特美帕嗪與潑尼松龍
**特美帕嗪與潑尼松龍**（常見商品名為 Temaril-P®）是一種在獸醫學中廣泛使用的複方藥物，主要用於控制犬隻的搔癢和咳嗽。 * **特美帕嗪 (Trimeprazine)**（又稱 alimemazine）是一種吩噻嗪類衍生物，具有強效的抗組織胺、輕度鎮靜及鎮咳作用。 * **潑尼松龍 (Prednisolone)** 是一種中效糖皮質激素，提供強大的抗發炎和免疫抑制效果。 > **臨床要點：** 將抗組織胺與皮質類固醇結合使用的協同效應，使得只需較低劑量的潑尼松龍即可達到相同的止癢效果。這種「節省類固醇」的策略有助於將長期使用糖皮質激素引起的不良反應風險降至最低，同時有效控制臨床症狀。
作用機制: The drug exerts its effects through two distinct mechanisms: * **Trimeprazine**: Acts primarily as a competitive antagonist at **H1-histamine receptors**, preventing histamine-induced capillary permeability, vasodilation, and pruritus. It also exhibits central antitussive and sedative properties by antagonizing central **dopamine (D2)** and **muscarinic (M1)** receptors in the brainstem and reticular activating system. * **Prednisolone**: Diffuses across cell membranes and binds to **cytosolic glucocorticoid receptors**. The receptor-ligand complex translocates to the nucleus → alters gene transcription → induces production of lipocortin-1 (annexin-1) → inhibits **phospholipase A2**. This blocks the release of arachidonic acid, thereby suppressing the synthesis of key inflammatory mediators, including **prostaglandins** and **leukotrienes**.
各物種劑量
- Antipruritic and antitussive therapy · Weight up to 10 lb = 1/2 tab PO twice daily; 11-20 lb = 1 tablet twice daily; 21-40 lb = 2 tablets twice daily; over 40 lb = 3 tablets twice daily. After 4 days reduce dose to 1/2 of initial dose or to an amount just sufficient to maintain remission of symptoms; adjust as necessary. · PO · twice daily · After 4 days reduce dose
- Treatment of pruritus · 1 tablet per 10 kg of body weight once daily for 3-5 days, then every other day. · PO · once daily then every other day · 3-5 days then every other day · Giving with an EFA (essential fatty acid) may reduce the dose and frequency, if not the need for, glucocorticoids.
- Atopic dermatitis · 1 tablet of Temaril-P per 5 kg body weight q12h for one week, then once daily for one week, then q48h (every other day). · PO · q12h then once daily then q48h · 1 week q12h, 1 week once daily, then q48h
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
- Systemic fungal infections
- Hypovolemia or shock
- Tetanus or strychnine intoxication
- Late pregnancy (last trimester) due to risk of inducing parturition
不良反應
- Sedation
- Depression
- Hypotension
- Extrapyramidal reactions (rigidity, tremors, weakness, restlessness)
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased appetite)
- Elevated liver enzymes
- Weight loss or weight gain
- Vomiting
- Diarrhea
- Iatrogenic hyperadrenocorticism (Cushing's syndrome) with chronic use
- Delayed wound healing
- Osteoporosis
- Increased susceptibility to infections
藥物相互作用
- ACE Inhibitors · Phenothiazines may increase hypotensive effects
- Amphotericin B · Concomitant use with glucocorticoids may cause severe hypokalemia
- Antacids · May cause reduced GI absorption of oral phenothiazines
- Antidiarrheal mixtures (Kaolin/pectin, bismuth) · May cause reduced GI absorption of oral phenothiazines
- Anticholinesterase agents (pyridostigmine, neostigmine) · In myasthenia gravis patients, concomitant use may lead to profound muscle weakness
- Aspirin (salicylates) · Glucocorticoids may reduce salicylate blood levels
- Cisapride · Increased risk for cardiac arrhythmias when used with phenothiazines
- CNS Depressants (barbiturates, narcotics, anesthetics) · May cause additive CNS depression
- Cyclophosphamide · Glucocorticoids may inhibit hepatic metabolism of cyclophosphamide
- Cyclosporine · May mutually inhibit hepatic metabolism, increasing blood levels of both drugs
- Digoxin · Increased risk for arrhythmias secondary to glucocorticoid-induced hypokalemia
- Diuretics, potassium-depleting (furosemide, thiazides) · Concomitant use with glucocorticoids may cause hypokalemia
監測
- Efficacy (reduction in pruritus or coughing)
- Degree of sedation
- Anticholinergic effects
- Adverse effects associated with corticosteroids (e.g., PU/PD, weight changes, liver enzyme elevations)
過量
Acute overdosage should be handled similarly to phenothiazine (e.g., acepromazine) toxicity. Overdose may cause profound sedation, depression, hypotension, and extrapyramidal signs (tremors, rigidity). Treatment is largely supportive and symptomatic. Do not use epinephrine for hypotension as it may cause further vasodilation (epinephrine reversal); use norepinephrine or phenylephrine if pressors are required.
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