溴化鉀 / 溴化鈉
Potassium Bromide / Sodium Bromide
Potassium bromide (KBr), Sodium bromide (NaBr)
別名: KBr · NaBr · Bromide
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Seizures (Maintenance) | 20-30 mg/kg PO once daily, with food | PO | q24h | — | 🌎 NA |
| Seizures (Rapid Loading Dose) | 400 mg/kg PO divided into 8 doses given over a 48-hour period (i.e., 50 mg/kg every 6 hours for 2 days) | PO | q6h | 2 days | 🌎 NA |
| Seizures (Alternative Loading Dose) | 400-600 mg/kg/day divided and given with food | PO | divided | 1 to 5 days | 🌎 NA |
| Seizures (Alternative Loading Dose 2) | 125 mg/kg/day for 5 days PO divided q12h | PO | q12h | 5 days | 🌎 NA |
| Status epilepticus / NPO | 100 mg/kg body weight every 4 hours for 6 total doses | Rectal | q4h | 24 hours | 🌎 NA |
| Seizures (IV Loading - Sodium Bromide) | 600-1200 mg/kg, diluted in a solution and administered over eight hours | IV | once | 8 hours | 🌎 NA |
- Seizures (Maintenance): Dose is for potassium bromide. If sodium bromide is used, decrease dose by 15% (i.e., 17-26 mg/kg).
- Seizures (Rapid Loading Dose): Giving entire loading dose at once will usually cause vomiting. Start maintenance dose after loading.
- Seizures (Alternative Loading Dose): May be given over 24 hours or more gradually over 5 days. Then go to initial maintenance dose.
- Seizures (Alternative Loading Dose 2): Resume at 35 mg/kg PO once daily after loading.
- Seizures (IV Loading - Sodium Bromide): Sodium bromide only. If target serum bromide concentrations are not reached, additional IV NaBr may be administered. Use with caution.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Refractory seizures (3rd choice therapy) | 10-20 mg/kg/day PO | PO | q24h | — | 🌎 NA |
| Epilepsy (2nd line therapy) | 30 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
- Refractory seizures (3rd choice therapy): Follow same guidelines as dogs. Use with extreme caution.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
溴化物是歷史最悠久的抗癲癇藥物之一，自19世紀以來即應用於人類與獸醫學。它們是鹵化物鹽類，主要作為狗的難治性癲癇的第一線或輔助治療，特別是當單獨使用苯巴比妥（Phenobarbital）效果不佳或因肝毒性而有禁忌時。
主要臨床特徵：
- 不具肝毒性： 與苯巴比妥不同，溴化物不經肝臟代謝，完全由腎臟排泄，是患有肝功能障礙的癲癇犬的首選藥物。
- 半衰期極長： 在狗體內的半衰期約為16-25天。因此，需要3到4個月才能達到穩態血清濃度。通常需要給予負荷劑量（Loading doses）以迅速控制癲癇。
- 飲食敏感性： 溴離子在腎臟中會與氯離子競爭重吸收。飲食中鹽分（氯化物）攝取量的改變會直接且成反比地影響血清溴化物濃度。
- 貓的禁忌症： 貓通常避免使用溴化物，因為有極高風險引發嚴重的、類似氣喘的下呼吸道疾病（貓肺炎），甚至可能致命。
作用機轉
Bromide's anti-seizure activity stems from its generalized depressant effect on neuronal excitability.
- Mechanism: The bromide ion (Br⁻) is a halide that closely mimics the chloride ion (Cl⁻) in the body. It competes with chloride for transport across cell membranes, particularly at the GABA_A receptor chloride channels.
- Pathway: GABA binds to the receptor → channel opens → Bromide traverses the channel more readily than chloride → membrane hyperpolarization.
- Result: This hyperpolarization lowers the resting membrane potential, making it significantly harder for the neuron to depolarize. This effectively raises the seizure threshold and limits the spread of epileptic electrical discharges across the brain.
安全性與警告
禁忌症
- Cats (relative to absolute contraindication due to severe pulmonary effects)
- Patients with severe renal dysfunction (requires extreme caution and dose adjustment)
- Pregnant or lactating animals (crosses placenta and enters milk, causing fetal growth retardation/intoxication)
不良反應
- Profound sedation (especially transiently during loading or when combined with phenobarbital)
- Polyphagia (increased appetite) and subsequent weight gain
- Polydipsia and polyuria (increased thirst and urination)
- Ataxia and hind limb paresis (signs of toxicity)
- Gastrointestinal upset (vomiting, anorexia, constipation)
- Pancreatitis (reported in combination with phenobarbital/primidone)
- Pruritic dermatitis (rare)
- Paradoxical hyperactivity (rare)
- Cats: Severe lower respiratory effects (cough, dyspnea, peribronchial infiltrates)
注意事項
Dietary Warning: Chloride intake must remain strictly consistent. Sudden increases in dietary salt (e.g., salty treats, switching to a high-chloride prescription diet) will cause rapid excretion of bromide and potential seizure breakthrough.
- Renal Impairment: Use with caution in older animals or those with renal disease, as decreased GFR will lead to bromide accumulation and toxicity.
- Feline Patients: Use with extreme caution, if at all, in cats due to the risk of fatal peribronchial infiltrates and dyspnea.
- GI Irritation: Potassium bromide is a gastric irritant. Giving the medication with food or dividing the dose can help mitigate vomiting. If vomiting persists, switching to sodium bromide may be beneficial.
藥物交互作用
Additive sedation and CNS depression.
May enhance the renal excretion of bromides, lowering serum levels and potentially causing seizure breakthrough.
Increases renal excretion of bromide, reducing serum bromide levels and affecting seizure control.
Decreases renal excretion of bromide, increasing serum bromide levels and risking bromide toxicity.
May potentially reduce the efficacy of antiseizure medications.
監測
- Serum bromide concentrations (Therapeutic range in dogs: 1-3 mg/mL)
- Seizure frequency and severity
- Signs of toxicity (sedation, ataxia, weakness)
- Renal function (BUN, Creatinine, USG)
- Body weight (due to polyphagia)
藥物動力學
半衰期
吸收
Well absorbed after oral administration, primarily in the small intestine. Also well absorbed rectally in dogs (bioavailability 60-100%).
分佈
Distributed in the extracellular fluid and mimics the volume of distribution of chloride (0.2-0.4 L/kg). Not bound to plasma proteins. Readily enters the CSF (87% of serum concentration in dogs). Enters maternal milk.
代謝
Not metabolized by the liver. Excreted unchanged.
排除
Principally excreted by the kidneys. Competes with chloride for renal tubular reabsorption.
過量
Toxicity (bromism) is more likely with chronic overdoses, but acute overdoses can occur.
Clinical Signs of Bromism:
- Profound sedation to stupor
- Ataxia, tremors, and hind limb paresis
- Muscle pain
- Conscious proprioceptive deficits
- Anisocoria and hyporeflexia
Treatment:
- Acute Ingestion: Standard gut removal techniques (emesis, gastric lavage). Death from acute oral ingestion is rare as spontaneous vomiting usually occurs.
- Enhancing Excretion: Administration of parenteral 0.9% sodium chloride (NaCl) or oral sodium chloride, parenteral glucose, and loop diuretics (e.g., furosemide) are highly effective in promoting renal excretion and reducing bromide loads in intoxicated patients.
可用產品
劑型
- Compounded oral solution (typically 250 mg/mL)
- Compounded oral capsules
- Chemical powder/crystals (Reagent or ACS grade)
獸醫用
- Compounded oral solutions (e.g., 250 mg/mL)
- Compounded oral capsules
人用標示
- None (Not FDA-approved)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store in tight containers. Solutions may be stored for up to one year in clear or brown, glass or plastic containers at room temperature. Refrigerating the solution may help reduce microbial growth but may cause crystals to form. If precipitation occurs, warming the solution will resolubilize the bromide.
飼主須知
寵物主人重要指引：
- 按時服藥是關鍵： 抗癲癇藥物必須嚴格按照規律的時間表給藥。漏服是導致治療失敗的主要原因。如果忘記餵藥，請在想起來時盡快補餵，但應與下一次服藥時間錯開，以避免腸胃不適。
- 嚴格控制飲食： 溴化物的濃度直接受狗飲食中鹽分（氯化物）含量的影響。未經獸醫同意，請勿改變狗的飲食。避免餵食高鹽零食（如豬耳朵、起司或熱狗），因為這會導致藥物從體內快速排出，進而引發癲癇發作。
- 需要耐心： 因為這種藥物在體內停留的時間非常長，除非獸醫最初開立了高劑量的「負荷劑量」，否則可能需要幾個月的時間才能看到完全的效果。
- 預期的副作用： 口渴、排尿增加和食慾大增是常見的。在最初的幾週內，您的狗也可能看起來非常嗜睡或走路搖晃（共濟失調）。如果搖晃非常嚴重或您的狗看起來神智不清，請立即聯繫您的獸醫。
- 給藥方式： 液體藥物應使用針筒仔細測量。可以將其與食物混合餵食，以幫助預防腸胃不適和嘔吐。
VetSheet 藥物參考供合格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商最新仿單。