賴諾普利
賴諾普利 (Lisinopril) 是一種**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，用於治療**鬱血性心衰竭 (CHF)** 和**全身性高血壓**。 主要臨床重點： * **直接具備活性**：與依那普利 (Enalapril) 不同，賴諾普利不是前驅藥，不需要經過肝臟生物轉化即可發揮作用，這對於併發嚴重肝功能障礙的病患可能具有優勢。 * **每日一次給藥**：與其他某些 ACE 抑制劑相比，它通常具有較長的作用時間，使許多病患能夠方便地每日給藥一次。 * **腎臟保護**：常被用於減少慢性腎病 (CKD) 或蛋白質流失性腎病病患的蛋白尿，並幫助維持腎功能。 * **血流動力學益處**：降低總周邊阻力、肺血管阻力及肺微血管楔壓，同時增加心輸出量和運動耐受力。 > **臨床提示**：雖然依那普利和貝那普利 (Benazepril) 在獸醫學中更常用且研究更廣泛，但賴諾普利是一個可行且通常較便宜的替代方案，特別是在偏好每日一次給藥的情況下。
作用機制: Lisinopril exerts its effects by interfering with the **Renin-Angiotensin-Aldosterone System (RAAS)**. * **Mechanism**: It competitively binds to and inhibits **angiotensin-converting enzyme (ACE)**. * **Pathway**: **Angiotensin I** → (blocked by ACE inhibition) → Decreased **Angiotensin II**. * **Physiological Effects**: 1. **Vasodilation**: Reduction in Angiotensin II (a potent vasoconstrictor) leads to decreased systemic vascular resistance (afterload) and venous tone (preload). 2. **Decreased Aldosterone**: Lower Angiotensin II levels reduce the secretion of **aldosterone** from the adrenal cortex → decreased sodium and water retention. 3. **Bradykinin Preservation**: ACE is also responsible for the breakdown of bradykinin. Inhibition leads to increased bradykinin levels, contributing to vasodilation (but also potentially causing a mild cough). * **Net Result**: Decreased blood pressure, reduced cardiac workload, and decreased proteinuria due to efferent arteriolar vasodilation in the glomerulus.
各物種劑量
- Adjunctive treatment of heart failure · 0.25-0.5 mg/kg · PO · q24h
- Adjunctive treatment of heart failure · 0.5 mg/kg · PO · q12-24h
- Adjunctive treatment of heart failure · 0.5 mg/kg · PO · q24h
- Adjunctive treatment of heart failure · 0.25-0.5 mg/kg · PO · q24h · Highest recommended doses should be used unless not tolerated by patient.
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
- Known hypersensitivity to ACE inhibitors
- Pregnancy (especially 2nd and 3rd trimesters)
不良反應
- Anorexia
- Vomiting
- Diarrhea
- Lethargy or weakness
- Hypotension
- Renal dysfunction (azotemia)
- Hyperkalemia
- Cough (rare in animals compared to humans)
藥物相互作用
- Antidiabetic Agents (insulin, oral agents) · Possible increased risk for hypoglycemia; enhanced monitoring recommended.
- Diuretics (e.g., furosemide, hydrochlorothiazide) · Potential for increased hypotensive effects; reducing furosemide doses (by 25-50%) is often recommended when initiating ACE inhibitors in CHF.
- Potassium-Sparing Diuretics (e.g., spironolactone, triamterene) · Increased risk of hyperkalemia; enhanced monitoring of serum potassium recommended.
- Other Hypotensive Agents · Potential for additive hypotensive effects.
- Lithium · Increased serum lithium levels possible; increased monitoring required.
- NSAIDs · May reduce the anti-hypertensive or positive hemodynamic effects of lisinopril; may increase the risk of acute renal failure.
- Potassium Supplements · Increased risk for hyperkalemia.
監測
- Clinical signs of CHF (respiratory rate/effort, exercise tolerance)
- Blood pressure (especially upon initiation or dose changes)
- Serum electrolytes (specifically potassium)
- Renal panel (BUN, Creatinine)
- Urine protein
- Periodic CBC with differential
過量
The primary concern with overdosage is **hypotension**. * **Toxicity Thresholds**: In dogs, the lowest dosage documented to cause hypotension is 27 mg/kg. Dosages below 20 mg/kg generally cause only mild signs (vomiting, lethargy). In cats, hypotension was noted at 4.9 mg/kg in a single case. In birds, mild somnolence occurred at 41 mg/kg. * **Clinical Signs**: Hypotension, lethargy, vomiting, and tachycardia. * **Treatment**: Recent overdoses should be managed using gut-emptying protocols when warranted. Supportive treatment with **volume expansion using normal saline** is recommended to correct blood pressure. Due to 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。