아만타딘 염산염

항바이러스제 (인플루엔자 A); NMDA 수용체 길항제

**아만타딘(Amantadine)**은 원래 인플루엔자 A의 예방 및 치료를 위한 항바이러스제로 개발되었으나, 현대 수의학에서는 주로 **NMDA(N-메틸-D-아스파르트산) 수용체 길항제**로서의 특성을 활용합니다. 주요 임상 적용 분야는 다음과 같습니다: * **보조 진통제**: 주로 개와 고양이에서 만성, 신경병증성 또는 오피오이드 내성 통증(예: 중증 골관절염, 골육종)을 치료하는 데 사용됩니다. 단독 진통제로는 효과가 거의 없지만, NSAID, 오피오이드 또는 가바펜틴과 병용할 때 중추 감작(central sensitization)을 억제하는 데 탁월한 효과를 발휘합니다. * **말 인플루엔자**: 말-2형 인플루엔자 바이러스에 대해 연구되었으나, 높은 비용, 불규칙한 경구 흡수율, 정맥 투여 시 발작 위험 등으로 인해 임상적 사용은 제한적입니다. > **임상 핵심**: 아만타딘은 신경계가 통증 신호에 과민해지는 '와인드업(wind-up) 통증'(이질통 및 통각과민)을 치료하는 데 매우 중요한 약물입니다.

작용 기전: Amantadine has distinct mechanisms depending on the therapeutic target: * **Analgesia (NMDA Antagonism)**: Chronic pain causes excessive release of excitatory neurotransmitters (glutamate and aspartate). These bind to the **NMDA receptor** on postsynaptic neurons in the dorsal horn of the spinal cord. Amantadine acts as a non-competitive antagonist, blocking the open ion channel of the **NMDA receptor** → prevents calcium (Ca2+) influx → reduces central sensitization and "wind-up" pain. * **Antiviral**: Interferes with the **influenza A virus M2 transmembrane protein** → blocks the uncoating of the virus particle and prevents viral replication. * **Antiparkinsonian (Human)**: Potentiates dopaminergic neurotransmission in the CNS and exhibits mild anticholinergic activity.

동물 종별 용량

Dogs

Osteoarthritis pain when NSAIDs alone are not effective · 3-5 mg/kg PO once daily in addition to an NSAID · PO · q24h · Meloxicam at approved doses was used for this study.
Adjunctive therapy for chronic pain · 3-5 mg/kg PO once daily · PO · q24h
To decrease wind-up · 3-5 mg/kg PO once daily for one week · PO · q24h · 1 week
Analgesia (adjunct for chronic pain) · 3-5 mg/kg · PO · sid to bid · Chronic · Potentiates the effects of other analgesics. Often combined with NSAIDs.

Cats

Adjunctive therapy for chronic pain · 3 mg/kg PO once daily · PO · q24h · May be useful addition to NSAIDs; has not been evaluated for toxicity. May need to be compounded.
Adjunctive therapy for chronic pain · 3-5 mg/kg PO once daily · PO · q24h
Adjunctive therapy for chronic pain · 3 mg/kg PO once daily · PO · q24h
Analgesia (adjunct for chronic pain) · 3-5 mg/kg · PO · sid · Chronic · Liquid formulations may be bitter and difficult to administer.

Horses

Acute treatment of equine-2 influenza · 5 mg/kg IV q4h · IV · q4h · Not commonly used due to expense, PK variability, and seizure risk.

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

투여 경로

POIV

금기

Known hypersensitivity to amantadine or rimantadine
Untreated angle-closure glaucoma
Extra-label use in chickens, turkeys, and ducks (Prohibited by FDA)

이상반응

Agitation or restlessness (especially early in therapy)
Loose stools, flatulence, or diarrhea
Narrow safety margin in cats (potential for neurotoxicity)
Seizures (reported in horses given IV)

약물 상호작용

Anticholinergic drugs · May enhance the anticholinergic effects of amantadine.
CNS Stimulants (e.g., selegiline) · Concomitant use may increase the CNS stimulatory effects of amantadine.
Trimethoprim/sulfa, quinidine, quinine, thiazide diuretics, triamterene · May decrease the renal excretion of amantadine, yielding higher and potentially toxic blood levels.
Urinary acidifiers (e.g., methionine, ammonium chloride, ascorbic acid) · May increase the renal excretion of amantadine, potentially decreasing its efficacy.
Trimethoprim/Sulfamethoxazole · Decreased renal clearance of amantadine, potentially leading to toxicity · moderate
Anticholinergics · Increased anticholinergic side effects (e.g., dry mouth, urine retention) · minor
CNS stimulants · Increased risk of agitation, restlessness, or seizures · moderate

모니터링

Adverse effects (especially GI upset and agitation/behavioral changes)
Clinical efficacy (reduction in pain scores, improved mobility)

과용량

Overdoses are potentially very serious due to a fairly narrow therapeutic index. * **Cats**: Toxic dose reported is 30 mg/kg. Behavioral effects may be noted at 15 mg/kg. * **Dogs**: Behavioral effects noted at 15 mg/kg. * **Humans**: Overdoses as low as 2 grams have been fatal. Signs include cardiac dysfunction (arrhythmias, hypertension, tachycardia), pulmonary edema, CNS toxicity (tremors, seizures, psychosis, agitation, coma), hyperthermia, and renal dysfunction. **Treatment**: No specific antidote. Empty the gut if possible. Provide intensive monitoring and supportive therapy. Forced urine acidifying diuresis may increase renal excretion. Physostigmine has been suggested for cautious use in treating CNS effects.

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