알로푸리놀

크산틴 산화효소 억제제

**알로푸리놀(Allopurinol)**은 수의학에서 널리 사용되는 강력한 **크산틴 산화효소 억제제**입니다. 주요 임상 적용 분야는 다음과 같습니다: * **요산염 요로결석:** 주로 개(특히 달마시안과 같은 호발 품종)에서 요산 결석을 용해하고 예방하는 데 사용됩니다. 크산틴 결석 형성을 방지하기 위해 반드시 저퓨린 식단과 병행해야 합니다. * **개 리슈만편모충증:** 리슈만편모충 증식 억제제로 작용합니다. 장기 관리를 위해 메글루민 안티모니에이트(meglumine antimoniate) 또는 밀테포신(miltefosine)과 병용하는 경우가 많습니다. * **조류 및 파충류 의학:** 조류와 파충류의 고요산혈증 관리 및 통풍 치료에 사용됩니다. *임상 팁:* 알로푸리놀은 크산틴의 요중 배설을 증가시키므로, 식이 퓨린 제한 없이 장기간 고용량으로 투여할 경우 역설적으로 크산틴 요로결석이 형성될 수 있습니다.

작용 기전: Allopurinol and its primary active metabolite, **oxypurinol** (alloxanthine), competitively inhibit the enzyme **xanthine oxidase**. * **Normal Pathway:** Hypoxanthine → **xanthine oxidase** → Xanthine → **xanthine oxidase** → Uric Acid * **Inhibition:** By blocking this enzyme, allopurinol prevents the conversion of oxypurines to uric acid. This decreases serum and urine concentrations of uric acid, while increasing the levels of the more water-soluble precursors (hypoxanthine and xanthine). **In Leishmaniasis:** Allopurinol acts as a purine analogue. *Leishmania* organisms mistakenly incorporate allopurinol metabolites into their RNA, which disrupts protein synthesis and inhibits parasite multiplication.

동물 종별 용량

Dogs

Urate uroliths (dissolution) · 15 mg/kg PO q12h; only in conjunction with low purine foods. · PO · q12h
Urate uroliths (prevention) · 10-20 mg/kg/day · PO · Daily · Preferable to minimize recurrence with dietary therapy to avoid xanthine uroliths.
Urate uroliths (dissolution and prevention) · 7-10 mg/kg PO three times daily · PO · TID · Goal is to reduce urine urate:creatinine ratio by 50%.
Leishmaniasis (First line treatment) · 10 mg/kg PO twice daily · PO · BID · 6-12 months · Used plus Meglumine antimoniate 75-100 mg/kg once daily for 4-8 weeks.
Leishmaniasis (Second line treatment) · 10 mg/kg PO twice daily · PO · BID · 6-12 months · Used plus Miltofosine 2 mg/kg PO once daily for 4 weeks OR allopurinol alone.
Leishmaniasis · 20 mg/kg PO q12h · PO · q12h · 9 months · With Meglumine antimoniate (100 mg/kg/day SQ) until resolution.
Leishmaniasis (Alternate protocol alone) · 10 mg/kg PO q8h or 10-20 mg/kg PO q12h · PO · q8h or q12h · 1-4 months
Leishmaniasis · 10 mg/kg PO twice daily · PO · BID · If possible use with meglumine antimoniate, if not, use alone.
Leishmaniasis (with renal insufficiency) · 5 mg/kg PO twice daily · PO · BID
Leishmaniasis · 15 mg/kg PO twice daily · PO · BID · months

투여 경로

POIV

금기

Known hypersensitivity to allopurinol
Red-tailed hawks (anecdotal reports of severe toxicity)

이상반응

Xanthine urolithiasis (especially with high doses or non-restricted diets)
Hypersensitivity reactions (rash, erythema)
Lethargy
Gastrointestinal upset
Hepatotoxicity (rare)
Bone marrow suppression (rare)

약물 상호작용

Chlorpropamide · May increase risks for hypoglycemia and hepato-renal reactions
Cyclophosphamide · Increased bone marrow depression may occur
Cyclosporine · Allopurinol may increase cyclosporine levels
Diuretics (Furosemide, Thiazides, Diazoxide) and Alcohol · Can increase uric acid levels, antagonizing allopurinol's effect
Oral Anticoagulants (e.g., Warfarin) · Allopurinol may reduce the metabolism of warfarin thereby increasing its effect
Trimethoprim/Sulfamethoxazole · Thrombocytopenia has occurred in a few human patients when used concurrently
Uricosuric Agents (e.g., Probenecid, Sulfinpyrazone) · May increase the renal excretion of oxypurinol and thereby reduce xanthine oxidase inhibition; additive effects on blood uric acid may be beneficial
Urinary Acidifiers (e.g., Methionine, Ammonium Chloride) · May reduce the solubility of uric acid in the urine and induce urolithiasis
Azathioprine · Allopurinol inhibits the metabolism of azathioprine, leading to severe, potentially fatal myelosuppression. · major
Mercaptopurine · Allopurinol inhibits the metabolism of mercaptopurine, significantly increasing toxicity risk. · major
Amoxicillin / Ampicillin · Concurrent use increases the risk of cutaneous rash. · moderate

모니터링

Urine uric acid (for urolithiasis)
Adverse effects (rash, lethargy)
Periodic CBC, liver and renal function tests (e.g., BUN, Creatinine, liver enzymes); especially early in therapy

과용량

Information on acute overdosage in veterinary species is limited. Massive overdoses may cause gastrointestinal distress (vomiting, diarrhea). Treatment should consist of supportive care and monitoring of renal function. Adequate hydration is important to promote diuresis and excretion.

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