๋ฉ๋ผ์๋ฏผ
๋ฉ๋ผ์๋ฏผ(Melarsomine)์ ๊ฐ ์ฌ์ฅ์ฌ์์ถฉ(*Dirofilaria immitis*) ์ฑ์ถฉ ๊ฐ์ผ ์น๋ฃ์ ๋ ์ ์ ์ผ๋ก ์ฌ์ฉ๋๋ ์ ๊ธฐ ๋น์๊ณ ํํ์๋ฒ์ ์ ๋๋ค. ์ฑ์ํ ์ฑ์ถฉ๊ณผ ๋ฏธ์ฑ์(์ํ 4๊ฐ์, L5 ๋จ๊ณ) ์ ์ถฉ์ ๋ํด ๋์ ํจ๊ณผ๋ฅผ ๋ณด์ ๋๋ค. **์์ ์์ **: ๋ฉ๋ผ์๋ฏผ์ ์ ์ผํ๊ฒ ์น์ธ๋ ์ฑ์ถฉ ๊ตฌ์ถฉ์ ์ด์ง๋ง, ํ์ฌ ๋ฏธ๊ตญ ์ฌ์ฅ์ฌ์์ถฉํํ(AHS) ๊ฐ์ด๋๋ผ์ธ์ ๋ค์ค ์ ๊ทผ๋ฒ์ ๊ฐ๋ ฅํ ๊ถ์ฅํฉ๋๋ค. ๋ฉ๋ผ์๋ฏผ ํฌ์ฌ 1~2๊ฐ์ ์ ๋ถํฐ ๋ํํํ๋ฝํค๊ณ(์: ์ด๋ฒ๋ฉํด)์ **๋ ์์ฌ์ดํด๋ฆฐ(Doxycycline)**์ผ๋ก ์ฌ์ ์น๋ฃ๋ฅผ ํ๋ ๊ฒ์ด ๊ถ์ฅ๋ฉ๋๋ค. ๋ ์์ฌ์ดํด๋ฆฐ์ ์ฌ์ฅ์ฌ์์ถฉ์ ์์กด๊ณผ ๋ฒ์์ ํ์์ ์ธ ๊ณต์ ์ธ๊ท (*Wolbachia*)์ ์ ๊ฑฐํ์ฌ ์ฌ์์ถฉ์ ์ฝํ์ํค๊ณ , ์ถฉ์ฒด๋์ ๊ฐ์์ํค๋ฉฐ, ์ฌ์์ถฉ์ด ์ฃฝ์ ๋ ๋ฐ์ํ๋ ์ผ์ฆ ๋ฐ์๊ณผ ์ฌ๊ฐํ ํํ์ ์์ ์ฆ์ ์ํ์ ํฌ๊ฒ ์ค์ฌ์ค๋๋ค. ๋ฉ๋ผ์๋ฏผ์ ์ด์ ์ฝ๋ฌผ์ธ ํฐ์์ธํ๋ฅด์ฌ๋ง์ด๋๋ณด๋ค ํจ์ฌ ์์ ํ๊ณ ํจ๊ณผ์ ์ด์ง๋ง, ์ฌ์ ํ ์์ ์ญ์ด ์ข์ ์ ํํ ์ฉ๋ ๊ณ์ฐ๊ณผ ํฌ์ฌ ๊ธฐ์ ์ด ์๊ตฌ๋ฉ๋๋ค.
์์ฉ ๊ธฐ์ : While the exact mechanism of action is not definitively established, as an arsenical compound, melarsomine is believed to exert its parasiticidal effect by binding to **sulfhydryl (-SH) groups** of essential enzymes within the parasite. * **Enzyme Inhibition** โ Disrupts cellular respiration and vital metabolic pathways in the parasite. * **Target** โ Highly effective (90-99%) at killing adult and L5 larval stages of *D. immitis* in dogs. * **Clearance** โ Dead worms degrade and are swept into the pulmonary vasculature, where they are eventually cleared by the host's immune system (macrophages).
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Heartworm disease (Class I & II) ยท 2.5 mg/kg deep IM as directed (lumbar epaxial muscles (L3-L5) twice 24 hours apart ยท IM ยท q24h for 2 doses ยท 2 days ยท Use alternating sides with each administration. In 4 months, the regimen may be repeated.
- Heartworm disease (Class III) ยท 2.5 mg/kg deep IM as directed (lumbar epaxial muscles (L3-L5). Strict rest and give all necessary systemic treatment. One month later, give 2.5 mg/kg deep IM as directed (lumbar epaxial muscles (L3-L5) twice 24 hours apart. ยท IM ยท Once, then q24h for 2 doses 1 month later ยท 1 month + 2 days ยท Requires strict rest.
- Heartworm disease (Alternative Protocol / AHS Treatment of Choice) ยท 2.5 mg/kg deep IM as directed (lumbar epaxial muscles; L3-L5). Strict rest and give all necessary systemic treatment. One month later, give 2.5 mg/kg deep IM as directed (lumbar epaxial muscles; L3-L5) twice 24 hours apart ยท IM ยท Once, then q24h for 2 doses 1 month later ยท 1 month + 2 days ยท Treatment of choice regardless of stage of disease due to increased safety and efficacy.
์ฉ๋์ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์ฐธ๊ณ ์๋ฃ์ ๋๋ค. ํญ์ ์ต์ ๋ผ๋ฒจ๊ณผ ๊ฐ๋ณ ํ์์ ๋ํด ํ์ธํ์ญ์์ค.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Class IV (very severe) heartworm disease / Caval syndrome
- Cats (reportedly very toxic)
- Intravenous (IV) administration
- Subcutaneous (SC) administration
์ด์๋ฐ์
- Injection site reactions (pain, swelling, tenderness, firm nodules)
- Coughing/gagging
- Depression/lethargy
- Anorexia/inappetence
- Excessive salivation
- Fever
- Lung congestion
- Vomiting
- Pulmonary thromboembolism (can be fatal)
- Paresis and paralysis (rare)
์ฝ๋ฌผ ์ํธ์์ฉ
- Aspirin ยท Has been shown not to reduce adverse effects and may complicate therapy; use is not recommended.
- CNS Depressant Drugs ยท Drugs that have similar adverse effects (e.g., depression) may cause additive adverse effects or increase their incidence when used with melarsomine.
๋ชจ๋ํฐ๋ง
- Clinical efficacy
- Adverse effects (observe dogs for 24 hours after the last injection)
- Signs of pulmonary thromboembolism (coughing, hemoptysis, tachypnea, dyspnea)
- Injection site reactions
๊ณผ์ฉ๋
There is a **low margin of safety** with melarsomine. * **3X dose (7.5 mg/kg)** in healthy dogs causes respiratory inflammation and distress, excessive salivation, restlessness, panting, vomiting, edema, tremors, lethargy, ataxia, cyanosis, stupor, and death. * **2X dose** in infected dogs has caused diarrhea, excessive salivation, restlessness, panting, vomiting, and fever. * **Treatment**: Dimercaprol (BAL in Oil) may be considered to treat melarsomine overdoses, though it may reduce the clinical efficacy of the melarsomine.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.