아포모르핀

중추성 최토제 / 도파민 작용제

아포모르핀은 합성 아편양제제 유도체이지만 모르핀과 달리 유의미한 진통 효과는 없습니다. 수의학에서 섭취한 독성 물질을 신속하게 제거하기 위해 **개에게 가장 우선적으로 선택되는 최토제**로 널리 알려져 있습니다. * **신속한 작용:** 비경구(정맥/근육 주사) 또는 결막낭에 점안할 경우 매우 빠르게 구토를 유발합니다. * **종 특이성:** 개에게 매우 효과적입니다. 고양이의 경우 효과가 낮고 안전성 우려가 있어 사용에 논란이 있으며 일반적으로 권장되지 않습니다. * **한계점:** 다른 최토제와 마찬가지로 일반적으로 위 내용물의 40-60%(최대 80%)만 제거합니다. 구토 유발에 성공했다고 해서 추가적인 독성학적 모니터링이나 치료(예: 활성탄 투여)가 필요 없는 것은 아닙니다.

작용 기전: Apomorphine acts as a **non-selective dopamine agonist**. It directly stimulates **D2-dopaminergic receptors** in the **chemoreceptor trigger zone (CRTZ)** located in the area postrema of the medulla oblongata. **Mechanism Pathway:** Apomorphine administration → Crosses the blood-brain barrier → Stimulates D2 receptors in the CRTZ → Activates the central vomiting center → Initiates the emetic reflex. > **Clinical Pearl:** The CRTZ in dogs is highly sensitive to dopamine, making apomorphine highly effective. In contrast, the feline CRTZ is mediated primarily by alpha-2 adrenergic receptors, which is why alpha-2 agonists (like xylazine or dexmedetomidine) are the preferred emetics for cats, while apomorphine is often ineffective.

동물 종별 용량

Dogs

Induction of emesis · 0.03 mg/kg IV or 0.04 mg/kg IM (IV route preferred); alternatively a portion of tablet may be crushed in a syringe, dissolved with few drops of water and administered into the conjunctival sac. After sufficient vomiting occurs, rinse conjunctival sac free of unabsorbed apomorphine. · IV/IM/Topical · Once · IV route preferred.
Induction of emesis · 0.04 mg/kg IV or 0.08 mg/kg IM or SC · IV/IM/SC · Once
Induction of emesis · 0.04 mg/kg IV, 0.07 mg/kg IM, or 0.25 mg/kg into the conjunctival sac · IV/IM/Topical · Once
Induction of emesis · 0.2 mg/kg · SC · single dose · single dose · Authorized dose. Do not repeat if ineffective.
Induction of emesis · 20-40 μg/kg · IV · single dose · single dose · Non-authorized dose and route but some evidence suggests it is at least as effective.

Cats

Induction of emesis · 0.04 mg/kg IV or 0.08 mg/kg IM or SC · IV/IM/SC · Once · Use of apomorphine in cats is controversial and many recommend not using in this species.
Induction of emesis · Not recommended · IM · single dose · single dose · Xylazine is a potent emetic in cats and at least as safe.

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

투여 경로

IVIMSCTopical (conjunctival sac)

금기

Rodents and rabbits (unable to vomit or lack stomach wall strength)
Hypoxia, dyspnea, or shock
Lack of normal pharyngeal reflexes (risk of aspiration)
Seizuring, comatose, or severely CNS-depressed patients
Patients who have already vomited repeatedly
Ingestion of strong acids, alkalis, or other caustic agents (risk of esophageal/gastric rupture)
Ingestion of petroleum distillates (unless toxicity risk outweighs aspiration risk)
Ingestion of strychnine or other CNS stimulants (may precipitate seizures)
Oral opiate or other CNS depressant (e.g., barbiturates) toxicity
Hypersensitivity to morphine

이상반응

Protracted vomiting
CNS depression (lethargy, sedation)
CNS stimulation (excitement, restlessness)
Respiratory depression
Corneal ulcers (anecdotal, associated with conjunctival administration)

약물 상호작용

Antidopaminergic drugs (e.g., phenothiazines, metoclopramide) · May negate the emetic effects of apomorphine by blocking dopamine receptors in the CRTZ.
Ondansetron · May cause severe hypotension; concurrent use is contraindicated in humans.
Opiates or CNS/Respiratory depressants (e.g., barbiturates) · Additive CNS or respiratory depression may occur.
Antidopaminergics (e.g., phenothiazines) · May reduce the emetic effects of apomorphine · moderate
Opiates and CNS depressants · Additive CNS or respiratory depression · major

모니터링

CNS status (depression or excitement)
Respiratory rate and effort
Heart rate and rhythm
Vomitus (quantify volume, examine for toxic contents, and save for possible later analysis)

과용량

Excessive doses of apomorphine may result in: * Respiratory and/or cardiac depression * CNS stimulation (excitement, seizures) or severe CNS depression * Protracted vomiting **Treatment:** * **Naloxone** may reverse the CNS and respiratory depressant effects of the drug, but it **cannot** be expected to halt the vomiting. * **Atropine** has been suggested to treat severe bradycardias associated with overdose. * If protracted vomiting occurs from conjunctival administration, thoroughly flush the eye with sterile saline.

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