사이클로스포린

면역억제제 / 안과용 약물

사이클로스포린은 곰팡이에서 처음 분리된 고지용성 폴리펩타이드 약물입니다. 수의 안과에서는 반려견의 **건성 각결막염(KCS, 안구건조증)** 및 **만성 표재성 각막염(판누스)** 치료의 핵심 약물입니다. 눈물 분비를 촉진할 뿐만 아니라 만성 염증과 관련된 각막 색소 침착 및 육아 조직 형성을 감소시킵니다. 장기간 국소적으로 사용해도 전신적인 면역 억제 부작용 없이 일반적으로 안전합니다.

작용 기전: Cyclosporine is a **calcineurin inhibitor**. It binds to cyclophilin within T-lymphocytes, inhibiting the enzyme calcineurin → prevents dephosphorylation of Nuclear Factor of Activated T-cells (NFAT) → **blocks transcription of interleukin-2 (IL-2)** and other inflammatory cytokines. In the eye, this halts local inflammatory mediator production, arresting self-perpetuating lacrimal adenitis. It also acts as a **prolactin analog**, fitting onto lacrimal prolactin receptors to directly stimulate tear production. Furthermore, it increases conjunctival mucin stores, improving the overall quality of the tear film.

동물 종별 용량

Cats

Keratoconjunctivitis sicca (KCS) · Not recommended · topical ophthalmic · Preliminary results have not been promising; often aggravates ophthalmic herpes virus infections.

Dogs

Keratoconjunctivitis sicca (KCS) · 0.2% ointment · topical ophthalmic · twice daily (up to 3 times a day initially in difficult cases) · Life-long · 3-8 weeks of therapy are necessary before a dramatic increase in the Schirmer tear test becomes evident.
German Shepherd Pannus (chronic superficial keratitis) · 0.2% ointment · topical ophthalmic · twice daily · Life-long · Preferred over chronic topical corticosteroids due to lack of systemic side effects.

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

투여 경로

topical ophthalmic

금기

Feline keratoconjunctivitis sicca associated with active herpes virus infection
Feline eosinophilic keratitis (historically, though newer evidence varies, the monograph notes it is not promising)

이상반응

Mild ocular irritation upon application
Aggravation of ophthalmic herpes virus infections (especially in cats)

약물 상호작용

Itraconazole · Inhibits cytochrome P450 metabolism of ciclosporin, increasing blood concentrations up to five-fold. Dose reduction (halving dose or doubling interval) is required. · major
Ketoconazole · Inhibits cytochrome P450 metabolism of ciclosporin, significantly increasing blood concentrations. · major
Diltiazem · Competitively inhibits enzymes involved in ciclosporin metabolism, increasing serum levels. · moderate
Doxycycline · Inhibits enzymes involved in ciclosporin metabolism, increasing serum levels. · moderate
Aminoglycosides · Increased risk of nephrotoxicity; concomitant use is not recommended. · major
NSAIDs · Increased risk of nephrotoxicity; concomitant use is not recommended. · major
Quinolones · Increased risk of nephrotoxicity; concomitant use is not recommended. · moderate
Trimethoprim/Sulphonamides · Increased risk of nephrotoxicity; concomitant use is not recommended. · moderate
ACE inhibitors · Increased risk of hyperkalaemia. · moderate
Macrocyclic lactones (e.g., ivermectin, milbemycin) · Ciclosporin inhibits MDR1 P-glycoprotein, decreasing the efflux of macrocyclic lactones from the blood-brain barrier, potentially resulting in CNS toxicity. · major

모니터링

Schirmer Tear Test (STT) after 1 month of therapy, then periodically
Fluorescein staining to monitor for corneal ulceration
Resolution of corneal pigmentation and neovascularization

과용량

Systemic toxicity has **not** been noted in dogs given this drug chronically via the topical ophthalmic route. Even if 100% of the ophthalmic dose were absorbed, it is well below the systemic therapeutic/toxic dose.

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