메틸페니데이트
메틸페니데이트는 구조적 및 약리학적으로 암페타민과 유사한 중추신경계(CNS) 흥분제입니다. 수의학에서는 주로 반려견의 **기면증/탈력발작** 및 **운동항진증(과동증)**의 진단 및 관리를 위해 허가 외(off-label)로 사용됩니다. 중추신경계 효과 외에도 약한 교감신경 흥분 작용이 있으나, 표준 치료 용량에서는 말초 순환에 미치는 영향이 최소화됩니다. > **임상적 주의사항**: 메틸페니데이트는 미국에서 2급(C-II) 통제 약물로 분류되어 엄격한 처방 규제가 적용되며, 인체 오남용의 위험이 매우 높습니다. 수의사는 처방 및 조제 시 적절한 법적, 윤리적 예방 조치를 취해야 합니다.
작용 기전: Methylphenidate acts primarily as a **norepinephrine-dopamine reuptake inhibitor (NDRI)**. * It binds to and blocks the **dopamine transporter (DAT)** and **norepinephrine transporter (NET)** on presynaptic neurons. * Blockade of these transporters → prevents the reuptake of monoamines → increases the concentration of **dopamine** and **norepinephrine** in the extraneuronal space (synaptic cleft). * This amplified monoamine signaling in the brainstem arousal system and cerebral cortex leads to increased alertness, focus, and CNS stimulation.
동물 종별 용량
- Treatment of narcolepsy/cataplexy · 5-10 mg (total dose) · PO · once daily
- Treatment of narcolepsy/cataplexy (to supplement imipramine) · 0.25-0.5 mg/kg or 5-10 mg (total dose) · PO · q12-24h · Used to supplement imipramine given at 0.5-1 mg/kg PO q8-12h
- Diagnosis and treatment of hyperkinesis · 5-20 mg (total dose) · PO · q8-12h · 3 days · Give for 3 days and assess for improvement of target behaviors (anxiety, overactivity, learning ability)
- Hyperkinesis-hyperactivity · Small dogs: 5+ mg total dose; Large Dogs: 20-40 mg total dose · PO · q12h
용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.
투여 경로
금기
- Seizure disorders
- Cardiac disease or hypertension
- Aggressive animals
이상반응
- Tachycardia (increased heart rate)
- Tachypnea (increased respiratory rate)
- Anorexia
- Tremors
- Hyperthermia (particularly exercise-induced)
약물 상호작용
- Anticonvulsants (phenobarbital, primidone, phenytoin) · Methylphenidate may increase serum levels of these anticonvulsants
- Clonidine · Rare cases of cardiovascular effects (including death) reported in humans; mechanism unknown
- Hypotensive drugs · Methylphenidate may reduce the efficacy of hypotensive effects
- MAO Inhibitors (amitraz, selegiline) · Concurrent use could lead to a severe hypertensive crisis
- SSRI Antidepressants (fluoxetine, sertraline) · Methylphenidate may inhibit SSRI metabolism and increase their serum levels
- Tricyclic Antidepressants (amitriptyline, clomipramine) · Methylphenidate may inhibit TCA metabolism and increase their serum levels
- Warfarin · Methylphenidate may inhibit warfarin metabolism and increase INR
모니터링
- Clinical efficacy (improvement in target behaviors or narcoleptic episodes)
- Vital signs (heart rate, respiratory rate)
- Body weight (monitor for anorexia/weight loss)
- Periodic CBC with differential and platelet counts (recommended during prolonged therapy based on human guidelines)
과용량
Toxicity can occur at relatively low doses in veterinary patients. * **Dogs**: Doses of 1 mg/kg (or below) can cause toxic reactions. One fatality was reported at 3.1 mg/kg, though research dogs have survived 20 mg/kg/day for 90 days. * **Cats**: A 5 mg tablet caused severe toxicity (tremors, agitation, mydriasis, tachycardia, tachypnea, hypertension) which resolved after 25 hours with supportive care. **Clinical Signs of Overdose**: Primarily CNS over-stimulation and excessive sympathomimetic effects: hyperactivity, salivation, diarrhea, head bobbing, agitation, tachycardia, hypertension, tremors, seizures, and hyperthermia. **Treatment**: * **Decontamination**: Standard gut detoxification (emesis, activated charcoal, cathartic). *Avoid emesis if the animal is already symptomatic* due to seizure/aspiration risks. * **Supportive Care**: * **Phenothiazines** (e.g., acepromazine, chlorpromazine) to control agitation. * **Beta-blockers** to manage severe tachycardia. * **External cooling** for hyperthermia. * **Cyproheptadine** may be administered to help prevent or treat serotonin syndrome.
VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.