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Beeinflussen Medikamente gegen das benigne Prostatasyndrom Stimmung oder Kognition?

  • K. F. Becher
  • S. Madersbacher
  • M. C. MichelEmail author
Leitthema

Zusammenfassung

Basierend auf neuen Daten diskutieren wir das Risiko zentralnervöser Nebenwirkungen, v. a. eingeschränkte Kognition/Demenz und depressive Störungen, beim Einsatz von Medikamenten zur Behandlung des benignen Prostatasyndroms (BPS). Beim Einsatz von Antimuskarinika sind kognitive Störungen gut dokumentiert und mechanistisch gut verstanden, unterscheiden sich quantitativ aber in der Auftretenswahrscheinlichkeit. Das Auftreten von depressiven Störungen beim Einsatz von 5α-Reduktasehemmern wird erst seit kurzem diskutiert, wurde aber konsistent in mehreren Studien beschrieben und ist mechanistisch plausibel. Es scheint beim Einsatz von Dutasterid und Finasterid ähnlich häufig vorzukommen. Eine moderat vermehrte Diagnose von Demenz unter Behandlung mit Tamsulosin, nicht aber anderen α1-Adrenozeptorblockern, wurde in einer Studie beschrieben, ist mechanistisch nur bedingt plausibel und könnte durch Selektionsartefakte bedingt sein. Insgesamt sollte bei der BPS-Behandlung auf das Auftreten zentralnervöser Nebenwirkungen geachtet werden.

Schlüsselwörter

5α-Reduktasehemmer α1-Adrenozeptorantagonisten Demenz Muskarinrezeptorantagonisten Nebenwirkungen Zentrales Nervensystem 

Do benign prostatic hyperplasia drugs affect mood or cognition?

Abstract

Based on new evidence, we discuss the risk of central nervous side effects, mainly reduced cognition/dementia and depressive symptoms during the use of drugs for the treatment of lower urinary symptoms suggestive of benign prostatic hyperplasia. Cognitive impairments during use of muscarinic antagonists are well documented and mechanistically well understood, but their occurrence differs quantitatively between members of this drug class. The occurrence of depressive symptoms while using 5α-reductase inhibitors only became known recently but has now been observed consistently in several studies and is mechanistically plausible; it appears to occur with similar incidence when using dutasteride and finasteride. A moderate increase in new diagnoses of dementia has recently been reported from a single study upon use of tamsulosin but not other α1-adrenoceptor antagonists. The plausibility of a mechanistic cause–effect relationship is only moderate, and the association could be explained based on selection bias. Overall, physicians should be alert for the occurrence of central nervous side effects during the treatment of lower urinary tract symptoms.

Keywords

5α-reductase inhibitors α1-adrenoceptor antagonists dementia Muscarinic receptor antagonists Side effects Central nervous system 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K. F. Becher: Beratungstätigkeit und Vortragstätigkeit auf Honorarbasis für die Firmen Astellas, Ferring und Pfizer. S. Madersbacher: Beratungs und vortragstätigkeit. Astellas, Ferring, GSK. M. C. Michel Begrenzt auf BPS: früherer (bis Juli 2016) Angestellter und jetzt Berater von Boehringer Ingelheim; früherer (2016) Berater von Recordati. Für Urologie allgemein: Berater für Apogepha, Astellas, Ferring und Velicept; Aktieninhaber von Velicept.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung für Geriatrie und FrührehabilitationHelios Hanseklinikum Stralsund GmbHStralsundDeutschland
  2. 2.Abteilung für Urologie, Kaiser Franz Josef SpitalSigmund Freud PrivatuniversitätWienÖsterreich
  3. 3.Institut für PharmakologieJohannes Gutenberg UniversitätMainzDeutschland

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