Desoxycorticosterone Pivalate (DOCP)
**Desoxycorticosterone pivalate (DOCP)** is a long-acting, injectable **mineralocorticoid** used primarily for the management of typical hypoadrenocorticism (Addison's disease) in dogs, and extra-label in cats. * **Clinical Pearl:** Unlike fludrocortisone, DOCP possesses *zero* glucocorticoid activity. Therefore, patients receiving DOCP must also receive concurrent glucocorticoid supplementation (e.g., physiologic doses of prednisone or hydrocortisone), especially during times of stress or illness. * It is formulated as a microcrystalline depot suspension, allowing for slow dissolution and a prolonged duration of action (typically 21-30 days).
กลไกการออกฤทธิ์: DOCP acts as an exogenous analog of aldosterone. * **Target Site:** Acts primarily at the **renal distal tubule** and collecting ducts. * **Mechanism:** Binds to mineralocorticoid receptors → upregulates **Na+/K+ ATPase** pumps and epithelial sodium channels (ENaC) → increases the absorption of **sodium (Na+)** and enhances **potassium (K+)** and **hydrogen (H+)** ion excretion. * **Requirement:** To be effective, mineralocorticoids require a functioning kidney.
ขนาดยาตามชนิดสัตว์
- Maintenance therapy of hypoadrenocorticism · 2.2 mg/kg IM every 25 days plus prednisolone (0.25-1 mg/cat PO twice daily; if daily oral dosing not feasible, may give 10 mg of methylprednisolone acetate once a month IM) · IM · q25d
- Maintenance therapy of hypoadrenocorticism · 10-12.5 mg (total dose) IM per month. Adjust dose based-upon follow-up serum electrolyte concentrations monitored every 1-2 weeks during initial maintenance period. Normal electrolyte values 2 weeks following injection, suggests adequate dosing, but does not provide information regarding duration of action. Prednisone at 1.25 mg PO once a day or IM methylprednisolone acetate 10 mg once a month can provide long-term glucocorticoid supplementation. · IM · monthly
- Hypoadrenocorticism · 2.2 mg/kg IM every 25 days · IM · q25d · Dosage requirements are variable and should be individualized to the patient.
- Hypoadrenocorticism · Initially, inject 2.2 mg/kg IM or SC every 25 days. Reevaluate at 12 and 25 days after initial injection. If hyponatremia and/or hyperkalemia are noted at 12 days, increase dose by 10%. If they are noted at 25 days (but not on day 12), shorten dosing interval by 2 days. · IM/SC · q25d
- Hypoadrenocorticism · 1.5-2.2 mg/kg IM q20-30 days · IM · q20-30d
- Hypoadrenocorticism · Initially, 2.2 mg/kg IM q25 days. If electrolytes remain in normal range at 30 days, reduce dose by 10% a month. In our clinic, we have used a dose of DOCP as low as 1 mg/kg q30 days with good control of hypoadrenocorticism. · IM · q25-30d
ขนาดยาเป็นข้อมูลอ้างอิงทางคลินิกสำหรับสัตวแพทย์ผู้มีใบอนุญาต โปรดตรวจสอบกับฉลากล่าสุดและผู้ป่วยแต่ละรายเสมอ
วิธีการให้ยา
ข้อห้ามใช้
- Congestive heart failure
- Severe renal disease
- Edema
อาการไม่พึงประสงค์
- Injection site irritation
- Polyuria (PU)
- Polydipsia (PD)
- Hypernatremia
- Hypokalemia
- Hypertension
- Edema
- Weight gain (fluid retention)
อันตรกิริยาระหว่างยา
- Amphotericin B · Patients may develop hypokalemia if mineralocorticoids are administered concomitantly.
- Aspirin · DOCP may reduce salicylate levels.
- Digoxin · Because DOCP may cause hypokalemia, it should be used with caution and increased monitoring when used in patients receiving digitalis glycosides.
- Insulin · Potentially, DOCP could increase the insulin requirements of diabetic patients.
- Potassium-depleting diuretics (e.g., furosemide, thiazides) · Patients may develop hypokalemia if administered concomitantly; as diuretics can cause a loss of sodium, they may counteract the effects of DOCP.
การติดตาม
- Serum electrolytes (Na+, K+)
- BUN and Creatinine (initially every 1-2 weeks, then once stabilized, every 3-4 months)
- Body weight
- Physical examination for edema
การได้รับยาเกินขนาด
Overdosage may cause polyuria, polydipsia, hypernatremia, hypertension, edema, and hypokalemia. Cardiac enlargement is possible with prolonged overdoses. Excessive weight gain may be indicative of fluid retention secondary to sodium retention. **Treatment:** * Electrolytes should be aggressively monitored. * Potassium may need to be supplemented. * Discontinue the drug in patients until clinical signs associated with overdosage have resolved, then restart the drug at a lower dosage.
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