클로파지민

항마이코박테리아 항생제Highly Important

클로파지민은 지용성이 매우 높은 페나진 염료 항마이코박테리아 항생제입니다. 수의학에서는 주로 고양이 나병, 개 나병성 육아종과 같은 나병 유사 증후군 및 *마이코박테리움 아비움* 복합체(MAC) 감염 치료를 위한 다제 병용 요법의 일부로 사용됩니다. **임상 요점:** * **병용 요법:** 마이코박테리아는 박멸이 매우 어렵고 내성이 생기기 쉬우므로 클로파지민은 거의 단독 요법으로 사용되지 않습니다. * **지용성:** 극도의 지용성으로 인해 지방 조직과 망상내피계(대식세포)에 대량으로 축적됩니다. * **착색:** 염료로서의 특성으로 인해 피부, 눈, 체액이 눈에 띄고 오래 지속되는 변색을 일으키는 특징적인 부작용이 있습니다. * **확보의 어려움:** 수의사가 소동물을 위해 정확한 용량을 구하고 조제하는 것이 매우 어려울 수 있으며, 종종 조제 약사의 도움이 필요합니다.

작용 기전: Clofazimine exerts a slowly bactericidal effect against susceptible mycobacteria (*M. leprae*, *M. tuberculosis*, *M. avium* complex, *M. bovis*, *M. chelonei*). * **DNA Binding:** It binds directly to mycobacterial DNA (preferentially at guanine base sequences) → blocks template function → **inhibits DNA replication and cell growth**. * **Intracellular Accumulation:** It is heavily taken up by macrophages, concentrating the drug exactly where intracellular mycobacteria reside. * **Immunomodulation:** Exhibits anti-inflammatory and immunosuppressive properties, likely by inhibiting T-lymphocyte activation and proliferation, though the exact mechanism remains poorly understood.

동물 종별 용량

Birds

Avian mycobacteriosis · 6 mg/kg PO once daily · PO · q24h · Protocol 1: with rifampin 45 mg/kg and ethambutol 30 mg/kg.
Avian mycobacteriosis (recommended regime for raptors) · 1.5 mg/kg PO q24h · PO · q24h · Protocol 2: with ethambutol 20 mg/kg, cycloserine 5 mg/kg, enrofloxacin 15 mg/kg q12h.

Dogs

Mycobacterium avium complex (MAC) as part of a multi-drug regimen · 4 mg/kg PO once daily · PO · q24h · Other drugs that may be used in combination include doxycycline, clarithromycin, and/or enrofloxacin.
M. avium intracellularae complex infections, leprosy, or opportunistic mycobacteriosis · 4-8 mg/kg PO once a day · PO · q24h · 4 weeks · Usually as part of a multi-drug protocol.
Mycobacterial infections · 4-8 mg/kg · PO · q24h · 2-6 months · Generally used in combination therapy with other antimicrobials including fluoroquinolones and clarithromycin.

Cats

Treatment of feline leprosy · 25-50 mg once per day or 50 mg every other day · PO · q24h or q48h · Using a regimen of either two or three drugs (with clarithromycin and/or rifampin).
Treatment of localized atypical mycobacterial infections · 8 mg/kg PO once daily · PO · q24h · At least 4 weeks beyond complete clinical resolution · Perform wide surgical excision of lesion if possible. Base antibiotic selection on culture and susceptibility results.

투여 경로

금기

Use with caution in patients with pre-existing gastrointestinal conditions (diarrhea, abdominal pain)
Known hypersensitivity to clofazimine

이상반응

Skin, eye, and body fluid discoloration (pink to brownish-black)
Gastrointestinal pain, nausea, vomiting, diarrhea (dose-limiting)
Hepatotoxicity (reported in a dog receiving concurrent rifampin)
Photosensitization (reported in a cat)
Nausea
Diarrhoea
Discoloration of skin, eyes, and body fluids (red-brown/orange)
Renal impairment
Hepatic impairment
Photosensitization

약물 상호작용

Isoniazid · May reduce clofazimine levels in the skin and increase amounts in plasma and urine; clinical significance is unclear.
Dapsone · May reduce the anti-inflammatory effects of clofazimine; clinical significance is unclear.

모니터링

Efficacy against mycobacterial disease
Adverse effects (primarily gastrointestinal)
Hepatic function (especially in dogs)
Hepatic function (ALT, AST, ALP, Bilirubin)
Renal function (BUN, Creatinine, SDMA)
Clinical signs of photosensitization
Gastrointestinal tolerance

과용량

Very limited data is available. The LD50 for rabbits is 3.3 g/kg and is greater than 5 g/kg in mice, rats, and guinea pigs. Treatment, if required, would include gut emptying and supportive care. Contact an animal poison control center for additional guidance.

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