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Medikamenteninduzierte Myopathien

Medically induced myopathia

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Zusammenfassung

Muskuläre Nebenwirkungen einiger Anästhetika, Analgetika, Antibiotika, Antihistaminika, antiviraler Substanzen, Kardiotropika, Immunsuppressiva, Lipidsenker, Psychotropika, Zytostatika und verschiedener anderer Substanzen sind häufiger als angenommen und werden immer wieder übersehen. Klinisch manifestieren diese muskulären Nebenwirkungen in Form von Müdigkeit, Myalgien, Paresen, Steifigkeit, Dunkelfärbung des Harns, Belastungsintoleranz, Verlangsamung, Muskelkrämpfen, Muskelkater, Atrophien, Atemnot, Dysphagie, Faszikulationen, abgeschwächten Reflexen, Bewusstseinsstörung bzw. Hyperthermie. Die Diagnose medikamenteninduzierter Myopathien basiert auf der Anamnese, Neurostatus, Blut- und Harnchemie, bildgebenden Verfahren, Elektroneuro- und Myographie, und Muskelbiopsie. Ein Medikament, das bei einem Patienten einmal eine Myopathie induziert hat, sollte ihm nicht noch einmal verabreicht werden. Vor allem bei Patienten mit bekannter Myopathie sollten myotoxische Substanzen extrem vorsichtig eingesetzt werden. Substanzen die am häufigsten medikamenteninduzierte Myopathien auslösen sind Kortison, Statine, Fibrate, antiretrovirale Substanzen, Immunsuppressiva, Kolchizin, Amiodaron, halogenierte Inhalationsnarkotika, Lokalanästhetika sowie Zytostatika. Viele Medikamente sind nur in Kombination mit anderen myotoxisch und viele sind erst dann myotoxisch, wenn der Muskel bereits vorgeschädigt ist.

Summary

Muscular side effects of various anesthetics, analgetics, antibiotics, antihistaminic drugs, antiretrovirals, cardiotropics, immunosuppressants, lipid-lowering drugs, psychotropic drugs, anticancer drugs, and other substances are more frequent than assumed and are easily overlooked. Clinically, muscular side effects manifest as fatigue, myalgias, persistent or transient weakness, stiffness, intolerance to exercise, psychomotor slowing, muscle cramps, wasting, dyspnea, dysphagia, fasciculations, reduced tendon reflexes, impaired consciousness, myoglobinuria, renal failure, or hyperthermia. Diagnosis of these drug-induced myopathies is based on history, clinical neurologic examination, blood work, urine analysis, repetitive stimulation, electromyography, and muscle biopsy. A drug which induces muscular side effects should never be given again. Particularly in patients suffering from primary myopathy, myotoxic drugs should be applied with caution. The drugs which most frequently induce muscular side effects are steroids, statins, fibrates, antiretrovirals, immunosuppressants, colchicine, amiodarone, and anticancer drugs. Many drugs exhibit their myotoxic potential only in combination with other drugs or premorbid pathologic myogenic conditions.

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Finsterer, J. Medikamenteninduzierte Myopathien. Nervenarzt 77, 682–693 (2006). https://doi.org/10.1007/s00115-006-2080-4

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