These may help.
IVOMEC, HEARTGARD30 & ACAREXX
AVAILABLE IN TABLETS / CHEWABLES
FOR HEARTWORM PREVENTION, TOPICAL
SOLUTION FOR EAR MITE TREATMENT,
OR AS ORAL OR INJECTABLE SOLUTION
FOR OTHER PARASITE PROBLEMS
HOW THIS MEDICATION IS USED
In the mid-1980's, ivermectin was introduced as probably the most broad-spectrum anti-parasite medication ever. It is effective against most common intestinal worms (except tapeworms), most mites, and some lice. It is not effective against fleas, ticks, flies, or flukes. It is effective against larval heartworms (the "microfilariae" that circulate in the blood) but not against adult heartworms (that live in the heart and pulmonary
arteries).
The most common uses in small animal practice for ivermectin would include:
Monthly prevention of heartworm infection
Treatment of ear mite situations
Clearing heartworm larvae in active heartworm infection
Treatment of sarcoptic, notoedric or demodectic mange
It should be noted that doses of ivermectin used for prevention and treatment of heartworm disease are approximately 50 times lower than doses used for other parasites.
SIDE EFFECTS
Side effects are not a concern with the extremely low doses used in commercially marketed heartworm preventives. problems may arise when higher doses, such as those used against mites, are employed.
Side effects generally do not occur with any anti-mange doses of ivermectin except in Collies, Shetland sheepdogs, Australian shepherds, and Old English sheepdogs, though some individual animals that are not members of these sensitive breeds may also be prone to side effects. Very low test doses are often recommended to identify these individuals regardless of their breed. Collies with ivermectin sensitivity have been found to have a mutant gene for what is called the "P-glycoprotein." The P-glycoprotein has been studied largely because overexpression of this protein (i.e. having more of it than normal) results poor function of chemotherapy drugs in the treatment of cancer. The P-glycoprotein appears to be involved in keeping drugs out of certain body tissues. Having excess P-glycoprotein keeps chemotherapy drugs from reaching the tumor; having a mutant/non-functional protein fails to keep medications like ivermectin out of the central nervous system. Approximately 35% of Collies appear affected by this condition.
Heartworm preventive doses are so low that side effects are not produced even in ivermectin sensitive individuals.
Side effects of concern are: dilated pupils and drunken gait which can progress to respiratory paralysis and death if medication is not withdrawn and supportive care is withheld.
INTERACTIONS WITH OTHER DRUGS
Ivermectin should not be used in combination with valium or related tranquilizers (the infinitesimal doses used in Heartgard excepted). It should not be used in conjunction with Amitraz (Mitaban?) dips nor with Amitraz tick prevention collars (Preventic? collars). These medications are all members of the monoamine oxidase inhibitor group and when they used together their effects add together creating sedation and adverse neurologic effects.
CONCERNS AND CAUTIONS
Ivermectin use in pregnancy and lactation is not felt to be a problem.
Ivermectin has an extremely bitter taste and is best disguised in food if it is to be used orally long term (as in the treatment of demodectic mange).
Uses of oral/injectable ivermectin in small animals for anything other than heartworm prevention is considered off-label use and is not approved by the FDA.
Again, the breeds considered at high risk for ivermectin toxicity are collies, Shetland sheepdogs, Australian shepherds, and Old English sheepdogs. Not every individual dog from these breeds is sensitive to ivermectin. It is possible to test an individual using a low dose of ivermectin.
Topical ivermectin for ears (Acarexx?) is FDA approved for cats and kittens over 4 weeks of age.
WHILE WE RECOGNIZE THAT IT IS POSSIBLE TO BUY IVERMECTIN (IVOMEC?) THROUGH SOME CATALOGS, WE STRONGLY DISCOURAGE THIS PRACTICE GIVEN THE PRECISE DOSES USED FOR SMALL ANIMALS AND THE POTENTIAL FOR SERIOUS SIDE EFFECTS IF THE PRODUCT IS INCORRECTLY USED.
FOR INFORMATION ON SPECIFIC DISEASES TREATED WITH IVERMECTIN
Demodectic Mange
Sarcoptic Mange
Notoedric Mange
Heartworm Disease
Ear Mite Infection
BRAND NAME: BAYTRIL
AVAILABLE IN
5.7 mg, 22.7 mg, 68 mg & 136 mg
TABLETS
BACKGROUND
Until penicillin came on the scene in the 1940's, our efforts to combat bacterial infection were largely ineffective. As different antibiotics were developed, different types of bacteria were conquered, yet one bacterial species remained seemingly invincible: Pseudomonas aurugenosa. Eventually antibiotics (the aminoglycoside class) were developed that could kill Pseudomonas but they were available only as injectable products and had potential to cause significant kidney damage if used too long. With these kind of side effects and the ability to treat Pseudomonas limited to hospitalized patients (where injections could be given regularly), the battle with Pseudomonas was far from won.
A major breakthrough was the development of the fluoroquinolone class of antibiotics (including enrofloxacin, its counterpart for human use ciprofloxacin, and several others). These medications are active against many bacterial types including Pseudomonas. They are available as tablets and are not associated with the serious side effects that plagued the aminoglycoside group.
Fluoroquinolones act by deactivating bacterial enzymes necessary for the transcription of DNA. DNA is very tightly coiled in order to fit inside a cell. Segments to be used must be uncoiled by an enzyme called DNA gyrase. The fluoroquinolone antibiotic deactivates DNA gyrase making the reading of DNA impossible. The bacterial cell dies. Mammalian DNA gyrase is of a completely different shape and remains unharmed.
USES OF THIS MEDICATION
This medication may be used in either dogs or cats to combat different types of infections, especially those involving Pseudomonas. Enrofloxacin is also active against Staphylococci, and is commonly used for infections of the skin.
SIDE EFFECTS
At approximately ten times the recommended dose vomiting and diarrhea may be seen with this medication. At normal doses, this should not be seen. Dogs with Pseudomonas ear infections require very high doses of enrofloxacin and nausea may indeed become a problem.
In immature dogs (less than 8 months of age) damage to joint cartilage can occur. This phenomenon is only seen in growing dogs and does not seem to be a problem in cats. It is preferable not to use this medication in puppies unless the severity of the infection present warrants it.
The use of enrofloxacin can produce crystals in urine. These crystals may show up on a laboratory test thus it is important to be aware of this side effect.
See below regarding the recently described feline retinal problem associated with enrofloxacin at higher doses.
INTERACTIONS WITH OTHER DRUGS
Sucralfate (a medication used to treat stomach ulcers) may bind enrofloxacin and prevent it from entering the body. These medications should be given at least 2 hours apart if they are used together.
Theophylline (an airway dilator) blood levels may be higher than usual if this medication is used concurrently with enrofloxacin. The dose of theophylline may need to be reduced.
If enrofloxacin is used with oral cyclosporine (an immunosuppressive medication used for inflammatory bowel disease), the kidney damaging properties of cyclosporine may become worse.
Medications or supplements containing iron, zinc, magnesium or aluminum will bind enrofloxacin and prevent absorption into the body. Such medications should be separated from enrofloxacin by at least two hours.
CONCERNS AND CAUTIONS
Enrofloxacin tablets are enteric coated to hide the drug's naturally bitter taste. If the tablets are crushed for some reason, the bitter taste is more readily apparent. Crushing tablets to put in an animal's food is unlikely to be an effective way to administer enrofloxacin. Recently, Bayer has manufactured an alternative valled a ?flavor-tab? which is much more palatable than the purple-colored enteric coated tablets. The tan colored ?flavor-tabs? are more easily crushed and mixed in food.
Pseudomonas infections are especially common in ears. In this location, especially high doses of enrofloxacin are needed to clear this infection. Expect to give a lot of pills and be prepared for expense.
Enrofloxacin has toxic properties in humans. It is for veterinary use only.
Enrofloxacin should not be used in pregnant, or nursing pets nor in immature dogs unless the severity of the infection warrants it.
Enrofloxacin may lower the seizure threshhold (meaning that it can facilitate seizures). This is not a problem for normal animals but fluoroquinolones are best not used in animals with known seizure disorders.
Retinal damage has been seen in cats when higher doses (such as might be used to treat a Pseudomonas ear infection) are used. This reaction is not common even with very high doses, but there is no way to pedict which cats will react. Blindness, temporary or permanent, can result. This reaction has only been reported with enrofloxacin and not with other fluoroquinolones, as it is theorized that the biochemical structure of enrofloxacin leads to especially high concentrations in the feline eye (in other words, this reaction is theoretically possible with any fluoroquinolones but enrofloxacin is especially predisposed to causing this reaction).
BRAND NAME: FLAGYL
AVAILABLE IN
250mg & 500mg
TABLETS
USES OF THIS MEDICATION
Metronidazole is an antibiotic especially effective against anaerobic infections (infections that grow without the presence of oxygen.) In addition, it has anti-inflammatory properties in the large intestine and is a very effective anti-diarrhea medication. It is an effective antibiotic against certain protozoal infections, especially GIARDIA.
A common use of this medication would be the treatment of colitis, which may or may not be caused by inflammatory bowel disease.
HOW THIS MEDICATION WORKS
The normal tissues of our bodies depend on the presence of oxygen for survival and, indeed, we have an elaborate circulatory system to see that oxygen is transported throughout our bodies. In other words, our cells live aerobically.
Abscessed tissues and tumors with poor central circulation do not receive blood supply and oxygen. Only bacteria that can live without oxygen can survive in these areas. These bacteria are called "anaerobic" bacteria.
In anaerobic conditions, the metronidazole molecule changes so as to inhibit the DNA repair enzymes that normally would repair cells. This means death for anaerobic bacteria but no effect on aerobic tissues.
Metronidazole is also used in radiotherapy for cancer as this DNA effect can sensitize anaerobic tumor tissues to radiation making a smaller dose of radiation more effective.
Metronidazole is able to modify cell mediated immunity so as to normalize excessive immune reactions, especially in the large intestine. We do not know how metronidazole is able to do this.
SIDE EFFECTS
Side effects are not commonly seen with this medication unless the patient is taking especially high doses (general anti-diarrheal doses should not be a problem) or moderate doses for a long time period (months). Side effects seen can relate to nausea or appetite loss or side effects can be neurologic (staggering, head tilt to one side, dilated pupils, and bizarre back and forth eye movements called "nystagmus"). These side effects resolve in a matter of days when medication is withdrawn and, again, only occur with chronic use (months) or short term use with especially high doses.
INTERACTIONS WITH OTHER MEDICATIONS
In humans, concurrent use of metronidazole with alcoholic beverages induces marked nausea. This should obviously not be a problem for pets.
If metronidazole is used concurrently with phenobarbital (medication for epilepsy), metronidazole may not be as effective. If metronidazole is used concurrently with Cimetidine (Tagamet HB), there is a slight increased risk for metronidazole use to yield the side effects mentioned above.
CONCERNS AND CAUTIONS
Metronidazole is best given with food
Metronidazole can cause birth defects if given to a pregnant patient. It should never be administered during pregnancy.
BRAND NAME: PANACUR
AVAILABLE IN
ORAL SUSPENSION
AND GRANULES
BACKGROUND
The care of animals has always included the management of internal parasites. As technology has progressed, the medications developed have become more and more broad in the spectrum of parasites they can eradicate. Fenbendazole is a member of the benzimidizole group of anti-parasite medications which makes it a relatively broad spectrum product.
HOW THIS MEDICATION IS USED
Fenbendazole (often abbreviated ?FBZ?) is used in both large and small animals. In dogs, it is useful against roundworms, hookworms, and the more difficult to treat whipworms. It is effective against the Taenia species of tapeworm but not against the Common tapeworm Dipylidium caninum. It is also effective against giardia, a protozoan and several species of lungworm and even some flukes.
Fenbendazole is rarely required for feline use but can certainly be used safely in the cat. Fenbendazole is not approved by the FDA for use in the cat, however.
SIDE EFFECTS
Some animals experience vomiting/nausea after deworming.
INTERACTIONS WITH OTHER DRUGS
There are no significant drug interactions in small animal use.
CONCERNS AND CAUTIONS
Fenbendazole is considered safe for use in pregnancy in all species.
Treatment is necessary for three consecutive days. Treatment may require a second course depending on which parasite is being treated.
