알렌드론산 나트륨

경구용 비스포스포네이트 / 골흡수 억제제

**알렌드론산 나트륨(Alendronate sodium)**은 주로 파골세포의 골흡수를 억제하는 데 사용되는 경구용 질소 함유 비스포스포네이트입니다. **주요 임상 요약:** * **주요 적응증:** 수의학에서는 난치성 고칼슘혈증(예: 고양이의 특발성 고칼슘혈증, 악성 종양으로 인한 고칼슘혈증), 고양이 파골세포성 치아 흡수 병변(FORLs), 골육종 또는 조직구 육종의 보조 치료제로 사용됩니다. * **시험적 사용 단계:** 소동물에서의 임상 경험은 아직 매우 제한적입니다. 복용량과 안전성 프로파일은 여전히 확립 중입니다. * **생체이용률의 한계:** 경구 흡수율이 매우 낮으며(<2%), 음식물에 의해 급격히 감소하므로 엄격한 금식 프로토콜이 필요합니다. * **식도 위험성:** 사람에서 심각한 식도 자극 및 미란을 유발하는 것으로 알려져 있으며, 반려동물에서는 위장관 통과를 빠르게 하기 위해 특수한 투여 기술(예: 물 먹이기, 입술에 버터 바르기)이 필요합니다.

작용 기전: Alendronate is a nitrogenous bisphosphonate that strongly binds to **hydroxyapatite** crystals in the bone matrix. * **Mechanism:** During bone resorption, the drug is locally released and endocytosed by **osteoclasts**. * **Intracellular Pathway:** Inside the osteoclast, alendronate inhibits the enzyme **farnesyl pyrophosphate synthase (FPPS)** within the mevalonate pathway → prevents the prenylation (lipid modification) of small GTP-binding proteins (such as Ras, Rho, and Rab) → disrupts osteoclast cytoskeletal organization and ruffled border formation → induces osteoclast **apoptosis**. * **Secondary Effects:** By inhibiting osteoclastogenesis and promoting apoptosis, it indirectly reduces angiogenesis and may inhibit cancer cell proliferation in osteogenic neoplasms.

동물 종별 용량

Cats

Feline odontoclastic resorptive lesions (FORLs) · 3 mg/kg · PO · q12h · Note: Use for this indication in cats is at present very controversial. (Plumb 2006)
Idiopathic hypercalcemia (after dietary change has been attempted) · Initially 2 mg/kg. Most cats respond to 10 mg (total dose). · PO · once weekly · Administer at least 6 mL of water after administration and butter the lips to increase salivation and increase transit. If efficacious, effects usually seen in 3-4 weeks. Monitor via serum ionized calcium.

Dogs

Refractory hypercalcemia · 0.5-1 mg/kg · PO · once daily
Investigational treatment of histiocytic sarcoma complex · Loading dose of 70 mg/m 2 (NOT mg/kg) · PO · daily for 14 days, then every other day for 14 days, then once weekly · Monitor for esophageal problems (excessive salivation, regurgitation).

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Esophageal abnormalities (e.g., strictures, achalasia) that delay esophageal emptying
Inability to stand or sit upright for 30 minutes post-administration (human guideline; veterinary relevance is managed via water chasers/activity)
Severe renal dysfunction (Creatinine Clearance < 35 mL/min)
Known hypersensitivity to alendronate or other bisphosphonates

이상반응

Upper GI irritation and erosions
Esophageal stricture or ulceration
Vomiting
Inappetence
Jaw osteonecrosis (rare but documented in humans)
Musculoskeletal pain
Hypocalcemia (with overdose)
Hypophosphatemia (with overdose)

약물 상호작용

Aspirin · Increased risk of upper GI adverse effects and erosions.
Calcium-containing oral products or food · Likely to significantly decrease the already low oral bioavailability of alendronate.
Ranitidine (IV) · Increased oral alendronate bioavailability two-fold in a human study.
NSAIDs · Humans taking NSAIDs with alendronate had no higher rates of GI adverse reactions than when NSAIDs were used with placebo, though caution is still advised. · moderate
Antacids (Aluminum, Magnesium, Calcium) · Significantly decreases alendronate absorption · major
Iron supplements · Decreases alendronate absorption · major

모니터링

Serum ionized calcium
Serum phosphorus
Serum potassium and sodium
Signs of GI adverse effects (excessive salivation, regurgitation, dysphagia, inappetence)

과용량

**Toxicity Profile:** No lethality was observed in dogs receiving doses up to 200 mg/kg. Lethality in rodents occurs at >550 mg/kg. **Clinical Signs of Overdose:** Hypocalcemia, hypophosphatemia, and severe upper GI reactions (ulceration, erosions). **Treatment:** * **DO NOT induce vomiting** due to the risk of severe esophageal irritation. * Administer **oral antacids or milk** immediately to bind the drug and prevent systemic absorption. * Monitor serum calcium and phosphorus levels closely. * Provide supportive care as needed.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.