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Gastrointestinale Nebenwirkungen durch Psychopharmaka

Gastrointestinal side-effects of antipsychotic agents

  • Schwerpunkt: Medikamentöse Nebenwirkungen im Gastrointestinaltrakt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Psychopharmaka beeinflussen nicht nur das zentrale Nervensystem, sondern durch Interferenz mit Rezeptoren des enterischen Nervensystems über cholinerge, adrenerge, dopaminerge und serotonerge Impulse v.a. auch die Motilität im Bereich des gesamten Gastrointestinaltrakts. In Abhängigkeit vom Ausmaß der Interaktion mit den verschiedenen Neurotransmittersystemen und/oder deren Rezeptoren überwiegen agonistische oder antagonistische Einflüsse auf die gastrointestinale Motilität. Dies begründet die Art der gastrointestinalen Symptomatik und führt dazu, dass entweder Übelkeit, Erbrechen, Refluxbeschwerden und Obstipation oder aber Diarrhöen im Vordergrund stehen. Die besondere Bedeutung von Serotonin als Botenstoff des ENS, die Störung dieses Systems beim Reizdarmsyndrom und bei chronisch-entzündlichen Darmerkrankungen hat dazu geführt, sich diese spezifischen Nebenwirkungen auch in der Therapie dieser Krankheitsbilder nutzbar zu machen. Theoretische Überlegungen und klinische Effektivität stimmen jedoch nicht immer überein, was v.a. darauf zurückzuführen ist, dass wir in unserem Verständnis der Regulation des ENS erst am Anfang stehen. Daneben greifen speziell SSRI in die Thrombozytenfunktion ein und so muss insbesondere bei älteren Patienten mit entsprechender Komorbidität und Einnahme von NSAR mit einem erhöhten Risiko gastrointestinaler Blutungen gerechnet werden.

Abstract

The most common side-effects of antipsychotic agents are CNS complaints but gastrointestinal side-effects are also very frequent. Many side-effects can be attributed to acetylcholine, histamine, serotonin and α-adrenergic receptor interactions with psychopharmacological treatment. Many psychotropic drugs share the ability to modify gastrointestinal motility and depending on the site of action, they can slow or increase intestinal transit times causing nausea, vomiting and gastroesophageal reflux, constipation or diarrhea. With respect to gastrointestinal side-effects, serotonin is of major importance and functions as a main neurotransmitter of sensory motor functions in the digestive tract. Serotonin reuptake inhibitors are of potential benefit in functional gastrointestinal diseases and with further understanding of the brain-gut axis and specifically of the role of serotonin in neural sensorimotor functions, novel therapies can be developed that allow a more global control of irritable bowel syndrome. However, many prescribers of novel serotonin reuptake inhibitors are unaware that SSRI may be associated with an increased risk of GI bleeding especially in older patients and concurrent use of NSAR. In a short review, the psychotropic drugs are broadly classified according to their mechanism and site of action on the central and enteric nervous system and the pathophysiology of the peripheral and enteric nervous system is refreshed.

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  1. Israelitisches Krankenhaus Hamburg, Akademisches Lehrkrankenhaus der Universität Hamburg, Medizinische Klinik, Orchideenstieg 14, 22297 , Hamburg, Deutschland

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Fibbe, C., Layer, P. Gastrointestinale Nebenwirkungen durch Psychopharmaka. Gastroenterologe 1, 197–208 (2006). https://doi.org/10.1007/s11377-006-0034-9

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