클로람부실

면역억제제 / 항종양제

클로람부실은 질소 머스타드 유도체로 수의학에서 주로 **항종양제** 및 **면역억제제**로 사용됩니다. * **임상 요점:** 고양이의 중증 자가면역 질환(예: 염증성 장질환, 낙엽성 천포창) 및 소세포(저등급) 위장관 림프종 치료에 매우 선호됩니다. 이는 시클로포스파미드나 아자티오프린과 같은 다른 알킬화제에 비해 고양이에게 독성이 현저히 낮고 내약성이 좋기 때문입니다. * 또한 림프구성 백혈병, 다발성 골수종, 진성 적혈구증가증, 거대글로불린혈증을 포함한 다양한 종양성 질환에도 사용됩니다. * 골수 억제를 유발할 수 있으므로 치료 중 전체 혈구 계산(CBC)의 정기적인 모니터링이 필수적입니다.

작용 기전: Chlorambucil is a **cell-cycle nonspecific alkylating agent**. * **Mechanism:** It works by forming highly reactive carbonium ions that cross-link with cellular **DNA** → prevents DNA transcription and replication → disrupts nucleic acid function → ultimately leads to cell death (apoptosis). * Its immunosuppressive effects are secondary to its cytotoxic action on rapidly dividing lymphoid cells.

동물 종별 용량

Dogs

Adjunctive therapy for glomerulonephritis · 0.1-0.2 mg/kg PO once daily or every other day · PO · q24h or q48h
Canine lymphoma (first level treatment when combination chemo is declined) · 6-8 mg/m2 (NOT mg/kg) PO every other day · PO · q48h · Used in combination with Prednisone 40 mg/m2 PO daily for 7 days then every other day. Perform CBC every 2-3 weeks.
Lymphoproliferative disease; macroglobulinemia · 2-4 mg/m2 (NOT mg/kg) PO q24-48h · PO · q24-48h
Pemphigus complex · 0.2 mg/kg q24-48h · PO · q24-48h · With Prednisone 2-4 mg/kg PO divided q12h
Pemphigus complex · 0.1-0.2 mg/kg once daily initially until marked improvement (or 75% improvement) of clinical signs (may require 4-8 weeks). Then alternate day dosing is begun and maintained for several weeks. · PO · q24h initially, then q48h · Several weeks · Used in combination with corticosteroids. Alternately decrease chlorambucil and corticosteroids until lowest possible dose is attained.
Adjunctive treatment of inflammatory bowel disease · 1.5 mg/m2 (NOT mg/kg) PO every other day · PO · q48h
Chronic lymphocytic leukaemia · 2-6 mg/m2 initially until remission achieved, then at reduced dosage/frequency; OR 0.2 mg/kg for 7 days then 0.1 mg/kg for maintenance; OR 20 mg/m2 every 1-2 weeks · PO · q24h or q1-2wk · Until remission, then maintenance · Give with food. Often used with prednisolone 40 mg/m2 p.o. q24h for 7 days then 20 mg/m2 q48h.
Lymphoma · 15-20 mg/m2 with prednisolone; OR 2-6 mg/m2; OR 1.4 mg/kg as single dose substitute for cyclophosphamide in CHOP-type protocols · PO · q2wk (15-20 mg/m2) or q24-48h (2-6 mg/m2) · Protocol dependent · Give with food.

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

투여 경로

금기

Known hypersensitivity or resistance to the drug
Pregnancy (potential teratogen)

이상반응

Myelosuppression (anemia, leukopenia, thrombocytopenia)
Gastrointestinal toxicity (vomiting, diarrhea)
Alopecia and delayed hair regrowth (especially in Poodles and Kerry Blue Terriers)
Neurotoxicity (rare; facial twitching, myoclonus, agitation, seizures)

약물 상호작용

Chloramphenicol · Additive bone marrow depression
Flucytosine · Additive bone marrow depression
Amphotericin B · Additive bone marrow depression
Colchicine · Additive bone marrow depression
Azathioprine · Increased risk of infection and immunosuppression
Cyclophosphamide · Increased risk of infection and immunosuppression
Cyclosporine · Increased risk of infection and immunosuppression
Corticosteroids · Increased risk of infection and immunosuppression
Hepatic cytochrome P450 stimulators · Increases cytotoxic effects of chlorambucil · major
Prednisolone · Synergistic effect in the management of lymphoid neoplasia · minor

모니터링

Clinical efficacy
CBC and Platelets (once weekly or every other week initially; once stable, monthly or every 3-6 months)
Uric acid levels (if warranted)
Liver enzymes (if warranted)

과용량

The oral LD50 in mice is 123 mg/kg. In humans, acute overdoses up to 5 mg/kg resulted in **neurologic toxicity (seizures)** and **pancytopenia** (nadirs at 1-6 weeks post ingestion). * **Treatment:** Consists of gut emptying when appropriate (beware of rapidly changing neurologic status if inducing vomiting). * **Monitoring:** CBCs several times a week for several weeks should be performed. Blood component therapy may be necessary.

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