밀베마이신 옥심

마크로라이드계 항기생충제

밀베마이신 옥심은 수의학에서 널리 사용되는 **마크로라이드계 항기생충제**입니다. - **주요 용도**: 매월 심장사상충 예방 및 장내 기생충(구충, 회충, 편충) 구제. - **오프라벨 용도**: 전신성 모낭충증, 옴, 츠메진드기, 코진드기 치료. > **임상 팁**: 일반적으로 안전하지만, **ABCB1(MDR1) 유전자 돌연변이**가 있는 견종(콜리, 오스트레일리안 셰퍼드, 셸티 등)에서 모낭충증 치료를 위해 고용량을 매일 투여할 경우 신경 독성 위험이 있으므로 주의가 필요합니다. 이들 견종에게는 이버멕틴보다 안전한 대안으로 여겨지지만, 고용량 치료를 시작하기 전에 유전자 검사를 권장합니다.

작용 기전: Milbemycin acts primarily on the nervous system of invertebrates. - Binds to **glutamate-gated chloride channels** and **GABA receptors** in the parasite's nervous system. - This binding increases membrane permeability to chloride ions → **hyperpolarization** of nerve and muscle cells. - Results in flaccid paralysis and death of the parasite. *Note*: Mammals are generally protected because their GABA receptors are confined to the central nervous system, and intact P-glycoprotein (P-gp) pumps at the blood-brain barrier prevent the drug from accumulating in the CNS.

동물 종별 용량

Cats

Prevention of heartworm; treat adult hookworm and adult roundworms · 2 mg/kg PO once monthly · PO · q30d

Dogs

Heartworm prophylaxis, control of adult hookworms, roundworms, and whipworms · 0.5 mg/kg PO once a month · PO · q30d · Minimum dosage. Can also be used with nitenpyram for flea control.
Microfilaricide chemotherapy (in adulticide-pretreated dogs) · 0.5 mg/kg PO · PO · once · Repeat in 2 weeks if necessary. Give approximately one month after melarsomine.
Treatment of generalized demodicosis · 1-3 mg/kg/day PO · PO · q24h · Until resolved · Begin at 1 mg/kg/day with skin scraping after 30 days. Increase to 2 mg/kg if minimal improvement, then 3 mg/kg if needed. Dogs homozygous for MDR1 mutation can show neuro side effects at 1-2.2 mg/kg/day.
Treatment of cheyletiellosis · 2 mg/kg PO every 7 days for 3 doses · PO · q7d · 3 doses
Treatment of scabies · 2 mg/kg PO every 7 days for 3 doses or 0.75 mg/kg once daily for 30 days · PO · q7d or q24h · 3 doses or 30 days
Chronic rhinitis caused by Pneumonyssus caninum · 1 mg/kg PO once every 10 days for 3 treatments · PO · q10d · 3 treatments

Reptiles

Nematodes · 0.5-1 mg/kg PO; repeat in 2 weeks · PO · once, repeat in 14 days · Until clear · If 14 days after second dose fecal is positive, a third dose is given. Appears to be safe in chelonians (unlike ivermectin).

투여 경로

POtopical

금기

Puppies less than 4 weeks of age or less than 2 lbs
Kittens less than 6 weeks of age or less than 1.5 lbs

이상반응

Transient shock-like syndrome (in microfilaremic animals)
Ataxia
Trembling
Mydriasis
Hypersalivation
Lethargy
Pyrexia
Seizures
Coma

약물 상호작용

Benzodiazepines · Effects may be potentiated by milbemycin; concurrent use is not advised in humans and warrants caution in animals.
P-glycoprotein inhibitors (Amiodarone, Ketoconazole, Cyclosporine, Diltiazem, Erythromycin, Clarithromycin, Quinidine, Spironolactone, Tamoxifen, Verapamil) · May inhibit the efflux pump at the blood-brain barrier, increasing the risk of milbemycin neurotoxicity, particularly in dogs at risk for the ABCB1-1 (MDR1) mutation.

모니터링

Heartworm status (prior to initiation of therapy)
Neurologic signs (especially in susceptible breeds or at high doses)
Skin scrapings (if treating demodicosis)

과용량

Beagles have tolerated a single oral dose of 200 mg/kg (200 times monthly rate). Rough-coated collies have tolerated doses of 10 mg/kg (20 times labeled) without adversity. Toxic doses can cause mydriasis, hypersalivation, lethargy, ataxia, pyrexia, seizures, coma, and death. There is no specific antidotal treatment; supportive therapy is recommended.

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