피모벤단

강심혈관확장제 (양성 변력제 및 혈관확장제)

피모벤단은 **강심혈관확장제(Inodilator)**로 분류되는 매우 효과적인 심혈관계 약물로, 양성 변력 작용(심장 수축력 증가)과 혈관 확장 특성을 모두 가지고 있습니다. **주요 임상 용도:** * **개:** 주로 **확장성 심근병증(DCM)** 또는 **점액종성/퇴행성 승모판 질환(MMVD)**에 속발하는 울혈성 심부전(CHF)을 치료하는 데 사용됩니다. 기존의 ACE 억제제/푸로세마이드 단독 요법과 비교하여 생존 시간과 삶의 질을 크게 향상시킵니다. 도베르만 핀셔의 DCM에 대한 1차 치료제로 간주되며 ACVIM C 및 D 단계 심부전 관리의 초석입니다. * **고양이:** 제한성 및 확장성 심근병증에 오프라벨로 사용됩니다. 양성 변력 작용으로 인해 비대성 심근병증(HCM)에는 일반적으로 금기입니다. > **임상 팁:** 모노그래프에는 전임상 사용에 대한 연구가 진행 중이라고 언급되어 있지만, 획기적인 EPIC 연구를 통해 피모벤단은 전임상(ACVIM B2 단계) MMVD가 있는 반려견의 심부전 발병을 지연시키는 표준 치료법으로 확립되었습니다.

작용 기전: Pimobendan exerts its dual **inodilator** effects through two distinct mechanisms: 1. **Positive Inotropy (Calcium Sensitization):** It increases the sensitivity of the cardiac myofilament **Troponin C** to intracellular calcium → enhances cardiac contractility. Unlike older inotropes (e.g., digoxin), it achieves this *without* increasing intracellular calcium levels → **no increase in myocardial oxygen consumption**. 2. **Vasodilation (PDE-III Inhibition):** It inhibits the enzyme **phosphodiesterase III (PDE-III)** in vascular smooth muscle → prevents the breakdown of cAMP → ↑ intracellular cAMP → smooth muscle relaxation → **mixed arterial and venous dilation**. This reduces both cardiac preload and afterload. Additionally, pimobendan possesses mild antithrombotic activity.

동물 종별 용량

Cats

Management of myocardial failure (DCM), especially if not associated with taurine deficiency · 1.25-1.5 mg/cat PO q12hrs · PO · q12h · Off-label use. Little information about clinical efficacy due to rarity of condition.
Heart failure associated with systolic dysfunction (Off-label) · 0.1-0.3 mg/kg · PO · q12h · Lifelong · Not authorized (off-label). Pharmacokinetics may differ from dogs. Administer 1 hour before food.

Dogs

Management of the signs of mild, moderate or severe congestive heart failure due to AV valve insufficiency or dilated cardiomyopathy · 0.5 mg/kg total daily dose. Divide daily dose into two portions that are not necessarily equal (using whole and half tablets) and administer approximately 12 hours apart. · PO · Divided q12h
Treatment of congestive heart failure secondary to myxomatous mitral valve disease (MMVD) · 0.4-0.6 mg/kg PO divided twice daily · PO · Divided twice daily
Treatment of heart failure secondary to dilated cardiomyopathy or chronic mitral valve insufficiency · 0.25 mg/kg PO twice daily · PO · Twice daily
General dosing · 0.2-0.6 mg/kg PO divided q12h · PO · Divided q12h
Adjunctive drug for the emergency treatment of CHF (if not overtly critical and a strong positive oral inotrope is needed) · 0.1-0.3 mg/kg PO q12h · PO · q12h
Adjunctive treatment of acute or chronic stage D heart failure (refractory to standard treatment) · 0.3 mg/kg PO to three times daily · PO · Up to TID · Outside of FDA-approved labeling; requires client consent.

투여 경로

POIV

금기

Hypersensitivity to pimobendan
Hypertrophic cardiomyopathy (HCM)
Aortic stenosis
Any condition where augmentation of cardiac output is inappropriate for functional or anatomic reasons
Any condition where augmentation of cardiac output via increased contractility is not possible anatomically or functionally

이상반응

Poor appetite
Lethargy
Diarrhea
Dyspnea
Azotemia
Weakness and ataxia
Pleural effusion
Syncope
Cough
Ascites
Heart murmur
Arrhythmias (atrial fibrillation, increased ventricular ectopic beats)
Worsening mitral valve lesions (acute hemorrhages, endocardial papilloform hyperplasia) with chronic use
Moderate positive chronotropic effect (tachycardia)
Vomiting (dose-dependent)
Reduced appetite or lethargy (rare)

약물 상호작용

Verapamil · Calcium antagonist; attenuates pimobendan-induced increases in cardiac contractility.
Propranolol · Beta-antagonist; attenuates pimobendan-induced increases in cardiac contractility.
Diltiazem · Calcium channel blocker; assumed to potentially attenuate positive inotropic effects.
Atenolol · Beta-blocker; assumed to potentially attenuate positive inotropic effects.
Beta-blockers (e.g., atenolol, propranolol) · Attenuates the positive inotropic effects of pimobendan · moderate
Calcium-channel blockers (e.g., verapamil, diltiazem) · Attenuates the positive inotropic effects of pimobendan · moderate

모니터링

ECG (rate and rhythm)
Blood pressure
Echocardiography (cardiac function and valve lesions)
Clinical signs of heart failure (coughing, exercise intolerance)
Resting respiratory rate (RRR) at home
Heart rate and rhythm
Respiratory rate and effort (Resting Respiratory Rate - RRR)
Echocardiographic parameters (fractional shortening, left atrial/ventricular dimensions)
Clinical signs of congestive heart failure

과용량

Overdoses primarily manifest as cardiovascular signs. **Clinical Signs:** * Tachycardia (dose-dependent increases in heart rate) * Mild, non-clinical heart murmurs * Hypotension **Treatment:** * **Decontamination:** Induce emesis and administer activated charcoal if exposure was recent. * **Monitoring:** Continuously monitor heart rate, blood pressure, and ECG. * **Supportive Care:** Control hypotension with IV fluids and dopamine if necessary.

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