サクシマー
サクシマー（DMSA）は、主に小動物や鳥類の**鉛中毒**の治療に使用される経口重金属キレート剤です。ジメルカプロール（BAL）の水溶性アナログですが、経口投与が可能であり、治療指数が広いという大きな利点があります。 * **対象毒素:** 鉛（Pb）に対して非常に有効であり、ヒ素（As）や水銀（Hg）中毒にも有効な可能性があります。 * **安全性:** 一般的に安全で効果的です。亜鉛、銅、鉄などの必須微量元素を過剰にキレートすることはなく、消化管からの鉛の吸収を促進することもありません。 > **臨床のポイント:** 小動物の鉛中毒において、サクシマーは自宅で経口投与でき、腎毒性が低く、必須ミネラルを急激に枯渇させないため、CaEDTAよりも好まれることがよくあります。
作用機序: Succimer acts as a heavy metal chelator through its **sulfhydryl (-SH) groups**. * **Binding:** The sulfhydryl groups physically bind (chelate) heavy metal ions (such as **lead, mercury, and arsenic**) in the bloodstream and tissues. * **Complex Formation:** Heavy metal + Succimer → **Water-soluble chelate complex**. * **Excretion:** These stable, water-soluble complexes are subsequently filtered by the kidneys and excreted safely in the urine, thereby reducing the heavy metal burden in the body.
動物種別の用量
- Lead poisoning · 10 mg/kg PO three times daily for 5 days, followed by 10 mg/kg PO twice daily for 2 weeks · PO · TID then BID · 19 days
- Lead poisoning · 10 mg/kg PO q8h · PO · q8h · 10 days · Blood lead levels should be rechecked a few days following the last dose; a second round may be necessary.
- Lead poisoning · 15-35 mg/kg PO twice daily · PO · BID · 5 days
- Lead poisoning · 30 mg/kg PO twice daily · PO · BID · minimum of 7 days · If severe neurologic signs, may supplement with one dose of CaEDTA (<50 mg/kg IM).
- Lead poisoning · 10 mg/kg PO q8h · PO · q8h · 10 days · Blood lead levels should be rechecked a few days following the last dose; a second round may be necessary.
- Lead poisoning · 10 mg/kg PO three times daily for 5 days, followed by 10 mg/kg PO twice daily for 2 weeks · PO · TID then BID · 19 days
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
- Hypersensitivity to succimer
- Continued exposure to the lead source (source must be removed prior to or concurrently with therapy)
有害事象
- Gastrointestinal upset (vomiting, diarrhea)
- Flu-like symptoms (fatigue, body aches)
- Increased liver enzymes (AST, ALT)
- Rash
- Unpleasant sulfurous odor imparted to breath, saliva, urine, and feces
薬物相互作用
- Other chelating agents (CaEDTA, dimercaprol, trientine, penicillamine) · Concomitant use is not recommended in humans due to potential for increased toxicity or altered efficacy.
モニタリング
- Blood lead levels (recheck a few days after completing therapy)
- Gastrointestinal adverse effects
- Liver enzymes (AST, ALT)
- Hydration status
過量投与
### Overdose & Toxicity * **Dogs:** Succimer has a relatively wide margin of safety. Doses up to 200 mg/kg/day did not cause overt toxicity. However, massive doses (300 mg/day) caused fatalities, primarily presenting with **kidney and GI tract lesions**. * **Birds:** Cockatiels are particularly sensitive to high doses. Doses of 80 mg/kg PO q12h caused a significant number of fatalities, whereas 40 mg/kg q12h did not. * **Treatment:** If an acute overdose occurs, standardized gut evacuation (emesis/lavage) followed by activated charcoal protocols are recommended.
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。