Kürşat ALTINBAŞ, Erhan KURT, E. Timuçin ORAL

İkinci kuşak antipsikotiklerin endokrin yan etkileri: İstisna mı, kural mı?

Amaç: Klasik antipsikotiklerin özellikle ekstrapiramidal sistem (EPS) yan etkileri nedeniyle, yaklaşık on yıl önce yeni kuşak antipsikotiklerin piyasaya çıkışı, psikiyatri topluluğunda heyecanla karşılanmıştı. İkinci kuşak antipsikotiklerin kullanımının yaygınlaşmasıyla, önceden beklenmeyen yan etkileri hakkında daha fazla bilgi edinilmesi, son bir kaç yıldır bu alanda giderek daha soğukkanlı bir yaklaşımın yerleşmesine neden oldu. İkinci kuşak antipsikotiklerin dikkat çekici yan etkilerinden bir tanesi, hiperprolaktinemi dışında klasik antipsikotiklerle nadir görülen metabolik bozukluklardır. Bu gözden geçirmede ikinci kuşak antipsikotiklerin endokrin yan etkilerine ışık tutulması planlanmaktadır. Yöntem: İkinci kuşak antipsikotik kullanımına bağlı endokrin yan etkiler için PubMed, ProQuest elektronik veri tabanları ve Türkçe literatür taranarak sonuçlar gözden geçirildi. Sonuçlar ve Tartışma: İkinci kuşak antipsikotikler, klasik antipsikotiklere göre pozitif belirtilerde eşit etkinlikte, negatif belirtilerde ise daha etkin olup bozulmuş bilişsel işlevlerde belirgin düzelme sağlayarak yaşam kalitesini artırmaktadır. Bu ilaçların ayrıcalıklı bir özelliği de ihmal edilebilir düzeyde EPS yan etkilerinin olmasıdır. Öte yandan, özellikle uzun dönem tedavi sırasında dikkat edilmesi gerekli olan kilo artışı, glikoz ve lipit metabolizma bozukluğu ve klasik antipsikotiklerle de görülen hiperprolaktinemi gibi endokrin yan etkileri, ikinci kuşak antipsikotiklerin en zayıf yanıdır. Bu nedenle, ikinci kuşak antipsikotiklerle tedavi sırasında endokrin yan etkilerin ve metabolik parametrelerin izlenmesi önerilir.

Anahtar Kelimeler:

Lipid metabolizması, Endokrin sistem, İlaç yan etkisi raporlama sistemleri, Metabolik hastalıklar, Hiperprolaktinemi, Kilo artışı, Glukoz metobolizması bozuklukları, Antipsikotik ajanlar

Endocrine side effects of second generation antipsychotics: Is it rule or exception?

Objective: Although, novel antipsychotics welcomed with great enthusiasm a decade ago by psychiatric community, mainly because of the extrapyramidal (EPS) side effects of classical antipsychotics; lights were getting dimmed a bit in the last couple of years. As the use of second generation antipsychotics (SGA) was getting higher, more data collected about the previously unexpected side effects. One of the interesting side-effects of SGAs is metabolic problem, which is indeed, very rare with classical antipsychotic treatment with the exception of hyperprolactinemia. This review is planned to shed light on the endocrine side effects of SGAs. Methods: PubMed and ProQuest electronic database were searched for a comprehensive review and Turkish literature was also checked. Results and Discussion: SGAs have equal efficacy on positive symptoms, greater effects on negative symptoms, cognitive functions and quality of life comparing to classical antipsychotics. Another privilege of these drugs is the negligible EPS side effects. On the other hand, endocrine side effects like weight gain, glucose and lipid metabolism dysregulations and hyperprolactinemia, which is also in common with the classical ones, are the Achilles’ ankle of these novel antipsychotics, which should especially be considered in the long-term treatment. Therefore, monitorization of the endocrine side effects and metabolic parameters is highly recommended during the treatment with SGAs.

Keywords:

Lipid Metabolism, Endocrine System, Adverse Drug Reaction Reporting Systems, Metabolic Diseases, Hyperprolactinemia, Weight Gain, Glucose Metabolism Disorders, Antipsychotic Agents,

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