플루드로코르티손 아세테이트
플루드로코르티손은 수의학에서 주로 강력한 **무기질코르티코이드** 특성을 위해 사용되는 강력한 경구용 **합성 코르티코스테로이드**입니다. * **주요 적응증:** 개와 고양이의 **부신피질기능저하증(애디슨병)**에 대한 주요 치료제이며, 주사용 DOCP의 경구용 대안으로 사용됩니다. * **이중 작용:** 무기질코르티코이드 효과(히드로코르티손보다 125배 강력함)를 위해 사용되지만, 상당한 **글루코코르티코이드 활성**(히드로코르티손의 10-15배)도 가지고 있습니다. * **임상 요점:** 고유의 글루코코르티코이드 활성 때문에 플루드로코르티손으로 관리되는 개의 약 50%는 DOCP로 치료받는 환축과 달리 매일 프레드니손/프레드니솔론을 추가로 보충할 필요가 없습니다. 그러나 고용량에서는 이러한 글루코코르티코이드 활성으로 인해 의인성 부신피질기능항진증 증상(다음/다뇨, 다식증)이 나타날 수 있습니다.
작용 기전: Fludrocortisone acts as a potent agonist at mineralocorticoid receptors. * Binds to **cytosolic mineralocorticoid receptors** in the principal cells of the **renal distal tubules** and **collecting ducts** → translocates to the nucleus. * Upregulates the transcription of **epithelial sodium channels (ENaC)** on the apical membrane and **Na+/K+-ATPase pumps** on the basolateral membrane. * This mechanism → promotes active **sodium reabsorption** (and obligate water retention) while accelerating the excretion of **potassium** and **hydrogen ions** into the tubular lumen. * Also binds to **glucocorticoid receptors**, contributing to anti-inflammatory and metabolic effects (gluconeogenesis, protein catabolism).
동물 종별 용량
- Maintenance therapy of hypoadrenocorticism · 0.02 mg/kg PO once daily · PO · once daily · Prednisone or prednisolone (1.25 mg per cat PO once daily) can be used for glucocorticoid replacement.
- Maintenance therapy of hypoadrenocorticism · 0.1 mg total dose/cat PO once daily · PO · once daily · Administer with prednisolone (0.2 mg/kg PO once daily).
- Hypoadrenocorticism · 0.05-0.1 mg/kg PO q24h or divided q12h · PO · q24h or divided q12h · For those animals that still exhibit Addisonian signs even with prednisone therapy.
- Hypoadrenocorticism · Initial dose of 0.01 mg/kg PO twice daily · PO · twice daily · Adjust dose based on monitoring serum electrolyte concentrations every 1-2 weeks until stable. Once stable, recheck every 3-4 months. Addition of NaCl (0.1 g/kg/day) can be useful in reducing the dose of fludrocortisone and reducing PU/PD.
- Maintenance of hypoadrenocorticism · Initially, 0.01-0.02 mg/kg/day PO and adjusted by 0.05-0.1 mg (total dose) increments · PO · daily · Adjust based on serial electrolyte determinations. Most dogs will ultimately require 0.02-0.03 mg/kg/day.
- Hypoadrenocorticism · 0.01 mg/kg PO twice daily · PO · twice daily · Titrate dose to effect; typically dose needs to be increased over time. Only 50% of dogs on fludrocortisone require supplemental prednisone.
용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.
투여 경로
금기
- Known hypersensitivity to fludrocortisone
이상반응
- Polyuria (PU)
- Polydipsia (PD)
- Hypertension
- Edema
- Hypokalemia
- Hypernatremia
- Signs of iatrogenic Cushing's syndrome (due to glucocorticoid effects)
약물 상호작용
- Amphotericin B · Patients may develop hypokalemia if administered concomitantly.
- Aspirin · Fludrocortisone may reduce salicylate levels.
- Potassium-depleting diuretics (e.g., thiazides, furosemide) · May cause hypokalemia; diuretics can cause sodium loss, counteracting the effects of fludrocortisone.
- Insulin · Potentially increases the insulin requirements of diabetic patients.
모니터링
- Serum electrolytes (Sodium, Potassium)
- BUN and Creatinine
- Body weight
- Physical examination for signs of edema or hypertension
- Clinical signs of PU/PD
과용량
Overdosage is typically characterized by excessive mineralocorticoid effects: * **Clinical Signs:** Hypertension, edema, severe hypokalemia, and hypernatremia. Excessive glucocorticoid signs (severe PU/PD, panting) may also occur. * **Management:** Discontinue the drug until clinical signs associated with overdosage have resolved. Electrolytes should be aggressively monitored. Potassium supplementation may be required. Once resolved, restart the drug at a lower dosage.
VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.