依米達普利
**依米達普利 (Imidapril)** 是一種**血管張力素轉化酶 (ACE) 抑制劑**，在獸醫學中主要用於治療犬隻因二尖瓣逆流或擴張性心肌病引起的**充血性心衰竭 (CHF)**。通常與利尿劑、匹莫苯丹 (Pimobendan) 或螺內酯 (Spironolactone) 併用以達到最佳療效。此外，它也用於控制與慢性腎功能不全、腎小球疾病和蛋白質流失性腎病相關的**蛋白尿**，並可能有助於降低**高血壓**。 > **臨床警告：** 在低血壓或腎臟灌流不良（例如急性少尿性腎衰竭）的動物中，ACE 抑制劑更容易引起或加重腎前性氮血症。若存在低血壓、低血鈉或心室出口阻塞，應極度謹慎使用。 **臨床提示：** 雖然主要核准用於犬隻，但將 ACE 抑制劑用於患有心臟病的貓，是基於理論上的益處以及在其他物種中的研究結果推斷而來。
作用機制: Imidapril acts by competitively inhibiting the **angiotensin-converting enzyme (ACE)**. * **Angiotensin I** → (ACE inhibition) → Decreased **Angiotensin II** production. * Inhibits the breakdown of **bradykinin** (a potent vasodilator). The overall cardiovascular effect is a reduction in preload and afterload via **venodilation and arteriodilation**, decreased salt and water retention via reduced **aldosterone** production, and inhibition of angiotensin-aldosterone-mediated cardiac and vascular remodeling. In the kidneys, it causes **efferent arteriolar dilation**, which reduces intraglomerular pressure and glomerular filtration, thereby decreasing **proteinuria**.
各物種劑量
- Congestive heart failure, proteinuria, or hypertension · 0.25 mg/kg · PO · q24h · For dogs weighing >4 kg.
- Cardiac disease or proteinuria · 0.5 mg/kg · PO · q24h · Anecdotal dose; no data available.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新藥品仿單及個別病患確認。
給藥途徑
禁忌症
- Acute renal failure
- Congenital heart disease
- Hemodynamically relevant stenoses (e.g., aortic stenosis)
- Obstructive hypertrophic cardiomyopathy
- Hypovolemia
- Breeding, pregnant, or lactating bitches
- Dogs weighing < 4 kg (safety not established)
不良反應
- Hypotension
- Hyperkalemia
- Azotemia
- Anorexia (rare)
- Vomiting (rare)
- Diarrhea (rare)
藥物相互作用
- Spironolactone · Could result in hyperkalemia, though in practice, spironolactone and ACE inhibitors appear safe to use concurrently. · moderate
- Potassium supplements · Increased risk of hyperkalemia. · moderate
- NSAIDs · Increased risk of nephrotoxicity and decreased clinical efficacy of the ACE inhibitor. · major
- Diuretics · Increased risk of hypotension. · moderate
- Vasodilators (e.g., anesthetic agents, antihypertensives) · Increased risk of hypotension. · moderate
- Beta-blockers · Increased risk of hypotension when combined with negative inotropes. · moderate
監測
- Blood pressure
- Serum creatinine and BUN
- Serum electrolytes (especially potassium and sodium)
- Clinical signs of hypotension (weakness, syncope)
過量
Doses of up to **5 mg/kg/day** have been well tolerated in healthy dogs. If overdosage occurs, monitor closely for signs of **hypotension** (weakness, lethargy, disorientation). If hypotension occurs, supportive care including intravenous fluids may be required.
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