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Neuere Antipsychotika

Unterschiede im Nebenwirkungsprofil bei Frauen und Männern

Differences between men and women in side effects of second-generation antipsychotics

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Zusammenfassung

In dieser Übersichtsarbeit diskutieren wir, ob es geschlechtsspezifische Unterschiede im Nebenwirkungsprofil von Antipsychotika (AP) der 2. Generation gibt. Die Ergebnisse stützen sich auf eine Medline-Suche für die Jahre 1974 bis Dezember 2005. Obwohl sich Frauen und Männer in ihrer Pharmakokinetik unterscheiden, wurden höhere Plasmaspiegel bei Frauen bisher nur für Clozapin und Olanzapin nachgewiesen. Eine Hyperprolaktinämie, die besonders unter Risperidon und Amisulprid gefunden wird, ist bei Frauen im Vergleich zu Männern stärker ausgeprägt. Die meisten Studien zeigen, dass Clozapin und Olanzapin mit der stärksten Gewichtszunahme einhergehen und dass diese bei Frauen tendenziell stärker ist. Die wenigen Studien, die es gibt, geben weiter eine höhere Prävalenz des metabolischen Syndroms bei Frauen an. Für die neueren AP gibt es sehr wahrscheinlich keine geschlechtsspezifischen Unterschiede in der Häufigkeit und Schwere von akuten oder chronischen Bewegungsstörungen. Frauen besitzen hingegen ein erhöhtes Risiko einer Störung der kardialen Repolarisation (QT-Verlängerung) mit der Gefahr von Torsades-de-Pointes-Arrhythmien unter antipsychotischer Therapie. Zusammenfassend finden sich zwar deutliche Hinweise auf geschlechtsspezifische Unterschiede im Nebenwirkungsprofil der neueren AP, doch gerade in der Beurteilung etwaiger klinischer Konsequenzen bleibt vieles zurzeit noch spekulativ. Wir benötigen prospektive Studien, die geschlechtsspezifische Aspekte als primäre Untersuchungsparameter haben, um die Bedeutung dieser Unterschiede für die Behandlung von Frauen verlässlich abschätzen zu können.

Summary

In this review we investigate whether sex differences exist for side effects of second-generation antipsychotics. Results are based on a MEDLINE search for the years 1974 through 2005. Even if pharmacokinetics differ between females and males, significantly higher plasma levels for women have been demonstrated only for olanzapine and clozapine. Hyperprolactinaemia is mainly induced by treatment with risperidone and amisulpride, and there is evidence for more pronounced prolactin levels in females. Most studies reviewed indicate that clozapine and olanzapine are associated with more body weight gain, once more especially in female patients. Furthermore, the few published studies indicate that metabolic syndrome is more frequent in females and there are likely no gender-specific differences between the new antipsychotic medications concerning frequency and degree of acute or chronic movement disturbance. The risk of QT prolongation with torsades de pointes arrhythmia is again higher in females. In conclusion, there is some evidence of sex differences in the side effects of second-generation antipsychotics. For better understanding of the basic mechanisms in sex differences, future studies with a primary focus on this topic are required. More specific data will help to determine how these differences shall affect clinical management.

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  1. Universitätsklinik für Psychiatrie I, Paracelsus MPU Salzburg, Österreich

    A. B. Whitworth

  2. Abteilung Allgemeine Psychiatrie, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    W. Aichhorn, E. M. Weiss, H. Hinterhuber &  J. Marksteiner

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Aichhorn, W., Whitworth, A.B., Weiss, E.M. et al. Neuere Antipsychotika. Nervenarzt 78, 45–52 (2007). https://doi.org/10.1007/s00115-006-2112-0

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