Лекарственные средства, ассоциированные с лекарственно-индуцированным паркинсонизмом

Лекарственно-индуцированный паркинсонизм (ЛИП) – одно из самых частых экстрапирамидных нарушений, которое развивается на фоне назначения большого ряда лекарственных средств (ЛС). Изначально ЛИП был описан как нежелательная реакция (НР) на фоне применения антипсихотических ЛС, но позже признан НР ряда других препаратов, включая прокинетики, антидепрессанты, блокаторы кальциевых каналов и противоэпилептические ЛС. Относительный риск развития ЛИП на фоне приема типичных антипсихотиков увеличен в 2,92 раза по сравнению с пациентами, которые не принимают эти препараты. Риск развития ЛИП у пациентов, получающих флунаризин, повышен в 2,75–4,07 раз. Риск ЛИП при применении антидепрессантов увеличен в 2,14 раза. Среди препаратов этой группы с повышенным риском развития ЛИП чаще всего ассоциирован прием селективных ингибиторов обратного захвата серотонина (относительный риск 1,24). Среди других препаратов из группы антидепрессантов имеются данные о развитии ЛИП на фоне применения дулоксетина, миртазапина, амитриптиллина, кломипрамина, венлафаксина, тразодона. Среди антиконвульсантов ЛИП достаточно редко может развиваться на фоне назначения вальпроевой кислоты, габапентина, прегабалина, карбамазепина, окскарбазепина. Риск ЛИП у пациентов, получающих метоклопрамид, крайне низок (0,06%), однако он в 2,16 раза выше, чем у лиц, которые не принимают данное ЛС. Среди ЛС из других групп ЛИП может возникать на фоне применения карбоната лития, такролимуса, циклоспорина, амиодарона, каптоприла, амфотерицина В. При развитии у пациента ЛИП по возможности необходимо снизить дозу или отменить препарат-индуктор, или заменить его на другое ЛС с минимальным риском ЛИП. Симптомы ЛИП чаще всего регрессируют в течение нескольких недель или месяцев после уменьшения дозы или отмены ЛС-индуктора. Если симптомы сохраняются дольше, то необходимо исключить наличие у пациента болезни Паркинсона или деменции с тельцами Леви.

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