米替福新
**米替福新 (Miltefosine)** 是一種口服**抗利什曼原蟲**藥物，主要在獸醫學中用於治療**犬利什曼原蟲症 (CanL)**，這是一種由細胞內寄生蟲（嬰兒利什曼原蟲）引起的嚴重全身性疾病。 - 最初是作為**抗腫瘤**（抗癌）藥物開發的。 - **臨床要點**：雖然它能顯著降低寄生蟲量並改善臨床症狀，但極少能達到完全的寄生蟲學治癒。使疾病進入緩解期是主要的治療目標。 - 與**別嘌醇 (Allopurinol)** 併用時，療效會顯著提升。 - 在人類醫學中屬於孤兒藥，在美國並無商業化的獸醫標籤產品，但在流行地區（如歐洲）被廣泛使用。
作用機制: Miltefosine is an **alkylphosphocholine** (phospholipid derivative). Its exact mechanism against *Leishmania* is multifactorial: - **Inhibits macrophage penetration**: Interacts with **glycosomes** and **glycosylphosphatidyl-inositol (GPI) anchors** that are essential for the parasite's intracellular survival. - **Enzyme inhibition**: Inhibits **phospholipase** → disrupts parasite membrane signal transduction and lipid metabolism. - **Apoptosis induction**: Triggers apoptosis-like cell death in the parasite by disrupting lipid rafts in the cell membrane. - Additionally, miltefosine exhibits mild antineoplastic, immunomodulatory, and antiviral properties.
各物種劑量
- Canine leishmaniasis · 2 mg/kg PO · PO · once a day · 28 days · Poured onto food, with a full or partial meal.
- Canine leishmaniasis (alternative treatment to meglumine antimoniate) · 2 mg/kg PO · PO · once daily · 28 days · Use with allopurinol (10 mg/kg PO q12h, orally for at least 6 months).
- Leishmaniosis · 2 mg/kg · PO · q24h · 28 days · It is particularly important that the full course is completed and given with allopurinol. Pour on feed to reduce digestive side effects.
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
- Hypersensitivity to miltefosine
- Pregnant animals
- Lactating animals
- Breeding animals
- Pregnancy
- Lactation
不良反應
- Vomiting (most common)
- Diarrhea
- Inappetence
- Potential nephrotoxicity
- Potential hepatotoxicity
- Vomiting (moderate, transient)
- Diarrhoea (moderate, transient)
監測
- Baseline and periodic renal function
- Hepatic enzymes
- Adverse effects (especially vomiting)
- Patient weight
- Clinical signs of leishmaniosis
- Gastrointestinal signs (vomiting, diarrhoea)
過量
Overdoses are likely to cause severe **gastrointestinal signs** (vomiting, diarrhea, anorexia). In cases of massive overdose, there is a potential for **hepatic, renal, and retinal toxicity**. There is **no specific antidote** for miltefosine overdose; treatment should consist of prompt gastrointestinal decontamination (if recent and patient is asymptomatic) followed by aggressive supportive care (IV fluids, antiemetics, hepatoprotectants).
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。