미르타자핀

사환계 항우울제; 5-HT3 길항제

미르타자핀은 비정형 사환계 항우울제로, 수의학에서는 주로 개와 고양이의 강력한 **식욕 촉진제** 및 **항구토제**로 널리 사용됩니다. * **임상 요점**: 만성 신장 질환(CKD), 울혈성 심부전, 위장관 질환, 간 질환 또는 종양 환자에게 특히 유익하며, 구역질과 식욕 부진을 동시에 개선합니다. * 난치성 구토나 항암 화학요법으로 인한 구역 및 구토(CINV) 치료를 위해 다른 항구토제와 안전하게 병용할 수 있습니다. * 주요 용량 제한 부작용은 진정 작용이지만, 고양이에서는 역설적인 흥분(발성 증가, 애교 증가)이 자주 관찰됩니다. > **중요**: 진정 부작용을 최소화하기 위해 항상 최저 유효 용량을 사용하십시오. 개에서는 하루 30mg을 초과하지 마십시오. 고용량에서는 역설적으로 식욕 촉진 효과가 사라집니다.

작용 기전: Mirtazapine has a complex, multi-receptor pharmacological profile (often classified as a NaSSA - Noradrenergic and Specific Serotonergic Antidepressant): * **Central pre-synaptic α2-adrenergic receptors**: Antagonism blocks the negative feedback loop → **increases Norepinephrine (NE)** release → stimulates appetite via other α-receptors. * **5-HT3 receptors**: Potent antagonism in the Chemoreceptor Trigger Zone (CRTZ) and GI tract → provides robust **anti-nausea and antiemetic** effects. * **5-HT2 receptors**: Antagonism contributes to its anxiolytic profile. * **H1 (Histamine) receptors**: Potent antagonism → produces prominent **sedative effects**. * **Peripheral α1-adrenergic & Muscarinic receptors**: Moderate antagonism → may cause occasional orthostatic hypotension and mild anticholinergic effects.

동물 종별 용량

Cats

As an appetite stimulant and/or antiemetic · 3.75 mg (¼ of a 15 mg tablet) · PO · q72h (every 3 days)
As an appetite stimulant and/or antiemetic · 3 mg per cat · PO · q72h (every 3 days)
As an appetite stimulant and/or antiemetic · 3-4 mg per cat · PO · q72h (every 3 days)
Appetite stimulation · 1.9 mg/cat · PO · q48h · Can double dose if needed or increase frequency to q24h but not both.

Dogs

As an appetite stimulant and/or antiemetic · 0.6 mg/kg · PO · q24h · Not to exceed 30 mg per day for appetite stimulation
As an appetite stimulant and/or antiemetic · >75 lb. = 15 mg PO q12h or 30 mg PO q24h (once daily) · PO · q12h or q24h
Appetite stimulation / Management of social fears · 1.1-1.3 mg/kg · PO · q24h · Anecdotal use for social fears.

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

투여 경로

POTopical (Transdermal)

금기

Hypersensitivity to mirtazapine
Use of monoamine oxidase inhibitors (MAOIs, e.g., selegiline) within the past 14 days
Pre-existing haematological disease

이상반응

Drowsiness/sedation
Vocalization (especially in cats)
Increased affection (cats)
Hypotension
Tachycardia
Sedation (common and can be profound)
Increased vocalization (especially in cats)
Altered behavior and increased interaction with others
Blood dyscrasias (reported in humans)

약물 상호작용

CLONIDINE · Mirtazapine may cause increases in blood pressure
DIAZEPAM (and other benzodiazepines) · Minimal effects on mirtazapine blood levels, but may cause additive impairment of motor skills
FLUVOXAMINE · May cause increased serum concentrations of mirtazapine
LINEZOLID · Increased risk for serotonin syndrome
SELEGILINE, AMITRAZ · Increased risk for serotonin syndrome; MAO inhibitors considered contraindicated with mirtazapine
TRAMADOL · Increased risk for serotonin syndrome
Other behaviour-modifying drugs (e.g., SSRIs, MAOIs) · Increased risk of serotonin syndrome · major

모니터링

Increased appetite
Decreased episodes of vomiting
Weight gain
Adverse effects (sedation, vocalization, tachycardia)
Appetite and body weight
Behavioral changes (sedation, vocalization)
Complete blood count (due to human risk of blood dyscrasias)
Hepatic and renal function parameters

과용량

Ingestion of upwards of 10-fold to 30-fold the therapeutic dose in humans exhibits minimal toxicity requiring no acute intervention other than observation. > **Treatment**: Despite the wide safety margin, standard overdose protocols (including the administration of **activated charcoal**) and monitoring are recommended in acute overdose situations.

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