스트렙토조신
스트렙토조신은 원래 *Streptomyces achromogenes*에서 유래한 **항종양 항생제**이나, 상용 제품은 합성으로 제조됩니다. 수의학에서는 주로 췌장 베타 세포에 대한 표적 독성을 이용하여 반려견의 **재발성, 수술 불가 또는 전이성 인슐린종**을 치료하는 핵심 약물로 사용됩니다. * **임상 요점**: 인슐린종은 과도한 인슐린을 분비하여 생명을 위협하는 저혈당을 유발하는 췌장의 기능성 종양입니다. 스트렙토조신은 이러한 종양 세포를 선택적으로 파괴하여 저혈당을 조절하고 종양 진행을 늦추는 데 도움을 줍니다. * 심각한 독성 프로파일로 인해 일반적으로 수술적 절제가 불완전하거나 불가능한 난치성 증례에만 제한적으로 사용됩니다.
작용 기전: Streptozocin acts primarily as an **alkylating agent**. * **DNA Damage**: It cross-links DNA strands → inhibits **DNA synthesis** and prevents precursor incorporation into DNA. * **Beta-Cell Toxicity**: The drug enters cells via the **GLUT2 transporter**, which is highly expressed on pancreatic beta cells. Once inside, it causes a species-specific diabetogenic effect in dogs by reducing **nicotinamide adenine dinucleotide (NAD)** and ATP concentrations → irreversible beta cell necrosis. * While it possesses antibacterial activity against gram-positive and gram-negative bacteria, its severe cytotoxicity precludes its use as an antibiotic.
동물 종별 용량
- Recurrent insulinoma after surgery (investigational) · Begin saline diuresis: Give normal saline at 18-20 mL/kg/hour for 7-8 hours. Over the 4th-5th hour, give streptozocin in the saline solution at a dose of 500 mg/m 2 IV. Give an antiemetic (e.g., butorphanol) at the end of the 7-hour period. · IV · Once · 7-8 hours total · Requires aggressive fluid therapy.
- Pancreatic islet cell tumors · Normal saline is given IV at 18.3 mL/kg/hr for 3 hours, then streptozocin is administered at 500 mg/m 2 over two hours with the saline diuresis continuing. After streptozocin infusion completed, continue saline diuresis for another 2 hours. Butorphanol is administered as an antiemetic immediately after streptozocin. · IV · May repeat at 3 week intervals · Until evidence of tumor progression, recurrence of hypoglycemia, or drug toxicity · Monitor for myelosuppression and nephrotoxicity.
용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.
투여 경로
금기
- Patients without a confirmed histologic diagnosis of insulinoma
- Patients with completely resectable tumors
- Pregnancy (unless benefits outweigh risks; FDA Category C)
이상반응
- Serious, permanent renal toxicity
- Severe and protracted vomiting and nausea
- Mild myelosuppression
- Elevated liver enzymes
- Severe tissue necrosis if extravasated (vesicant)
약물 상호작용
- Doxorubicin · Streptozocin may prolong the half-life of doxorubicin; dosage adjustment may be required.
- Myelosuppressive drugs (e.g., carmustine) · Additive or synergistic myelosuppression may occur.
- Nephrotoxic drugs (aminoglycosides, amphotericin B, cisplatin) · May cause additive nephrotoxicity when used concurrently.
- Niacinamide (nicotinamide) · Can block the diabetogenic effects of streptozocin without altering its antineoplastic activity; this may be beneficial or detrimental depending on the clinical goal.
모니터링
- Blood glucose (to assess efficacy)
- Baseline and post-treatment renal function tests (including urinalysis)
- CBC (for myelosuppression)
- Baseline and pre-retreatment liver function tests
- Hydration status (especially for the first few days after treatment or if vomiting is a problem)
과용량
Severe toxicity may result if acutely overdosed, primarily manifesting as **acute renal failure**, **severe gastrointestinal distress**, and **myelosuppression**. Dosages must be calculated carefully based on body surface area (m^2). Treatment is supportive, focusing on aggressive fluid diuresis and management of uremia and cytopenias.
VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.