이소소르비드 디니트레이트 / 이소소르비드 모노니트레이트

혈관 확장제 (유기 질산염)

이소소르비드 디니트레이트(ISDN) 및 이소소르비드 모노니트레이트(ISMN)는 주로 심장의 전부하를 감소시키는 데 사용되는 강력한 **정맥 확장제**인 **유기 질산염**입니다. 인의에서는 협심증 및 울혈성 심부전(CHF)에 널리 사용되지만, 소동물 임상에서의 경험과 입증된 효능은 아직 제한적입니다. 난치성 심부전의 보조 요법이나 ACE 억제제를 견디지 못하는 환자에게 간혹 사용됩니다. 개는 사람에 비해 치료적 혈역학적 효과를 얻기 위해 훨씬 더 높은 용량이 필요한 것으로 보입니다. 지속적인 사용은 **질산염 내성**을 유발할 수 있습니다.

작용 기전: Organic nitrates act as prodrugs that donate nitric oxide (NO) to vascular smooth muscle, leading to profound vasodilation (predominantly venous, with some arterial effects at higher doses). **Mechanism Pathway:** Organic Nitrate → converted to **free radical Nitric Oxide (NO)** → activates **soluble guanylate cyclase (sGC)** → increases intracellular **cyclic GMP (cGMP)** → activates **Protein Kinase G (PKG)** → decreases intracellular calcium and dephosphorylates **myosin light chain** → **Vascular Smooth Muscle Relaxation**. * **Hemodynamic Effects:** By dilating the venous capacitance vessels, nitrates significantly decrease venous return to the heart (**reduced preload**), which lowers ventricular filling pressures and helps alleviate pulmonary edema in CHF. * **Additional Effects:** Nitrates functionally antagonize acetylcholine, norepinephrine, and histamine. They also relax non-vascular smooth muscle, including biliary, bronchial, gastrointestinal, ureteral, and uterine tissues.

동물 종별 용량

Cats

Adjunctive treatment of heart failure associated with thyroid storm · Isosorbide dinitrate at 0.5-2 mg/kg PO q8-12h · PO · q8-12h · Start at lowest level and titrate upward.
Refractory heart failure or in combination with hydralazine or amlodipine in patients unable to tolerate ACE inhibitors · Isosorbide dinitrate at 0.5-2 mg/kg PO twice daily OR isosorbide mononitrate at 0.25-2 mg/kg PO twice daily · PO · twice daily · Efficacy is unknown.

Dogs

Refractory heart failure or in combination with hydralazine or amlodipine in patients unable to tolerate ACE inhibitors · Isosorbide dinitrate at 0.5-2 mg/kg PO twice daily OR isosorbide mononitrate at 0.25-2 mg/kg PO twice daily · PO · twice daily · Efficacy is unknown. It is unknown if nitrate-free periods are required to prevent nitrate tolerance.

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

투여 경로

POSublingual

금기

Cardiogenic or hypovolemic shock
Severe hypotension
Hypovolemia
Use as a sole agent for treating heart failure
Concurrent use with selective phosphodiesterase inhibitors (e.g., sildenafil)

이상반응

Postural hypotension
Reflex tachycardia
Lethargy or weakness (secondary to hypotension)
Gastrointestinal upset
Restlessness
Headache (well-documented in humans, difficult to assess in animals)
Hypersensitivity reactions (rare)

약물 상호작용

Antihypertensive Drugs (e.g., ACE inhibitors, amlodipine, beta-blockers) · Possible additive hypotensive effects; monitor blood pressure closely.
Phenothiazines (e.g., acepromazine) · Possible additive hypotensive effects due to alpha-adrenergic blockade.
Selective Phosphodiesterase Inhibitors (e.g., sildenafil, pimobendan) · Concurrent use with sildenafil can cause profound, life-threatening hypotension and is strictly contraindicated. Use with pimobendan (a PDE3 inhibitor) is common in vet med but requires monitoring for excessive vasodilation.

모니터링

Clinical efficacy (improvement in respiratory rate/effort, resolution of pulmonary edema)
Systemic blood pressure (monitor for hypotension)
Heart rate (monitor for reflex tachycardia)
Renal values and electrolytes (if used concurrently with diuretics and ACE inhibitors)

과용량

**Toxicity Profile:** Isosorbide mononitrate caused significant lethality in rats and mice at massive dosages (2000 mg/kg and 3000 mg/kg, respectively). **Clinical Signs of Overdose:** * Profound venous pooling * Decreased cardiac output * Severe hypotension * Reflex tachycardia * Collapse or syncope **Treatment:** * Treatment is primarily **supportive**. * **Avoid Epinephrine:** Drug therapies with agents such as epinephrine are NOT recommended as they may exacerbate the cardiovascular collapse. * **Fluid Therapy:** Increasing central fluid volume may be useful to counteract venous pooling, but in patients with pre-existing congestive heart failure (CHF), IV fluids must be administered with **extreme caution** to avoid precipitating fulminant pulmonary edema.

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