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PEER REVIEWED 38 CE: INFLAMMATORY BOWEL DISEASE steroids are anticipated. In dogs, many steroid-refractory cases can be rescued with cyclosporine single therapy. 55 One retrospective study demonstrated that only 26% of dogs with chronic enteropathy progress to complete remission, with intermittent clinical signs remaining in approximately one-half of cases. Furthermore, 4% were completely uncontrolled and 13% were euthanized because of poor response to treatment. 38 This suggests that the prognosis of these patients can be poor. Finally, the main negative prognostic indicator for chronic enteropathy in dogs has been identified as hypoalbuminemia. 33,38 More prospective treatment trials are necessary, especially in severely affected and hypoproteinemic animals, to improve long-term survival in these cases. Kayode Garraway Kayode Garraway, DVM, received his veterinary degree from St. George's University College of Veterinary Medicine, with his clinical year completed at North Carolina State University College of Veterinary Medicine. He did a small animal rotating internship at the University of Tennessee College of Veterinary Medicine, followed by a specialty internship in internal medicine and critical care at Gulf Coast Veterinary Specialists in Houston, Texas. He is currently in his third year of residency in small animal internal medicine at Iowa State University College of Veterinary Medicine. He is also currently completing a master's degree in veterinary clinical sciences and is an adjunct instructor at Iowa State University. His interests include small animal gastroenterology and immunology. Karin Allenspach Karin Allenspach, DVM, PhD, DECVIM-CA, received her veterinary degree from the University of Zurich. She did an internship in small animal emergency medicine and critical care at Tufts University School of Veterinary Medicine and a residency in small animal internal medicine at the University of Pennsylvania School of Veterinary Medicine. She was awarded a PhD in veterinary immunology from the University of Bern, Switzerland, for her work on canine chronic enteropathies. She is a board-certified internist and currently appointed as professor in small animal medicine at Iowa State University. Albert Jergens Albert Jergens, DVM, MS, PhD, DACVIM (SAIM), received his veterinary degree from Texas A&M; College of Veterinary Medicine. He completed a residency in small animal internal medicine at the University of Missouri-Columbia College of Veterinary Medicine. He was awarded a PhD in immunology from Iowa State University, where he is currently a board-certified internist in small animal internal medicine. His clinical interests include gastroenterology, gastrointestinal endoscopy, and host- microbiota interactions mediating gastrointestinal health and disease. Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications SENTINEL ® SPECTRUM ® (milbemycin oxime/lufenuron/praziquantel) is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; for the prevention and control of flea populations (Ctenocephalides felis); 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 and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older. Dosage and Administration SENTINEL SPECTRUM should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes. Dosage Schedule Body Weight Milbemycin Oxime per chewable Lufenuron per chewable Praziquantel per chewable Number of chewables 2 to 8 lbs. 2.3 mg 46 mg 22.8 mg One 8.1 to 25 lbs. 5.75 mg 115 mg 57 mg One 25.1 to 50 lbs. 11.5 mg 230 mg 114 mg One 50.1 to 100 lbs. 23.0 mg 460 mg 228 mg One Over 100 lbs. Administer the appropriate combination of chewables To ensure adequate absorption, always administer SENTINEL SPECTRUM to dogs immediately after or in conjunction with a normal meal. SENTINEL SPECTRUM may be offered to the dog by hand or added to a small amount of dog food. The chewables 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 a few minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. Contraindications There are no known contraindications to the use of SENTINEL SPECTRUM. 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. Prior to administration of SENTINEL SPECTRUM, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM 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 SENTINEL SPECTRUM has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime and lufenuron alone. Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, salivation, and weakness. To report suspected adverse drug events, contact Virbac at 1-800-338-3659 or the FDA at 1-888-FDA-VETS. 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 SENTINEL SPECTRUM 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. Manufactured for: Virbac AH, Inc. P.O. Box 162059, Ft. Worth, TX 76161 NADA #141-333, Approved by FDA © 2015 Virbac Corporation. All Rights Reserved. SENTINEL and SPECTRUM are registered trademarks of Virbac Corporation. 02/15 To see the references for this article, please visit tvpjournal.com .