氟尼辛葡甲胺
**氟尼辛葡甲胺 (Flunixin meglumine)** 是一種強效的獸醫專用非類固醇消炎止痛藥 (NSAID)，廣泛用於鎮痛、消炎和退燒。 * **主要用途**：在美國獲 FDA 批准用於馬、牛和豬。在馬匹中，它是治療**疝痛 (colic)** 相關內臟疼痛的黃金標準鎮痛藥，也用於肌肉骨骼疾病。在牛和豬中，主要用於控制與呼吸道疾病和內毒素血症相關的發燒。 * **標籤外使用**：雖然過去曾用於小動物（狗），但現在已大多被更安全、對 COX-2 具選擇性的新型 NSAID（如卡洛芬、美洛昔康）所取代。由於貓對 NSAID 毒性高度敏感，通常被視為禁忌症。 * **臨床要點**：氟尼辛能顯著改善敗血性休克動物的血流動力學，並對反芻動物和馬匹的內臟疼痛具有極佳療效。然而，它可能會掩蓋疝痛病患與內毒素血症或腸道壞死相關的行為和心肺體徵。
作用機制: Flunixin meglumine is a potent, non-selective inhibitor of the **cyclooxygenase (COX)** enzyme system. * **Mechanism**: Cell membrane phospholipids → **Phospholipase A2** → Arachidonic Acid → **COX-1 / COX-2** → Decreased production of **prostaglandins** and **thromboxanes**. * By inhibiting prostaglandin synthesis, it reduces inflammation, lowers body temperature (antipyretic), and provides significant analgesia. * Unlike some other NSAIDs, flunixin does not appreciably alter gastrointestinal motility in horses, making it highly suitable for colic management.
各物種劑量
- As an analgesic · 1-2 mg/kg · IV · q24h
- As an analgesic (oral paste) · 1-4 mg/kg · PO · once daily
- As an analgesic · 1-2 mg/kg · IV · q24h
- As an analgesic (oral paste) · 1-4 mg/kg · PO · once daily
- General · 0.5-2 mg/kg · PO or IM · one time daily
- For labeled indications · 1.1-2.2 mg/kg (1-2 mL per 100 lbs. BW) · slow IV · once a day as a single dose or divided into two doses q12h · up to 3 days · Avoid rapid IV administration
- As an analgesic · 1.1-2.2 mg/kg · IV · q6-12 hours · Recommend 72 hour milk withdrawal at this dose rate
- As an analgesic for visceral pain · 0.25-1 mg/kg · IV · q12-24h
- Using combination product (Resflor Gold) · 40 mg/kg florfenicol/2.2 mg/kg flunixin (6 mL/100 lb. B.W.) · SC · once · Do not administer more than 10 mL at each site. Injection should be given only in the neck.
給藥途徑
禁忌症
- Known hypersensitivity to flunixin
- Cats (generally contraindicated due to availability of safer alternatives)
- Patients with preexisting GI ulcers (e.g., Equine Gastric Ulcer Syndrome - EGUS)
- Patients with significant renal, hepatic, or hematologic diseases
- Breeding bulls (lack of reproductive safety data)
- Use to ambulate cattle intended for slaughter
不良反應
- Anaphylaxis (especially after rapid IV administration in horses and cattle)
- IM injection site reactions (localized swelling, induration, stiffness, sweating, and rarely clostridial myonecrosis)
- Gastrointestinal ulceration (oral and gastric ulcers, especially with prolonged use or high doses)
- Renal ischemia and nephrotoxicity (especially in dehydrated patients, dogs, and birds)
- Hematochezia and hematuria (reported in cattle treated > 3 days)
- Hypoproteinemia and hematologic abnormalities
藥物相互作用
- Aspirin · May decrease plasma levels of flunixin and increase the likelihood of GI adverse effects (blood loss)
- Cyclosporine · May increase cyclosporine blood levels and increase the risk for nephrotoxicity
- Digoxin · May increase serum levels of digoxin; use with caution in severe cardiac failure
- Enrofloxacin · Increases AUC and elimination half-life of both flunixin and enrofloxacin in dogs
- Furosemide & other diuretics · May reduce the saluretic and diuretic effects of the diuretic
- Methotrexate · Serious toxicity has occurred with concomitant use; use together with extreme caution
- Nephrotoxic agents (e.g., aminoglycosides, amphotericin B) · Increased risk of synergistic nephrotoxicity
- Probenecid · May cause a significant increase in serum levels and half-life of flunixin
- Warfarin · May increase the risk for bleeding
監測
- Analgesic, anti-inflammatory, and antipyretic efficacy
- Gastrointestinal effects (especially in dogs and horses)
- CBCs and occult blood in feces with chronic use in horses
- Renal parameters (BUN, Creatinine, USG) in susceptible species or dehydrated patients
過量
Acute overdosage should be handled by using established protocols of emptying the gut (if oral ingestion and practical/possible) and treating the patient supportively. * **Gastric Ulceration**: A distinct possibility in horses that have received overdoses. Consider using prophylactic anti-ulcer medications (e.g., omeprazole) in overdosed horses. * **Renal Protection**: Ensure adequate hydration and monitor renal values closely.
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