Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 20 SEPTEMBER/OCTOBER 2018 Physical assessment, in particular cardiac auscultation, is always recommended but can be of limited value in determining whether a cat has cardiac disease. The incidence of heart murmurs in apparently healthy cats is only 16% to 44%. 6-8 The prevalence of cardiomyopathy detected by echocardiography in a large population of shelter cats was 15.3%, and the most prevalent primary heart disease in these cats was hypertrophic cardiomyopathy. 8 For cats with heart disease, arrhythmias may have more predictive value than heart murmurs. In another study, echocardiographic evidence of structural heart disease was present for 96% of cats with ventricular arrhythmias, including premature ventricular complexes, ventricular tachycardia, and accelerated idioventricular rhythm. 9 Thoracic radiographs are indicated for cats suspected of having heart disease but have low sensitivity for detecting hypertrophic heart disease. To help guide the diagnosis, testing for N-terminal pro B-type natriuretic peptide (NT-proBNP), a peptide rapidly produced by myocardial cells after stretch or hypoxia, can be used. Levels >100 pmol/L are suggestive of myocardial stretch or hypoxia and indicate a need for additional diagnostics for cardiac workup (e.g., thoracic radiographs, blood pressure, blood chemistry, thyroid panel). Respiratory signs accompanying an NT-proBNP level ≥270 pmol/L are suggestive of cardiac disease origin and indicate the need for further cardiac diagnostics. 10 Those cats with symptomatic heart disease often exhibit reduced body conditioning, abnormal lung sounds, and pale or cyanotic mucus membranes, coupled with a history of tachypnea or dyspnea, lethargy, and/or inappetence. Cats with cardiomyopathies present unique sedation and anesthesia challenges, depending on the type of myocardial disease. Although numerous cardiomyopathies occur in cats, the most common is hypertrophic (obstructive) cardiomyopathy. This disease is characterized by diffuse or segmental hypertrophy of the left ventricular myocardium with development of cardiomyofiber disarray. Left ventricular outflow tract obstruction can develop as a result of systolic anterior motion of the mitral valve leaflet. Also common are left atrial dilation and mitral valve regurgitation. These phenotypic changes result in a heart that consumes more oxygen because the Unfortunately, for cats, no single drug provides the optimal balance of sedation without cardiorespiratory depression; therefore, the clinician must select a drug combination that produces the least amount of cardiorespiratory depression with the best quality of sedation. PA100648X_BrS1 P1c Interceptor ™ Plus (milbemycin oxime/praziquantel) Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Before using INTERCEPTOR PLUS, please consult the product insert, a summary of which follows: Indications INTERCEPTOR PLUS is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; and for the treatment and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), adult whipworm (Trichuris vulpis), and adult tapeworm (Taenia pisiformis, Echinococcus multilocularis, Echinococcus granulosus, and Dipylidium caninum) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older. Dosage and Administration INTERCEPTOR PLUS should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes (see EFFECTIVENESS). See product insert for complete dosing and administration information. Contraindications There are no known contraindications to the use of INTERCEPTOR PLUS. Warnings Not for use in humans. Keep this and all drugs out of the reach of children. Precautions Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention (see EFFECTIVENESS). Prior to administration of INTERCEPTOR PLUS, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. INTERCEPTOR PLUS is not effective against adult D. immitis. Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy, have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae. Do not use in puppies less than six weeks of age. Do not use in dogs or puppies less than two pounds of body weight. The safety of INTERCEPTOR PLUS has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime alone (see ANIMAL SAFETY). Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime or praziquantel: vomiting, diarrhea, depression/lethargy, ataxia, anorexia, convulsions, weakness, and salivation. To report suspected adverse drug events, contact Elanco US Inc. at 1-888-545-5973 or the FDA at 1-888-FDA-VETS. For technical assistance call Elanco US Inc. at 1-888-545-5973. Information for Owner or Person Treating Animal: Echinococcus multilocularis and Echinococcus granulosus are tapeworms found in wild canids and domestic dogs. E. multilocularis and E. granulosus can infect humans and cause serious disease (alveolar hydatid disease and hydatid disease, respectively). Owners of dogs living in areas where E. multilocularis or E. granulosus are endemic should be instructed on how to minimize their risk of exposure to these parasites, as well as their dog's risk of exposure. Although INTERCEPTOR PLUS was 100% effective in laboratory studies in dogs against E. multilocularis and E. granulosus, no studies have been conducted to show that the use of this product will decrease the incidence of alveolar hydatid disease or hydatid disease in humans. Because the prepatent period for E. multilocularis may be as short as 26 days, dogs treated at the labeled monthly intervals may become reinfected and shed eggs between treatments. Effectiveness Heartworm Prevention: In a well-controlled laboratory study, INTERCEPTOR PLUS was 100% effective against induced heartworm infections when administered once monthly for 6 consecutive months. In well-controlled laboratory studies, neither one dose nor two consecutive doses of INTERCEPTOR PLUS provided 100% effectiveness against induced heartworm infections. Intestinal Nematodes and Cestodes Treatment and Control: Elimination of the adult stage of hookworm (Ancylostoma caninum), roundworm (Toxocara canis, Toxascaris leonina), whipworm (Trichuris vulpis) and tapeworm (Echinococcus multilocularis, Echinococcus granulosus, Taenia pisiformis and Dipylidium caninum) infections in dogs was demonstrated in well-controlled laboratory studies. Palatability In a field study of 115 dogs offered INTERCEPTOR PLUS, 108 dogs (94.0%) accepted the product when offered from the hand as if a treat, 1 dog (0.9%) accepted it from the bowl with food, 2 dogs (1.7%) accepted it when it was placed in the dog's mouth, and 4 dogs (3.5%) refused it. Storage Information Store at room temperature, between 59° and 77°F (15-25°C). How Supplied INTERCEPTOR PLUS is available in four strengths, formulated according to the weight of the dog. Each strength is available in color-coded packages of six chewable tablets each. The tablets containing 2.3 mg milbemycin oxime/ 22.8 mg praziquantel or 5.75 mg milbemycin oxime/57 mg praziquantel are also available in color coded packages of one chewable tablet each. Manufactured for: Elanco US Inc. Greenfield, IN 46140, USA Product of Japan NADA #141-338, Approved by FDA Interceptor, Elanco and the diagonal bar logo are trademarks of Eli Lilly and Company or its affiliates.

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