雙脒苯脲
**雙脒苯脲 (Imidocarb)** 是一種二脒類抗原蟲藥物，主要用於獸醫學中治療蜱媒原蟲感染。 **主要臨床應用：** - **巴貝斯蟲症 (Babesiosis)**：對犬的犬巴貝斯蟲 (*Babesia canis*) 以及馬和羊的巴貝斯蟲具有高度療效。 - **焦蟲症 (Cytauxzoonosis)**：用於治療貓的貓焦蟲 (*Cytauxzoon felis*) 感染，通常作為綜合治療方案的一部分。 - **其他用途**：有時作為犬艾利希體、犬肝簇蟲和貓血液黴漿菌的替代或輔助治療。 *臨床提示*：雖然對犬巴貝斯蟲高度有效，但對吉氏巴貝斯蟲 (*B. gibsoni*) 的療效通常較差。它無法清除美洲肝簇蟲的包囊階段。
作用機制: Imidocarb acts by directly targeting the **nucleic acids** of susceptible protozoal organisms. - It binds to and intercalates with **DNA** → causing the double helix to unwind and denature. - This structural damage → **inhibits cellular repair and replication** → leading to parasite death. - *Mechanistic Note*: As a diamidine derivative, it may also interfere with polyamine synthesis and function, further disrupting the parasite's metabolic pathways.
各物種劑量
- Cytauxzoon felis · 3-4 mg/kg · IM · repeated 7 days after initial dose · Efficacy not proven. Cholinergic effects can be mitigated by pre-treating with atropine. Must also give supportive therapy (IV fluids, prophylactic heparin, nutritional/nursing care, analgesia, and potentially transfusion).
- Cytauxzoon felis · 5 mg/kg · IM · once and then 14 days later
- Feline hemoplasmosis (Mycoplasma haemofelis, M. haemominutum) · 5 mg/kg · IM, SC · every 14 days · until able to maintain a normal PCV · Alternative for cats intolerant of doxycycline.
- Feline clinical ehrlichiosis or anaplasmosis · 5 mg/kg · IM · every 14 days · for at least 2-4 treatments · Alternative to doxycycline.
- Treatment of large babesial species infection · 2.5 mg/kg · IM · once · 1 dose · Dose based on imidocarb dipropionate. Can improve clinical signs. Alternative agents are preferable for smaller species (e.g., B. felis).
- Babesiosis · 1.2 mg/kg · IM · repeat in 10-14 days
- Equine piroplasmosis (Babesia caballi; Babesia equi) · 2.2 mg/kg · IM · once · Will generally allow clinical signs to subside.
- Equine piroplasmosis (Babesia caballi) · 2 mg/kg · IM · once a day · for 2 days · To eliminate B. caballi.
- Equine piroplasmosis (Babesia equi) · 4 mg/kg · IM · at 72 hour intervals · for 4 doses · B. equi is more difficult to eliminate.
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
- Intravenous (IV) administration
- Patients exposed to cholinesterase-inhibiting drugs
- Patients exposed to pesticides or certain chemicals
不良反應
- Pain and inflammation at the injection site (rarely ulceration)
- Salivation/drooling
- Nasal drip/discharge
- Vomiting (usually brief)
- Panting
- Diarrhea
- Restlessness
- Lacrimation and sweating (horses)
- Severe renal tubular or hepatic necrosis (rare)
- Salivation (drooling)
- Vomiting
- Injection site inflammation (mild to severe, potential ulceration)
- Anaphylactoid reactions (reported in cattle)
藥物相互作用
- Cholinesterase-inhibiting drugs (e.g., pyridostigmine) · Increased risk of severe cholinergic toxicity; concurrent use is contraindicated.
- Pesticides and chemicals · May exacerbate cholinergic adverse effects and toxicity.
- Anticholinesterases · Increased risk of severe cholinergic toxicity · major
監測
- Clinical efficacy (resolution of parasitemia and clinical signs)
- Adverse effect profile (cholinergic signs, injection site reactions)
- Creatine kinase (CK) levels (may be significantly increased post-IM injection)
- Liver and kidney function (especially in cases of suspected overdose or pre-existing disease)
- Resolution of clinical signs of babesiosis (fever, anemia, lethargy)
- Blood smears or PCR to confirm parasite clearance
- Injection site for signs of inflammation, necrosis, or ulceration
- Immediate post-injection monitoring for cholinergic crisis
過量
**Acute Toxicity & Overdose Signs:** - **Dogs**: At 1.5X the labeled dose (9.9 mg/kg), dogs exhibited signs of liver injury (mildly elevated liver enzymes), pain/swelling at the injection site, and vomiting. - **General Overdose/Chronic Toxicity**: Presents primarily with severe **cholinergic signs** (vomiting, weakness, lethargy, excessive salivation) or adverse changes in liver, kidney, lung, or intestinal function. - **Horses**: The reported LD-50 is 16 mg/kg. **Treatment:** - **Atropine** or other antimuscarinics may be highly useful to treat the cholinergic signs associated with imidocarb toxicity. - Provide symptomatic and supportive care for organ dysfunction.
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。