複方樟腦鴉片酊 (Paregoric)
Paregoric 是一種鴉片類胃腸動力調節劑，偶爾用於獸醫病患的腹瀉症狀治療。 **主要臨床重點：** * **成分：** 每 5 mL 含有相當於 2 mg 的無水嗎啡，並含有茴香油、甘油、苯甲酸、樟腦和酒精。 * **法規狀態：** 屬於第三級 (C-III) 管制藥品。 * **重要警告：** **切勿**將 Paregoric 與一般鴉片酊 (Opium tincture) 混淆。一般鴉片酊每 5 mL 含有 50 mg 無水嗎啡，效力是 Paregoric 的 **25 倍**。若誤用可能導致致命的過量中毒。 * **物種注意事項：** 由於可能引起反常的中樞神經興奮，在貓的使用極具爭議。對於馬匹及其他可能患有感染性腹瀉的動物，鴉片類藥物會延遲病原體的清除並使病情惡化。
作用機制: Paregoric exerts its antidiarrheal effects primarily through the action of morphine on **mu-opioid receptors** in the gastrointestinal tract. * **Motility Inhibition:** Binding to enteric opioid receptors decreases the release of acetylcholine → inhibits excessive GI propulsion and peristalsis, increasing intestinal transit time. * **Secretion Reduction:** Decreases intestinal secretion induced by cholera toxin, prostaglandin E2, and calcium-mediated (non-cyclic AMP/GMP mediated) diarrheas. * **Absorption:** Prolonged transit time allows for enhanced mucosal absorption of water and electrolytes, solidifying the stool.
各物種劑量
- Maldigestion, malabsorption, anti-diarrheal · 0.05-0.06 mg/kg PO two to three times daily · PO · BID to TID · Use is controversial; this species may react with excitatory behavior.
- Antidiarrheal · 15-30 mL PO · PO · Dose for calves.
- Antidiarrheal · 15-30 mL PO (Foals); 15-60 mL PO (Adults) · PO · May have a detrimental effect in acute/bacterial diarrhea by delaying microbe clearance.
- Acute colitis · 0.06 mg/kg PO three times daily · PO · TID
- Maldigestion; malabsorption; antidiarrheal · 0.05-0.06 mg/kg PO two to three times daily · PO · BID to TID
- Antidiarrheal · 0.05-0.06 mg/kg PO q12h · PO · q12h
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 narcotic analgesics
- Patients receiving monoamine oxidase inhibitors (MAOIs)
- Diarrhea caused by toxic ingestion (until the toxin is eliminated from the GI tract)
不良反應
- Dogs: Constipation, bloat, sedation, paralytic ileus, toxic megacolon, pancreatitis, CNS effects
- Cats: Excitatory behavior (controversial use)
- Horses: Delayed clearance of GI microbes, prolonged febrile state
藥物相互作用
- CNS Depressants (anesthetics, antihistamines, phenothiazines, barbiturates, tranquilizers, alcohol) · May cause increased CNS or respiratory depression when used concurrently.
- Monoamine Oxidase Inhibitors (MAOIs, e.g., amitraz, selegiline) · Contraindicated. Opiates should not be used for at least 14 days after receiving MAOIs due to the risk of severe, potentially fatal reactions.
監測
- Clinical efficacy (resolution of diarrhea)
- Fluid and electrolyte status (especially in severe diarrhea)
- CNS effects (sedation in dogs, excitation in cats), particularly if using high dosages
過量
Acute overdosage of opiate antidiarrheals can result in severe **CNS, cardiovascular, gastrointestinal, or respiratory toxicity**. * Because opiates significantly reduce GI motility, absorption of the drug from the GI tract may be delayed and prolonged, leading to a sustained toxic effect. * **Treatment:** Naloxone is the specific reversal agent and may be necessary to reverse opiate-induced respiratory depression and CNS effects. Supportive care is essential.
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。