デソキシコルチコステロンピバレート (DOCP)
**デソキシコルチコステロンピバレート (DOCP)** は、主に犬および猫の定型副腎皮質機能低下症（アジソン病）の管理に使用される、長時間作用型の注射用**鉱質コルチコイド**です。 * **臨床のポイント:** フルドロコルチゾンとは異なり、DOCPには糖質コルチコイド作用が**全くありません**。そのため、DOCPの投与を受ける患者は、特にストレス時や病気の際に、糖質コルチコイド（プレドニゾロンやヒドロコルチゾンの生理的用量など）の同時補充を受ける必要があります。 * 微結晶デポ懸濁液として製剤化されており、ゆっくりと溶解し、長期間（通常21〜30日）の作用持続時間を可能にします。
作用機序: DOCP acts as an exogenous analog of aldosterone. * **Target Site:** Acts primarily at the **renal distal tubule** and collecting ducts. * **Mechanism:** Binds to mineralocorticoid receptors → upregulates **Na+/K+ ATPase** pumps and epithelial sodium channels (ENaC) → increases the absorption of **sodium (Na+)** and enhances **potassium (K+)** and **hydrogen (H+)** ion excretion. * **Requirement:** To be effective, mineralocorticoids require a functioning kidney.
動物種別の用量
- Maintenance therapy of hypoadrenocorticism · 2.2 mg/kg IM every 25 days plus prednisolone (0.25-1 mg/cat PO twice daily; if daily oral dosing not feasible, may give 10 mg of methylprednisolone acetate once a month IM) · IM · q25d
- Maintenance therapy of hypoadrenocorticism · 10-12.5 mg (total dose) IM per month. Adjust dose based-upon follow-up serum electrolyte concentrations monitored every 1-2 weeks during initial maintenance period. Normal electrolyte values 2 weeks following injection, suggests adequate dosing, but does not provide information regarding duration of action. Prednisone at 1.25 mg PO once a day or IM methylprednisolone acetate 10 mg once a month can provide long-term glucocorticoid supplementation. · IM · monthly
- Hypoadrenocorticism · 2.2 mg/kg IM every 25 days · IM · q25d · Dosage requirements are variable and should be individualized to the patient.
- Hypoadrenocorticism · Initially, inject 2.2 mg/kg IM or SC every 25 days. Reevaluate at 12 and 25 days after initial injection. If hyponatremia and/or hyperkalemia are noted at 12 days, increase dose by 10%. If they are noted at 25 days (but not on day 12), shorten dosing interval by 2 days. · IM/SC · q25d
- Hypoadrenocorticism · 1.5-2.2 mg/kg IM q20-30 days · IM · q20-30d
- Hypoadrenocorticism · Initially, 2.2 mg/kg IM q25 days. If electrolytes remain in normal range at 30 days, reduce dose by 10% a month. In our clinic, we have used a dose of DOCP as low as 1 mg/kg q30 days with good control of hypoadrenocorticism. · IM · q25-30d
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Congestive heart failure
- Severe renal disease
- Edema
有害事象
- Injection site irritation
- Polyuria (PU)
- Polydipsia (PD)
- Hypernatremia
- Hypokalemia
- Hypertension
- Edema
- Weight gain (fluid retention)
薬物相互作用
- Amphotericin B · Patients may develop hypokalemia if mineralocorticoids are administered concomitantly.
- Aspirin · DOCP may reduce salicylate levels.
- Digoxin · Because DOCP may cause hypokalemia, it should be used with caution and increased monitoring when used in patients receiving digitalis glycosides.
- Insulin · Potentially, DOCP could increase the insulin requirements of diabetic patients.
- Potassium-depleting diuretics (e.g., furosemide, thiazides) · Patients may develop hypokalemia if administered concomitantly; as diuretics can cause a loss of sodium, they may counteract the effects of DOCP.
モニタリング
- Serum electrolytes (Na+, K+)
- BUN and Creatinine (initially every 1-2 weeks, then once stabilized, every 3-4 months)
- Body weight
- Physical examination for edema
過量投与
Overdosage may cause polyuria, polydipsia, hypernatremia, hypertension, edema, and hypokalemia. Cardiac enlargement is possible with prolonged overdoses. Excessive weight gain may be indicative of fluid retention secondary to sodium retention. **Treatment:** * Electrolytes should be aggressively monitored. * Potassium may need to be supplemented. * Discontinue the drug in patients until clinical signs associated with overdosage have resolved, then restart the drug at a lower dosage.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。