二巰基丁二酸 (Succimer)
二巰基丁二酸 (DMSA) 是一種口服重金屬螯合劑，在獸醫學中主要用於治療小動物和鳥類的**鉛中毒**。它是二巰基丙醇 (BAL) 的水溶性類似物，但具有可口服給藥且治療指數更寬的顯著優勢。 * **目標毒素：** 對鉛 (Pb) 高度有效；對砷 (As) 和汞 (Hg) 中毒也具潛在療效。 * **安全性：** 通常安全有效。它不會過度螯合大多數必需微量元素（如鋅、銅和鐵），也不會增加胃腸道對鉛的吸收。 > **臨床要點：** 在小動物鉛中毒的治療中，Succimer 通常比 CaEDTA 更受青睞，因為它可以在家口服、腎毒性較低，且不會劇烈消耗必需礦物質。
作用機制: Succimer acts as a heavy metal chelator through its **sulfhydryl (-SH) groups**. * **Binding:** The sulfhydryl groups physically bind (chelate) heavy metal ions (such as **lead, mercury, and arsenic**) in the bloodstream and tissues. * **Complex Formation:** Heavy metal + Succimer → **Water-soluble chelate complex**. * **Excretion:** These stable, water-soluble complexes are subsequently filtered by the kidneys and excreted safely in the urine, thereby reducing the heavy metal burden in the body.
各物種劑量
- Lead poisoning · 10 mg/kg PO three times daily for 5 days, followed by 10 mg/kg PO twice daily for 2 weeks · PO · TID then BID · 19 days
- Lead poisoning · 10 mg/kg PO q8h · PO · q8h · 10 days · Blood lead levels should be rechecked a few days following the last dose; a second round may be necessary.
- Lead poisoning · 15-35 mg/kg PO twice daily · PO · BID · 5 days
- Lead poisoning · 30 mg/kg PO twice daily · PO · BID · minimum of 7 days · If severe neurologic signs, may supplement with one dose of CaEDTA (<50 mg/kg IM).
- Lead poisoning · 10 mg/kg PO q8h · PO · q8h · 10 days · Blood lead levels should be rechecked a few days following the last dose; a second round may be necessary.
- Lead poisoning · 10 mg/kg PO three times daily for 5 days, followed by 10 mg/kg PO twice daily for 2 weeks · PO · TID then BID · 19 days
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
- Hypersensitivity to succimer
- Continued exposure to the lead source (source must be removed prior to or concurrently with therapy)
不良反應
- Gastrointestinal upset (vomiting, diarrhea)
- Flu-like symptoms (fatigue, body aches)
- Increased liver enzymes (AST, ALT)
- Rash
- Unpleasant sulfurous odor imparted to breath, saliva, urine, and feces
藥物相互作用
- Other chelating agents (CaEDTA, dimercaprol, trientine, penicillamine) · Concomitant use is not recommended in humans due to potential for increased toxicity or altered efficacy.
監測
- Blood lead levels (recheck a few days after completing therapy)
- Gastrointestinal adverse effects
- Liver enzymes (AST, ALT)
- Hydration status
過量
### Overdose & Toxicity * **Dogs:** Succimer has a relatively wide margin of safety. Doses up to 200 mg/kg/day did not cause overt toxicity. However, massive doses (300 mg/day) caused fatalities, primarily presenting with **kidney and GI tract lesions**. * **Birds:** Cockatiels are particularly sensitive to high doses. Doses of 80 mg/kg PO q12h caused a significant number of fatalities, whereas 40 mg/kg q12h did not. * **Treatment:** If an acute overdose occurs, standardized gut evacuation (emesis/lavage) followed by activated charcoal protocols are recommended.
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