Arzneimittelinteraktionen bei der medikamentösen Epilepsietherapie

 

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Zusammenfassung

Interaktionen von Antiepileptika untereinander und mit Medikamenten für andere Erkrankungen oder mit körpereigenen Substanzen sind eine häufige, klinisch wichtige und oft vermeidbare Ursache für Komplikationen der oft lebenslangen Behandlung epilepsiekranker Menschen. Obwohl Interaktionen für einige Patienten auch vorteilhaft sein können, kommt es nach der derzeitigen, noch lückenhaften Datenlage bei 6% aller Patienten unter der Kombination mehrerer Antiepileptika zu klinisch relevanten, unerwünschten Wirkungen. Zudem kann infolge einer Interaktion auch ein Wirkungsverlust auftreten. Bei Interaktionen von enzyminduzierenden Antiepileptika mit anderen Medikamenten oder mit körpereigenen Substanzen kann es ebenfalls zu einer wesentlichen Wirkungsabschwächung kommen, beispielsweise bei onkologischen Behandlungen. Daher wird zur Prävention von unerwünschten Interaktionen empfohlen, falls möglich schon in der Ersttherapie vorher unbehandelter Patienten mit Epilepsie bevorzugt im Vergleich zu den klassischen Medikamenten gleich wirksame, aber interaktionsfreie oder interaktionsarme Antiepileptika einzusetzen.

Summary

Interactions among antiepileptic drugs, with medications used for other disorders or with endogenous substances are a common and important cause of clinically relevant and often preventable complications in chronic treatment of patients with epilepsy. Although interactions may also be beneficial in some patients, the available evidence suggests that in 6% of patients experiencing adverse effects an interaction is responsible. In addition drug interactions may lead to clinically relevant loss of therapeutic effect. Interaction of enzyme inducing AEDs with other medications or endogenous substances may also lead to clinically relevant loss of therapeutic effects, for example in oncology. To prevent undesirable interactions, we recommend to start treatment with antiepileptic drugs for epilepsy that are efficacious as classical AEDs but are not involved or less involved in drug interactions.

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