枸櫞酸乙胺嗪 / 迪愛西
**枸櫞酸乙胺嗪 (DEC)** 是一種哌嗪衍生物驅蟲藥，過去曾是犬隻每日預防心絲蟲疾病的標準藥物。 * **現狀**：目前已大多被現代的每月一次大環內酯類藥物（如伊維菌素、米爾貝肟）所取代。在美國已無獸醫專用的口服製劑上市。 * **適應症**：FDA 批准用於犬隻心絲蟲 (*D. immitis*) 的預防及蛔蟲感染的治療。也可用於雪貂、動物園動物，以及牛羊的寄生蟲性支氣管炎（英國）。 * **臨床要點**：與較新的每月預防藥不同，DEC 必須**每天**給藥，這在過去常造成飼主順從性不佳的挑戰。
作用機制: The exact mechanism of DEC is not completely understood, but it exhibits both direct paralytic and host-dependent immunomodulatory effects: * **Direct Paralysis**: DEC acts as an agonist at **nicotinic acetylcholine receptors (nAChRs)** on the nematode somatic muscle → Depolarization of the muscle membrane → **Spastic paralysis** of the parasite. * **Immunomodulation**: DEC alters the parasite's surface membrane (interfering with arachidonic acid metabolism) → Exposes hidden antigens → Enhances host immune system clearance of microfilariae.
各物種劑量
- Treatment of ascarids · 55-110 mg/kg PO · PO · Once · Single dose
- Heartworm prophylaxis · 5.5 mg/kg PO once a day · PO · q24h · Continuous
- Treatment of early stages of Dictyocaulus viviparous infestations · 22 mg/kg IM for 3 successive days; or 44 mg/kg IM once. · IM · q24h or Once · 3 days or Single dose · DEC is available in an injectable dosage form containing 400 mg/mL in the U.K., no FDA-approved injectable form is available in the U.S.A.
- Heartworm prophylaxis · 6.6 mg/kg PO once a day preceding infection and for 60 days following last exposure to mosquitoes. · PO · q24h · 60 days post-exposure · In dogs that become microfilaremic while on DEC, may continue, but do not interrupt daily DEC therapy.
- Heartworm prophylaxis · 6.6 mg/kg PO daily from beginning of mosquito season and for two months thereafter. · PO · q24h · Seasonal + 2 months · Should be given year-round in areas where mosquitoes are active throughout the year. Re-examine 3 months after starting therapy and at 6-month intervals for microfilaria.
- Heartworm prophylaxis · 2.5-3 mg/kg PO daily; begin prior to mosquito season · PO · q24h · Continuous
- Heartworm prophylaxis · 5-7 mg/kg PO daily. Begin before infection is likely and continue 60 days after mosquito season. · PO · q24h · Seasonal + 60 days · Some areas will require year-round treatment.
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
- Dogs with circulating microfilaria (due to risk of severe shock-like reaction)
不良反應
- Vomiting
- Diarrhea
- Fixed drug eruptions (rare)
- Severe anaphylactoid reaction (in microfilaremic dogs)
- Hepatic injury (reported in cats)
藥物相互作用
- Pyrantel · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.
- Morantel · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.
- Levamisole · Theoretical enhancement of toxic effects due to shared nicotine-like mechanism of action; use with intensified monitoring.
監測
- Microfilaria status (prior to and during heartworm prophylaxis)
- Clinical efficacy (when used as an anthelmintic)
過量
DEC is considered a relatively non-toxic compound with a wide margin of safety. * **Clinical Signs**: Large overdoses generally result in self-limiting vomiting or CNS depression. * **Management**: For very large, recent ingestions, consider GI decontamination (inducement of vomiting, activated charcoal, cathartics). If clinical signs occur, provide supportive care (e.g., IV fluids).
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。