디페녹실레이트 및 아트로핀

오피오이드 작용제 / 항콜린제

**디페녹실레이트(Diphenoxylate)**는 메페리딘과 구조적으로 유사한 합성 페닐피페리딘 유도체 오피오이드 작용제입니다. 수의학에서는 주로 개에서 **지사제** 및 **진해제**(기침 억제제)로 사용됩니다. 주요 약리학적 특징: * **운동성 조절**：위장관 통과 시간을 늦추어 수분 흡수를 증가시키고 설사를 줄입니다. * **남용 방지**：상업용 제제에는 치료 용량 이하의 **아트로핀 황산염**이 포함되어 있습니다. 정상 용량에서는 아트로핀이 임상적 영향을 미치지 않지만, 과량 복용 시 불쾌한 항콜린성 부작용(예: 구갈, 빈맥)을 유발하여 남용을 방지합니다. * **통제 약물**：오피오이드 특성으로 인해 **V급 통제 약물**로 분류됩니다. > **임상 팁**：고양이에서의 사용은 역설적인 흥분 행동의 위험 때문에 논란이 많습니다. 체중 10kg 미만의 소형견의 경우, 강력한 정제로 인한 우발적인 과다 복용을 피하고 정확한 용량 조절을 위해 액상 제제의 사용이 강력히 권장됩니다.

작용 기전: Diphenoxylate exerts its effects primarily through interaction with opioid receptors in the gastrointestinal tract and central nervous system: * **GI Motility**: Binds to **μ-opioid receptors** in the enteric nervous system (myenteric plexus) → decreases the release of acetylcholine and prostaglandins → inhibits excessive GI propulsion and increases segmental (non-propulsive) contractions → **prolongs intestinal transit time**. * **Secretion Reduction**: Decreases intestinal secretion induced by cholera toxin, prostaglandin E2, and non-cAMP/cGMP mediated diarrheas. Enhances mucosal fluid and electrolyte absorption. * **Antitussive Effect**: Acts directly on the **medullary cough center** in the brain → depresses the cough reflex. * **Atropine Component**: Acts as a competitive antagonist at **muscarinic acetylcholine receptors**, though its dose in this combination is too low to exert significant systemic anticholinergic effects unless overdosed.

동물 종별 용량

Cats

As an antidiarrheal · 0.08-0.1 mg/kg PO q12h · PO · q12h · Use in cats is controversial.

Dogs

As an antidiarrheal · 0.1-0.2 mg/kg PO q12h · PO · q12h
As an antidiarrheal · 0.05 mg/kg PO three times a day · PO · TID · Maximum 5 days · Probably should not be given longer than 5 days and are potentially contraindicated when diarrhea is suspected to be caused by enteric infections
As an antidiarrheal · 0.05-0.2 mg/kg PO q8-12h · PO · q8-12h
As an antidiarrheal · 0.05-0.1 mg/kg PO three to four times a day. · PO · TID to QID
As an antitussive · Approximately 0.25 mg/kg PO q8-12h · PO · q8-12h
As an antitussive · 0.2-0.5 mg/kg PO q12h · PO · q12h · Until clinical signs subside · May be used for extended periods. Constipation is an occasional problem, but stool softeners can alleviate.

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

투여 경로

금기

Known hypersensitivity to narcotic analgesics
Patients receiving monoamine oxidase inhibitors (MAOIs)
Diarrhea caused by toxic ingestion (until the toxin is eliminated from the GI tract)
Intestinal obstruction
Bacterial-induced acute diarrhea (may enhance bacterial proliferation)

이상반응

Constipation
Bloat
Sedation
Paralytic ileus (potential)
Toxic megacolon (potential)
Pancreatitis (potential)
CNS depression or excitation
Excitatory behavior (especially in cats)

약물 상호작용

CNS Depressant Drugs (anesthetics, antihistamines, phenothiazines, barbiturates, tranquilizers, alcohol) · May cause increased CNS or respiratory depression when used concurrently.
Monoamine Oxidase Inhibitors (MAOIs) (e.g., amitraz, selegiline) · Contraindicated. Do not use opiate antidiarrheals for at least 14 days after receiving MAOIs due to risk of severe adverse reactions.

모니터링

Clinical efficacy (resolution of diarrhea or cough)
Fluid and electrolyte status (especially in severe diarrhea)
CNS effects (sedation or excitation), particularly if using high dosages
Bowel movements (monitor for constipation)
Plasma amylase and lipase (may be artificially increased for up to 24 hours post-administration)

과용량

Acute overdosage can result in severe **CNS, cardiovascular, gastrointestinal, or respiratory toxicity**. * **Delayed Absorption**: Because opiates significantly reduce GI motility, absorption of the drug from the GI tract may be delayed and prolonged, meaning toxicity can worsen over time. * **Opiate Toxicity**: Signs include profound sedation, respiratory depression, and pinpoint pupils. **Naloxone** may be necessary to reverse the opiate effects. * **Atropine Toxicity**: Massive overdoses may induce atropine toxicity (dry mouth, tachycardia, hyperthermia, dilated pupils, agitation).

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