티오프로닌 (Tiopronin)

항요로결석제 (시스틴)

**티오프로닌(Tiopronin)**은 주로 반려견의 **시스틴 요로결석**(방광 결석)을 관리하고 예방하는 데 사용되는 특수 **항요로결석제**입니다. 시스틴뇨증은 특정 아미노산(특히 시스틴)의 신세뇨관 재흡수에 발생하는 유전적 대사 결함으로, 시스틴은 산성 소변에서 매우 용해되기 어려워 결석을 형성하기 쉽습니다. 식이 조절(초저단백, 알칼리화 식단) 및 소변 알칼리화가 결석을 용해하거나 재발을 방지하는 데 완전히 효과적이지 않을 때 주로 티오프로닌이 사용됩니다. * **주요 특징:** * 소변 내 시스틴 용해도를 높이는 **킬레이트제**로 작용합니다. * 페니실라민에 비해 부작용 발생률이 낮을 수 있어 종종 선호되지만, 비교적 고가입니다. * 예방적 성공을 위해서는 평생 치료와 보호자의 엄격한 순응도가 필요합니다.

작용 기전: Tiopronin is an active **sulfhydryl (-SH) compound**. In the urine, it undergoes a **thiol-disulfide exchange** with cystine (which is a cysteine-cysteine disulfide). * **Mechanism Pathway:** Tiopronin + Cystine → **Tiopronin-Cysteine Disulfide Complex** + Cysteine. * This newly formed complex is up to 50 times more water-soluble than cystine alone. * By increasing the solubility of cystine in the urine, tiopronin prevents the precipitation of cystine crystals and facilitates the gradual dissolution of existing **cystine calculi**.

동물 종별 용량

Dogs

Prophylactic treatment of cystine urinary calculi · 30 mg/kg PO q12h · PO · q12h · Increase water intake and urine diuresis. Alkalinize urine (pH 6.5-7.0) using potassium citrate. In cases with low cystine excretion and low urolith recurrence rate, tiopronin dose may be individually decreased (<30 mg/kg) or stopped.
Dissolution of uroliths · Approximately 40 mg/kg PO q12h · PO · q12h · Reevaluation of uroliths with ultrasound or radiography every 4th week. After urolith dissolution, give prophylactic dose. If urolith dissolution is not achieved after 2-3 months, surgery is recommended.
In conjunction with an alkalinizing, protein and sodium restricted diet (e.g., u/d) · 30-40 mg/kg PO divided into two daily doses · PO · divided into two daily doses
Treatment of cystine urinary calculi · 20 mg/kg PO twice daily · PO · twice daily · 1-3 months · Relatively high incidence of adverse effects
Prevention of cystine urinary calculi · 15 mg/kg PO twice daily · PO · twice daily

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

투여 경로

금기

Agranulocytosis
Aplastic anemia
Thrombocytopenia or other significant hematologic abnormality
Impaired renal or hepatic function
Sensitivity to either tiopronin or penicillamine

이상반응

Coombs'-positive regenerative spherocyte anemia
Aggressiveness
Proteinuria
Thrombocytopenia
Elevations in liver enzymes and bile acids
Dermatologic effects (small pustules, dry crusty nose, ecchymosis, itching, rashes, mouth ulcers, jaundice)
Myopathy (staggering, difficulty chewing)
Lethargy
Sulfur odor of the urine
GI distress
Allergic reactions (adenopathy)
Arthralgias
Dyspnea
Fever
Edema
Nephrotic syndrome

약물 상호작용

Nephrotoxic drugs · Potentially additive toxic effects
Hepatotoxic drugs · Potentially additive toxic effects
Bone marrow depressing drugs · Potentially additive toxic effects

모니터링

Physical examination (1, 3, 6, & 12 months after start, then twice a year)
Ultrasonography/radiography of the urinary tract
Urinalyses (specific gravity, protein, pH, sediment, and cyanide nitroprusside reaction) using AM samples
CBC (with platelets)
Liver enzymes (alkaline phosphatase, ALT)
Quantitative measurements of urinary cystine excretion related to urinary creatinine excretion (AM samples, before start and once a year during treatment)

과용량

There is little information available regarding acute toxicity or overdosage of tiopronin in veterinary species. It is suggested to contact an animal poison control center for further information and guidance in the event of an overdose situation. Treatment would likely be supportive and symptomatic.

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