νλ‘λ©νμ§
νλ‘λ©νμ§μ μμνμμ μ£Όλ‘ νꡬν μ λ° ννμ€νλ―Όμ λ‘ μ¬μ©λλ νλ Έν°μμ§ μ λ체μ λλ€. * **μ£Όμ μ©λ**: κ°μ κ³ μμ΄μ λ©μ€κΊΌμκ³Ό ꡬν λ₯Ό μ‘°μ νλ λ° κ°λ μ¬μ©λλ©°, μν νΌμ± νΌλΆμΌμ΄ μλ κ°μ κ°λ €μμ¦ μΉλ£μ μλλ λ° μμ΅λλ€(νμμ κ²½μ° ν¨λ₯μ μΌλ°μ μΌλ‘ λ¨μ΄μ§). * **μ½λ¦¬νμ νΉμ§**: μμΈνλ‘λ§μ§κ³Ό κ°μ μ§μ μ μ ꡬ쑰μ μΌλ‘ μ μ¬νμ§λ§, νλ‘λ©νμ§μ κ°λ ₯ν ννμ€νλ―Ό νΉμ±κ³Ό ν¨κ» νꡬν , νμ½λ¦°, μ§μ λ° κ²½λ―Έν κ΅μ λ§μ·¨ ν¨κ³Όλ₯Ό λνλ΄λ κ²μ΄ νΉμ§μ λλ€. > **μμ ν**: μ§μ μμ© λ° μΆμ²΄μΈλ‘ λΆμμ©μ κ°λ₯μ± λλ¬Έμ λ§λ‘νΌννΈλ μ¨λ¨μΈνΈλ‘ κ³Ό κ°μ μ΅μ νμ νꡬν μ λλ λννλλΌλ―Όκ³Ό κ°μ νμ€ ννμ€νλ―Όμ μ λΉν΄ νλ μμν μμμμλ μλμ μΌλ‘ λλ¬Όκ² μ²λ°©λ©λλ€.
μμ© κΈ°μ : Promethazine exerts its effects through competitive antagonism at multiple receptor sites centrally and peripherally: * **H1-Receptor Antagonism**: Competitively blocks histamine at H1 receptors β reduces allergic responses and pruritus. * **D2-Dopaminergic Antagonism**: Blocks dopamine receptors in the Chemoreceptor Trigger Zone (CRTZ) of the medulla β provides central **antiemetic** effects. * **Muscarinic Antagonism**: Blocks acetylcholine at muscarinic receptors β contributes to antiemetic efficacy and causes anticholinergic side effects (e.g., dry mouth). * **Alpha-1 Adrenergic Antagonism**: Blocks peripheral alpha-1 receptors β can lead to vasodilation and subsequent hypotension.
λλ¬Ό μ’ λ³ μ©λ
- As an antiemetic Β· 2 mg/kg PO or IM once daily Β· PO/IM Β· q24h
- As an antihistamine Β· 0.2-0.4 mg/kg PO three to four times a day Β· PO Β· q6-8h
- As an antihistamine Β· 1-2 mg/kg PO q12h Β· PO Β· q12h
- As an antiemetic Β· 2 mg/kg PO or IM once daily Β· PO/IM Β· q24h
- As an antihistamine Β· 0.2-0.4 mg/kg PO three to four times a day Β· PO Β· q6-8h
- As an antihistamine Β· 1-2 mg/kg PO q12h Β· PO Β· q12h
μ©λμ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μ°Έκ³ μλ£μ λλ€. νμ μ΅μ λΌλ²¨κ³Ό κ°λ³ νμμ λν΄ νμΈνμμμ€.
ν¬μ¬ κ²½λ‘
κΈκΈ°
- Hypovolemia or shock (due to hypotensive effects)
- Tetanus or strychnine intoxication (due to extrapyramidal effects)
- Human label black box warning: Contraindicated in children < 2 years old (fatal respiratory depression)
- Known hypersensitivity to phenothiazines
- Severe central nervous system depression
- Comatose patients
- Use with caution in patients with seizure disorders
- Use with caution in patients with severe hepatic or cardiovascular disease
μ΄μλ°μ
- Sedation or lethargy
- Anticholinergic effects (dry mouth, urinary retention, decreased GI motility)
- Hypotension (especially with rapid IV administration or in hypovolemic patients)
- Extrapyramidal signs (tremors, rigidity, torticollis) - rare but possible
- Sedation / Lethargy
- Dry mucous membranes (anticholinergic effect)
- Tachycardia
- Hypotension
- Paradoxical excitation (especially in cats)
- Gastrointestinal disturbances
μ½λ¬Ό μνΈμμ©
- Antacids Β· May cause reduced GI absorption of oral phenothiazines.
- Antidiarrheal mixtures (e.g., Kaolin/pectin, bismuth subsalicylate) Β· May cause reduced GI absorption of oral phenothiazines.
- Atropine & other anticholinergics Β· May have additive anticholinergic effects when used with promethazine.
- CNS Depressant Agents (barbiturates, narcotics, anesthetics) Β· May cause additive CNS depression if used with phenothiazines.
- Epinephrine Β· Phenothiazines block alpha-adrenergic receptors; concomitant epinephrine can lead to unopposed beta-activity causing vasodilation and increased cardiac rate (epinephrine reversal). Β· major
- Metoclopramide Β· Phenothiazines may potentiate the extrapyramidal effects of metoclopramide.
- Monoamine Oxidase Inhibitors (MAOIs) Β· May potentiate extrapyramidal effects.
- Opiates Β· May enhance the hypotensive effects of phenothiazines; dosages may need to be reduced.
- Organophosphate Agents Β· Phenothiazines should not be given within one month of worming with these agents as their toxic effects may be potentiated.
- CNS Depressants (e.g., opioids, barbiturates, anesthetics) Β· Additive central nervous system depression and sedation. Β· major
- Anticholinergic agents (e.g., atropine, glycopyrrolate) Β· Additive anticholinergic effects (tachycardia, dry mouth, ileus). Β· moderate
λͺ¨λν°λ§
- Clinical efficacy (resolution of vomiting or pruritus)
- Degree of sedation
- Hydration status (if vomiting persists)
- Heart rate and rhythm
- Blood pressure (especially with IV use)
- Level of consciousness / CNS status
- Respiratory rate
κ³Όμ©λ
Overdose may result in profound sedation, severe hypotension, or acute extrapyramidal clinical signs (e.g., torticollis, tremors, excessive salivation, rigidity). * **Treatment**: Supportive care is primary. Acute extrapyramidal signs have been successfully treated with injectable **diphenhydramine** in humans. Hypotension should be treated with IV fluids; avoid epinephrine due to the risk of epinephrine reversal (use alpha-agonists like phenylephrine if pressors are required).
VetSheet μ½λ¬Ό λ νΌλ°μ€λ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μμ¬κ²°μ 보쑰 λꡬμ΄λ©°, μ λ¬Έμ νλ¨μ΄λ μ μ‘°μ¬μ μ΅μ λΌλ²¨μ λμ νμ§ μμ΅λλ€.