아스피린

비스테로이드성 항염증제 (NSAID) / 혈소판 응집 억제제

**아스피린(아세틸살리실산)**은 진통, 해열, 항염증 특성으로 인해 다양한 수의학 종에서 활용되는 고전적인 비스테로이드성 항염증제(NSAID)입니다. 통증 관리 외에도 아스피린은 **항혈소판 효과**로 인해 수의학에서 독특한 가치를 지닙니다. 개(예: 면역 매개성 용혈성 빈혈, 심장사상충증 또는 사구체 질환)와 고양이(예: 비대성 심근병증에 속발하는 동맥 혈전색전증 예방)에서 항혈전제로 자주 사용됩니다. > **임상 요점:** 고양이에게 아스피린을 사용할 때는 극도의 주의가 필요합니다. 고양이는 살리실산 대사를 담당하는 간 효소인 **글루쿠로닐 전이효소(glucuronyl transferase)**가 상대적으로 결핍되어 있습니다. 이로 인해 반감기가 크게 연장되어(개의 경우 약 8시간인 반면 고양이는 최대 45시간), 너무 자주 투여할 경우 치명적인 축적 및 독성에 매우 취약해집니다.

작용 기전: Aspirin exerts its effects primarily through the **irreversible inhibition of cyclooxygenase (COX) enzymes**, with a strong affinity for **COX-1**. - **Anti-inflammatory & Analgesic:** Inhibits COX-1 (and to a lesser extent COX-2) → decreases synthesis of pro-inflammatory **prostaglandins**. - **Antiplatelet Effect:** Irreversibly acetylates COX-1 in platelets → blocks the synthesis of **Thromboxane A2 (TXA2)**, a potent inducer of platelet aggregation and vasoconstriction. Because platelets lack a nucleus, they cannot synthesize new COX enzymes; thus, the antiplatelet effect lasts for the lifespan of the platelet (typically 7-10 days). - **Gastric Protection Modulator:** While aspirin does not directly inhibit COX-2, it modifies it to interact with lipoxygenase (LOX) → produces **aspirin-triggered lipoxin (ATL)**, which provides some gastric mucosal protective actions, potentially explaining why gastric damage may decrease with chronic use.

동물 종별 용량

Dogs

For analgesia · 10 mg/kg PO q12h · PO · q12h · Recommend using buffered varieties of aspirin in dogs.
As an antiinflammatory/antirheumatic · 25 mg/kg PO q8h · PO · q8h
For antipyrexia · 10 mg/kg PO twice daily · PO · twice daily
Post-Adulticide therapy for heartworm disease · 7-10 mg/kg PO once a day · PO · once a day
For adjunctive therapy in IMHA (antithrombotic) · 0.5 mg/kg PO twice daily · PO · twice daily · At this low dose risk for gastric ulceration is low, but adding misoprostol may reduce the risk.
For adjunctive therapy of glomerular disease (antithrombotic) · 0.5 mg/kg PO q24h · PO · q24h
For adjunctive therapy with azathioprine and glucocorticoids for immune-mediated hemolytic anemia · 0.5 mg/kg PO once daily · PO · once daily
As an analgesic/antiinflammatory prior to elective intraocular surgery · 6.5 mg/kg two to three times daily · PO · two to three times daily
Reduction of platelet aggregation (e.g. IMHA) · 0.5-1 mg/kg · PO · q24h · Alternatively 0.5 mg/kg p.o. q12h. Doses are anecdotal.
Analgesia, pyrexia, inflammation · 10-20 mg/kg · PO · q12h · Safety and efficacy of this dose has not been established.

Birds

투여 경로

금기

Known hypersensitivity to salicylates
Active gastrointestinal bleeding or ulcers
Bleeding disorders (relative contraindication)
Asthma (relative contraindication)
Renal insufficiency (relative contraindication)
Pregnancy (especially later stages; low-grade teratogen and may delay labor)

이상반응

Gastric irritation (nausea, anorexia, vomiting)
Gastrointestinal ulceration and occult blood loss
Secondary anemia or hypoproteinemia (due to chronic GI blood loss)
Metabolic acidosis (especially in cats)
Hypersensitivity reactions (rare in dogs)

약물 상호작용

Alkalinizing drugs (e.g., sodium bicarbonate, acetazolamide) · Significantly increases the renal excretion of salicylates; carbonic anhydrase inhibitors may cause systemic acidosis and increase CNS salicylate levels, leading to toxicity.
Aminoglycosides · May increase the likelihood of nephrotoxicity. · major
Corticosteroids · May increase salicylate clearance (decreasing serum levels) and significantly increase the risk of gastrointestinal ulceration and bleeding.
Digoxin · Aspirin may increase plasma levels of digoxin by decreasing its clearance.
Furosemide · May compete with renal excretion of aspirin, delaying its elimination and potentially causing toxicity at high doses.
Heparin or Oral Anticoagulants · Increased risk of bleeding due to synergistic antiplatelet/anticoagulant effects.
Methotrexate · Aspirin may displace methotrexate from plasma proteins, increasing the risk of methotrexate toxicity.
Other NSAIDs · Increased risk of severe GI ulceration. A washout period of 3-10 days is recommended when switching from aspirin to a COX-2 selective NSAID. · major
Phenobarbital · May increase the rate of aspirin metabolism by inducing hepatic enzymes.
Probenecid, Sulfinpyrazone · Aspirin may antagonize the uricosuric effects of these drugs.
Spironolactone · Aspirin may inhibit the diuretic activity of spironolactone.

모니터링

Analgesic and/or antipyretic efficacy
Bleeding times (if indicated)
Packed Cell Volume (PCV)
Stool guaiac tests (for occult GI bleeding)
Acid-base status (in cases of overdose)

과용량

**Clinical Signs of Acute Toxicity:** - **Early signs:** Depression, vomiting (may be blood-tinged), anorexia, hyperthermia, panting/increased respiratory rate. - **Acid-Base Disturbances:** Initially, a respiratory alkalosis occurs due to hyperventilation, followed by a profound metabolic acidosis. - **Severe signs:** Muscular weakness, pulmonary and cerebral edema, hypernatremia, hypokalemia, ataxia, seizures, coma, and death. **Treatment Protocol:** 1. **Decontamination:** Emesis (if within 12 hours of ingestion), activated charcoal, and an oral cathartic. Gastric lavage with 3-5% sodium bicarbonate may delay absorption. 2. **Fluid Therapy:** IV fluids (e.g., Dextrose 5% in water) to correct dehydration. 3. **Alkaline Diuresis:** Forced alkaline diuresis with sodium bicarbonate enhances renal excretion, but should only be attempted if acid-base status can be monitored. Mannitol (1-2 g/kg/hr) may enhance diuresis. 4. **Supportive Care:** GI protectants. Control seizures with IV diazepam. 5. **Coagulopathy Management:** Phytonadione (Vitamin K1) at 2.5 mg/kg divided q8-12h and ascorbic acid (though ascorbic acid may negate urinary alkalinization). 6. **Heroic Measures:** Peritoneal dialysis or exchange transfusions in severe cases.

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