Çocuk ve Ergenlerde Psikotrop İlaçların Endokrin ve Metabolik Yan Etkileri

Son on yılda çocuk ve ergenlerde psikotrop ilaçların kullanımında artış görülmekte olup endokrin ve metabolik yan etkileri ise kullanımlarını sınırlandırabilmektedir. Atipik antipsikotikler çocuk ve ergenlerde gelişimsel dönemlerine uygun olmayan tiroid, kan şekeri, cinsiyet hormonları düzeyi, büyüme hızı ve kemik metabolizmasını içeren pek çok yan etkiye neden olabilmektedir. Atipik antipsikotiklerin kilo aldırıcı etkileri açısından çocuklar daha fazla risk altında olup, yaşla uyumlu olmayan kilo artışı glukoz ve lipid anormallikleri ve kardiyovaskuler mortalite birlikteliği nedeni ile özellikle önemlidir. Aripiprazol ve ziprasidon metabolik yan etkiler açısından en az riske sahip antipsikotik ilaçlardır. Çocuk ve ergenlerde ağırlık artışı ve diyabet ile en fazla ilişkili olan antipsikotik ilaç ise olanzapindir. Çocuklarda karşılaştırmalı uzun süreli veriler olmamasına rağmen var olan bilgiler antipsikotiklerle uzun süreli tedavide dislipidemi ve bozulmuş glukoz toleransını içeren metabolik yan etkilerin alarm seviyesinde olduğunu öne sürmektedir. Hiperglisemi ve glukozüri gelişimi açısından en yüksek riskli ajanlar olanzapin ve klozapindir. Risperidon ve haloperidol kullanımında hiperprolaktinemi açısından dikkatli olunmalıdır. İştah supresyonu ve kilo kaybı ile birlikte olan antidepresanlar arasında selektif serotonin geri alım inhibitörleri, bupropion ve venlafaksin bulunmaktadır. Lityum, karbamazepin ve valproat tedavisiyle tiroid fonksiyonları etkilenebilmektedir. Valproatla birlikte en sık görülen yan etkinin kilo artışı olduğu rapor edilmiştir. Genç kızlarda valproat tedavisiyle hiperandrojenizm ve polikistik over sendromu gelişimi akılda tutulmalıdır.

[Endocrine and Metabolic Adverse Effects of Psychotropic Drugs in Children and Adolescents]

Much as an increase in the use of psychotropic drugs is observed in children and adolescents over the last decade, the endocrine and metabolic side effects of these drugs can limit their use. Atypical antipsychotics can cause many side effects, which are not suitable for the developmental periods of children and adolescents, such as those related with thyroid, blood sugar, level of sex hormones, growth rate and bone metabolism. Children are under a more serious risk regarding the weight increasing effects of atypical antipsychotics and weight gain that is not proportionate with age is especially important due to the association between glucose or lipid abnormalities and cardiovascular mortality. Aripiprazole and ziprasidone are the least risky antipsychotic drugs when it comes to metabolic side affects. The antipsychotic drug that is associated with weight increase and diabetes in children and adolescents most is olanzapine. Even though there are no comparative long-term data concerning children, it is suggested by the currently available information that metabolic side effects including dyslipidemia and impaired glucose tolerance are at an alarming level when it comes to long-term treatment with antipsychotics. The most risky agents in terms of hyperglycemia and glucosuria development are olanzapine and clozapine. Use of risperidone and haloperidol should be undertaken with caution since it may bring about the risk of hyperprolactinemia. Among the antidepressants associated with weight loss and suppression of appetite are selective serotonin reuptake inhibitors, bupropion and venlafaxine. Thyroid functions can be affected by lithium, carbamazepine and valproate treatments. It is reported that the side effect most frequently associated with valproate is weight increase. The relationship between valproate treatment and the development of hyperandrogenism and polycystic ovary syndrome in young women should also be kept in mind.

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