카르바마제핀
카르바마제핀은 삼환계 항우울제인 이미프라민과 화학적으로 관련된 디벤조아제핀 이미노스틸벤 유도체입니다. > **임상 요점:** 인의에서는 주요 항경련제 및 기분 안정제로 널리 사용되지만, 수의학(특히 개)에서의 유용성은 빠른 간 자가유도(autoinduction)로 인해 심각하게 제한됩니다. 개는 치료 며칠 후 이 약물을 매우 빠르게 대사하므로 치료 혈청 농도를 유지하는 것이 극히 어렵습니다. 이러한 약동학적 한계 때문에 동물의 발작 조절에 사용되는 경우는 드뭅니다. 대신 수의학에서는 주로 다음과 같은 용도로 사용됩니다: * 개의 **행동 의학** (예: 편도체 과활성 또는 폭발적 공격성 관리, 종종 SSRI와 병용). * 말의 **신경병증성 통증** 또는 시프로헵타딘과 같은 다른 치료에 반응하지 않는 **광과민성 머리 흔들기(photic head shaking)**와 같은 특정 신경 질환.
작용 기전: Carbamazepine primarily acts by **blocking voltage-gated sodium channels** in neuronal membranes. * **Mechanism:** Binds preferentially to the inactive state of sodium channels → delays their recovery → **inhibits repetitive neuronal firing** and stabilizes hyperexcited neural membranes. * It also decreases the synaptic transmission of excitatory impulses and may reduce the release of the excitatory neurotransmitter glutamate. * Structurally related to tricyclic antidepressants, it also possesses mild anticholinergic, antidiuretic, and muscle relaxant properties.
동물 종별 용량
- For photic head shaking · 10 mg/kg PO q6h or 29 mg/kg PO q12h · PO · q6h or q12h · May be helpful in some horses that do not respond to cyproheptadine.
- As a psychotherapeutic agent · 4-8 mg/kg PO q12h · PO · q12h · Not commonly used, but may have some utility in dogs that seem to have amygdalar hyperactivity; sometimes used in conjunction with SSRIs to control explosive aggression.
용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.
투여 경로
금기
- Patients receiving MAO Inhibitors (e.g., selegiline) within the past 14 days
- Patients with a history of bone marrow depression
- Known hypersensitivity to carbamazepine or tricyclic antidepressants
이상반응
- Sedation and lethargy
- Ataxia (unsteadiness)
- Gastrointestinal upset (vomiting, anorexia)
- Hepatotoxicity (elevated liver enzymes)
- Blood dyscrasias (rare but possible bone marrow suppression)
약물 상호작용
- Azole Antifungals (e.g., Ketoconazole, Itraconazole) · May increase plasma levels or effects of carbamazepine
- Calcium Channel Blockers (e.g., Diltiazem, Verapamil) · May increase plasma levels or effects of carbamazepine; Carbamazepine may also decrease their effects
- Cimetidine · May increase plasma levels or effects of carbamazepine
- Danazol · May increase plasma levels or effects of carbamazepine
- Grapefruit Juice · May increase plasma levels or effects of carbamazepine
- Isoniazid · May increase plasma levels or effects of carbamazepine; Carbamazepine may also increase effects of Isoniazid
- Macrolides (e.g., Erythromycin, Clarithromycin) · May increase plasma levels or effects of carbamazepine
- MAO Inhibitors (e.g., Selegiline) · Contraindicated; discontinue MAOI at least 14 days prior to carbamazepine
- Niacin · May increase plasma levels or effects of carbamazepine
- SSRI Antidepressants (e.g., Fluoxetine) · May increase plasma levels or effects of carbamazepine
- Tricyclic Antidepressants (e.g., Clomipramine, Amitriptyline) · May increase plasma levels or effects of carbamazepine; Carbamazepine may also decrease their effects, though it can increase Clomipramine levels
모니터링
- Complete Blood Count (CBC)
- Liver function tests
- Clinical efficacy and behavioral changes
과용량
Overdose can lead to significant CNS depression, severe ataxia, tremors, seizures, respiratory depression, and cardiovascular abnormalities (tachycardia, hypotension). Treatment is primarily supportive and symptomatic, including gastric decontamination if caught early, IV fluids, and respiratory support. Seizures should be treated with standard anticonvulsants (e.g., diazepam, phenobarbital).
VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.