클로피도그렐

혈소판 응집 억제제

**클로피도그렐(Clopidogrel)**은 수의학에서 위험한 혈전 생성을 예방하기 위해 널리 사용되는 강력한 경구용 혈소판 응집 억제제(티에노피리딘계)입니다. - **고양이 의학**: 기저 심장 질환(예: 비대성 심근병증)이 있는 고양이의 **고양이 대동맥 혈전색전증(FATE)**을 예방하는 데 자주 사용됩니다. 또한 혈관 조절 효과를 통해 색전증 발생 후 골반지 혈액 순환을 개선할 수 있습니다. - **개 의학**: **면역 매개성 용혈성 빈혈(IMHA)**, 단백질 소실성 장병증/신증(PLE/PLN), 부신피질기능항진증과 같은 질환과 관련된 과응고 상태를 관리하는 데 사용됩니다. **임상 팁**: 클로피도그렐은 쓴맛이 매우 강합니다. 고양이가 알약의 맛을 느끼면 침을 심하게 흘릴 수 있습니다. 투약 순응도를 높이기 위해 빈 젤라틴 캡슐 안에 약을 넣어 투여하는 것을 강력히 권장합니다.

작용 기전: Clopidogrel is a **prodrug** that requires hepatic biotransformation (via **CYP450** enzymes) to its active, highly unstable thiol metabolite. - The active metabolite → binds selectively and **irreversibly** to the **P2Y12** subtype of **ADP-receptors** on the platelet surface. - This blocks **ADP** binding → prevents activation of the **glycoprotein IIb/IIIa** complex. - Without this complex, platelet-fibrinogen binding cannot occur, effectively halting both primary and secondary platelet aggregation. - It also inhibits the release of other pro-aggregation compounds (serotonin, calcium, thromobospondin). Because the binding is irreversible, the platelet is inhibited for its entire lifespan (approximately 7-10 days). Normal coagulation only returns as new platelets are synthesized.

동물 종별 용량

Dogs

As an anti-platelet agent · 1-3 mg/kg PO once daily; if used with aspirin give lower doses (0.5-1 mg/kg PO once daily) · PO · once daily
Thromboprophylaxis · 1.1-4 mg/kg · PO · q24h · A single loading dose of 4-10 mg/kg p.o. may help achieve therapeutic concentrations more rapidly.

Cats

To prevent thrombus formation · 18.75 mg (practically, 1/4 of a 75 mg tablet) PO once daily · PO · once daily
To prevent thrombus formation (combination therapy) · 7 mg (total dose) PO once daily in combination with aspirin 40-81 mg (total dose) every 3 days. · PO · once daily · Clinical trials are needed to determine appropriate dosage and indications.
To prevent thrombus formation · 1-3 mg/kg PO once daily; if used with aspirin give lower doses (0.5-1 mg/kg PO once daily) · PO · once daily
Thromboprophylaxis · 18.75 mg/cat · PO · q24h · A single loading dose of 4-10 mg/kg p.o. may help achieve therapeutic concentrations more rapidly. Administer in a gelatin capsule to improve compliance due to bitter taste.

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

투여 경로

금기

Active pathologic bleeding
Known hypersensitivity to the drug

이상반응

Vomiting
Anorexia
Bleeding/hemorrhage
Diarrhea
Rashes
Thrombotic thrombocytopenic purpura (TTP) - rare in humans

약물 상호작용

Aspirin · Increased risk for bleeding; however, many patients take both medications intentionally for dual antiplatelet therapy. · moderate
Heparin / Low Molecular Weight Heparins (LMWH) · Clopidogrel appears safe to use concurrently with heparin.
NSAIDs · Increased risk for bleeding; clopidogrel may interfere with NSAID metabolism.
Phenytoin · Clopidogrel may interfere with phenytoin metabolism.
Proton Pump Inhibitors (e.g., omeprazole) · May decrease the efficacy of clopidogrel by inhibiting CYP2C19, the enzyme needed to convert clopidogrel to its active metabolite.
Torsemide · Clopidogrel may interfere with torsemide metabolism.
Warfarin · Increased risk for bleeding; clopidogrel may interfere with warfarin metabolism.
Anticoagulants · High risk of bleeding complications · major

모니터링

Clinical efficacy (prevention of thromboembolic events)
Adverse effects (vomiting, anorexia)
Signs of bleeding (petechiae, ecchymosis, melena, epistaxis)

과용량

Limited information is available. Reported lethal oral doses for mice and rats were 1500 mg/kg and 2000 mg/kg, respectively. **Clinical Signs**: Acute toxic signs may include bleeding or vomiting. **Treatment**: Platelet transfusions have been suggested if rapid reversal is required.

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