普賴蘇濃 / 潑尼松龍
**普賴蘇濃 (Prednisolone)** 是一種強效的中效合成皮質類固醇，在獸醫學中被廣泛使用。在眼科中，它被認為是治療**前葡萄膜炎 (anterior uveitis)** 的黃金標準和最有效的藥物。 其不同配方在臨床上有重要區別： * **醋酸普賴蘇濃 (Prednisolone Acetate)**：配製為懸浮液。它具有卓越的抗發炎活性，並且能透過完整的角膜*極佳地穿透*進入眼前段，效果優於地塞米松 (dexamethasone) 產品。 * **磷酸鈉普賴蘇濃 (Prednisolone Sodium Phosphate)**：配製為溶液。它穿透完整角膜的效果不如醋酸鹽形式，但適用於眼表面的發炎。 > **臨床要點**：雖然是局部點眼，但普賴蘇濃可經由鼻淚管和結膜血管被全身吸收。在小型動物（20公斤以下）中，頻繁使用可能導致全身性副作用，包括使糖尿病病情不穩定。
作用機制: Prednisolone exerts its effects by diffusing across cell membranes and binding to specific cytosolic **glucocorticoid receptors**. The receptor-ligand complex translocates to the nucleus → binds to glucocorticoid response elements (GREs) on DNA → alters gene transcription. Mechanistically, it induces the synthesis of **lipocortin-1** (annexin-1), which inhibits the enzyme **phospholipase A2**. This inhibition prevents the release of **arachidonic acid** from membrane phospholipids, thereby potently shutting down the downstream synthesis of inflammatory mediators, including **prostaglandins** and **leukotrienes**.
各物種劑量
- Severe anterior uveitis · 1 drop topically every hour; may be combined with subconjunctival corticosteroids · Topical / Subconjunctival · q1h · Re-evaluate 24 hours after beginning treatment · Ensure no underlying FHV-1 corneal ulceration is present.
- Moderate to mild uveitis / Post-operative anterior segment surgery · 1 drop topically · Topical · q6h (4 times daily) · Taper based on clinical response · Initial treatment, followed by tapering.
- Feline IMHA Induction · 3-4 mg/kg · PO · q24h · Until remission · May be combined with chlorambucil, ciclosporin, or mycophenolic acid.
- Severe anterior uveitis · Apply topically every hour; may be combined with subconjunctival corticosteroids · Topical / Subconjunctival · q1h · Re-evaluate 24 hours after beginning treatment · Equine Recurrent Uveitis (ERU) management.
- Moderate to mild uveitis / Post-operative anterior segment surgery · Apply topically · Topical · q6h (4 times daily) · Taper based on clinical response · Initial treatment, followed by tapering.
- Severe anterior uveitis · 1 drop topically every hour; may be combined with subconjunctival corticosteroids · Topical / Subconjunctival · q1h · Re-evaluate 24 hours after beginning treatment · Frequency depends on severity.
- Moderate to mild uveitis / Post-operative anterior segment surgery · 1 drop topically · Topical · q6h (4 times daily) · Taper based on clinical response · Initial treatment, followed by tapering.
給藥途徑
禁忌症
- Corneal ulcers (absolute contraindication for topical use)
- Ocular viral infections (e.g., Feline Herpesvirus-1)
- Ocular fungal infections
- Use with extreme caution in patients with uncontrolled diabetes mellitus or systemic infectious diseases
- Pregnant animals
- Renal disease (systemic use)
- Diabetes mellitus (systemic use)
- Ulcerative keratitis (topical ophthalmic use)
- Systemic fungal infections
- Concurrent NSAID administration
- Corneal ulcers
不良反應
- Systemic absorption leading to iatrogenic hyperadrenocorticism (PU/PD/PP, panting, alopecia)
- Insulin resistance and destabilization of diabetes mellitus
- Delayed corneal healing
- Potentiation or exacerbation of ocular infections (bacterial, viral, fungal)
- Corneal degeneration or calcification (with long-term topical use)
- Hypothalamic-pituitary axis (HPA) suppression
- Adrenal atrophy
- Proteinuria and glomerular changes (dogs)
- Weight loss and muscle atrophy (catabolic effects)
- Iatrogenic hyperadrenocorticism (Cushing's syndrome)
- Vomiting and diarrhoea
- Gastrointestinal ulceration
- Hyperglycaemia
- Decreased serum T4 values
- Impaired wound healing
藥物相互作用
- Topical NSAIDs (e.g., flurbiprofen, diclofenac) · Concurrent use may increase the risk of delayed corneal healing or corneal melting, though sometimes used together cautiously for severe inflammation.
- Insulin · Systemically absorbed prednisolone antagonizes insulin, increasing blood glucose and complicating diabetes regulation. · major
- Systemic NSAIDs · Increased risk of gastrointestinal ulceration if significant systemic absorption of prednisolone occurs.
- NSAIDs · Increased risk of gastrointestinal ulceration · major
- Acetazolamide · Increased risk of hypokalaemia · moderate
- Amphotericin B · Increased risk of hypokalaemia · moderate
- Potassium-depleting diuretics (e.g., furosemide, thiazides) · Increased risk of hypokalaemia · moderate
- Phenytoin · Enhanced metabolism of corticosteroids · moderate
- Phenobarbital · Enhanced metabolism of corticosteroids · moderate
- Itraconazole · Decreased metabolism of corticosteroids · moderate
- Ciclosporin · Synergistic immunosuppression; may alter pharmacokinetics · moderate
監測
- Resolution of clinical signs of uveitis (aqueous flare, miosis, pain, photophobia)
- Intraocular pressure (IOP) to monitor for secondary glaucoma
- Fluorescein staining (to ensure no corneal ulceration develops)
- Blood glucose and water intake/urine output in diabetic or small patients
- Clinical response to therapy
- Haematocrit (in cases of IMHA)
- Blood glucose (risk of hyperglycaemia)
- Serum T4 values (may be decreased)
- Renal parameters and urinalysis (proteinuria in dogs)
- Signs of GI ulceration (vomiting, melaena)
- Haematology at each visit (including 4 and 8 weeks after cessation of therapy)
- PCV (Packed Cell Volume)
- Liver parameters (especially if combined with azathioprine)
- Clinical signs of anaemia or GI bleeding
過量
Acute overdose from topical ophthalmic application is highly unlikely to cause severe toxicity. However, **chronic overdosage** or overly frequent application (especially in small patients <20 kg) can lead to systemic absorption resulting in **iatrogenic hyperadrenocorticism** (Cushing's syndrome), adrenal suppression, and destabilization of blood glucose in diabetic patients. If a corneal ulcer is present, overuse can lead to rapid corneal melting and perforation.
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