雷米普利
雷米普利是一種**長效前驅藥物型血管張力素轉化酶 (ACE) 抑制劑**，在獸醫學中主要作為血管擴張劑使用。 主要臨床應用包括： * **充血性心衰竭 (CHF)：** 作為混合型血管擴張劑（同時降低前負荷與後負荷），改善心輸出量與運動耐受力。 * **全身性高血壓：** 協助降低全身血壓，特別是在貓科動物中。 * **蛋白質流失性腎病與慢性腎病 (CKD)：** 降低腎絲球內壓與蛋白尿，有助於保護腎功能。 雖然依那普利 (enalapril) 和貝那普利 (benazepril) 在獸醫臨床上更為常用，但雷米普利提供了一種作用時間長且強效的替代方案。該藥物在英國及多個歐洲國家已正式核准用於獸醫。
作用機制: Ramipril is a pro-drug with minimal intrinsic pharmacologic activity. Upon absorption, it undergoes hepatic de-esterification → **ramiprilat** (the active metabolite). * Ramiprilat competitively binds to **Angiotensin-Converting Enzyme (ACE)**, preventing the conversion of **Angiotensin I** → **Angiotensin II**. * Because Angiotensin II is a potent vasoconstrictor, its reduction leads to **vasodilation** (decreased total peripheral and pulmonary vascular resistance). * Decreased Angiotensin II also reduces **aldosterone** secretion → decreased sodium and water retention, and increased plasma renin activity. * **Renal effects:** ACE inhibitors preferentially dilate the efferent arteriole of the glomerulus → decreased intraglomerular pressure → reduced proteinuria.
各物種劑量
- Treatment of arterial hypertension · 0.125 mg/kg PO once daily · PO · q24h
- CHF · 0.2 mg/kg PO once daily · PO · q24h · Anecdotal evidence; pharmacokinetic studies are lacking.
- Treatment of heart failure · Initially, 0.125 mg/kg PO once daily; depending on the severity of pulmonary congestion, dose may be increased to 0.25 mg/kg PO once daily · PO · q24h
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 ACE inhibitors
- Clinical cases of vascular stenosis (e.g., aortic stenosis)
- Obstructive hypertrophic cardiomyopathy
- Concurrent use with potassium-sparing diuretics (per UK label)
不良反應
- Anorexia
- Vomiting
- Diarrhea
- Weakness
- Hypotension
- Hyperkalemia
藥物相互作用
- Aspirin · May potentially negate the decrease in systemic vascular resistance induced by ACE inhibitors (though low-dose aspirin did not affect enalaprilat hemodynamics in one dog study).
- Antidiabetic agents (insulin, oral agents) · Possible increased risk for hypoglycemia; enhanced monitoring recommended.
- Diuretics (e.g., furosemide, hydrochlorothiazide) · Potential for increased hypotensive effects.
- Diuretics, potassium sparing (e.g., spironolactone, triamterene) · Increased hyperkalemic effects; enhanced monitoring of serum potassium required.
- NSAIDs · Potential for increased risk of renal dysfunction or hyperkalemia.
- Potassium supplements · Increased risk for hyperkalemia.
監測
- Clinical signs of CHF
- Serum electrolytes (especially potassium)
- Creatinine and BUN
- Urine protein
- CBC with differential (periodic)
- Blood pressure (if treating hypertension or if clinical signs of hypotension arise)
過量
Ramipril appears quite safe in dogs; dosages as high as 1 gram/kg induced only mild GI distress. Lethal doses in rodents are extremely high (10-11 grams/kg). * **Primary concern:** Hypotension. * **Treatment:** Supportive treatment with volume expansion (normal saline) is recommended to correct blood pressure. * **Note:** Because of the drug's long duration of action, prolonged monitoring and treatment may be required.
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。