글리피지드

설포닐우레아계 항당뇨병제

**글리피지드(Glipizide)**는 주로 인체의 제2형 당뇨병에 사용되는 2세대 경구용 설포닐우레아계 항당뇨병제이지만, 수의학, 특히 고양이 환자에게 특정한 용도로 사용됩니다. * **고양이 적용**: 기능하는 췌장 베타 세포가 아직 남아있는 단순 당뇨병 고양이의 치료에 유익할 수 있습니다. 새로 진단된 당뇨병 고양이의 약 **20%~30%**가 글리피지드 치료에 반응할 수 있습니다. * **임상적 유용성**: 일반적으로 보호자가 (주로 바늘에 대한 공포로 인해) 인스린 주사를 절대적으로 거부하거나, 고양이가 아주 적은 용량의 인슐린으로 잘 조절되어 보호자가 경구용 약물로 전환하기를 원할 때 제한적으로 사용됩니다. * **개의 한계**: 글리피지드는 일반적으로 **개에게는 효과가 없습니다**. 개가 임상적 고혈당증을 보일 때쯤이면 대개 절대적 또는 상대적인 인슐린 결핍 상태(사람의 제1형 당뇨병과 유사)이며, 글리피지드가 작용하는 데 필요한 기능적 베타 세포가 부족합니다. * **임상적 주의사항**: 글리피지드 시험 투여에는 인내심이 필요합니다. 완전한 치료 효과가 관찰되기까지 **4~8주**가 걸릴 수 있습니다. 또한 고양이에서 장기간 사용 시 췌장 소도 아밀로이드 침착 증가를 촉진하여 남은 베타 세포의 파괴를 가속화할 가능성이 있습니다.

작용 기전: Glipizide lowers blood glucose concentrations by stimulating the release of endogenous insulin from the pancreas and enhancing peripheral insulin sensitivity. * **Pancreatic Mechanism**: Glipizide binds to the **sulfonylurea receptor 1 (SUR1)** on the membrane of pancreatic **β-cells** → This binding closes **ATP-sensitive potassium (K+) channels** → Decreased potassium efflux leads to **cellular depolarization** → Depolarization opens **voltage-dependent calcium (Ca2+) channels** → Calcium influx triggers the exocytosis of **insulin**-containing secretory granules. * **Extrapancreatic Effects**: Ongoing use enhances peripheral tissue sensitivity to circulating insulin and reduces the production of hepatic basal glucose, though the exact mechanisms for these secondary effects remain partially unexplained.

동물 종별 용량

Cats

Diabetes mellitus (non-ketotic, relatively healthy) · 2.5 mg per cat (initially), may increase to 5 mg per cat · PO · q12h · Ongoing if stable · Give in conjunction with a meal. Perform spot BG checks every 3-4h for initial 12-18h. Increase dose to 5 mg BID after 2 weeks if hyperglycemia persists and no adverse reactions occur.
Diabetes mellitus · 2.5-5 mg per cat · PO · q12h · 2-3 months trial · Combine with dietary fiber therapy. Evaluate every 1-2 weeks. If fasting BG remains >200 mg/dL after 2-3 months, discontinue and institute insulin.
Diabetes mellitus (mild weight loss, non-ketoacidotic, no peripheral neuropathy) · 2.5 mg (total dose) · PO · q12h
Diabetes mellitus · 5 mg per cat, may increase to 7.5 mg (maximum) · PO · q12h · 4-8 weeks trial · Decrease dose if hypoglycemia occurs. Response may be delayed; evaluate over 4-8 weeks before determining efficacy.
Non-ketotic diabetes mellitus · 2.5-5 mg per cat · PO · q12h · Start at the lower end of the dose range, increasing the dose as required if no adverse effects are reported after 2 weeks.

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

투여 경로

금기

Severe burns, trauma, or infection
Diabetic coma or other hypoglycemic conditions
Major surgery
Ketosis, ketoacidosis, or other significant acidotic conditions
Known hypersensitivity to sulfonylureas
Diabetic ketosis / ketoacidosis
Hepatic impairment
Renal impairment
Absolute insulin deficiency (Type I diabetes)
Insulin resistance

이상반응

Gastrointestinal upset (anorexia, vomiting in ~15% of cats)
Hypoglycemia (severe cases are rare)
Hepatotoxicity (cholestatic jaundice and elevated liver enzymes in ~8% of cats)
Increased pancreatic amyloid deposit formation
Allergic skin reactions (reported in humans)
Bone marrow suppression (reported in humans)
Vomiting
Hypoglycemia
Jaundice (hepatotoxicity)
Skin rashes
Fever

약물 상호작용

Alcohol · May cause a disulfiram-like reaction (anorexia, nausea, vomiting)
Azole Antifungals (ketoconazole, itraconazole, fluconazole) · May increase plasma levels of glipizide
Beta-blockers · May potentiate hypoglycemic effect and mask signs of hypoglycemia
Chloramphenicol · May displace glipizide from plasma proteins, increasing effect · moderate
Cimetidine · May potentiate hypoglycemic effect
Corticosteroids · May antagonize insulin effects and reduce glipizide efficacy
Thiazide Diuretics · May reduce hypoglycemic efficacy
Isoniazid · May reduce hypoglycemic efficacy
MAO Inhibitors · May potentiate hypoglycemic effect
Niacin · May reduce hypoglycemic efficacy
Phenothiazines · May reduce hypoglycemic efficacy
Phenytoin · May reduce hypoglycemic efficacy
Probenecid · May potentiate hypoglycemic effect
Sulfonamides · May displace glipizide from plasma proteins, increasing effect

모니터링

Physical examination and body weight (weekly during first month)
Urine glucose and ketones
Serial blood glucose measurements or spot checks
Liver enzymes (ALT, AST, ALP) and bilirubin (every 1-2 weeks initially)
Complete Blood Count (CBC)
Clinical signs of hypoglycemia or gastrointestinal distress
Blood glucose curves
Fructosamine levels
Liver enzymes (ALT, AST, ALP, Bilirubin)
Renal function (BUN, Creatinine)
Clinical signs of diabetes (water intake, urination, weight)

과용량

**Toxicity Profile**: Oral LD50 is greater than 4 g/kg in all tested animal species. The primary and most dangerous consequence of an overdose is **profound hypoglycemia**. **Management**: * **Decontamination**: Employ gut-emptying protocols (emesis, activated charcoal) if the ingestion is recent and the patient is asymptomatic. * **Treatment**: Monitor blood glucose closely. Administer parenteral glucose (e.g., IV dextrose bolus followed by a CRI) as needed. * **Monitoring**: Because of its relatively short half-life, prolonged hypoglycemia is less likely compared to older sulfonylureas (like chlorpropamide), but blood glucose monitoring and supportive care may still be required for several days. Massive overdoses may require monitoring of blood gases and serum electrolytes.

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