スクラルファート
スクラルファートは、局所的に作用する**胃腸粘膜保護薬**であり、主に口腔、食道、胃、十二指腸の潰瘍の治療および管理に使用されます。また、薬物（NSAIDsやアスピリンなど）による胃のびらんを予防するために使用されることもありますが、予防効果は不安定であると考えられています。 > **臨床のポイント：** 獣医学において、スクラルファートはしばしば胃腸管の「液体絆創膏」と表現されます。潰瘍を適切にコーティングするためには酸性環境が必要であるため、食事や他の制酸薬（H2ブロッカーやプロトンポンプ阻害薬など）との投与間隔が非常に重要です。 ヒト医療では、腎不全に続発する高リン血症の患者に対するリン吸着薬として使用されてきましたが、獣医学的研究（健康な猫など）では、血清リン濃度を低下させる効果について一貫性のない、または有意でない結果が示されています。
作用機序: Sucralfate exerts a **local, non-systemic effect** on the gastrointestinal mucosa. * **Polymerization:** After oral administration, sucralfate reacts with hydrochloric acid (HCl) in the stomach → undergoes cross-linking → forms a highly viscous, paste-like complex. * **Barrier Formation:** This complex carries a strong negative charge and binds tightly to the positively charged **proteinaceous exudates** (like albumin and fibrinogen) found at ulcer sites. This forms an insoluble physical barrier that protects the ulcerated tissue from further degradation by **pepsin**, acid, and bile salts. * **Enzyme & Bile Acid Inactivation:** Sucralfate directly inactivates **pepsin** and binds to bile acids, reducing their mucosal toxicity. * **Cytoprotection:** It exhibits cytoprotective properties, likely mediated through the local stimulation and release of **prostaglandin E2 (PGE2)** and **prostaglandin I2 (PGI2)**, which enhance mucosal blood flow and mucus/bicarbonate secretion. *Note: Sucralfate does not significantly alter gastric acid output or pancreatic enzyme activity.*
動物種別の用量
- General dosing · 0.25-0.5 grams PO q8-12h · PO · q8-12h
- Empirical dosage · ¼ of a 1 gram tablet per cat PO three to four times a day. · PO · TID-QID
- For gastric ulcers, esophagitis · 0.25-0.5 grams PO per cat PO q8-12h · PO · q8-12h
- General dosing · 75 mg/kg PO q4-6h; give 10 minutes prior to feeding · PO · q4-6h
- For adjunctive treatment (used with acid suppressive drugs) for preventing stress-induced ulcers in foals · 10-20 mg/kg PO q6-8h · PO · q6-8h
- For treating equine gastric ulcer syndrome · 20-40 mg/kg PO q8h · PO · q8h
- Right dorsal colitis (colonic ulcers) · 22 mg/kg PO q6-8h · PO · q6-8h · Sucralfate alone may not be beneficial in treatment of equine gastric ulcer syndrome, but can be used in conjunction with acid-suppressive therapy and may be more suited for treatment of right dorsal colitis.
- For esophagitis · 0.5-1 gram PO three times a day. Suspensions are more therapeutic than intact tablets. · PO · TID
- General dosing · For large dogs: 1 gram PO q8; for smaller dogs: 0.5 gram PO q8h · PO · q8h
投与経路
禁忌
- No absolute contraindications
- Use with caution in patients with decreased gastrointestinal transit times (e.g., megacolon, ileus) due to the risk of constipation
- Known hypersensitivity to sucralfate
有害事象
- Constipation (most common in dogs and humans)
- Vomiting (reported primarily in cats)
- Constipation (most common)
- Hypophosphatemia (rare, with prolonged use)
薬物相互作用
- Azithromycin · Decreased oral absorption; separate dosing by at least 2 hours
- Ciprofloxacin / Enrofloxacin (and other oral fluoroquinolones) · Decreased oral absorption; separate dosing by at least 2 hours
- Diclofenac · Decreased oral absorption; separate dosing by at least 2 hours
- Digoxin · Decreased oral absorption; separate dosing by at least 2 hours · moderate
- Doxycycline · Decreased oral absorption; separate dosing by at least 2 hours
- Erythromycin · Decreased oral absorption; separate dosing by at least 2 hours
- Ketoconazole · Decreased oral absorption; separate dosing by at least 2 hours
- Levothyroxine · Decreased oral absorption; separate dosing by at least 2 hours
- Penicillamine · Decreased oral absorption; separate dosing by at least 2 hours
- Tetracycline · Decreased oral absorption; separate dosing by at least 2 hours
- Theophylline · Decreased oral absorption; separate dosing by at least 2 hours
- Vitamins (fat soluble) · Decreased oral absorption; separate dosing by at least 2 hours
- Warfarin · Decreased oral absorption; separate dosing by at least 2 hours
モニタリング
- Clinical efficacy (resolution of vomiting, melena, anorexia, or abdominal pain)
- Endoscopic examination of ulcer healing
- Fecal occult blood
- Resolution of clinical signs of GI ulceration (e.g., vomiting, melena, anorexia)
- Fecal consistency (monitor for constipation)
過量投与
Overdosage is highly unlikely to cause any significant systemic problems due to minimal absorption. Laboratory animals receiving massive doses up to 12 grams/kg orally demonstrated no incidence of mortality. The primary concern with a massive overdose would be constipation.
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。