Formulary small animals

Editor: Fergus Allerton BSAVA Small Animal Formulary 10th edition • Part A: Canine and FelineEmergency doses for dogs and cats ALWAYS read the relevant monographs. Cardiac emergencies ■ Asystole or pulseless electrical activity Adrenaline: 10 μg (micrograms)/kg i.v every 3–5 minutes until return of spontaneous circulation – this is equivalent to 1 ml/10 kg using 1:10,000 concentration (100 μg/ml). Double dose if used intratracheally. ■ Hyperkalaemic myocardial toxicity Calcium: 50–150 mg/kg calcium (boro)gluconate = 0.5–1.5 ml/kg of a 10% solution i.v. over 20–30 min or Soluble insulin: 0.5 IU/kg i.v. followed by 2–3 g of dextrose/unit of insulin (for urinary tract obstruction but not hypoadrenocorticism). Half the dextrose should be given as a bolus and the remainder administered i.v. over 4–6h. ■ Other bradyarrhythmias Atropine: 0.01–0.03 mg/kg i.v. – this is equivalent to 0.3–1 ml/20 kg using 0.6 mg/ml solution. ■ Ventricular tachycardia Lidocaine: Dogs: 2–8 mg/kg i.v. in 2 mg/kg boluses, followed by a constant rate i.v. infusion of 0.025–0.1 mg/kg/min. Cats: 0.25–2.0 mg/kg i.v. slowly in 0.25–0.5 mg/kg boluses followed by a constant rate i.v. infusion of 0.01–0.04 mg/kg/min. Pulmonary emergencies ■ Respiratory arrest Doxapram: 5–10 mg/kg i.v., repeat according to need; duration of effect is approximately 15–20 min. Neonates: 1–2 drops under the tongue (oral solution) or 0.1 ml i.v. into the umbilical vein; this should be used only once. Metabolic emergencies ■ Anaphylaxis Adrenaline: 10 μg/kg i.v. – this is equivalent to 1 ml/10 kg using 1:10,000 concentration (100 μg/ml). ■ Hypocalcaemia Calcium: 50–150 mg/kg calcium (boro)gluconate = 0.5–1.5 ml/kg of a 10% solution i.v. over 20–30 min. ■ Hypoglycaemia Glucose: 1–5 ml 50% dextrose i.v. slowly over 10 min. Neurological emergencies ■ Status epilepticus control Diazepam: 0.5 mg/kg i.v. or rectal – repeat after 3 minutes for up to 3 doses or Midazolam: 0.3 mg/kg i.v. or rectal – repeat after 3 minutes for up to 3 doses. If the seizures have been controlled, maintain on an i.v. infusion of midazolam at 0.3 mg/kg/h while establishing or changing maintenance therapy If seizures not controlled by above: Propofol: induce with 1–4 mg/kg i.v. and then maintain on 0.1–0.4 mg/kg/min. ■ Raised intracranial pressure (impending herniation) Mannitol: 0.25–0.5 g/kg i.v. infusion of 15–20% solution over 30 min. May repeat 1–2 times after 4–8 hours as long as hydration and electrolytes monitored. (For acute glaucoma see monograph.) Anaesthesia emergencies ■ Reversing agents Naloxone: 0.015–0.04 mg/kg i.v., i.m., s.c., intratracheal (give to effect). Atipamezole: Five times the previous medetomidine or dexmedetomidine dose i.m.; if that dose unknown, use 100 μg(micrograms)/kg i.m. or very slow i.v.Small Animal Formulary 10th edition – Part A: Canine and Feline Editor-in-Chief: Fergus Allerton BSc BVSc CertSAM DipECVIM-CA MRCVS European Veterinary Specialist in Small Animal Internal Medicine Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH Published by: British Small Animal Veterinary Association Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB A Company Limited by Guarantee in England. Registered Company No. 2837793. Registered as a Charity. Copyright © 2020 BSAVA Small Animal Formulary First edition 1994 Second edition 1997 Third edition 1999 Fourth edition 2002 Fifth edition 2005 Sixth edition 2008 Seventh edition 2011 Eighth edition 2014 Small Animal Formulary – Part A: Canine and Feline Ninth edition 2017 Tenth edition 2020 Small Animal Formulary – Part B: Exotic Pets Ninth edition 2015 Tenth edition 2020 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder. A catalogue record for this book is available from the British Library. ISBN 978-1-910443-70-5 The publishers, editors and contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned or referred to in this publication. Details of this kind must be verified in each case by individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded that in each case they must follow all appropriate national legislation and regulations (for example, in the United Kingdom, the prescribing cascade) from time to time in force. Printed in the UK by Cambrian Printers, Aberystwyth SY23 3TN Printed on ECF paper made from sustainable forests. 10009PUBS20BSAVA Small Animal Formulary 10th edition: Part A – Canine and Feline ii Contents Editorial Panel iii Preface v Foreword vi Introduction Notes on the monographs vii Distribution categories viii The prescribing cascade ix Drug storage and dispensing xii Health and safety in dispensing xiii Drug listings and monographs 1 (listed A–Z by generic name) Appendix I: general information Abbreviations 441 Writing a prescription 442 Topical polypharmaceuticals for ear disease 443 Guidelines for responsible antibacterial use 444 Guidelines on prescribing glucocorticoids 445 Radiographic contrast agents: MRI 448 Composition of intravenous fluids 451 Safety and handling of chemotherapeutic agents 451 Body weight to body surface area conversion tables 455 Percentage solutions 455 Drugs usage in renal and hepatic insufficiency 456 Suspected Adverse Reaction Surveillance Scheme 458 Further reading and useful websites 458 Appendix II: protocols Chemotherapy protocols for lymphoma 460 Immunosuppression protocols 467 Sedation/immobilization protocols 471 Sedative combinations for dogs 471 Sedative combinations for cats 474 Index sorted by therapeutic class 476 Index (alphabetical by generic and trade names 484BSAVA Small Animal Formulary 10th edition: Part A – Canine and Feline iii Editorial Panel Fergus Allerton BSc BVSc CertSAM DipECVIM-CA MRCVS Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH Daniel Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS Department of Small Animal Clinical Sciences, University of Liverpool, Leahurst, Neston, Wirral CH64 7TE Nick Bexfield BVetMed PhD DSAM DipECVIM-CA PGDipMEdSci PGCHE FHEA MRCVS Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES Daniel L. Chan DVM DipACVECC DipECVECC DipACVN FHEA MRCVS The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA Heidi Featherstone BVetMed DVOphthal DipECVO MRCVS The Ralph Veterinary Hospital, Fourth Avenue, Globe Business Park, Marlow SY7 1LG Polly Frowde MA VetMB DipECVIM-CA MRCVS Davies Veterinary Specialists Limited, Manor Farm Business Park, Higham Gobion, Hertfordshire SG5 3HR Jenny Helm BVMS CertSAM DipECVIM-CA FHEA MRCVS College of Medical, Veterinary & Life Sciences, University of Glasgow, Bearsden Road, Glasgow G61 1QH Hannah Hodgkiss-Geere BVM&S MSc PhD DipECVIM-CA FHEA MRCVS Institute of Veterinary Science, University of Liverpool, Chester High Road, Neston CH64 7TE Andrew Kent BVSc DipECVIM-CA MRCVS Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH David Killick BVetMed PgCELTHE PhD CertSAM DipECVIM-CA(Onc) MRCVS Institute of Veterinary Science, University of Liverpool, Leahurst, Chester High Road CH64 7TE Hilary Jackson BVM&S DVD DipACVD DipECVD MRCVS The Dermatology Referral Service, 528 Paisley Road West, Glasgow G51 1RN, Daniel S. Mills BVSc PhD CBiol FRSB FHEA CCAB DipECAWBM(BM) FRCVS Joseph Banks Laboratories, School of Life Sciences, University of Lincoln, Lincoln LN6 7DLBSAVA Small Animal Formulary 10th edition: Part A – Canine and Feline iv Jo Murrell BVSc(Hons) PhD DipECVAA MRCVS Highcroft Veterinary Referrals, 615 Wells Road, Whitchurch, Bristol BS14 9BE Catherine Stalin MA VetMB DipECVN FHEA MRCVS Small Animal Hospital, University of Glasgow, Bearsden Road, Glasgow G61 1BD Andrew Tanner BSc(Hons) Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH Angelika von Heimendahl MScAg BVM DipECAR MScVet (Cons) MRCVS Veterinary Reproduction Service, Reed Veterinary Surgery, London Road, Herts SG8 8BD James Warland MA VetMB Dip-ECVIM-CA MRCVS Wellcome – MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Puddicombe Way, Cambridge CB2 0AWBSAVA Small Animal Formulary 10th edition: Part A – Canine and Feline v Preface Welcome to Part A of the 10th edition of the BSAVA Small Animal Formulary, providing up-to-date information about the drugs used for cats and dogs. I would like to start by thanking Professor Ian Ramsey for his tremendous work over the previous four editions of the Formulary, cementing this book as a superbly useful tool for small animal veterinary surgeons. In revising the latest edition, several new drug monographs have been added, including additional chemotherapeutic agents. The introduction of bullet points within the description of uses should highlight where certain drugs have multiple, reported indications. Through ongoing veterinary research data relating to drug use, adverse reactions and drug interactions is developed regularly; veterinary surgeons and nurses are reminded to also consult other sources when confronted with a medication with which they are unfamiliar. As well as the cited references, textbooks such as the excellent series of manuals published by the BSAVA can provide a wealth of pertinent information. This year, the guidelines on antibacterial use have been adapted to reflect the 2018 launch of the PROTECT ME initiative. Antimicrobial resistance is likely to represent a major challenge to human and animal healthcare in this new decade. Veterinary surgeons have a responsibility to pursue rational antibacterial use at all times and are encouraged to refer to the latest recommendations regarding the need for and selection of antibacterial medication for any particular condition. An illustrative flowchart has been added to the information regarding the prescribing cascade following the clarifications published by the Veterinary Medicines Directorate in 2019. Veterinary surgeons are reminded of the need to ensure that their prescribing policies and practices comply with existing guidelines and legislation. The Formulary provides information about many drugs not authorized for use in animals. Authorized products should be considered first for every patient; when such products are not available, or not clinically suitable, unauthorized medicines may be used in accordance with the cascade. In such cases, a clear clinical justification, made on an individual basis, should be recorded in the clinical notes or on the prescription. I would like to thank the Editorial Panel members for their efforts on this edition. I would also like to thank Alessandra Mathis, Jacques Ferreira, Gwen Covey-Crump, Tim Nuttall, Charlotte Robinson and James Swann for their invaluable advice with particular sections. My gratitude also goes to the editorial team members at BSAVA for their generous and enthusiastic assistance. I would welcome all comments and feedback from BSAVA members on this latest edition of the Small Animal Formulary. Fergus Allerton January 2020vi BSAVA Small Animal Formulary 10th edition: Part A – Canine and Feline Foreword The BSAVA Small Animal Formulary for the cat and dog, which was first published over twenty years ago, is recognized as an invaluable asset for the small animal clinician and is one of the Association’s most useful member benefits. Available as both a hard copy and as an App, it can be accessed quickly by the busy clinician as a resource to help with immediate prescribing advice, as well as by veterinary students during their training. As the numbers of licensed medications available to the small animal vet has increased, a reference source such as this can be a life saver during a hectic working day. The 10th edition of the Formulary sees Fergus Allerton take up the reins from Ian Ramsey who has guided the editorial team for many years. Fergus has assembled a knowledgeable and experienced group of subject experts to review the Formulary, which has been fully updated. Thirteen new drug monographs have been added together with client information leaflets for a further nine drugs. The launch of the Small Animal Formulary: Part A – Canine and Feline, together with the updated Small Animal Formulary: Part B – Exotic Pets, provides primary care veterinary surgeons and specialists alike with a complete guide to prescribing across all of species encountered by veterinary surgeons in clinical practice. Fergus and his team are to be congratulated on bringing out this new and updated 10th edition of the Formulary. Sue Paterson MA VetMB DVD DipECVD FRCVS BSAVA President 2019–2020Introduction vii Introduction Notes on the monographs • Name. The rINN generic name is used where this has been agreed. When a choice of names is available the more commonly used in the UK has been provided. The list of trade names is not necessarily comprehensive, and the mention or exclusion of any particular commercial product is not a recommendation or otherwise as to its value. Any omission of a product that is authorized for a particular canine or feline indication is purely accidental. All monographs were updated in the period July–December 2019. Products that are not marketed for use in animals (whether authorized by the Veterinary Medicines Directorate or not) are marked with an asterisk. Note that an indication that a product is authorized does not necessarily mean that it is authorized for all species and indications listed in the monograph; users should check individual data sheets. You may also wish to refer to the VMD’s Product Information Database (www.vmd.defra.gov.uk/ ProductInformationDatabase/). • Formulations. Only medicines and formulations that are available in the UK have been included – many others are available outside the UK and some medicines in different formulations. Common trade names of human medicines are provided. In many cases they are available as generic formulations and may be cheaper. However, be careful of assuming that the bioavailability of one brand is the same as that of another. Avoid switching between brands unnecessarily. • Action and Use. Veterinary surgeons using this publication are warned that many of the drugs and doses listed are not currently authorized by the Veterinary Medicines Directorate (VMD) or the European Agency for the Evaluation of Medicinal Products (EMEA) (either at all or for a particular species), or manufacturers’ recommendations may be limited to particular indications. The decision, and therefore the responsibility, for prescribing any drug for an animal lies solely with the veterinary surgeon. Expert assistance should be obtained when necessary. The ‘cascade’ and its implications are discussed below. For information on combination drugs, it is important to refer to all relevant monographs. • Safety and handling. This section only outlines specific risks and precautions for a particular drug that are in addition to the general advice given below in the ‘Health and safety in dispensing’ section. A separate Appendix deals with chemotherapeutic drugs. • Contraindications and Adverse reactions: The list of adverse reactions is not intended to be comprehensive and is limited to those effects that may be of clinical significance. The information for both of these sections is taken from published veterinary and human references and not just from product literature. INTRODUCTIONviii Introduction • Drug interactions. A listing of those interactions which may be of clinical significance. • Doses. These are based on those recommended by the manufacturers in their data sheets and package inserts, or are based on those given in published articles or textbooks, or are based on clinical experience. These recommendations should be used only as guidelines and should not be considered appropriate for every case. Clinical judgement must take precedence. Doses for small mammals, birds, reptiles and other groups of animals should never be extrapolated from the doses provided in this book for dogs and cats. The BSAVA Small Animal Formulary: Part B – Exotic Pets and other sources should be consulted where such doses are required. Distribution categories Authorized small animal medicines within Great Britain now fall within the first four categories below and all packaging supplied by drug manufacturers and distributors was changed in 2008. Medical products not authorized for veterinary use retain their former classification (e.g. GSL, P, POM). Other laws apply in other jurisdictions. Some nutritional supplements (nutraceuticals) are not considered medicinal products and therefore are not classified. Where a product does not have a marketing authorization it is designated ‘general sale’. AVM-GSL: Authorized veterinary medicine – general sales list. This may be sold by anyone. NFA-VPS: Non-food animal medicine – veterinarian, pharmacist, Suitably Qualified Person (SQP). These medicines for companion animals must be supplied by a veterinary surgeon, pharmacist or SQP. An SQP has to be registered with the Animal Medicines Training Regulatory Authority (AMTRA). Veterinary nurses can become SQPs but it is not automatic. POM-VPS: Prescription-only medicine – veterinarian, pharmacist, SQP (formerly PML livestock products, MFSX products and a few P products). These medicines for food-producing animals (including horses) can only be supplied on an oral or written veterinary prescription from a veterinary surgeon, pharmacist or SQP and can only be supplied by one of those groups of people in accordance with the prescription. POM-V: Prescription-only medicine – veterinarian. These medicines can only be supplied against a veterinary prescription that has been prepared (either orally or in writing) by a veterinary surgeon to animals under their care following a clinical assessment, and can only be supplied by a veterinary surgeon or pharmacist in accordance with the prescription. CD: Controlled Drug. A substance controlled by the Misuse of Drugs Act 1971 and Regulations. The CD is followed by (Schedule 1), (Schedule 2), (Schedule 3), (Schedule 4) or (Schedule 5) depending INTRODUCTION