메틸프레드니솔론

글루코코르티코이드

메틸프레드니솔론은 히드로코르티손보다 약 4~5배 더 강력하고 무기질코르티코이드 활성이 거의 없는 합성 중간 작용형 **글루코코르티코이드**입니다. 강력한 항염증 및 면역 억제 특성으로 수의학에서 광범위하게 사용됩니다. **임상 요점 및 제형:** * **메틸프레드니솔론 염기:** 유지 또는 점감 요법을 위한 경구용 정제. * **메틸프레드니솔론 아세테이트 (Depo-Medrol®):** 근육내, 병변내 또는 관절내 주사용 미세결정 현탁액. 천천히 흡수되어 장기간의 저장 효과(수주~수개월)를 제공합니다. **주의:** 심각하고 장기적인 시상하부-뇌하수체-부신(HPA) 축 억제를 유발할 수 있습니다. * **메틸프레드니솔론 소듐 숙시네이트 (Solu-Medrol®):** 급성 위기(예: 척수 손상, 중증 알레르기 반응, 쇼크) 시 빠른 정맥 투여를 위해 고안된 수용성 에스테르. 단, 쇼크/외상에 대한 고용량 사용은 점점 더 논란이 되고 있습니다. 매우 효과적이지만, 글루코코르티코이드 요법의 목표는 항상 전신 부작용, 특히 의인성 부신피질기능항진증(쿠싱 증후군)을 최소화하기 위해 **가능한 한 최단 기간 동안 최소 유효 용량을 사용하는 것**입니다.

작용 기전: Glucocorticoids exert their effects by diffusing across cell membranes and binding to specific **cytoplasmic glucocorticoid receptors (GR)**. * **Genomic Pathway:** The receptor-ligand complex translocates to the nucleus → binds to **glucocorticoid response elements (GREs)** on target genes → alters gene transcription. * **Anti-inflammatory Mechanism:** They induce the synthesis of **lipocortin-1 (annexin-1)** → inhibits **phospholipase A2** → blocks the release of arachidonic acid from membrane phospholipids → profoundly decreases the synthesis of pro-inflammatory **prostaglandins and leukotrienes**. * **Immunosuppressive Mechanism:** They suppress the transcription of inflammatory cytokines (e.g., IL-1, IL-2, IL-6, TNF-alpha), inhibit macrophage and neutrophil migration/function, and induce apoptosis in lymphocytes. * **Metabolic Effects:** Stimulate hepatic gluconeogenesis, promote protein catabolism, and redistribute lipid stores.

동물 종별 용량

Cats

Labeled uses (Oral) · Cats weighing 5-15 lbs: 2 mg; Cats weighing >15 lbs: 2-4 mg; these total daily doses should be divided · PO · q6-10h · Divide total daily dose and give 6-10 hours apart.
Labeled uses (Injectable) · up to 20 mg (average 10 mg) · IM · May repeat at weekly intervals · Depending on breed (size), severity of condition, and response.
Intralesional (sub-lesional) use · 10-40 mg total dose · intralesional · A sufficient volume of 20 mg/mL methylprednisolone acetate is used to undermine the lesion.

Horses

Antiinflammatory (glucocorticoid effects) · 200 mg · IM · repeated as necessary · Labeled use.
Intra-articular use · 100 mg · IA

Dogs

Labeled uses (Oral) · Dogs weighing 5-15 lbs: 2 mg; Dogs weighing 15-40 lbs: 2-4 mg; Dogs weighing 40-80 lbs: 4-8 mg; these total daily doses should be divided · PO · q6-10h · Divide total daily dose and give 6-10 hours apart.
Labeled uses (Injectable) · 2-120 mg (average 20 mg) · IM · May repeat at weekly intervals · Depending on breed (size), severity of condition, and response.
Intralesional (sub-lesional) use · 10-40 mg total dose · intralesional · A sufficient volume of 20 mg/mL methylprednisolone acetate is used to undermine the lesion.

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

투여 경로

POIMIVIA (intra-articular)IntralesionalIntrasynovialSC

금기

Systemic fungal infections (unless used for Addison's replacement)
Viral infections
Arrested tuberculosis
Peptic or corneal ulcers
Acute psychoses
Cushingoid syndrome
Idiopathic thrombocytopenia (for IM administration)
Acute local infections (for intrasynovial/intratendinous use)
Chronic systemic therapy using sustained-release injectable forms
Pregnant animals
Renal disease
Diabetes mellitus

이상반응

Polyuria (PU), polydipsia (PD), polyphagia (PP)
Iatrogenic hyperadrenocorticism (Cushingoid signs) with sustained use
HPA axis suppression
Weight gain and lipidemias
Dull, dry haircoat and alopecia
Muscle wasting and weakness
Gastrointestinal ulceration, vomiting, diarrhea, melena, hematochezia
Elevated liver enzymes (ALP, ALT) and hepatopathy
Pancreatitis
Activation or worsening of diabetes mellitus (especially in cats)
Behavioral changes (depression, lethargy, viciousness, panting)
Extracellular hyperglycemia leading to volume expansion and potential CHF (cats)
Hypothalamic-pituitary-adrenal (HPA) axis suppression
Adrenal atrophy
Weight loss (catabolic effect)

약물 상호작용

Amphotericin B · May cause hypokalemia; potential for CHF and cardiac enlargement · moderate
Analgesics/Opiates/Local Anesthetics (epidural) · Combination in epidurals has caused serious CNS injuries and death
Anticholinesterase agents (e.g., pyridostigmine) · May lead to profound muscle weakness in myasthenia gravis patients
Aspirin · Glucocorticoids may reduce salicylate blood levels
Barbiturates · May increase the metabolism of glucocorticoids and decrease blood levels
Cyclophosphamide · Glucocorticoids may inhibit hepatic metabolism of cyclophosphamide
Cyclosporine · May mutually inhibit hepatic metabolism, increasing blood levels of both drugs
Potassium-depleting diuretics · May cause hypokalemia
Ephedrine · May reduce methylprednisolone blood levels
Estrogens · May potentiate the effects of methylprednisolone
Insulin · Insulin requirements may increase due to glucocorticoid-induced insulin resistance · moderate
Ketoconazole and Azole Antifungals · May decrease metabolism of glucocorticoids; ketoconazole may induce adrenal insufficiency upon withdrawal

모니터링

Weight, appetite, and signs of edema
Serum and/or urine electrolytes
Total plasma proteins, albumin
Blood glucose
Growth and development in young animals
ACTH stimulation test (if iatrogenic Cushing's or Addison's is suspected)
Clinical signs of iatrogenic hyperadrenocorticism (PU/PD, polyphagia, weight gain)
Blood glucose levels (especially in diabetic or pre-diabetic patients)
Serum electrolytes (specifically potassium)
Thyroid panel (T3 and T4 may be artificially decreased)
Signs of gastrointestinal ulceration (melena, vomiting blood)

과용량

Short-term administration of massive doses is unlikely to cause harmful effects, though one case of acute CNS effects in a dog after accidental ingestion has been reported. If acute overdose occurs, provide supportive treatment as required. **Chronic Overdosage:** Chronic usage leads to serious adverse effects, primarily iatrogenic hyperadrenocorticism (Cushing's syndrome), characterized by profound metabolic, dermatologic, and immunosuppressive changes.

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