität und Mortalität assoziiert sein kann. Leider verhalten sich einige gerade auch der neueren AED nicht gewichtsneutral. Zu einer Gewichtszunahme können vor allem Valproat (VPA) und Pregabalin (PGB), aber auch Gabapentin (GBP) und fraglich ebenso Carbamazepin (CBZ) führen. Dagegen kann die Dauergabe von Topiramat (TPM), Zonisamid (ZNS), Felbamat (FBM) und wohl auch der kürzlich zugelassenen Rufinamid (RFM) und Stiripentol (STP) mit einer Gewichtsabnahme vergesellschaftet sein. Lamotrigin (LTG), Phenytoin (PHT), die Barbiturate, Levetiracetam (LEV), Lacosamid (LCM) und Oxcarbazepin (OXC) gelten als gewichtsneutral. Die beobachteten Gewichtsänderungen gehen teilweise mit einer gleichgerichteten Veränderung von Appetit und Nahrungsaufnahme einher. Auch genetische Faktoren sind wahrscheinlich für die AED abhängigen Gewichtsveränderungen relevant.

Abstract

Antiepileptic drugs (AED) are usually taken for a number of years. Therefore, long-term tolerability is of great importance for the choice of an AED. Weight change is a highly relevant side effect and can be associated with increased morbidity and mortality. Unfortunately, several AEDs and especially some of the newer AEDs induce weight changes. Weight gain has been observed with valproate (VPA) and pregabalin (PGB) but also with gabapentin (GBP) and questionably with carbamazepine (CBZ). Weight loss, on the other hand, has been associated with long-term treatment with topiramate (TPM), zonisamide (ZNS), felbamate (FBM) and was also reported for rufinamide (RFM) and stiripentole (STP). Lamotrigine (LTG), phenytoine (PHT), the barbiturates, levetiracetam (LEV), lacosamide (LCM), and oxcarbazepine (OXC) are considered to have no systematic effect on body weight. The weight change observed was frequently associated with a change in appetite and food consumption in the same direction. Genetic factors are likely relevant for the AED-related weight change.

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Interessenkonflikt

Diese Übersichtsarbeit wurde sowohl durch das Nationale Genomforschungsnetz (NGNF1, 01GS0118) als auch durch die Fa. Eisai finanziell gefördert.

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  1. Interdisziplinäres Epilepsiezentrum Marburg, Klinik für Neurologie, Universitätsklinikum Gießen und Marburg GmbH und Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland

    F. Rosenow, H.M. Hamer & K.M. Klein

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  1. F. Rosenow
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  2. H.M. Hamer
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  3. K.M. Klein
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Correspondence to F. Rosenow.

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Rosenow, F., Hamer, H. & Klein, K. Gewichtsveränderungen unter Antiepileptikagabe. Z. Epileptol. 22, 163–169 (2009). https://doi.org/10.1007/s10309-009-0042-0

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