金諾芬
金諾芬 (Auranofin) 是一種口服金鹽製劑，在獸醫學中主要用於其免疫調節特性（此療法稱為**金療法 chrysotherapy**）。 * **臨床應用**：歷史上曾用於治療犬貓的落葉型天皰瘡和特發性多發性關節炎等免疫介導疾病。 * **療效與毒性**：與注射型金製劑（如金硫葡萄糖）相比，它的毒性通常較低，但療效也較弱。 * **現代背景**：其應用已逐漸被更新、更安全且更有效的免疫抑制劑（如環孢素、黴酚酸酯）所取代。 * **需要重新配製**：由於人類商業膠囊劑量為 3 mg，通常需要重新配製才能準確用於小動物。
作用機制: The exact mechanism of gold salts is not fully elucidated, but they possess anti-inflammatory, antirheumatic, and immunomodulating effects. * **Macrophage Inhibition**: Auranofin is taken up by macrophages → inhibits **phagocytosis** and suppresses **lysosomal enzyme activity**. * **Mediator Suppression**: Inhibits the release of **histamine** and the production of **prostaglandins**. * **T-Cell Modulation**: Selectively suppresses **helper T-cells (CD4+)** without significantly affecting suppressor T-cell populations, thereby dampening the autoimmune response.
各物種劑量
- Rescue drug for feline pemphigus and for idiopathic dermatoses and plasma cell pododermatitis/stomatitis · 0.2-0.3 mg/kg · PO · twice daily · Must be reformulated for accurate dosing.
- Immune-mediated arthropathies and dermatopathies · 0.05-0.2 mg/kg (up to 9 mg/day total dose) · PO · q12h
- Treatment of pemphigus complex (with corticosteroids) · 0.12-0.2 mg/kg · PO · twice daily
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Systemic Lupus Erythematosus (SLE) - may exacerbate signs
- Pregnancy (known teratogen and maternotoxic)
不良反應
- Immune-mediated thrombocytopenia (dose-dependent)
- Hemolytic anemia
- Leukopenia
- Gastrointestinal disturbances (particularly diarrhea, dose-dependent)
- Renal toxicity (proteinuria)
- Hepatotoxicity (increased liver enzymes)
- Dermatosis
- Corneal ulcers
藥物相互作用
- Cytotoxic agents (including high dose corticosteroids) · Safety when used with these agents has not been established; use with caution.
- Penicillamine · Increased potential for hematologic or renal toxicity; use with gold salts is not recommended.
- Antimalarial drugs · Increased potential for hematologic or renal toxicity; use with gold salts is not recommended.
監測
- Hepatic function tests (baseline, monthly for 2-3 months, then every other month)
- Renal function tests including urinalysis (baseline, monthly for 2-3 months, then every other month)
- CBC with platelet counts (baseline, monthly for 2-3 months, then every other month). Note: eosinophilia may denote impending reactions.
過量
Very limited data is available. The minimum lethal oral dose in rats is 30 mg/kg. * **Decontamination**: Gut-emptying protocols should be employed after an acute overdose when applicable. * **Antidotes**: Chelating agents (e.g., penicillamine, dimercaprol) have been used for severe toxicities, but their use is controversial.
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。