Today's Veterinary Practice

MAR-APR 2018

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For oral use in dogs Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Description: CREDELIO (lotilaner) is a beef-flavored, chewable tablet for oral administration to dogs and puppies according to their weight. Each chewable tablet is formulated to provide a minimum lotilaner dosage of 9 mg/lb (20 mg/kg). Lotilaner has the chemical composition of 5-[(5S)-4,5-dihydro-5-(3,4,5-trichlorophenyl)- 5-(trifluoromethyl)-3-isoxazolyl]-3-methyl-N-[2-oxo-2-[(2,2,2-trifluoroethyl)amino]ethyl]- 2-thiophenecarboxamide. Indications: CREDELIO kills adult fleas and is indicated for the treatment of flea infestations (Ctenocephalides felis) and the treatment and control of tick infestations [Amblyomma americanum (lone star tick), Dermacentor variabilis (American dog tick), Ixodes scapularis (black-legged tick) and Rhipicephalus sanguineus (brown dog tick)] for one month in dogs and puppies 8 weeks of age and older, and weighing 4.4 pounds or greater. Dosage and Administration: CREDELIO is given orally once a month, at the minimum dosage of 9 mg/lb (20 mg/kg). Dosage Schedule: Body Weight Lotilaner Per Chewable Tablets Chewable Tablet (mg) Administered 4.4 to 6.0 lbs 56.25 One 6.1 to 12.0 lbs 112.5 One 12.1 to 25.0 lbs 225 One 25.1 to 50.0 lbs 450 One 50.1 to 100.0 lbs 900 One Over 100.0 lbs Administer the appropriate combination of chewable tablets CREDELIO must be administered with food (see Clinical Pharmacology). Treatment with CREDELIO can begin at any time of the year and can continue year round without interruption. Contraindications: There are no known contraindications for the use of CREDELIO. Warnings: Not for human use. Keep this and all drugs out of the reach of children. Precautions: The safe use of CREDELIO in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures (see Adverse Reactions). Adverse Reactions: In a well-controlled U.S. field study, which included 284 dogs (198 dogs treated with CREDELIO and 86 dogs treated with an oral active control), there were no serious adverse reactions. Over the 90-day study period, all observations of potential adverse reactions were recorded. Reactions that occurred at an incidence of 1% or greater are presented in the following table. Dogs with Adverse Reactions in the Field Study Adverse Reaction CREDELIO Group: Active Control Group: (AR) Number (and Percent) of Number (and Percent) of Dogs with the AR (n=198) Dogs with the AR (n=86) Weight Loss 3 (1.5%) 2 (2.3%) Elevated Blood Urea Nitrogen (BUN) 2 (1.0%)* 0 (0.0%) Polyuria 2 (1.0%)* 0 (0.0%) Diarrhea 2 (1.0%) 2 (2.3%) *Two geriatric dogs developed mildly elevated BUN (34 to 54 mg/dL; reference range: 6 to 31 mg/dL) during the study. One of these dogs also developed polyuria and a mildly elevated potassium (6.5 mEq/L; reference range: 3.6 to 5.5 mEq/L) and phosphorous (6.4 mg/dL; reference range: 2.5 to 6.0 mg/dL). The other dog also developed a mildly elevated creatinine (1.7 to 2.0 mg/dL; reference range: 0.5 to 1.6 mg/dL) and weight loss. In addition, one dog experienced intermittent head tremors within 1.5 hours of administration of vaccines, an ear cleaning performed by the owner, and its first dose of CREDELIO. The head tremors resolved within 24 hours without treatment. The owner elected to withdraw the dog from the study. In an Australian field study, one dog with a history of seizures experienced seizure activity (tremors and glazed eyes) six days after receiving CREDELIO. The dog recovered without treatment and completed the study. In the U.S. field study, two dogs with a history of seizures received CREDELIO and experienced no seizures throughout the study. In three well-controlled European field studies and one U.S. laboratory study, seven dogs experienced episodes of vomiting and four dogs experienced episodes of diarrhea between 6 hours and 3 days after receiving CREDELIO. To report suspected adverse events, for technical assistance or to obtain a copy of the Safety Data Sheet (SDS), contact Elanco US, Inc. at 1-888-545-5973. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or Clinical Pharmacology: Following oral administration of 43 mg/kg (approximately 1X the maximum labeled dose), peak lotilaner concentrations were achieved between 6 hours and 3 days in dogs 2 months of age and between 1 and 7 days in dogs 10 months of age. Dogs 2 months of age had a shorter elimination half-life (average of 9.6 days) than at 10 months of age (average of 28.4 days). Due to reduced drug bioavailability in the fasted state, CREDELIO must be administered with a meal or within 30 minutes after feeding. Mode of Action: Lotilaner is an ectoparasiticide belonging to the isoxazoline group. Lotilaner inhibits insect and acarine gamma-aminobutyric acid (GABA)-gated chloride channels. This inhibition blocks the transfer of chloride ions across cell membranes, which results in uncontrolled neuromuscular activity leading to death of insects and acarines. The selective toxicity of lotilaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines' GABA receptors versus mammalian GABA receptors. Effectiveness: In well-controlled European laboratory studies, CREDELIO began to kill fleas four hours after administration or infestation, with greater than 99% of fleas killed within eight hours after administration or infestation for 35 days. In a well-controlled U.S. laboratory study, CREDELIO demonstrated 100% effectiveness against adult fleas 12 hours after administration or infestation for 35 days. In a 90-day well-controlled U.S. field study conducted in households with existing flea infestations of varying severity, the effectiveness of CREDELIO against fleas on Days 30, 60 and 90 compared to baseline was 99.5%,100% and 100%, respectively. Dogs with signs of flea allergy dermatitis showed improvement in erythema, papules, scaling, alopecia, dermatitis/pyodermatitis and pruritus as a direct result of eliminating fleas. In well-controlled laboratory studies, CREDELIO demonstrated > 97% effectiveness against Amblyomma americanum, Dermacentor variabilis, Ixodes scapularis and Rhipicephalus sanguineus ticks 48 hours after administration or infestation for 30 days. In a well-controlled European laboratory study, CREDELIO started killing Ixodes ricinus ticks within four hours after administration. Palatability: In the U.S. field study, which included 567 doses administered to 198 dogs, 80.4% of dogs voluntarily consumed CREDELIO when offered by hand or in an empty bowl, an additional 13.6% consumed CREDELIO when offered with food, and 6.0% required placement of the chewable tablet in the back of the dog's mouth. Animal Safety: In a margin of safety study, CREDELIO was administered orally to 24 (8 dogs/group) 8-week-old Beagle puppies at doses of 43 mg/kg, 129 mg/kg, and 215 mg/kg (approximately 1, 3, and 5X the maximum labeled dose, respectively) every 28 days for eight consecutive doses. The 8 dogs in the control group (0X) were untreated. There were no clinically-relevant, treatment-related effects on clinical observations, physical and neurological examinations, body weights, food consumption, electrocardiograms, clinical pathology (hematology, clinical chemistries, coagulation profiles and urinalysis), gross pathology, histopathology, or organ weights. Blood concentrations of lotilaner confirmed systemic exposure of all treated dogs, although the exposure was less than dose proportional at 5X. In a well-controlled field study, CREDELIO was used concurrently with other medications, such as vaccines, anthelmintics, antibiotics, steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of CREDELIO with other medications. Storage Information: Store at 15-25°C (59 -77°F), excursions permitted between 5 to 40°C (41 to 104°F). How Supplied: CREDELIO is available in five chewable tablet sizes for use in dogs: 56.25, 112.5, 225, 450, and 900 mg lotilaner. Each chewable tablet size is available in color-coded packages of 1 or 6 chewable tablets. NADA #141-494, Approved by the FDA Manufactured for: Elanco US Inc Greenfield, IN 46140 USA Credelio, Elanco and the diagonal bar logo are trademarks of Eli Lilly and Company or its affiliates. Rev. date 11/2017 PA209456X 12266 CRE1 Chewable Tablets

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