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ピモベンダン

Pimobendan

4,5-Dihydro-6-[2-(p-methyoxyphenyl)-5benzimidazolyl]-5-methyl-3(2H)pyridazinone

強心血管拡張薬（陽性変力薬および血管拡張薬）POIV犬猫

別名: Vetmedin · Acardi · Cardisure · Pimocard · Fortekor-Plus · UDCG-115 · Pimobendanum

VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス

0.5 mg/kg total daily dose. Divide daily dose into two portions that are not necessarily equal (using whole and half tablets) and administer approximately 12 hours apart.PO· Divided q12h
— 🐕

用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。

動物種別用量

🌎 NA — North America🌍 EU — Europe

犬

適応用量経路頻度期間地域
Management of the signs of mild, moderate or severe congestive heart failure due to AV valve insufficiency or dilated cardiomyopathy0.5 mg/kg total daily dose. Divide daily dose into two portions that are not necessarily equal (using whole and half tablets) and administer approximately 12 hours apart.PODivided q12h—🌎 NA
Treatment of congestive heart failure secondary to myxomatous mitral valve disease (MMVD)0.4-0.6 mg/kg PO divided twice dailyPODivided twice daily—🌎 NA
Treatment of heart failure secondary to dilated cardiomyopathy or chronic mitral valve insufficiency0.25 mg/kg PO twice dailyPOTwice daily—🌎 NA
General dosing0.2-0.6 mg/kg PO divided q12hPODivided q12h—🌎 NA
Adjunctive drug for the emergency treatment of CHF (if not overtly critical and a strong positive oral inotrope is needed)0.1-0.3 mg/kg PO q12hPOq12h—🌎 NA
Adjunctive treatment of acute or chronic stage D heart failure (refractory to standard treatment)0.3 mg/kg PO to three times dailyPOUp to TID—🌎 NA
Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD0.15 mg/kgIVsingle doseSingle dose, transition to PO 12 hours later🌍 EU
Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD0.1-0.3 mg/kgPOq12hLifelong🌍 EU
  • Adjunctive treatment of acute or chronic stage D heart failure (refractory to standard treatment): Outside of FDA-approved labeling; requires client consent.
  • Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD: Oral pimobendan can be continued 12 hours after administration of the injection.
  • Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD: Administer 1 hour before food.

猫

適応用量経路頻度期間地域
Management of myocardial failure (DCM), especially if not associated with taurine deficiency1.25-1.5 mg/cat PO q12hrsPOq12h—🌎 NA
Heart failure associated with systolic dysfunction (Off-label)0.1-0.3 mg/kgPOq12hLifelong🌍 EU
  • Management of myocardial failure (DCM), especially if not associated with taurine deficiency: Off-label use. Little information about clinical efficacy due to rarity of condition.
  • Heart failure associated with systolic dysfunction (Off-label): Not authorized (off-label). Pharmacokinetics may differ from dogs. Administer 1 hour before food.

用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。

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概要

ピモベンダンは、​強心血管拡張薬（イノジレーター）​に分類される非常に有効な循環器薬であり、陽性変力作用（心収縮力の増強）と血管拡張作用の両方を併せ持ちます。

​主な臨床用途:​

  • ​犬:​ 主に​拡張型心筋症（DCM）​または​粘液腫性/変性性僧帽弁疾患（MMVD）​に続発するうっ血性心不全（CHF）の治療に使用されます。従来のACE阻害薬/フロセミド療法単独と比較して、生存期間と生活の質を大幅に改善します。ドーベルマンのDCMに対する第一選択薬と見なされており、ACVIMステージCおよびDの心不全管理の基礎となります。
  • ​猫:​ 拘束型および拡張型心筋症に対して適応外使用されます。陽性変力作用があるため、肥大型心筋症（HCM）には通常禁忌です。

​臨床のポイント:​ モノグラフでは前臨床段階での使用に関する研究が進行中であると記されていますが、画期的なEPIC試験により、前臨床段階（ACVIMステージB2）のMMVDの犬における心不全の発症を遅らせるための標準治療としてピモベンダンが確立されています。

作用機序

Pimobendan exerts its dual inodilator effects through two distinct mechanisms:

  1. ​Positive Inotropy (Calcium Sensitization):​ It increases the sensitivity of the cardiac myofilament Troponin C to intracellular calcium → enhances cardiac contractility. Unlike older inotropes (e.g., digoxin), it achieves this without increasing intracellular calcium levels → no increase in myocardial oxygen consumption.
  2. ​Vasodilation (PDE-III Inhibition):​ It inhibits the enzyme ​phosphodiesterase III (PDE-III)​ in vascular smooth muscle → prevents the breakdown of cAMP → ↑ intracellular cAMP → smooth muscle relaxation → mixed arterial and venous dilation. This reduces both cardiac preload and afterload.

Additionally, pimobendan possesses mild antithrombotic activity.

安全性・警告

禁忌

  • Hypersensitivity to pimobendan
  • Hypertrophic cardiomyopathy (HCM)
  • Aortic stenosis
  • Any condition where augmentation of cardiac output is inappropriate for functional or anatomic reasons
  • Any condition where augmentation of cardiac output via increased contractility is not possible anatomically or functionally

有害事象

  • Poor appetite
  • Diarrhea
  • Dyspnea
  • Azotemia
  • Weakness and ataxia
  • Pleural effusion
  • Syncope
  • Cough
  • Ascites
  • Heart murmur
  • Arrhythmias (atrial fibrillation, increased ventricular ectopic beats)
  • Worsening mitral valve lesions (acute hemorrhages, endocardial papilloform hyperplasia) with chronic use
  • Moderate positive chronotropic effect (tachycardia)
  • Vomiting (dose-dependent)
  • Reduced appetite or lethargy (rare)

注意事項

Use with caution in patients with uncontrolled cardiac arrhythmias.

Safety has not been evaluated in:

  • Dogs younger than 6 months of age
  • Dogs with congenital heart defects
  • Dogs with diabetes mellitus or other serious metabolic diseases
  • Breeding, pregnant, or lactating animals (high doses in lab animals caused increased resorptions)

​Note:​ Patients treated chronically should be regularly examined for worsening mitral valvular lesions and regurgitation.

医薬品相互作用

Verapamil

Calcium antagonist; attenuates pimobendan-induced increases in cardiac contractility.

Propranolol

Beta-antagonist; attenuates pimobendan-induced increases in cardiac contractility.

Diltiazem

Calcium channel blocker; assumed to potentially attenuate positive inotropic effects.

Atenolol

Beta-blocker; assumed to potentially attenuate positive inotropic effects.

Beta-blockers (e.g., atenolol, propranolol)Moderate

Attenuates the positive inotropic effects of pimobendan

Calcium-channel blockers (e.g., verapamil, diltiazem)Moderate

Attenuates the positive inotropic effects of pimobendan

監視

  • ECG (rate and rhythm)
  • Blood pressure
  • Echocardiography (cardiac function and valve lesions)
  • Clinical signs of heart failure (coughing, exercise intolerance)
  • Resting respiratory rate (RRR) at home
  • Heart rate and rhythm
  • Respiratory rate and effort (Resting Respiratory Rate - RRR)
  • Echocardiographic parameters (fractional shortening, left atrial/ventricular dimensions)
  • Clinical signs of congestive heart failure

薬物動態

半減期

猫Pharmacokinetics may differ from dogs; generally considered to have a longer half-life in cats.犬Pimobendan: ~0.5 hours; Active metabolite: ~2 hours

吸収

Peak levels of parent compound and active metabolite observed 1-4 hours post-dose. Food decreases bioavailability of aqueous solutions (effect on chewable tablets is unknown).

分布

Steady-state volume of distribution is 2.6 L/kg. Protein binding of pimobendan and active metabolite in dog plasma is >90%.

代謝

Oxidatively demethylated to a pharmacologically active metabolite, which is then conjugated with sulfate or glucuronic acid.

消失

Excreted mainly via feces. Clearance is approximately 90 mL/min/kg.

過剰投与

Overdoses primarily manifest as cardiovascular signs.

​Clinical Signs:​

  • Tachycardia (dose-dependent increases in heart rate)
  • Mild, non-clinical heart murmurs
  • Hypotension

​Treatment:​

  • ​Decontamination:​ Induce emesis and administer activated charcoal if exposure was recent.
  • ​Monitoring:​ Continuously monitor heart rate, blood pressure, and ECG.
  • ​Supportive Care:​ Control hypotension with IV fluids and dopamine if necessary.

製品

製剤

  • Injectable: 0.75 mg/ml solution
  • Oral: 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured chewable tablets
  • Oral: 5 mg hard capsules
  • Compound Oral: 1.25 mg pimobendan / 2.5 mg benazepril tablets
  • Compound Oral: 5 mg pimobendan / 10 mg benazepril tablets

動物用医薬品

  • Vetmedin Chewable Tablets: 1.25 mg, 2.5 mg, 5 mg
  • Vetmedin 0.75 mg/ml injectable solution
  • Vetmedin 1.25 mg, 5 mg, 10 mg chewable tablets
  • Vetmedin 5 mg hard capsules
  • Cardisure 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured tablets
  • Pimocard 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured tablets
  • Fortekor-Plus (pimobendan/benazepril combination tablets)

ヒト用医薬品

  • None

規制ステータス

European Union✓ 承認済み処方箋医薬品EMA
🐕 Dogs

Licensed for preclinical DCM in Dobermanns and preclinical MMVD.

United Kingdom✓ 承認済み処方箋医薬品VMD
🐕 Dogs

POM-V classification.

規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

保管・安定性

Store chewable tablets or capsules at room temperature below 25°C (77°F) in a dry place.

飼主向け情報

ピモベンダンは、ペットの心臓がより効果的に血液を送り出すのを助け、血管を広げて心臓への負担を軽減する薬です。

  • ​投与方法:​ 適切に吸収されるように、​空腹時​（理想的には食事の1時間前）にこの薬を与えてください。
  • ​厳密なスケジュール:​ 獣医師の指示に従い、正確に12時間間隔で投与するようにしてください。
  • ​生涯にわたる治療:​ ピモベンダンは心不全を管理するための治療薬であり、完治させるものではありません。通常、ペットの生涯にわたって必要となります。獣医師に相談せずに​この薬の投与を中止しないでください​。
  • ​自宅でのモニタリング:​ 睡眠中のペットの呼吸数（安静時呼吸数）を観察してください。継続して1分間に30回を超える場合は、獣医師に連絡してください。
  • ​安全性:​ 子供や他の動物の手の届かないところに保管してください。

VetSheet医薬品リファレンスは獣医専門家の臨床意思決定支援を目的としており、専門的判断または製造業者の最新医薬品情報の代替にはなりません。