디에틸카르바마진 시트르산염

항기생충약 / 구충제 (피페라진 유도체)

**디에틸카르바마진 시트르산염(DEC)**은 피페라진 유도체 구충제로, 과거 반려견의 매일 투여용 심장사상충 예방약으로 널리 쓰였던 표준 약물입니다. * **현황**: 현재는 매월 1회 투여하는 마크로사이클릭 락톤계(예: 이버멕틴, 밀베마이신)로 대부분 대체되었습니다. 미국 내에서는 수의용 경구 제제가 더 이상 시판되지 않습니다. * **적응증**: 반려견의 심장사상충(*D. immitis*) 예방 및 회충증 치료용으로 FDA 승인을 받았습니다. 페럿, 동물원 동물 및 소/양의 기생충성 기관지염(영국)에도 사용됩니다. * **임상 요점**: 최신 월 1회 예방약과 달리 DEC는 **매일** 투여해야 하므로, 과거 보호자의 투약 순응도를 유지하는 데 어려움이 있었습니다.

작용 기전: The exact mechanism of DEC is not completely understood, but it exhibits both direct paralytic and host-dependent immunomodulatory effects: * **Direct Paralysis**: DEC acts as an agonist at **nicotinic acetylcholine receptors (nAChRs)** on the nematode somatic muscle → Depolarization of the muscle membrane → **Spastic paralysis** of the parasite. * **Immunomodulation**: DEC alters the parasite's surface membrane (interfering with arachidonic acid metabolism) → Exposes hidden antigens → Enhances host immune system clearance of microfilariae.

동물 종별 용량

Cats

Treatment of ascarids · 55-110 mg/kg PO · PO · Once · Single dose

Ferrets

Heartworm prophylaxis · 5.5 mg/kg PO once a day · PO · q24h · Continuous

Cattle

Treatment of early stages of Dictyocaulus viviparous infestations · 22 mg/kg IM for 3 successive days; or 44 mg/kg IM once. · IM · q24h or Once · 3 days or Single dose · DEC is available in an injectable dosage form containing 400 mg/mL in the U.K., no FDA-approved injectable form is available in the U.S.A.

Dogs

Heartworm prophylaxis · 6.6 mg/kg PO once a day preceding infection and for 60 days following last exposure to mosquitoes. · PO · q24h · 60 days post-exposure · In dogs that become microfilaremic while on DEC, may continue, but do not interrupt daily DEC therapy.
Heartworm prophylaxis · 6.6 mg/kg PO daily from beginning of mosquito season and for two months thereafter. · PO · q24h · Seasonal + 2 months · Should be given year-round in areas where mosquitoes are active throughout the year. Re-examine 3 months after starting therapy and at 6-month intervals for microfilaria.
Heartworm prophylaxis · 2.5-3 mg/kg PO daily; begin prior to mosquito season · PO · q24h · Continuous
Heartworm prophylaxis · 5-7 mg/kg PO daily. Begin before infection is likely and continue 60 days after mosquito season. · PO · q24h · Seasonal + 60 days · Some areas will require year-round treatment.

투여 경로

POIM

금기

Dogs with circulating microfilaria (due to risk of severe shock-like reaction)

이상반응

Vomiting
Diarrhea
Fixed drug eruptions (rare)
Severe anaphylactoid reaction (in microfilaremic dogs)
Hepatic injury (reported in cats)

약물 상호작용

Pyrantel · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.
Morantel · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.
Levamisole · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.

모니터링

Microfilaria status (prior to and during heartworm prophylaxis)
Clinical efficacy (when used as an anthelmintic)

과용량

DEC is considered a relatively non-toxic compound with a wide margin of safety. * **Clinical Signs**: Large overdoses generally result in self-limiting vomiting or CNS depression. * **Management**: For very large, recent ingestions, consider GI decontamination (inducement of vomiting, activated charcoal, cathartics). If clinical signs occur, provide supportive care (e.g., IV fluids).

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