멜라소민

비소계 항기생충약 / 심장사상충 성충 구충제

멜라소민(Melarsomine)은 개 심장사상충(*Dirofilaria immitis*) 성충 감염 치료에 독점적으로 사용되는 유기 비소계 화학요법제입니다. 성숙한 성충과 미성숙(생후 4개월, L5 단계) 유충에 대해 높은 효과를 보입니다. **임상 요점**: 멜라소민은 유일하게 승인된 성충 구충제이지만, 현재 미국 심장사상충협회(AHS) 가이드라인은 다중 접근법을 강력히 권장합니다. 멜라소민 투여 1~2개월 전부터 대형환형락톤계(예: 이버멕틴)와 **독시사이클린(Doxycycline)**으로 사전 치료를 하는 것이 권장됩니다. 독시사이클린은 심장사상충의 생존과 번식에 필수적인 공생 세균(*Wolbachia*)을 제거하여 사상충을 약화시키고, 충체량을 감소시키며, 사상충이 죽을 때 발생하는 염증 반응과 심각한 폐혈전색전증의 위험을 크게 줄여줍니다. 멜라소민은 이전 약물인 티아세타르사마이드보다 훨씬 안전하고 효과적이지만, 여전히 안전역이 좁아 정확한 용량 계산과 투여 기술이 요구됩니다.

작용 기전: 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** → Disrupts cellular respiration and vital metabolic pathways in the parasite. * **Target** → Highly effective (90-99%) at killing adult and L5 larval stages of *D. immitis* in dogs. * **Clearance** → Dead worms degrade and are swept into the pulmonary vasculature, where they are eventually cleared by the host's immune system (macrophages).

동물 종별 용량

Dogs

Heartworm disease (Class I & II) · 2.5 mg/kg deep IM as directed (lumbar epaxial muscles (L3-L5) twice 24 hours apart · IM · q24h for 2 doses · 2 days · Use alternating sides with each administration. In 4 months, the regimen may be repeated.
Heartworm disease (Class III) · 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. · IM · Once, then q24h for 2 doses 1 month later · 1 month + 2 days · Requires strict rest.
Heartworm disease (Alternative Protocol / AHS Treatment of Choice) · 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 · IM · Once, then q24h for 2 doses 1 month later · 1 month + 2 days · Treatment of choice regardless of stage of disease due to increased safety and efficacy.

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

투여 경로

금기

Class IV (very severe) heartworm disease / Caval syndrome
Cats (reportedly very toxic)
Intravenous (IV) administration
Subcutaneous (SC) administration

이상반응

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)

약물 상호작용

Aspirin · Has been shown not to reduce adverse effects and may complicate therapy; use is not recommended.
CNS Depressant Drugs · Drugs that have similar adverse effects (e.g., depression) may cause additive adverse effects or increase their incidence when used with melarsomine.

모니터링

Clinical efficacy
Adverse effects (observe dogs for 24 hours after the last injection)
Signs of pulmonary thromboembolism (coughing, hemoptysis, tachypnea, dyspnea)
Injection site reactions

과용량

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