匹莫苯丹
Pimobendan
4,5-Dihydro-6-[2-(p-methyoxyphenyl)-5benzimidazolyl]-5-methyl-3(2H)pyridazinone
別名: Vetmedin · Acardi · Cardisure · Pimocard · Fortekor-Plus · UDCG-115 · Pimobendanum
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
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。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Management of the signs of mild, moderate or severe congestive heart failure due to AV valve insufficiency or dilated cardiomyopathy | 0.5 mg/kg total daily dose. Divide daily dose into two portions that are not necessarily equal (using whole and half tablets) and administer approximately 12 hours apart. | PO | Divided q12h | — | 🌎 NA |
| Treatment of congestive heart failure secondary to myxomatous mitral valve disease (MMVD) | 0.4-0.6 mg/kg PO divided twice daily | PO | Divided twice daily | — | 🌎 NA |
| Treatment of heart failure secondary to dilated cardiomyopathy or chronic mitral valve insufficiency | 0.25 mg/kg PO twice daily | PO | Twice daily | — | 🌎 NA |
| General dosing | 0.2-0.6 mg/kg PO divided q12h | PO | Divided q12h | — | 🌎 NA |
| Adjunctive drug for the emergency treatment of CHF (if not overtly critical and a strong positive oral inotrope is needed) | 0.1-0.3 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Adjunctive treatment of acute or chronic stage D heart failure (refractory to standard treatment) | 0.3 mg/kg PO to three times daily | PO | Up to TID | — | 🌎 NA |
| Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD | 0.15 mg/kg | IV | single dose | Single dose, transition to PO 12 hours later | 🌍 EU |
| Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD | 0.1-0.3 mg/kg | PO | q12h | Lifelong | 🌍 EU |
- Adjunctive treatment of acute or chronic stage D heart failure (refractory to standard treatment): Outside of FDA-approved labeling; requires client consent.
- Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD: Oral pimobendan can be continued 12 hours after administration of the injection.
- Congestive heart failure (MMVD or DCM) / Preclinical DCM / Preclinical MMVD: Administer 1 hour before food.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Management of myocardial failure (DCM), especially if not associated with taurine deficiency | 1.25-1.5 mg/cat PO q12hrs | PO | q12h | — | 🌎 NA |
| Heart failure associated with systolic dysfunction (Off-label) | 0.1-0.3 mg/kg | PO | q12h | Lifelong | 🌍 EU |
- Management of myocardial failure (DCM), especially if not associated with taurine deficiency: Off-label use. Little information about clinical efficacy due to rarity of condition.
- Heart failure associated with systolic dysfunction (Off-label): Not authorized (off-label). Pharmacokinetics may differ from dogs. Administer 1 hour before food.
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。
概覽
匹莫苯丹是一種高效的心血管藥物，被歸類為強心血管擴張劑 (Inodilator)，這意味著它同時具有正性肌力（增加心臟收縮力）和血管擴張的特性。
主要臨床用途：
- 犬： 主要用於治療繼發於擴張性心肌病 (DCM) 或黏液瘤性/退行性二尖瓣疾病 (MMVD) 的鬱血性心衰竭 (CHF)。與傳統的 ACE 抑制劑/呋塞米療法相比，它能顯著提高存活時間和生活品質。它被認為是杜賓犬 DCM 的第一線療法，也是 ACVIM C 期和 D 期心衰竭管理的基石。
- 貓： 標示外用於限制性和擴張性心肌病。由於其正性肌力作用，通常禁忌用於肥厚性心肌病 (HCM)。
臨床要點： 雖然專論提到臨床前使用的研究仍在進行中，但具有里程碑意義的 EPIC 研究已經確立匹莫苯丹作為延緩患有臨床前（ACVIM B2 期）MMVD 犬隻心衰竭發作的標準護理。
作用機制
Pimobendan exerts its dual inodilator effects through two distinct mechanisms:
- Positive Inotropy (Calcium Sensitization): It increases the sensitivity of the cardiac myofilament Troponin C to intracellular calcium → enhances cardiac contractility. Unlike older inotropes (e.g., digoxin), it achieves this without increasing intracellular calcium levels → no increase in myocardial oxygen consumption.
- Vasodilation (PDE-III Inhibition): It inhibits the enzyme phosphodiesterase III (PDE-III) in vascular smooth muscle → prevents the breakdown of cAMP → ↑ intracellular cAMP → smooth muscle relaxation → mixed arterial and venous dilation. This reduces both cardiac preload and afterload.
Additionally, pimobendan possesses mild antithrombotic activity.
安全性與警告
禁忌症
- Hypersensitivity to pimobendan
- Hypertrophic cardiomyopathy (HCM)
- Aortic stenosis
- Any condition where augmentation of cardiac output is inappropriate for functional or anatomic reasons
- Any condition where augmentation of cardiac output via increased contractility is not possible anatomically or functionally
不良反應
- Poor appetite
- Diarrhea
- Dyspnea
- Azotemia
- Weakness and ataxia
- Pleural effusion
- Syncope
- Cough
- Ascites
- Heart murmur
- Arrhythmias (atrial fibrillation, increased ventricular ectopic beats)
- Worsening mitral valve lesions (acute hemorrhages, endocardial papilloform hyperplasia) with chronic use
- Moderate positive chronotropic effect (tachycardia)
- Vomiting (dose-dependent)
- Reduced appetite or lethargy (rare)
注意事項
Use with caution in patients with uncontrolled cardiac arrhythmias.
Safety has not been evaluated in:
- Dogs younger than 6 months of age
- Dogs with congenital heart defects
- Dogs with diabetes mellitus or other serious metabolic diseases
- Breeding, pregnant, or lactating animals (high doses in lab animals caused increased resorptions)
Note: Patients treated chronically should be regularly examined for worsening mitral valvular lesions and regurgitation.
藥物相互作用
Calcium antagonist; attenuates pimobendan-induced increases in cardiac contractility.
Beta-antagonist; attenuates pimobendan-induced increases in cardiac contractility.
Calcium channel blocker; assumed to potentially attenuate positive inotropic effects.
Beta-blocker; assumed to potentially attenuate positive inotropic effects.
Attenuates the positive inotropic effects of pimobendan
Attenuates the positive inotropic effects of pimobendan
監測
- ECG (rate and rhythm)
- Blood pressure
- Echocardiography (cardiac function and valve lesions)
- Clinical signs of heart failure (coughing, exercise intolerance)
- Resting respiratory rate (RRR) at home
- Heart rate and rhythm
- Respiratory rate and effort (Resting Respiratory Rate - RRR)
- Echocardiographic parameters (fractional shortening, left atrial/ventricular dimensions)
- Clinical signs of congestive heart failure
藥物動力學
半衰期
吸收
Peak levels of parent compound and active metabolite observed 1-4 hours post-dose. Food decreases bioavailability of aqueous solutions (effect on chewable tablets is unknown).
分佈
Steady-state volume of distribution is 2.6 L/kg. Protein binding of pimobendan and active metabolite in dog plasma is >90%.
代謝
Oxidatively demethylated to a pharmacologically active metabolite, which is then conjugated with sulfate or glucuronic acid.
排除
Excreted mainly via feces. Clearance is approximately 90 mL/min/kg.
過量
Overdoses primarily manifest as cardiovascular signs.
Clinical Signs:
- Tachycardia (dose-dependent increases in heart rate)
- Mild, non-clinical heart murmurs
- Hypotension
Treatment:
- Decontamination: Induce emesis and administer activated charcoal if exposure was recent.
- Monitoring: Continuously monitor heart rate, blood pressure, and ECG.
- Supportive Care: Control hypotension with IV fluids and dopamine if necessary.
可用產品
劑型
- Injectable: 0.75 mg/ml solution
- Oral: 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured chewable tablets
- Oral: 5 mg hard capsules
- Compound Oral: 1.25 mg pimobendan / 2.5 mg benazepril tablets
- Compound Oral: 5 mg pimobendan / 10 mg benazepril tablets
獸醫用
- Vetmedin Chewable Tablets: 1.25 mg, 2.5 mg, 5 mg
- Vetmedin 0.75 mg/ml injectable solution
- Vetmedin 1.25 mg, 5 mg, 10 mg chewable tablets
- Vetmedin 5 mg hard capsules
- Cardisure 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured tablets
- Pimocard 1.25 mg, 2.5 mg, 5 mg, 10 mg flavoured tablets
- Fortekor-Plus (pimobendan/benazepril combination tablets)
人用標示
- None
各地核准狀態
Licensed for preclinical DCM in Dobermanns and preclinical MMVD.
POM-V classification.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store chewable tablets or capsules at room temperature below 25°C (77°F) in a dry place.
飼主須知
匹莫苯丹是一種幫助您的寵物心臟更有效泵血並擴張血管的藥物，從而減輕心臟的負擔。
- 給藥方式： 請在空腹時給予此藥物，最好在餵食前一小時，以確保其被充分吸收。
- 嚴格的時間表： 請盡量按照獸醫師的指示，精確地每隔 12 小時給藥一次。
- 終身治療： 匹莫苯丹是控制心衰竭的治療方法，而非治癒方法。通常需要終身服用。未經獸醫師同意，請勿自行停藥。
- 居家監測： 觀察寵物睡眠時的呼吸頻率（休息時呼吸頻率）。如果持續超過每分鐘 30 次，請聯繫您的獸醫師。
- 安全性： 請放置於兒童和其他動物接觸不到的地方。
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