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.
Issue link: http://todaysveterinarypractice.epubxp.com/i/321264
Today's Veterinary Practice May/June 2014 52 | DermaTology DeTails tvpjournal.com Color Coding 0n Dog Chewables Ivermectin Pyrantel Foil Backing Weight Per Month Content Content and Carton Up to 25 lb 1 68 mcg 57 mg Blue 26 to 50 lb 1 136 mcg 114 mg Green 51 to 100 lb 1 272 mcg 227 mg Brown chewables ®HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ©2013 Merial Limited, Duluth, GA. All rights reserved. HGD13TRTRADEAD3 (03/13). CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD ® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows: HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food. The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog's first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog's last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables. For customer service, please contact Merial at 1-888-637-4251. References 1. Mason is, Lloyd dH. scanning electron microscopical studies of the living epidermis and stratum corneum in dogs. Advances in Veterinary Dermatology: Proceedings of the Second World Congress of Veterinary Dermatology. oxford: Pergamon Press, 1993, pp 131-139. 2. draize JH. The determination of the pH of the skin of man and common labo- ratory animals. J Invest Dermatol 1942; 5:77-85. 3. Meyer w, neurand k. comparison of skin pH in domesticated and laboratory animals. Arch Dermatol Res 1991; 283:16-18. 4. Meyer w, neurand k, Bartels T. The "protective acid coat" of the skin of our domestic animals. Deutsche tierarztliche Wochenschrift 1991; 98:167-170. 5. Matousek JL, campbell kL, kakoma i, schaeffer dJ. The effects of four acidi- fying sprays, vinegar, and water on canine cutaneous pH levels. JAAHA 2003; 39:29-33. 6. Miller wH, griffin ce, campbell kL. Muller and Kirk's Small Animal Dermatology, 7th ed. st Louis: wB saunders, 2013, p 948. 7. Piekutowska a, Pin d, rème ca, et al. effects of a topically applied prepara- tion of epidermal lipids on the stratum corneum barrier of atopic dogs. J Comp Pathol 2008; 138(4):197-203. 8. reiter Lv, Torres sM, wertz Pw. characterization and quantification of cerami- des in the nonlesional skin of canine patients with atopic dermatitis compared with controls. Vet Dermatol 2009; 20(4):260-266. 9. shimada k, Yoon Js, Yoshihara T, et al. increased transepidermal water loss and decreased ceramide content in lesional and non-lesional skin of dogs with atopic dermatitis. Vet Dermatol 2009; 20(5-6):541-546. 10. van damme cM, willemse T, van dijk a, et al. altered cutaneous expression of beta- defensins in dogs with atopic dermatitis. Mol Immunol 2009; 46(13):2449-2455. 11. fitzgerald Jr. The Staph intermedius group of bacterial pathogens: species re-classification, pathogenesis, and the emergence of methicillin resistance. Vet Dermatol 2009; 20(5-6):490-495. 12. griffeth gc, Morris do, abraham JL, et al. screening for skin carriage of methi- cillin-resistant coagulase-positive staphylococci and Staphylococcus schleiferi in dogs with healthy and inflamed skin. Vet Dermatol 2008; 19(3):142-149. 13. foster g, Barley J. Staphylococcus schleiferi subspecies coagulans in dogs. Vet Rec 2007; 161(14):496. 14. rich M, roberts L, Jones M, Young v. Staphylococcus schleiferi subspecies coagulans in companion animals. Vet Rec 2007; 161(3):107. 15. ihrke PJ, gross TL. warning about postgrooming furunculosis. JAVMA 2006; 229(7):1081-1082. 16. Hillier a, alcorn Jr, cole Lk, kowalski JJ. Pyoderma caused by Pseudomonas aeruginosa infection in dogs: 20 cases. Vet Dermatol 2006; 17(6):432-439. 17. Pin d, carlotti dn, Jasmin P, et al. Prospective study of bacterial overgrowth syndrome in eight dogs. Vet Record 2006; 158(13):437-441. 18. iyori k, Toyoda Y, ide k, et al. Usefulness of cefovecin disk-diffusion test for predicting meca gene-containing strains of Staphylococcus pseudinterme- dius and clinical efficacy of cefovecin in dogs with superficial pyoderma. Vet Dermatol 2013; 24:162-167. 19. Papich Mg. ciprofloxacin pharmacokinetics and oral absorption of generic cip- rofloxacin tablets in dogs. Am J Vet Res 2012; 73:1085-1091. 20. abadia ar, aramayona JJ, Pia delfina JJ, Bregante Ma. ciprofloxacin pharma- cokinetics in dogs following oral administration. Zentralbl Veterinarmed A 1995; 42:505-511. 21. adams vJ, campbell Jr, waldner cL, et al. evaluation of client compli- ance with short-term administration of antimicrobials to dogs. JAVMA 2005; 226(4):567-574. 22. Hanssen aM, ericson sollid JU. sccmec in staphylococci: genes on the move. FEMS Immunol Med Microbiol 2006; 46(1):8-20. 23. deurenberg rH, vink c, kalenic s, et al. The molecular evolution of methicillin- resistant Staphylococcus aureus. Clin Microbiol Infect 2007; 13(3):222-235. 24. weese Js, van duijkeren e. Methicillin-resistant Staphylococcus aureus and Staphylococcus pseudintermedius in veterinary medicine. Vet Microbiol 2010; 140(3-4):418-429. 25. kloos i, straubinger rk, werckenthin c, Mueller rs. residual antibacterial activity of dog hairs after therapy with antimicrobial shampoos. Vet Dermatol 2013; 24(2):250-254. 26. Loeffler a, cobb Ma, Bond r. comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. Vet Rec 2011; 169(10):249. 27. Murayama n, nagata M, Terada Y, et al. comparison of two formulations of chlorhexidine for treating canine superficial pyoderma. Vet Rec 2010; 167(14):532-533. 28. Murayama n, nagata M, Terada Y, et al. efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma. Vet Dermatol 2010; 21(6):586-592. 29. faires M, gard s, aucoin d, weese Js. inducible clindamycin-resistance in methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococus pseudintermedius isolates from dogs and cats. Vet Microbiol 2009; 139(3-4):419-420. 30. Maaland Mg, Papich Mg, Turnidge J, guardabassi L. Pharmacodynamics of doxycycline and tetracycline against Staphylococcus pseudintermedius: Proposal of canine-specific breakpoints for doxycycline. J Clin Microbiol 2013; 51:3547-3554. TVP_2014-0506_DermDetails_Infections.indd 52 5/23/2014 3:24:58 PM