國際獸醫(yī)癲癇工作組共識建議：歐洲犬癲癇的藥物治療

Sofie F.M. Bhatti1*, Luisa De Risio2 , Karen Mu?ana3 , Jacques Penderis4 , Veronika M. Stein5 , Andrea Tipold5 , Mette Berendt6 , Robyn G. Farquhar7 , Andrea Fischer8 , Sam Long9 , Wolfgang L?scher10, Paul J.J. Mandigers11, Kaspar Matiasek12, Akos Pakozdy13, Edward E. Patterson14, Simon Platt15, Michael Podell16, Heidrun Potschka17, Clare Rusbridge18,19 and Holger A. Volk20?

翻譯 By @蘇蘇蘇蘇喬

校正 By @寵物神經(jīng)科醫(yī)生高健? ?

Pregabalin?普瑞巴林

There is limited data on the use of pregabalin in dogs. In a study by Dewey et al., (2009), the efficacy of oral pregabalin as an adjunct to PB and KBr was evaluated in 9 dogs [27]. According to Charalambous et al. (2014) [17], this study demonstrated an overall moderate/high risk of bias. Consequently, there is currently insufficient evidence to recommend the use of pregabalin as an adjunct AED [17]. If used, the recommended oral dose in dogs is 3?4 mg/kg BID-TID. The most common adverse effects (Table 2) in the study of Dewey et al., (2009) included sedation, ataxia and weakness, and to minimize these, treatment could be initiated at a dose of 2 mg/kg two to three times daily and escalated by 1 mg/kg each week until the final dose is achieved [27]. As pregabalin clearance is highly correlated with renal function, dose reduction is necessary in patients with reduced renal function [5, 9].

關(guān)于普瑞巴林在犬身上使用的數(shù)據(jù)有限。Dewey等人（2009）對9例犬進行了口服普瑞巴林作為苯巴比妥和溴化鉀輔助用藥的療效評估[27]。Charalambous等人(2014)[17]認為，該研究總體偏倚風(fēng)險為中/高。因此，目前沒有足夠的證據(jù)推薦使用普瑞巴林作為輔助抗癲癇藥物[17]。如果使用，推薦犬口服劑量為3-4 mg/kg BID-TID。在Dewey等人（2009）的研究中，最常見的不良反應(yīng)（表2）包括鎮(zhèn)靜、共濟失調(diào)和無力，為了最大限度地減少這些不良反應(yīng)，可以以每天2至3次 2 mg/kg的劑量開始治療，然后每周遞增1mg/kg，直到達到最終劑量[27]。由于普瑞巴林清除率與腎功能高度相關(guān)，因此對于腎功能下降的病患需要減量[5,9]。

Pregabalin is a GABA analogue that is structurally similar to gabapentin. Pregabalin was approved in 2004 for the treatment of adults with peripheral neuropathic pain and as adjunctive treatment for adults with focal seizures with or without secondary generalization. Pregabalin is more potent than gabapentin owing to a greater affinity for its receptor [112]. Pharmacokinetic studies have been performed in dogs, with a reported elimination half-life of approximately 7 h [103]. In humans, pregabalin does not bind to plasma proteins and is excreted virtually unchanged by the kidneys [9]. Pregabalin does not undergo hepatic metabolism and does not induce or inhibit hepatic enzymes such as the cytochrome P450 system [5]. No clinically relevant pharmacokinetic drug interactions have been identified in humans to date. The most commonly reported adverse effects in humans are dose-related and include dizziness, somnolence and ataxia [9].

普瑞巴林是GABA類似物，結(jié)構(gòu)上類似于加巴噴丁。普瑞巴林于2004年獲批準用于治療成人周外周神經(jīng)性疼痛，并作為伴有或不伴有繼發(fā)全身性抽搐發(fā)作的成人局灶性抽搐發(fā)作的輔助治療。普瑞巴林比加巴噴丁更有效，因為它對其受體更有親和力[112]。在犬身上進行了藥代動力學(xué)研究，據(jù)報道其消除半衰期約為7小時[103]。在人類中，普瑞巴林不與血漿蛋白結(jié)合，并且?guī)缀醪蛔兊赜赡I臟排出[9]。普瑞巴林不進行肝臟代謝，不誘導(dǎo)或抑制肝酶，如細胞色素P450系統(tǒng)[5]。迄今為止，在人類中尚未發(fā)現(xiàn)臨床相關(guān)的藥代動力學(xué)藥物相互作用。最常報道的人類不良反應(yīng)與劑量有關(guān)，包括頭暈、嗜睡和共濟失調(diào)[9]。