독세핀

삼환계 항우울제 / 항히스타민제

독세핀은 디벤조옥사제핀 유도체인 **삼환계 항우울제(TCA)**로, 수의학에서는 주로 기저에 불안 요소가 있는 심인성 피부 질환의 보조 치료제로 사용됩니다. 항우울제로 분류되지만 매우 강력한 **H1-항히스타민 특성**을 가지고 있어 가려움증과 행동 문제를 관리하는 이중 목적의 약물입니다. 아토피 피부염에 대한 단독 항히스타민제로서의 효능은 논란의 여지가 있으나, 가려움증이 불안 및 강박 행동(예: 말단 핥기 육아종, 과도한 그루밍)을 악화시키거나 유발할 때 매우 유용합니다. > **임상 요점**: 항불안 및 항히스타민 효과가 결합되어 있기 때문에 알레르기성 피부 질환을 앓고 있는 신경질적이거나 예민한 환자에게 자주 선택됩니다.

작용 기전: Doxepin exerts its effects through multiple receptor pathways: * **Monoamine Reuptake Inhibition:** In the central nervous system, doxepin blocks the presynaptic reuptake of **norepinephrine** (moderate inhibition) and **serotonin (5-HT)** (weak inhibition) → increasing their synaptic concentrations and prolonging their activity, which contributes to its antidepressant and anxiolytic effects. * **Receptor Antagonism:** It exhibits potent **H1-histamine receptor blockade** (providing anti-pruritic and sedative effects), as well as **anticholinergic (muscarinic)** and **alpha-1 adrenergic blocking** activity. These latter receptor affinities are largely responsible for its side effect profile (e.g., dry mouth, urinary retention, hypotension).

동물 종별 용량

Cats

Treatment of psychogenic dermatoses · 0.5-1 mg/kg PO q12-24h. Up to 25-50 mg (total dose) per cat. · PO · q12-24h · Allow 3-4 weeks for initial trial
Excessive grooming · 0.5-1 mg/kg PO q12h. · PO · q12h
Treatment of behavior problems (e.g., overgrooming, intercat aggression) · 0.5-1 mg/kg PO once to twice daily. · PO · SID to BID

Birds

Treatment of anxiety, pruritus caused feather plucking in psittacines · 1-2 mg/kg PO q12h · PO · q12h
Treatment of anxiety, pruritus caused feather plucking in psittacines · 0.5-1 mg/kg PO twice daily · PO · BID

Dogs

Treatment of psychogenic dermatoses · 3-5 mg/kg PO q12h; maximum dose is 150 mg (per dog) q12h · PO · q12h
Treatment of psychogenic dermatoses · 3-5 mg/kg, PO q8-12h. Begin at 3 mg/kg PO q12h for 2 weeks, then increase by 1 mg/kg PO q12h for 2 weeks up to the maximum dosage as needed; if no clinical response after at least 3-4 weeks of therapy, decrease dosage by 1 mg/kg PO q12h for 2 weeks until at the initial dosage · PO · q8-12h · Titrated over weeks
Antihistaminic effects in treatment of atopy · 2.2 mg/kg PO three times daily · PO · TID
Antihistaminic effects in treatment of atopy · 3-5 mg/kg twice daily · PO · BID · Used especially if dog has anxiety or other behavioral condition

투여 경로

POTopical

금기

Prior sensitivity to doxepin or other tricyclic antidepressants
Concomitant use with Monoamine Oxidase Inhibitors (MAOIs) such as selegiline or amitraz (within 14 days)
Urinary retention
Glaucoma
Severe cardiac disease
History of seizures
Concurrent use with MAOIs

이상반응

Hyperexcitability (paradoxical)
Gastrointestinal distress
Lethargy and sedation
Ventricular arrhythmias (particularly in overdose)
Anticholinergic effects (dry mouth, urinary retention, constipation)
Altered blood glucose levels
Sedation
Lethargy
Dry mouth (xerostomia)
Tachycardia
Urinary retention
Constipation

약물 상호작용

Anticholinergic Agents · Additive anticholinergic effects; use cautiously. · moderate
Cimetidine · May inhibit tricyclic antidepressant metabolism and increase the risk of toxicity. · moderate
CNS Depressants · Additive CNS depression; use cautiously. · moderate
Meperidine, Pentazocine, Dextromethorphan · Increased risk for serotonin syndrome.
Monoamine Oxidase Inhibitors (MAOIs, e.g., amitraz, selegiline) · Concomitant use (within 14 days) is generally contraindicated due to high risk of serotonin syndrome.
Quinidine · Increased risk for QTc interval prolongation and tricyclic adverse effects.
SSRIs (e.g., fluoxetine, paroxetine, sertraline) · Increased risk for serotonin syndrome.
Sympathomimetic Agents · May increase the risk of cardiac effects (arrhythmias, hypertension, hyperpyrexia).
Monoamine Oxidase Inhibitors (MAOIs) · Risk of fatal serotonin syndrome · major
Selective Serotonin Reuptake Inhibitors (SSRIs) · Increased risk of serotonin syndrome · major

모니터링

Efficacy (reduction in pruritus, anxiety, or compulsive behaviors)
Adverse effects (GI distress, lethargy, hyperexcitability)
ECG (if arrhythmias are suspected or in cases of overdose)
Heart rate and rhythm
Resolution of pruritus or behavioral signs
Signs of excessive sedation or anticholinergic effects

과용량

Overdosage with tricyclic antidepressants can be **life-threatening**. * **Clinical Signs:** Severe ventricular arrhythmias, cardiorespiratory collapse, profound CNS depression or seizures. * **Action:** Because the toxicities and therapies for treatment are complicated and controversial, it is highly recommended to contact an **animal poison control center** immediately for further information in any potential overdose situation.

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