로페라마이드

Loperamide

Loperamide hydrochloride

다른 이름: Imodium A-D · Neo-Diaral · K-Pek II · Diah-Limit · Diarolaeze · Entrocalm · Norimode · PJ 185 · R 18553 · Loperamida · Loperamidum

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

0.08 mg/kgPO· three times daily

체중— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증	용량	경로	빈도	기간	지역
Antidiarrheal	0.08 mg/kg	PO	three times daily	—	🌎 NA
Antidiarrheal	0.1-0.2 mg/kg	PO	q8-12h	—	🌎 NA
Antidiarrheal	0.1 mg/kg	PO	three times a day	Maximum 5 days	🌎 NA
Adjunctive treatment for diarrhea associated with chemotherapy	0.08 mg/kg	PO	three times daily	—	🌎 NA
Antidiarrheal	0.08 mg/kg	PO	3-4 times a day	—	🌎 NA
Antidiarrheal	0.1-0.2 mg/kg	PO	q6-12h	—	🌎 NA
Management of non-specific acute and chronic diarrhoea, and irritable bowel syndrome	0.04-0.2 mg/kg	PO	q8-12h	As needed	🌍 EU

Antidiarrheal: Collies and related breeds (MDR1 mutation) may be overly sensitive
Antidiarrheal: Potentially contraindicated when diarrhea is suspected to be caused by enteric infections
Management of non-specific acute and chronic diarrhoea, and irritable bowel syndrome: Do not use in dogs likely to be ivermectin-sensitive (e.g., collies) due to MDR1 mutation risk.

고양이

적응증	용량	경로	빈도	기간	지역
Diarrhea	0.04-0.06 mg/kg	PO	twice daily	—	🌎 NA
Diarrhea	0.08-0.16 mg/kg	PO	q12h	—	🌎 NA
Management of non-specific acute and chronic diarrhoea, and irritable bowel syndrome	0.04-0.2 mg/kg	PO	q8-12h	As needed	🌍 EU

Diarrhea: Using the suspension. Use is controversial; may react with excitatory behavior.
Diarrhea: Use is controversial.
Management of non-specific acute and chronic diarrhoea, and irritable bowel syndrome: Use with care; excitability may be seen.

소형 포유류

적응증	용량	경로	빈도	기간	지역
Antidiarrheal (Rabbits)	0.1 mg/kg in 1 mL of water	PO	q8h for 3 days, then once daily for 2 days	5 days total	🌎 NA
Antidiarrheal (Mice, Rats, Gerbils, Hamsters, Guinea pigs, Chinchillas)	0.1 mg/kg in 1 mL of water	PO	q8h for 3 days, then once daily for 2 days	5 days total	🌎 NA

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

로페라마이드는 수의학에서 주로 지사제 및 위장관(GI) 운동 조절제로 사용되는 합성 말초 작용 피페리딘 유도체 아편계 작용제입니다.

다른 많은 오피오이드와 달리 로페라마이드는 혈액뇌장벽에 있는 P-당단백질(P-gp) 유출 펌프의 기질입니다. 정상적인 동물의 경우, 이는 약물이 중추신경계(CNS)에 축적되는 것을 방지하여 전형적인 오피오이드 신경계 부작용을 최소화합니다.

임상 요점: 로페라마이드는 비감염성 설사(예: 토세라닙과 같은 약물로 인한 화학요법 유발 설사)의 증상 완화에 매우 효과적입니다. 그러나 ABCB1-1Δ(MDR1) 돌연변이로 인해 목양견 품종(예: 콜리, 오스트레일리안 셰퍼드)에 사용할 때는 극도로 주의하거나 완전히 피해야 합니다. 이러한 반려견의 경우 결함이 있는 P-gp 펌프로 인해 로페라마이드가 혈액뇌장벽을 통과하게 되어 표준 용량에서도 심각하고 치명적일 수 있는 신경 독성을 유발할 수 있습니다.

작용 기전

Loperamide exerts its antidiarrheal effects through multiple mechanisms within the gastrointestinal tract:

μ-opioid receptor agonism: Binds to mu-receptors in the myenteric plexus of the intestinal wall → inhibits the release of acetylcholine and prostaglandins → reduces peristalsis and increases intestinal transit time, allowing for greater fluid absorption.
δ-opioid receptor agonism: Binds to delta-receptors → decreases intestinal secretion induced by cholera toxin and prostaglandins.
Calcium channel modulation: Inhibits diarrheas caused by factors utilizing calcium as a second messenger (non-cAMP/cGMP mediated).
Mucosal absorption: Directly enhances the mucosal absorption of water and electrolytes.

안전성·주의사항

금기사항

Dogs tested positive for the ABCB1-1Δ (MDR1) mutation
Untested dogs of herding breeds susceptible to the MDR1 mutation
Diarrhea caused by toxic ingestion (until the toxin is eliminated)
Known hypersensitivity to narcotic analgesics
Infectious enteritis (relative contraindication, as decreased motility can delay pathogen clearance)
Intestinal obstruction
Dogs likely to be ivermectin-sensitive (MDR1/ABCB1 mutation, e.g., Collies, Australian Shepherds)
Infectious enteritis (where decreased motility may delay pathogen clearance)
Toxigenic diarrhea

부작용

Constipation
Bloat
Paralytic ileus
Toxic megacolon
Pancreatitis
CNS depression (especially in MDR1-mutant dogs)
Excitatory behavior (cats)
Excitability (especially in cats)
Profound sedation and ataxia (in MDR1 mutant dogs)

주의

Use with caution in patients with hypothyroidism, severe renal insufficiency, adrenocortical insufficiency (Addison's disease), and in geriatric or severely debilitated patients.

Use with extreme caution in patients with head injuries or increased intracranial pressure, as well as acute abdominal conditions (e.g., colic), as opiates may obscure the diagnosis or clinical course.

Use with extreme caution in patients suffering from respiratory disease or acute respiratory dysfunction (e.g., pulmonary edema secondary to smoke inhalation).

Use with extreme caution in patients with hepatic disease exhibiting CNS clinical signs of hepatic encephalopathy, as hepatic coma may result.

Small Patient Dosing: Many clinicians recommend avoiding tablet/capsule forms in dogs weighing less than 10 kg due to potency; dosage titration using liquid forms is recommended for safe use.