펜토산 폴리설페이트 나트륨

항염증제, 골관절염 질환 완화제

**펜토산 폴리설페이트 나트륨(PPS)**은 너도밤나무 헤미셀룰로오스에서 추출한 반합성 헤파린 유사 고분자 탄수화물 유도체입니다. 수의학에서는 주로 **골관절염 질환 완화제(DMOAD)** 및 하부 요로 질환의 보조 요법으로 사용됩니다. 주요 임상 적용: * **골관절염(OA):** 개, 고양이, 말에서 관절 기능 개선, 염증 감소 및 연골 건강 증진을 위해 사용됩니다. * **고양이 특발성 하부 요로 질환(FLUTD) / 간질성 방광염:** 방광 요로상피의 보호적인 글리코사미노글리칸(GAG) 층을 복원하는 데 도움을 주기 위해 허가 외(off-label)로 사용되지만, 단기 급성 발작에 대한 임상적 효능은 잘 입증되지 않았습니다. *임상 팁:* 구조적으로 헤파린과 유사하지만 항응고 활성은 현저히 약합니다(헤파린의 약 1/15). 그러나 출혈성 질환이 있거나 수술을 앞둔 환자에게는 여전히 주의가 필요합니다.

작용 기전: Pentosan polysulfate sodium exhibits multiple pharmacological effects depending on the target tissue: * **Osteoarthritis (Disease-Modifying Effects):** * **Inhibits catabolic enzymes:** Downregulates **matrix metalloproteinases (MMPs)** and **aggrecanases** that degrade articular cartilage. * **Stimulates matrix synthesis:** Promotes the synthesis of **hyaluronic acid** by synovial fibroblasts and preserves proteoglycan content within the cartilage matrix. * **Improves microcirculation:** Its mild anticoagulant, fibrinolytic, and hypolipidemic properties help mobilize thrombi and lipid deposits in subchondral blood vessels, thereby increasing synovial blood flow and nutrition to the joint. * **Interstitial Cystitis / FLUTD:** * **Urothelial Protection:** Excreted partially unchanged in the urine, PPS adheres to the mucosal membranes of the bladder wall. It acts as a synthetic **glycosaminoglycan (GAG) buffer**, preventing irritating urinary solutes and toxins from reaching and damaging the underlying transitional epithelial cells. * **Analgesia:** Provides mild local analgesic and anti-inflammatory effects within the bladder wall.

동물 종별 용량

Cats

Persistent or recurrent FLUTD · 2-16 mg/kg PO q12h · PO · q12h · Recent studies have not shown any statistical benefit.
Persistent or recurrent FLUTD · 8 mg/kg PO q12h · PO · q12h · Recent studies have not shown any statistical benefit.

Horses

Osteoarthritis · 3 mg/kg IM on four occasions with an interval of 7 days between injections. · IM · q7d · 4 doses
Osteoarthritis · Inject mixture back into joint · Intra-articular · Once · Prepare site as for surgery. Avoid iodine based skin preps; use neutral soapless cleanser. Withdraw ~1 mL synovial fluid, mix with pentosan in syringe, inject back. Firmly bandage and confine for 3-4 hours. Rest horse for 2 weeks, follow with 2 weeks graded walking.

Dogs

Osteoarthritis (High loading dose for treatment of OA signs of pain, lameness and stiffness) · 20 mg/kg PO twice weekly for 5 weeks · PO · twice weekly · 5 weeks · Always give on an empty stomach.
Osteoarthritis (Medium Loading dose for management of OA after joint surgery) · 10 mg/kg PO once weekly for 12 weeks · PO · once weekly · 12 weeks · Always give on an empty stomach.
Osteoarthritis (Maintenance dose) · 10 mg/kg once weekly for 4 weeks as needed · PO · once weekly · 4 weeks · Always give on an empty stomach.
Osteoarthritis · 3 mg/kg IM or SC on four occasions with an interval of 5-7 days between injections · IM/SC · q5-7d · 4 doses

투여 경로

POIMSCIntra-articular

금기

Known hypersensitivity to pentosan polysulfate sodium
Patients with active bleeding disorders
Use with caution prior to surgery

이상반응

Vomiting
Anorexia
Lethargy
Mild depression
Bleeding or prolonged coagulation times (dose-dependent increase in PTT in horses)
Transient increases in liver enzymes (reported in humans)

약물 상호작용

NSAIDs (e.g., carprofen, meloxicam) · May increase the risk of bleeding due to concurrent effects on coagulation and platelet function; use cautiously.
Aspirin · Increased risk of bleeding due to combined anticoagulant and antiplatelet effects.
Heparin · Additive anticoagulant effects; increased risk of hemorrhage.

모니터링

Clinical efficacy (improvement in lameness/mobility for OA, or reduction in urinary signs for FLUTD)
Signs of bleeding or bruising
Intra-articular bleeding (when administered directly into joints)

과용량

Information regarding overdoses is limited. * **Potential Signs:** Overdoses could potentially cause bleeding, thrombocytopenia, gastrointestinal distress, and liver function abnormalities. * **Treatment:** Treatment recommendations are basically supportive in nature. If an acute oral overdose occurs, consider standard protocols for drug removal from the gut (e.g., emesis, activated charcoal) if performed promptly.

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