戊聚糖多硫酸鈉
**戊聚糖多硫酸鈉 (PPS)** 是一種半合成、類似肝素的大分子碳水化合物衍生物，提取自山毛櫸半纖維素。在獸醫學中，它主要被用作**骨關節炎疾病修飾劑 (DMOAD)**，以及下泌尿道疾病的輔助治療。 主要臨床應用包括： * **骨關節炎 (OA)：** 用於犬、貓和馬，以改善關節功能、減輕發炎並促進軟骨健康。 * **貓自發性下泌尿道疾病 (FLUTD) / 間質性膀胱炎：** 標示外使用，幫助修復膀胱尿路上皮的保護性糖胺聚醣 (GAG) 層，儘管其對短期急性發作的臨床療效尚無充分文獻證實。 *臨床提示：* 雖然結構上與肝素相似，但其抗凝血活性明顯較弱（約為肝素的 1/15）。然而，對於有出血性疾病或即將接受手術的病患，仍需謹慎使用。
作用機制: Pentosan polysulfate sodium exhibits multiple pharmacological effects depending on the target tissue: * **Osteoarthritis (Disease-Modifying Effects):** * **Inhibits catabolic enzymes:** Downregulates **matrix metalloproteinases (MMPs)** and **aggrecanases** that degrade articular cartilage. * **Stimulates matrix synthesis:** Promotes the synthesis of **hyaluronic acid** by synovial fibroblasts and preserves proteoglycan content within the cartilage matrix. * **Improves microcirculation:** Its mild anticoagulant, fibrinolytic, and hypolipidemic properties help mobilize thrombi and lipid deposits in subchondral blood vessels, thereby increasing synovial blood flow and nutrition to the joint. * **Interstitial Cystitis / FLUTD:** * **Urothelial Protection:** Excreted partially unchanged in the urine, PPS adheres to the mucosal membranes of the bladder wall. It acts as a synthetic **glycosaminoglycan (GAG) buffer**, preventing irritating urinary solutes and toxins from reaching and damaging the underlying transitional epithelial cells. * **Analgesia:** Provides mild local analgesic and anti-inflammatory effects within the bladder wall.
各物種劑量
- Persistent or recurrent FLUTD · 2-16 mg/kg PO q12h · PO · q12h · Recent studies have not shown any statistical benefit.
- Persistent or recurrent FLUTD · 8 mg/kg PO q12h · PO · q12h · Recent studies have not shown any statistical benefit.
- Osteoarthritis · 3 mg/kg IM on four occasions with an interval of 7 days between injections. · IM · q7d · 4 doses
- Osteoarthritis · Inject mixture back into joint · Intra-articular · Once · Prepare site as for surgery. Avoid iodine based skin preps; use neutral soapless cleanser. Withdraw ~1 mL synovial fluid, mix with pentosan in syringe, inject back. Firmly bandage and confine for 3-4 hours. Rest horse for 2 weeks, follow with 2 weeks graded walking.
- Osteoarthritis (High loading dose for treatment of OA signs of pain, lameness and stiffness) · 20 mg/kg PO twice weekly for 5 weeks · PO · twice weekly · 5 weeks · Always give on an empty stomach.
- Osteoarthritis (Medium Loading dose for management of OA after joint surgery) · 10 mg/kg PO once weekly for 12 weeks · PO · once weekly · 12 weeks · Always give on an empty stomach.
- Osteoarthritis (Maintenance dose) · 10 mg/kg once weekly for 4 weeks as needed · PO · once weekly · 4 weeks · Always give on an empty stomach.
- Osteoarthritis · 3 mg/kg IM or SC on four occasions with an interval of 5-7 days between injections · IM/SC · q5-7d · 4 doses
給藥途徑
禁忌症
- Known hypersensitivity to pentosan polysulfate sodium
- Patients with active bleeding disorders
- Use with caution prior to surgery
不良反應
- Vomiting
- Anorexia
- Lethargy
- Mild depression
- Bleeding or prolonged coagulation times (dose-dependent increase in PTT in horses)
- Transient increases in liver enzymes (reported in humans)
藥物相互作用
- NSAIDs (e.g., carprofen, meloxicam) · May increase the risk of bleeding due to concurrent effects on coagulation and platelet function; use cautiously.
- Aspirin · Increased risk of bleeding due to combined anticoagulant and antiplatelet effects.
- Heparin · Additive anticoagulant effects; increased risk of hemorrhage.
監測
- Clinical efficacy (improvement in lameness/mobility for OA, or reduction in urinary signs for FLUTD)
- Signs of bleeding or bruising
- Intra-articular bleeding (when administered directly into joints)
過量
Information regarding overdoses is limited. * **Potential Signs:** Overdoses could potentially cause bleeding, thrombocytopenia, gastrointestinal distress, and liver function abnormalities. * **Treatment:** Treatment recommendations are basically supportive in nature. If an acute oral overdose occurs, consider standard protocols for drug removal from the gut (e.g., emesis, activated charcoal) if performed promptly.
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。