에날라프릴

안지오텐신 전환 효소(ACE) 억제제

에날라프릴은 수의학에서 널리 사용되는 **안지오텐신 전환 효소(ACE) 억제제**입니다. 전부하와 후부하를 모두 감소시키는 균형 잡힌 혈관 확장제로 작용하여 개와 고양이의 울혈성 심부전(CHF) 관리의 초석이 되며, 종종 피모벤단 및 푸로세미드와 함께 사용됩니다. 심혈관계 적용 외에도 에날라프릴은 **신장 보호 특성**으로 높이 평가받고 있습니다. 사구체 수출 세동맥의 저항을 감소시킴으로써 사구체 내압과 단백뇨를 효과적으로 줄여주어 만성 신장 질환(CKD) 및 단백 소실성 신증(PLN)의 표준 보조 치료제로 사용됩니다. > **임상 요점:** 에날라프릴은 간에서 활성 대사 산물인 **에날라프릴라트**로 생체 내 변환되어야 하는 **전구약물(Prodrug)**입니다. 중증 간 기능 장애가 있는 환자의 경우 이 변환이 손상될 수 있으므로 대체 요법을 고려해야 할 수 있습니다. 주로 신장을 통해 배설되므로 심각한 신장 기능 장애가 있는 환자에서는 종종 용량 조절이 필요합니다.

작용 기전: Enalapril is a prodrug converted in the liver to the active compound **enalaprilat**. Enalaprilat competitively binds to and inhibits **Angiotensin-Converting Enzyme (ACE)**. * **RAAS Inhibition:** Prevents the conversion of inactive **Angiotensin-I** → active **Angiotensin-II** (a potent vasoconstrictor). * **Vasodilation:** Decreased Angiotensin-II leads to reduced total peripheral resistance, pulmonary vascular resistance, and blood pressure (↓ afterload and preload). * **Aldosterone Reduction:** Lower Angiotensin-II levels reduce the secretion of **aldosterone** from the adrenal cortex, leading to decreased sodium and water retention, while mildly increasing potassium retention. * **Renal Hemodynamics:** Preferentially dilates the **efferent arteriole** of the glomerulus. This reduces intraglomerular hydrostatic pressure, thereby decreasing the filtration of proteins into the urine (anti-proteinuric effect) and slowing the progression of glomerular disease.

동물 종별 용량

Cats

For adjunctive treatment of heart failure due to hypertrophic cardiomyopathy · 1.25-2.5 mg (total dose) PO once daily (q24h). · PO · q24h
For adjunctive treatment of heart failure due to hypertrophic cardiomyopathy · 0.25-0.5 mg/kg (roughly 1.25-2.5 mg per cat) PO once a day (q24h) · PO · q24h
For adjunctive treatment of heart failure due to hypertrophic cardiomyopathy · 0.5 mg/kg PO once daily, twice daily if necessary · PO · once to twice daily
For proteinuria, hypertension in chronic kidney disease · 0.25 mg/kg PO once daily to 0.5 mg/kg PO twice daily; rarely higher · PO · once to twice daily
For systemic hypertension · As a 2nd step drug when systolic BP >160 mmHg, diastolic >120 mmHg: 1) amlodipine (0.625 mg per cat q24h, if cat greater then 6 kg, 1.25 mg/cat q24h), add ACE inhibitor if proteinuric; 2) ACE inhibitor (benazepril/enalapril 0.5 mg/kg q12h); 3) spironolactone (1-2 mg/kg twice daily); 4) hydralazine 0.5 mg/kg PO twice daily. Each step added (except when increasing amlodipine dose) if after 1-2 weeks systolic BP > 160 mmHg. · PO · q12h · Stepwise therapy protocol.

Ferrets

For adjunctive therapy for heart failure · 0.5 mg/kg PO once every other day (q48h) initially and may be increased to once a day if tolerated. · PO · q48h to q24h · Dissolve tablet(s) in distilled water and add a methylcellulose suspending agent (e.g., Ora-Plus) and cherry syrup for flavor.
For dilative cardiomyopathy · 0.25-0.5 mg/kg PO once a day to every other day · PO · q24h to q48h

Birds

투여 경로

POIV

금기

Hypersensitivity to ACE inhibitors
Pregnancy (Category C in first trimester, Category D in second/third trimesters due to fetal kidney developmental risks)

이상반응

Anorexia
Vomiting
Diarrhea
Weakness
Hypotension
Renal dysfunction
Hyperkalemia
Lethargy (especially in cats)
Inappetence

약물 상호작용

Antidiabetic agents (insulin, oral agents) · Possible increased risk for hypoglycemia; enhanced monitoring recommended
Diuretics (e.g., furosemide, hydrochlorothiazide) · Potential for increased hypotensive effects; furosemide doses may need reduction (by 25-50%) when adding enalapril
Potassium-sparing diuretics (e.g., spironolactone, triamterene) · Increased hyperkalemic effects; enhanced monitoring of serum potassium recommended
Hypotensive agents · Potential for increased hypotensive effect
Lithium · Increased serum lithium levels possible; increased monitoring required
NSAIDs · May reduce the anti-hypertensive or positive hemodynamic effects of enalapril; may increase risk for reduced renal function
Potassium supplements · Increased risk for hyperkalemia

모니터링

Clinical signs of CHF (respiratory rate/effort, exercise tolerance)
Serum electrolytes (especially potassium)
Renal panel (creatinine, BUN)
Urine protein (UPC ratio)
CBC with differential (periodic)
Blood pressure (especially if treating hypertension or if clinical signs of hypotension arise)

과용량

In dogs, a dose of 200 mg/kg was lethal, but 100 mg/kg was not. * **Primary Concern:** Severe **hypotension**. * **Treatment:** Supportive treatment with volume expansion using normal saline is recommended to correct blood pressure. * **Monitoring:** Because of the drug's long duration of action, prolonged monitoring and treatment may be required. * **Decontamination:** Recent overdoses should be managed by using gut emptying protocols when warranted.

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