銻酸甲胺
銻酸甲胺是一種五價銻化合物，主要用於治療犬隻的**利什曼原蟲症 (Leishmaniasis)**（可單獨使用或與別嘌呤醇 allopurinol 併用）。 * **臨床重點**：本藥無法完全根除病原體，治療期長且費用高昂。 * **抗藥性**：已有多起抗藥性報告，併用別嘌呤醇可降低抗藥性風險。 * **安全性**：對心臟、肝臟或腎臟功能不全的病患具相對禁忌，需極度謹慎使用。
作用機制: Meglumine antimoniate selectively inhibits leishmanial enzymes required for **glycolytic and fatty acid oxidation** → disruption of parasite bioenergetics → decreased ATP production → death of the organism. * **Synergy**: When used with allopurinol (a leishmaniostatic agent that disrupts RNA synthesis), the combination provides synergistic efficacy and helps prevent the emergence of resistant strains. * **Mechanistic Pearl**: While the exact mechanism remains partially elucidated, it is widely believed that pentavalent antimony (SbV) acts as a prodrug and is reduced to the more toxic and active **trivalent antimony (SbIII)** within the acidic environment of the macrophage phagolysosome, where the amastigotes reside.
各物種劑量
- Leishmaniosis (off-label) · 50 mg/kg · SC · q24h · 3-4 weeks · Use with extreme caution; cats may be more sensitive to toxicity.
- Leishmaniasis (First line treatment) · 75-100 mg/kg SC once daily for 4-8 weeks, with allopurinol (10 mg/kg PO twice daily for at least 6-12 months. · SC · q24h · 4-8 weeks · Used in combination with allopurinol.
- Leishmaniasis · 100 mg/kg SC daily for 3-4 weeks; better results are obtained with longer durations (4-6 weeks) of treatment. Protocol with allopurinol may reduce relapse rates: meglumine antimoniate as above with allopurinol at 20-40 mg/kg PO daily for a minimum of 3 weeks. Followed with long-term treatment with allopurinol (alone) at 20-40 mg/kg PO daily or intermittently (one week treatment per month). · SC · q24h · 3-6 weeks · Longer duration (4-6 weeks) yields better results.
- Leishmaniasis · 100 mg/kg/day SC until resolution; with allopurinol at 20 mg/kg PO q12h for 9 months. · SC · q24h · Until resolution · Used in combination with allopurinol.
- Leishmaniosis · 75-100 mg/kg · SC · q24h (or divided q12h) · 3-4 weeks · Often used in combination with allopurinol (10 mg/kg PO q12h for 6-12 months).
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
- Previous hypersensitivity to meglumine antimoniate
- Severe renal, hepatic, or cardiac failure (relative contraindication; weigh risks vs. benefits)
- Severe renal impairment
- Hepatic failure
- Cardiac disease
不良反應
- Injection site reactions (cutaneous abscesses, cellulitis, pain)
- Lethargy
- Gastrointestinal effects (inappetence, vomiting)
- Transient increases in liver enzymes
- Nephrotoxicity (tubular damage, proximal tubule cell vacuolization, coagulative necrosis)
- Pain and swelling at the injection site
- Nephrotoxicity (proteinuria, elevated BUN/creatinine)
- Anorexia
- Vomiting
- Hepatotoxicity (rare)
- Myalgia/arthralgia
藥物相互作用
- Agents that can prolong QT interval (e.g., tricyclic antidepressants, disopyramide, quinidine, procainamide) · Meglumine antimoniate may prolong QT interval further with increased risk for arrhythmias
- Aminoglycosides · Increased risk of nephrotoxicity · major
- NSAIDs · Increased risk of nephrotoxicity · moderate
監測
- Efficacy (PCR preferred)
- CBC (baseline and periodic)
- Liver enzymes (baseline and periodic)
- Renal function tests (serum creatinine, BUN) (baseline and periodic)
- Serum lipase and amylase (baseline and periodic)
- Urinalysis (baseline and periodic)
- Urinalysis (specifically for proteinuria/UPC ratio)
- BUN and Creatinine
- Liver enzymes (ALT, AST, ALP)
- Complete Blood Count (CBC)
- Clinical signs of injection site reactions
過量
No specific overdose information is available. Depending on the dosage, a single massive overdose could potentially cause **renal, hepatic, pancreatic, and hematologic toxicity**. Clinically, **gastrointestinal effects (severe vomiting)** and **profound lethargy** would be the most likely immediate outcomes. *Management*: Observe the patient closely, provide supportive care (IV fluids to protect renal function), and contact an animal poison control center for further guidance.
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。