브롬화칼륨 / 브롬화나트륨

항경련제

브롬화물은 19세기부터 인의 및 수의학에서 사용되어 온 가장 오래된 항경련제 중 하나입니다. 할로겐화물 염으로서, 주로 개에서 난치성 발작 장애의 1차 또는 보조 요법으로 사용되며, 특히 페노바르비탈 단독으로 불충분하거나 간독성으로 인해 금기일 때 유용합니다. **주요 임상적 특징:** * **간 손상 없음:** 페노바르비탈과 달리 브롬화물은 간에서 대사되지 않고 전적으로 신장을 통해 배설되므로 간 기능 장애가 있는 뇌전증 반려견에게 최우선으로 선택되는 약물입니다. * **매우 긴 반감기:** 개에서의 반감기는 약 16~25일입니다. 따라서 항정상태의 혈청 농도에 도달하는 데 3~4개월이 걸립니다. 신속한 발작 제어를 위해 **부하 용량(Loading doses)**이 자주 요구됩니다. * **식이 민감성:** 브롬화물은 신장 재흡수 과정에서 염화물(염분)과 경쟁합니다. 식이 중 염분(염화물) 섭취량의 변화는 혈청 브롬화물 농도에 직접적이고 반비례적인 영향을 미칩니다. * **고양이 금기:** 고양이의 경우 치명적일 수 있는 심각한 천식 유사 하기도 질환(고양이 폐렴) 발생 위험이 높기 때문에 브롬화물 사용을 일반적으로 피합니다.

작용 기전: Bromide's anti-seizure activity stems from its generalized depressant effect on neuronal excitability. * **Mechanism:** The bromide ion (Br⁻) is a halide that closely mimics the chloride ion (Cl⁻) in the body. It competes with chloride for transport across cell membranes, particularly at the **GABA_A receptor** chloride channels. * **Pathway:** GABA binds to the receptor → channel opens → Bromide traverses the channel more readily than chloride → **membrane hyperpolarization**. * **Result:** This hyperpolarization lowers the resting membrane potential, making it significantly harder for the neuron to depolarize. This effectively raises the seizure threshold and limits the spread of epileptic electrical discharges across the brain.

동물 종별 용량

Cats

Refractory seizures (3rd choice therapy) · 10-20 mg/kg/day PO · PO · q24h · Follow same guidelines as dogs. Use with extreme caution.
Epilepsy (2nd line therapy) · 30 mg/kg PO once daily · PO · q24h

Dogs

Seizures (Maintenance) · 20-30 mg/kg PO once daily, with food · PO · q24h · Dose is for potassium bromide. If sodium bromide is used, decrease dose by 15% (i.e., 17-26 mg/kg).
Seizures (Rapid Loading Dose) · 400 mg/kg PO divided into 8 doses given over a 48-hour period (i.e., 50 mg/kg every 6 hours for 2 days) · PO · q6h · 2 days · Giving entire loading dose at once will usually cause vomiting. Start maintenance dose after loading.
Seizures (Alternative Loading Dose) · 400-600 mg/kg/day divided and given with food · PO · divided · 1 to 5 days · May be given over 24 hours or more gradually over 5 days. Then go to initial maintenance dose.
Seizures (Alternative Loading Dose 2) · 125 mg/kg/day for 5 days PO divided q12h · PO · q12h · 5 days · Resume at 35 mg/kg PO once daily after loading.
Status epilepticus / NPO · 100 mg/kg body weight every 4 hours for 6 total doses · Rectal · q4h · 24 hours
Seizures (IV Loading - Sodium Bromide) · 600-1200 mg/kg, diluted in a solution and administered over eight hours · IV · once · 8 hours · Sodium bromide only. If target serum bromide concentrations are not reached, additional IV NaBr may be administered. Use with caution.

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

투여 경로

PORectalIV

금기

Cats (relative to absolute contraindication due to severe pulmonary effects)
Patients with severe renal dysfunction (requires extreme caution and dose adjustment)
Pregnant or lactating animals (crosses placenta and enters milk, causing fetal growth retardation/intoxication)

이상반응

Profound sedation (especially transiently during loading or when combined with phenobarbital)
Polyphagia (increased appetite) and subsequent weight gain
Polydipsia and polyuria (increased thirst and urination)
Ataxia and hind limb paresis (signs of toxicity)
Gastrointestinal upset (vomiting, anorexia, constipation)
Pancreatitis (reported in combination with phenobarbital/primidone)
Pruritic dermatitis (rare)
Paradoxical hyperactivity (rare)
Cats: Severe lower respiratory effects (cough, dyspnea, peribronchial infiltrates)

약물 상호작용

CNS Sedating Drugs · Additive sedation and CNS depression.
Diuretics (furosemide, thiazides) · May enhance the renal excretion of bromides, lowering serum levels and potentially causing seizure breakthrough.
High Chloride/Salt Diets · Increases renal excretion of bromide, reducing serum bromide levels and affecting seizure control.
Low Chloride/Salt Diets · Decreases renal excretion of bromide, increasing serum bromide levels and risking bromide toxicity.
Drugs that lower seizure threshold (e.g., xylazine) · May potentially reduce the efficacy of antiseizure medications.

모니터링

Serum bromide concentrations (Therapeutic range in dogs: 1-3 mg/mL)
Seizure frequency and severity
Signs of toxicity (sedation, ataxia, weakness)
Renal function (BUN, Creatinine, USG)
Body weight (due to polyphagia)

과용량

Toxicity (bromism) is more likely with chronic overdoses, but acute overdoses can occur. **Clinical Signs of Bromism:** * Profound sedation to stupor * Ataxia, tremors, and hind limb paresis * Muscle pain * Conscious proprioceptive deficits * Anisocoria and hyporeflexia **Treatment:** * **Acute Ingestion:** Standard gut removal techniques (emesis, gastric lavage). Death from acute oral ingestion is rare as spontaneous vomiting usually occurs. * **Enhancing Excretion:** Administration of parenteral 0.9% sodium chloride (NaCl) or oral sodium chloride, parenteral glucose, and loop diuretics (e.g., **furosemide**) are highly effective in promoting renal excretion and reducing bromide loads in intoxicated patients.

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