메데토미딘
Medetomidine
Medetomidine Hydrochloride
다른 이름: Domitor · Dorbene · Dormilan · Medetor · Sedastart · Sedator · Sededorm · MPV-785 · Medetomidine hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Refractory seizures (extra-label)
인증된 수의사 확인 필요
NA
반드시 함께 고려할 임상 맥락 (7)
- 1. Medetomidine dosages depend on the combination of drugs used and the dosage(s) of the other drug(s). Dosage adjustments will also need to be made to account for the degree of desired sedation; type, duration, and pain level of the procedure, and patient temperament and body weight/size.
- 3. Premedication with medetomidine will significantly reduce the dose of the induction agent required and will reduce volatile anesthetic requirements for maintenance anesthesia. All anesthetic agents used for induction or maintenance of anesthesia should be administered to effect.
- 4. For all dosages, the low end of the dose range is generally appropriate for IV administration, whereas the mid-upper range is most appropriate for IM or SC administration. Higher dosages will provide more profound sedation and analgesia.
- 5. When SC administration is used, the speed of sedation is slower, and the level of sedation is lighter and inconsistent. For more predictable sedation, IM or IV administration is recommended.
- 6. The effects of medetomidine can be reversed with atipamezole.
- It is most often dosed by volume at ½ or same volume of medetomidine that was administered and given IM. See Atipamezole.
- The commercially available injection should be stored at room temperature (15°C-30°C [59°F-86°F]) and protected from freezing. Use within 28 days of first vial puncture.
검토된 비계산 근거 (1)
근거 표시 전용 — 자동 계산 불가
Light sedation (often also used for pre-anesthesia)
a) Light sedation (often also used for pre-anesthesia): 5 – 20 µg/kg IM, IV, SC 18
반드시 함께 고려할 임상 맥락 (7)
- 1. Medetomidine dosages depend on the combination of drugs used and the dosage(s) of the other drug(s). Dosage adjustments will also need to be made to account for the degree of desired sedation; type, duration, and pain level of the procedure, and patient temperament and body weight/size.
- 3. Premedication with medetomidine will significantly reduce the dose of the induction agent required and will reduce volatile anesthetic requirements for maintenance anesthesia. All anesthetic agents used for induction or maintenance of anesthesia should be administered to effect.
- 4. For all dosages, the low end of the dose range is generally appropriate for IV administration, whereas the mid-upper range is most appropriate for IM or SC administration. Higher dosages will provide more profound sedation and analgesia.
- 5. When SC administration is used, the speed of sedation is slower, and the level of sedation is lighter and inconsistent. For more predictable sedation, IM or IV administration is recommended.
- 6. The effects of medetomidine can be reversed with atipamezole.
- It is most often dosed by volume at ½ or same volume of medetomidine that was administered and given IM. See Atipamezole.
- The commercially available injection should be stored at room temperature (15°C-30°C [59°F-86°F]) and protected from freezing. Use within 28 days of first vial puncture.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
메데토미딘(Medetomidine)은 강력한 합성 알파-2 아드레날린 수용체 작용제로, 수의학에서 깊은 진정, 진통 및 근육 이완 특성으로 널리 사용됩니다.
주요 임상적 특징은 다음과 같습니다:
- 이상성(Biphasic) 심혈관 반응: 초기의 말초 혈관 수축이 일시적인 고혈압을 유발하며, 이후 반사성 서맥과 정상 혈압 또는 경미한 저혈압이 뒤따릅니다.
- 가역성: 아티파메졸(Atipamezole)과 같은 특이적 알파-2 길항제를 사용하여 그 효과를 빠르고 완전하게 역전시킬 수 있습니다.
- 입체화학: 메데토미딘은 두 가지 입체 이성질체의 라세미 혼합물입니다. 활성 거울상 이성질체는 덱스메데토미딘(Dexmedetomidine)이며, 현대 수의학 시장에서 라세미 메데토미딘을 대체하고 있습니다.
- 시너지 효과: 오피오이드, 케타민 및 기타 마취제와 높은 시너지 효과를 나타내어 병용 마취제의 요구 용량을 크게 줄일 수 있습니다.
임상 팁: 체성 및 내장 진통 효과가 뛰어나지만, 진정 효과가 진통 효과보다 오래 지속되는 경향이 있습니다. 환자가 깊게 진정된 것처럼 보이더라도 큰 소리나 거친 취급에 의해 갑자기 깰 수 있습니다.
작용 기전
Medetomidine produces its effects by binding to and activating pre- and postsynaptic alpha-2 adrenergic receptors in the central and peripheral nervous systems.
- Central Nervous System: Activation of alpha-2 receptors in the locus coeruleus → inhibition of adenylyl cyclase → decreased cAMP → efflux of potassium (hyperpolarization) → decreased release of norepinephrine. This suppression of sympathetic outflow results in profound sedation, anxiolysis, and analgesia.
- Cardiovascular System: Activation of peripheral alpha-1 and alpha-2b receptors in vascular smooth muscle → profound vasoconstriction → increased systemic vascular resistance (hypertension) → baroreceptor-mediated increased vagal tone → reflex bradycardia.
- Endocrine/Metabolic: Inhibits insulin release from pancreatic beta cells → transient hyperglycemia. Decreases antidiuretic hormone (ADH) release → increased diuresis.
Medetomidine is highly selective, with an alpha-2:alpha-1 selectivity ratio of 1620:1 (approximately 10 times more specific than xylazine).
안전성·주의사항
금기사항
- Cardiac disease
- Respiratory disorders
- Liver or kidney diseases
- Shock or severe debilitation
- Animals stressed due to heat, cold, or fatigue
- Pregnancy (insufficient safety data; use only if benefits clearly outweigh risks)
- Cardiovascular disease
- Systemic disease
- Geriatric patients
- Pregnant animals
- Conditions where vomiting is contraindicated (e.g., gastrointestinal foreign body, raised intraocular pressure)
- Diabetes mellitus
부작용
- Bradycardia (often profound)
- Atrioventricular (AV) blocks
- Decreased respiratory rate and potential apnea
- Hypothermia
- Increased urination (diuresis)
- Vomiting (especially in cats)
- Pain on intramuscular injection
- Blanched or cyanotic mucous membranes (due to peripheral vasoconstriction)
- Rarely: prolonged sedation, paradoxical excitation, hypersensitivity, death from circulatory failure
- Decreased cardiac output
- Initial hypertension followed by normotension/hypotension
- Vomiting (especially common after IM administration)
- Diuresis (due to ADH suppression)
- Transient hyperglycemia (due to decreased insulin)
- Mydriasis
- Decreased intraocular pressure
- Spontaneous arousal from deep sedation
주의
- Agitated Patients: Dogs that are extremely agitated or excited may have a decreased response due to high circulating catecholamines overriding the receptor. Allow dogs to rest quietly before administration. Do not re-dose if they fail to respond.
- Age Extremes: Use with extreme caution in very young or geriatric animals due to reduced cardiovascular reserve.
- Hematologic: Medetomidine can inhibit ADP-induced platelet aggregation.
- Reversal: Treat medetomidine-induced bradycardia or excessive sedation with atipamezole rather than anticholinergics.
약물 상호작용
Controversial. Using anticholinergics to treat medetomidine-induced bradycardia can lead to severe hypertension, increased myocardial work, and arrhythmias. Concomitant use is generally discouraged, especially at higher medetomidine doses (>20 mcg/kg).
Synergistic enhancement of sedation and analgesia. Adverse cardiovascular and respiratory effects may also be pronounced. Reduced dosages and careful monitoring are advised.
When used after medetomidine, severe hypoxemia may occur. Significant dosage reductions of propofol are required along with adequate respiratory monitoring.
May reverse the effects of medetomidine, but atipamezole is the preferred and more specific reversal agent.
Significantly reduces the dose required for induction and maintenance of anesthesia.
Reduces the dose required to maintain anesthesia by up to 70%.
Contraindicated; may cause severe cardiovascular complications.
Synergistic sedation and analgesia (beneficial interaction).
모니터링
- Level of sedation and analgesia
- Heart rate and rhythm (ECG recommended in high-risk patients)
- Body temperature (monitor for hypothermia)
- Respiratory rate and depth
- Pulse oximetry (SpO2)
- Heart rate and rhythm (bradycardia is expected, but monitor for severe arrhythmias)
- Blood pressure (initial hypertension followed by normotension/hypotension)
- Oxygen saturation (SpO2)
- Body temperature (risk of hypothermia due to reduced metabolic rate and peripheral vasoconstriction)
- Depth of sedation
약동학
반감기
흡수
Rapid onset after IV (5 minutes) or IM (10-15 minutes) injection. SC absorption is unreliable. Can be absorbed via oral mucosa (sublingually) but efficacy may be lower than IM.
분포
Highly lipophilic, allowing rapid penetration of the blood-brain barrier to exert central effects.
대사
Undergoes extensive hepatic biotransformation.
배설
Metabolites are primarily excreted via the kidneys.
과다투여
Single doses of up to 5X (IV) and 10X (IM) have been tolerated in dogs, though severe adverse effects (profound bradycardia, AV blocks, respiratory depression) can occur. Death has occurred rarely in dogs (1 in 40,000) receiving 2X doses.
Important: Treatment of medetomidine-induced bradycardia with anticholinergic agents (atropine or glycopyrrolate) is not recommended due to the risk of severe hypertension, increased myocardial oxygen demand, and arrhythmias.
Atipamezole (an alpha-2 antagonist) is the safest and most effective choice to reverse medetomidine-induced cardiovascular and sedative effects.
제품
제형
- Injection: 1 mg/mL in 10 mL multidose vials
- Injectable: 1 mg/ml solution
동물용의약품
- Medetomidine HCl for Injection: 1 mg/mL in 10 mL multidose vials (Domitor®)
- Domitor 1 mg/ml solution for injection
- Dorbene 1 mg/ml solution for injection
- Dormilan 1 mg/ml solution for injection
- Medetor 1 mg/ml solution for injection
- Sedastart 1 mg/ml solution for injection
- Sedator 1 mg/ml solution for injection
- Sededorm 1 mg/ml solution for injection
규제 현황
Classified as POM-V.
Classified as POM-V.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store commercially available injection at room temperature (15-30°C) and protect from freezing.
보호자 정보
- 전문가 전용：이 약물은 강력한 진정제 및 마취 보조제로, 수의학 전문가에 의해서만 투여 및 모니터링되어야 합니다.
- 예상되는 외형 변화：진정 상태에서는 반려동물의 심박수가 크게 떨어지고 잇몸이 창백하거나 약간 푸르게 보일 수 있습니다. 이는 약물의 정상적인 반응이며 수의료진이 면밀히 모니터링합니다.
- 안정 유지：반려동물이 깊이 잠든 것처럼 보이더라도 갑작스러운 큰 소리나 거친 손길에 깜짝 놀라 깰 수 있습니다. 회복하는 동안 주변 환경을 조용하고 차분하게 유지해 주세요.
- 역전제(깨우는 약)：시술 후 수의사가 반려동물을 빠르고 부드럽게 깨우기 위해 '역전제'(아티파메졸)를 투여할 수 있습니다.
- 위험군 반려동물：반려동물에게 심장, 간 또는 신장 질환이 있거나 임신 중인 경우 이 약물의 사용이 안전하지 않을 수 있으므로 반드시 수의사에게 알려주셔야 합니다.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.