硫糖鋁
硫糖鋁（Sucralfate）是一種局部作用的**胃腸黏膜保護劑**，主要用於治療和管理口腔、食道、胃及十二指腸潰瘍。它偶爾也用於預防藥物（如非類固醇消炎藥或阿斯匹靈）引起的胃部糜爛，但其預防效果並不穩定。 > **臨床重點：** 在獸醫學中，硫糖鋁常被形容為胃腸道的「液體OK繃」。因為它需要酸性環境才能正確聚合並覆蓋在潰瘍面上，所以給藥時間與進食及其他制酸劑（如H2受體拮抗劑或質子幫浦抑制劑）的間隔至關重要。 雖然在人類醫學中，它曾被用作腎衰竭繼發高血磷症患者的磷結合劑，但獸醫研究（如在健康貓咪中）顯示其降低血清磷濃度的效果好壞參半或不顯著。
作用機制: Sucralfate exerts a **local, non-systemic effect** on the gastrointestinal mucosa. * **Polymerization:** After oral administration, sucralfate reacts with hydrochloric acid (HCl) in the stomach → undergoes cross-linking → forms a highly viscous, paste-like complex. * **Barrier Formation:** This complex carries a strong negative charge and binds tightly to the positively charged **proteinaceous exudates** (like albumin and fibrinogen) found at ulcer sites. This forms an insoluble physical barrier that protects the ulcerated tissue from further degradation by **pepsin**, acid, and bile salts. * **Enzyme & Bile Acid Inactivation:** Sucralfate directly inactivates **pepsin** and binds to bile acids, reducing their mucosal toxicity. * **Cytoprotection:** It exhibits cytoprotective properties, likely mediated through the local stimulation and release of **prostaglandin E2 (PGE2)** and **prostaglandin I2 (PGI2)**, which enhance mucosal blood flow and mucus/bicarbonate secretion. *Note: Sucralfate does not significantly alter gastric acid output or pancreatic enzyme activity.*
各物種劑量
- General dosing · 0.25-0.5 grams PO q8-12h · PO · q8-12h
- Empirical dosage · ¼ of a 1 gram tablet per cat PO three to four times a day. · PO · TID-QID
- For gastric ulcers, esophagitis · 0.25-0.5 grams PO per cat PO q8-12h · PO · q8-12h
- General dosing · 75 mg/kg PO q4-6h; give 10 minutes prior to feeding · PO · q4-6h
- For adjunctive treatment (used with acid suppressive drugs) for preventing stress-induced ulcers in foals · 10-20 mg/kg PO q6-8h · PO · q6-8h
- For treating equine gastric ulcer syndrome · 20-40 mg/kg PO q8h · PO · q8h
- Right dorsal colitis (colonic ulcers) · 22 mg/kg PO q6-8h · PO · q6-8h · Sucralfate alone may not be beneficial in treatment of equine gastric ulcer syndrome, but can be used in conjunction with acid-suppressive therapy and may be more suited for treatment of right dorsal colitis.
- For esophagitis · 0.5-1 gram PO three times a day. Suspensions are more therapeutic than intact tablets. · PO · TID
- General dosing · For large dogs: 1 gram PO q8; for smaller dogs: 0.5 gram PO q8h · PO · q8h
給藥途徑
禁忌症
- No absolute contraindications
- Use with caution in patients with decreased gastrointestinal transit times (e.g., megacolon, ileus) due to the risk of constipation
- Known hypersensitivity to sucralfate
不良反應
- Constipation (most common in dogs and humans)
- Vomiting (reported primarily in cats)
- Constipation (most common)
- Hypophosphatemia (rare, with prolonged use)
藥物相互作用
- Azithromycin · Decreased oral absorption; separate dosing by at least 2 hours
- Ciprofloxacin / Enrofloxacin (and other oral fluoroquinolones) · Decreased oral absorption; separate dosing by at least 2 hours
- Diclofenac · Decreased oral absorption; separate dosing by at least 2 hours
- Digoxin · Decreased oral absorption; separate dosing by at least 2 hours · moderate
- Doxycycline · Decreased oral absorption; separate dosing by at least 2 hours
- Erythromycin · Decreased oral absorption; separate dosing by at least 2 hours
- Ketoconazole · Decreased oral absorption; separate dosing by at least 2 hours
- Levothyroxine · Decreased oral absorption; separate dosing by at least 2 hours
- Penicillamine · Decreased oral absorption; separate dosing by at least 2 hours
- Tetracycline · Decreased oral absorption; separate dosing by at least 2 hours
- Theophylline · Decreased oral absorption; separate dosing by at least 2 hours
- Vitamins (fat soluble) · Decreased oral absorption; separate dosing by at least 2 hours
- Warfarin · Decreased oral absorption; separate dosing by at least 2 hours
監測
- Clinical efficacy (resolution of vomiting, melena, anorexia, or abdominal pain)
- Endoscopic examination of ulcer healing
- Fecal occult blood
- Resolution of clinical signs of GI ulceration (e.g., vomiting, melena, anorexia)
- Fecal consistency (monitor for constipation)
過量
Overdosage is highly unlikely to cause any significant systemic problems due to minimal absorption. Laboratory animals receiving massive doses up to 12 grams/kg orally demonstrated no incidence of mortality. The primary concern with a massive overdose would be constipation.
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