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Zeitschrift für Rheumatologie

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01.02.2016 | Muskuloskelettaler Schmerz | Empfehlungen und Stellungnahme von Fachgesellschaften

DGRh-Empfehlungen zur Implementierung aktueller Sicherheitsaspekte in die NSAR-Therapie muskuloskelettaler Schmerzen

verfasst von: Dr. W. W. Bolten, K. Krüger, S. Reiter-Niesert, D. O. Stichtenoth, Kommission Pharmakotherapie der DGRh

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 1/2016

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Zusammenfassung

NSAR lindern Schmerz und Entzündung durch Hemmung der COX-2 und konsekutive Verminderung der Synthese schmerzvermittelnder Prostaglandine. Unerwünschte Wirkungen limitieren die NSAR-Therapie. Die wichtigsten unerwünschten Wirkungen entstehen gastrointestinal durch Reduzierung der Synthese COX-1-abhängiger protektiver Prostaglandine und kardiovaskulär durch COX-2-Inhibition bzw. durch Verschiebung des Verhältnisses der Syntheserate COX-2- und COX-1-abhängiger pro- und antithrombotisch wirkender Prostaglandine. Besonders gefährdet sind Patienten mit einschlägig erhöhtem Risikoprofil. Strenge Überwachung der Indikation, die Wahl eines selektiven COX-2-Inhibitors oder/und die Komedikation mit einem PPI (ggf. auch Misoprostol) bei GI-Risikopatienten sowie der Einsatz kardioneutraler NSAR (Naproxen, niedrig dosiertes Ibuprofen) bzw. die Vermeidung eher kardial schädigender NSAR (z. B. Coxibe, Diclofenac, hochdosiertes Ibuprofen) bei CV-Risikopatienten sind geeignete Präventivmaßnahmen zur Senkung des NSAR-Risikos. Kontraindikationen wie z. B. eine Niereninsuffizienz (GFR < 30 ml/min) (KI für alle NSAR), Ulkusanamnese (KI für tNSAR) oder kardio- bzw. cerebrovaskuläre Vorerkrankungen (KI für Coxibe) sowie Medikamenteninteraktionen müssen beachtet werden. Therapeutische Entscheidungen werden für jeden Patienten individuell getroffen. Die Behandlungsnotwendigkeit sollte regelmäßig überprüft werden. Das Potenzial nichtmedikamentöser Behandlungsmaßnahmen sollte genutzt werden.

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Titel: DGRh-Empfehlungen zur Implementierung aktueller Sicherheitsaspekte in die NSAR-Therapie muskuloskelettaler Schmerzen
verfasst von: Dr. W. W. Bolten
K. Krüger
S. Reiter-Niesert
D. O. Stichtenoth
Kommission Pharmakotherapie der DGRh
Publikationsdatum: 01.02.2016
Verlag: Springer Berlin Heidelberg
Schlagwörter: Muskuloskelettaler Schmerz
Diclofenac
Ibuprofen
Naproxen
Misoprostol
Erschienen in: Zeitschrift für Rheumatologie / Ausgabe 1/2016
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI: https://doi.org/10.1007/s00393-015-0018-6

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DGRh-Empfehlungen zur Implementierung aktueller Sicherheitsaspekte in die NSAR-Therapie muskuloskelettaler Schmerzen

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