메드록시프로게스테론 아세테이트

프로게스틴 / 생식 호르몬

메드록시프로게스테론 아세테이트(MPA)는 프로게스테론의 강력한 합성 **프로게스틴** 유도체입니다. 과거 수의학에서는 행동 교정(예: 배회, 수컷 간의 공격성, 스프레이 행동) 및 피부 질환(예: 고양이 심인성 탈모증)에 사용되었습니다. 그러나 **심각한 부작용 발생 위험이 높아** 현재는 그 사용이 크게 감소했습니다. **임상 요점:** 행동 문제의 경우 더 안전한 대안(예: SSRI, TCA 또는 외과적 중성화)이 강력히 권장됩니다. MPA는 임신한 암개의 황체 기능 부전, 양성 전립선 비대증의 단기 관리 또는 저먼 셰퍼드의 뇌하수체성 소인증과 같은 특정 생식기계 적응증에 여전히 간혹 사용됩니다. 전신에 미치는 영향이 크기 때문에, 내분비 및 생식기계 합병증의 중대한 위험과 잠재적 이점을 신중하게 저울질해야 합니다.

작용 기전: MPA mimics endogenous progesterone by binding to intracellular **progesterone receptors**, translocating to the nucleus, and altering gene transcription. It transforms the proliferative endometrium into a secretory endometrium and inhibits spontaneous uterine contractions. * **Endocrine/Reproductive:** Exerts negative feedback on the hypothalamus and pituitary, decreasing **GnRH** → suppressing **FSH** and **LH** release, thereby inhibiting estrus and spermatogenesis. It also possesses anti-estrogenic properties and decreases plasma testosterone. * **Glucocorticoid Activity:** MPA has significant intrinsic affinity for **glucocorticoid receptors**, leading to profound suppression of the hypothalamic-pituitary-adrenal (HPA) axis (decreased ACTH and cortisol release). * **Metabolic Effects:** Induces peripheral insulin resistance, which can precipitate **diabetes mellitus**. * **Growth Hormone:** In dogs, progestins can stimulate the mammary glands to produce growth hormone, potentially leading to acromegaly.

동물 종별 용량

Cats

Behavioral disorders (reduce marking in neutered males) · 5-20 mg/kg SC or IM three to four times yearly · SC/IM · 3-4 times yearly · Use when all other drugs have been unsuccessful.
Feline psychogenic alopecia and dermatitis · 75-150 mg IM or SC · IM/SC · Repeat as necessary, but never more often than every 2-3 months
Progestagen-responsive dermatitis · 50-100 mg IM · IM · May repeat in 3-6 months if needed
Recurrent abortion secondary to progesterone-deficiency · 1-2 mg/kg IM once weekly · IM · q7d · Stop treatment 7-10 days prior to parturition
Long-term reproductive control · 2.5-5 mg PO once weekly; 25 mg injected every 6 months to postpone estrus · PO/IM/SC · q7d (PO) or q6mo (Injection)
Long-term reproductive control · 2 mg/kg IM q5 months · IM · q5 months

Horses

Management of spring transition, prevention of estrus behavior, induction of estrous cycle synchrony, pregnancy maintenance, modification of stallion behavior · 500 to 800 mg IM · IM · Interval varies · Most injections last 2 to 3 months · Will not prevent pregnancy loss and does not stop cyclicity.

Birds

Antipruritic and to suppress ovulation · 0.025-1 mL (3 mg/100 grams body weight) IM once every 4-6 weeks · IM · q4-6w · May cause obesity, fatty liver, polydipsia/polyuria and lethargy if used repeatedly.

투여 경로

POIMSC

금기

Pre-pubescent cats or dogs
Diabetes mellitus
Pseudopregnant bitches
Females in diestrus or with prolonged heat
Uterine hemorrhage or discharge
Pregnancy (unless specifically treating hypoluteoidism)

이상반응

Increased thirst (polydipsia) and urination (polyuria)
Increased appetite (polyphagia) and weight gain
Depression, lethargy, and personality changes
Adrenocortical depression (HPA axis suppression)
Mammary changes (enlargement, milk production, neoplasia)
Diabetes mellitus
Pyometra / Cystic endometrial hyperplasia
Temporary inhibition of spermatogenesis
Permanent local alopecia, skin atrophy, and depigmentation (with SC injection)
Acromegaly (in dogs)

약물 상호작용

Aminoglutethimide · May decrease medroxyprogesterone effects
Felbamate · May increase medroxyprogesterone metabolism
Rifampin · May decrease progestin activity due to microsomal enzyme induction and increased progestin metabolism

모니터링

Weight
Blood glucose (draw baseline before therapy and monitor periodically)
Mammary gland development
Adrenocortical function
Clinical efficacy

과용량

No specific reports on inadvertent acute overdosage were located. Overdose is expected to manifest as an exaggeration of adverse effects, including profound adrenal suppression, lethargy, metabolic derangements (hyperglycemia), and reproductive tract changes. Treatment should be supportive and symptomatic.

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