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Depotantipsychotika

Überblick und Hinweise für die Praxis

Long-acting injectable antipsychotics

Overview and advice for daily routine care

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Zusammenfassung

In neueren Untersuchungen konnte durch „long-acting injectable antipsychotics“ (LAI) eine signifikante Reduktion von Rückfall- und Rehospitalisierungsraten bei Erkrankungen des schizophrenen Formenkreises gezeigt werden. Grundsätzlich sind die Wirksamkeitsunterschiede zwischen den LAI als gering zu bewerten. Bezüglich Wirksamkeit und Nebenwirkungen sind die LAI den oralen Präparaten ähnlich. Extrapyramidal-motorische Störungen sind seltener bei den „second-generation long-acting injectable antipsychotics“ (SGA-LAI) als bei denen der 1. Generation (FGA-LAI). Spezifische Besonderheiten einiger LAI sind unbedingt zu beachten. Der sofortige Wirkeintritt bei den SGA-LAI ist z. B. nur für Olanzapin und Paliperidon gegeben. Die FGA-LAI sollten zuerst als Testdosis verabreicht werden, um die grundsätzliche Verträglichkeit sicherzustellen. Bei allen LAI besteht eine hohe Variabilität der Plasmaspiegel, die erheblichen Schwankungen unterliegen. Stabile Plasmaspiegel werden meist erst nach mehreren Monaten erreicht; dies erschwert die Dosistitration. Aktuelle Untersuchungen bezüglich der langfristigen Auswirkungen kontinuierlicher Antipsychotikagabe und des möglicherweise schlechteren Ansprechens auf Antipsychotika sollten beachtet werden.

Abstract

Recent investigations have demonstrated a significant reduction of relapse and hospitalization rates associated with the use of long-acting injectable antipsychotics (LAIs) in the treatment of schizophrenia. There are only marginal differences in the effectiveness of different specific LAIs. Furthermore, LAIs are comparable to the oral equivalents with respect to effectiveness and side effects. The occurrence of extrapyramidal motor disorders (EPD) is less frequent in second generation (SG) LAIs than in first generation (FG) LAIs. Moreover, specific characteristics of some substances should be considered: In SG-LAIs immediate onset of action is only applicable for olanzapine and paliperidone and FG-LAIs should always be given as a test dose first to assure a general tolerance. All LAIs have a high variability of plasma levels which complicates the dose titration. Last but not least, current research concerning long-term consequences of continuous treatment with antipsychotics and the potentially poorer response to antipsychotics should be considered.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. S. Köhler, A. Heinz, P. Sterzer geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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  1. Klinik für Psychiatrie und Psychotherapie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    S. Köhler, A. Heinz & P. Sterzer

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  1. S. Köhler
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  2. A. Heinz
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  3. P. Sterzer
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Correspondence to S. Köhler.

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Köhler, S., Heinz, A. & Sterzer, P. Depotantipsychotika. Nervenarzt 85, 1067–1074 (2014). https://doi.org/10.1007/s00115-013-3842-4

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  • DOI: https://doi.org/10.1007/s00115-013-3842-4

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