27 Livro - BSAVA Small Animal Formulary, 9th Edition Part B Exotic Pets - Outros (2025)

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90mm SPINE90mm SPINE120mm OBC120mm OBC120mm OFC120mm OFC25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round board25mm extra to wrap round boardBe part of the BSAVA communityBSAVA is run by vets for vets, and we are here to support you throughout your veterinary career. Together we form a strong network of veterinary professionals in the UK and overseas.BSAVA understands that sometimes life in practice can be solitary and pressured; therefore, we make it easy for you to communicate, share ideas and network at both national and regional levels.It’s easy to get in touch:01452 726700administration@bsava.comwww.bsava.comBSAVA Small Animal Formulary 9th edition · Part B: Exotic PetsBSAVA Small AnimalFormulary9th edition · Part B: Exotic PetsEditor-in-Chief:Anna Meredith3321PUBS15Covers Spreads 9 edn OUTSIDE RESIZED.indd 1 03/09/2015 14:16BSAVA Small AnimalFormulary9th edition · Part B: Exotic PetsAs the popularity of non-traditional pets grows, there is an increasing need for dedicated information on drug use in these animals. The monographs included in this Formulary have been adapted from those published in the BSAVA Small Animal Formulary, 8th edition to provide both generic and relevant species-specific information for mammals (excluding dogs and cats), birds, reptiles, amphibians and fish.The complementary BSAVA Small Animal Formulary, 9th edition: Part A – Canine and Feline is due for publication in 2017.3016 Small Animal Formulary INSIDE COVERS.indd 1 17/02/2015 09:43Editor-in-Chief:Anna Meredith MA VetMB PhD CertLAS DZooMed DipECZM MRCVSRoyal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian EH25 9RGPublished by:British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2ABA Company Limited by Guarantee in England.Registered Company No. 2837793.Registered as a Charity.Copyright © 2015 BSAVASmall Animal FormularyFirst edition 1994Second edition 1997Third edition 1999Reprinted with corrections 2000Fourth edition 2002Reprinted with corrections 2003Fifth edition 2005Reprinted with corrections 2007Sixth edition 2008Reprinted with corrections 2009, 2010Seventh edition 2011Reprinted with corrections 2012, 2013Eighth edition 2014Reprinted with corrections 2015 (twice)Small Animal Formulary – Part B: Exotic Pets Ninth edition 2015Reprinted with corrections 2015All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder.A catalogue record for this book is available from the British Library.ISBN 978 1 905 319 82 4The publishers, editors and contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned or referred to in this publication. Details of this kind must be verified in each case by individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded that in each case they must follow all appropriate national legislation and regulations (for example, in the United Kingdom, the prescribing cascade) from time to time in force. Printed in India by Imprint DigitalPrinted on ECF paper made from sustainable forests.Small AnimalFormulary9th edition – Part B: Exotic Pets3321MDC15ZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 1 03/09/2015 14:21BSAVA Small Animal Formulary 9th edition: Part B – Exotic PetsiiOther titles from BSAVA:Guide to Procedures in Small Animal PracticeGuide to the Use of Veterinary Medicines (available online)Manual of Canine & Feline Abdominal ImagingManual of Canine & Feline Abdominal SurgeryManual of Canine & Feline Advanced Veterinary NursingManual of Canine & Feline Anaesthesia and AnalgesiaManual of Canine & Feline Behavioural MedicineManual of Canine & Feline Cardiorespiratory MedicineManual of Canine & Feline Clinical PathologyManual of Canine & Feline DentistryManual of Canine & Feline DermatologyManual of Canine & Feline Emergency and Critical CareManual of Canine & Feline EndocrinologyManual of Canine & Feline Endoscopy and EndosurgeryManual of Canine & Feline Fracture Repair and ManagementManual of Canine & Feline GastroenterologyManual of Canine & Feline Haematology and Transfusion MedicineManual of Canine & Feline Head, Neck and Thoracic SurgeryManual of Canine & Feline Musculoskeletal DisordersManual of Canine & Feline Musculoskeletal ImagingManual of Canine & Feline Nephrology and UrologyManual of Canine & Feline NeurologyManual of Canine & Feline OncologyManual of Canine & Feline OphthalmologyManual of Canine & Feline Radiography and Radiology: A Foundation ManualManual of Canine & Feline Rehabilitation, Supportive and Palliative Care: Case Studies in Patient ManagementManual of Canine & Feline Reproduction and NeonatologyManual of Canine & Feline Surgical Principles: A Foundation ManualManual of Canine & Feline Thoracic ImagingManual of Canine & Feline UltrasonographyManual of Canine & Feline Wound Management and ReconstructionManual of Canine Practice: A Foundation ManualManual of Exotic Pet and Wildlife NursingManual of Exotic Pets: A Foundation ManualManual of Feline Practice: A Foundation ManualManual of Ornamental FishManual of Practical Animal CareManual of Practical Veterinary NursingManual of Psittacine BirdsManual of Rabbit Medicine Manual of Rabbit Surgery, Dentistry and ImagingManual of Raptors, Pigeons and Passerine BirdsManual of ReptilesManual of Rodents and FerretsManual of Small Animal Practice Management and Development Manual of Wildlife CasualtiesFor further information on these and all BSAVA publications, please visit our website: www.bsava.comZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 2 12/02/2015 09:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets iiiContentsEditorial Panel ivPreface to the ninth edition vForeword viIntroductionNotes on the monographs viiDistribution categories viiiThe prescribing cascade xDrug storage and dispensing xiHealth and safety in dispensing xiiDrug listings and monographs 1(listed A–Z by generic name)Appendix I: general information Abbreviations 301Writing a prescription 302Guidelines for responsible antibacterial use 303Dosing small and exotic animals 306Composition of intravenous fluids 307Safety and handling of chemotherapeutic agents 307Percentage solutions 310Drugs usage in renal and hepatic insufficiency 311Suspected Adverse Reaction Surveillance Scheme 313Further reading and useful websites 313Appendix II: protocols Chemotherapy protocols 315Sedation/immobilization protocols 318Index sorted by therapeutic class 323Index (alphabetical by generic and trade names) 329ZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 3 12/02/2015 09:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic PetsivEditorial PanelJohn Chitty BVetMed CertZooMed MRCVSAnton Vets, Anton Mill Road, Andover, Hants SP10 2NJJoanna Hedley BVM&S DZooMed DipECZM MRCVSBeaumont Sainsbury Animal Hospital, Royal Veterinary College, Royal College Street, London NW1 0TUAnna Meredith MA VetMB PhD CertLAS DZooMed DipECZM MRCVSRoyal (Dick) School of Veterinary Studies, University of Edinburgh,CBAAa.indd 15 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets16Aminophylline(Aminophylline*) POMFormulations: Injectable: 25 mg/ml solution. Oral: 100 mg tablet. For modified-release preparations see Theophylline (100 mg of aminophylline is equivalent to 79 mg of theophylline).Action: Aminophylline is a stable mixture of theophylline (q.v.) and ethylenediamine. Causes inhibition of phosphodiesterase, alteration of intracellular calcium, release of catecholamine, and antagonism of adenosine and prostaglandin, leading to bronchodilation and other effects.Use: Spasmolytic agent and has a mild diuretic action. It is used in the treatment of small airway disease. Beneficial effects include bronchodilation, enhanced mucociliary clearance, stimulation of the respiratory centre, increased sensitivity to PaCO2, increased diaphragmatic contractility, stabilization of mast cells and a mild inotropic effect. Aminophylline has a low therapeutic index and should be dosed on a lean body weight basis. Administer with caution in patients with severe cardiac disease, gastric ulcers, hyperthyroidism, renal or hepatic disease, severe hypoxia or severe hypertension. Therapeutic plasma aminophylline values are 5–20 µg/ml.Safety and handling: Do not mix aminophylline in a syringe with other drugs.Contraindications: Patients with known history of arrhythmias or seizures.Adverse reactions: Vomiting, diarrhoea, polydipsia, polyuria, reduced appetite, tachycardia, arrhythmias, nausea, twitching, restlessness, agitation, excitement and convulsions. Most adverse effects are related to the serum level and may be symptomatic of toxic serum concentrations. The severity of these effects may be decreased by the use of modified-release preparations. They are more likely to be seen with more frequent administration. Aminophylline causes intense local pain when given i.m. and is very rarely used or recommended via this route.Drug interactions: Agents that may increase the serum levels of aminophylline include cimetidine, diltiazem, erythromycin, fluoroquinolones and allopurinol. Phenobarbital may decrease the serum concentration of aminophylline. Aminophylline may decrease the effects of pancuronium. Aminophylline and beta-adrenergic blockers (e.g. propranolol) may antagonize each other’s effects. Aminophylline administration with halothane may cause an increased incidence of cardiac dysrhythmias and with ketamine an increased incidence of seizures.DOSESMammals: Ferrets: 4.4–6.6 mg/kg p.o., i.m. q12h; Rabbits: 2.0 mg/kg i.v. q12h (slowly i.v. for emergency bronchodilation); Guinea pigs: 50 mg/kg p.o. q12h.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 16 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 17Birds: 4–5 mg/kg i.m., i.v. q6–12h; Raptors: 8–10 mg/kg p.o., i.m., i.v. q6–8h (anecdotal) 1.Reptiles: 2–4 mg/kg i.m. once.Amphibians, Fish: No information available.References1 Huckabee JR (2000) Raptor therapeutics. Veterinary Clinics of North America: Exotic Animal Practice 3, 91–116Amitraz(Aludex, Promeris Duo) POM-VFormulations: Topical: 5% w/v concentrated liquid; spot-on 150 mg/ml amitraz combined with metaflumizone in pipettes of various sizes.Action: Increases neuronal activity through its action on octopamine receptors of mites.Use: To treat generalized mite infestation, including demodicosis and sarcoptic acariasis. Used for generalized demodicosis in ferrets and hamsters and for acariasis in rodents. Dip to be left on coat. Clipping long hair coats will improve penetration. Ensure accurate dilution and application, especially for smaller rodents. Concurrent bacterial skin infections should be treated appropriately.Safety and handling: Do not store diluted product.Contraindications: No information available.Adverse reactions: Sedation and bradycardia; can be reversed with an alpha-2 antagonist, e.g. atipamezole. Can cause irritation of the skin.Drug interactions: No information available.DOSESMammals: Ferrets, Guinea pigs: 0.3% solution (1 ml Aludex concentrated liquid in 17 ml water) applied topically to skin q14d for 3–6 treatments; Hamsters, Rats, Mice: 1.4 ml/l topically applied with a cotton bud q7d; Gerbils: 0.007% solution (1.4 ml Aludex concentrated liquid in 1000 ml water) applied with a cotton bud q14d for 3–6 treatments.Birds, Reptiles, Amphibians, Fish: No information available.Amitriptyline(Amitriptyline*) POMFormulations: Oral: 10 mg, 25 mg, 50 mg tablets; 5 mg/ml, 10 mg/ml solutions.Action: Blocks noradrenaline and serotonin re-uptake in the brain, resulting in antidepressive activity.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 17 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets18Use: Management of chronic anxiety problems, including ‘compulsive disorders’, separation anxiety and ‘compulsive disorders’, and psychogenic alopecia. Used for a minimum of 30 days for feather plucking in birds. Amitriptyline is bitter and can be distasteful. Some caution and careful monitoring is warranted in patients with cardiac or renal disease.Safety and handling: Normal precautions should be observed.Contraindications: Hypersensitivity to tricyclic antidepressants, glaucoma, history of seizures or urinary retention, severe liver disease.Adverse reactions: Sedation, dry mouth, vomiting, excitability, arrhythmias, hypotension, syncope, increased appetite, weight gain and, less commonly, seizures and bone marrow disorders have been reported in humans. The bitter taste may cause ptyalism.Drug interactions: Should not be used with monoamine oxidase inhibitors or drugs metabolized by cytochrome P450 2D6, e.g. chlorphenamine, cimetidine. If changing medication from one of these compounds, a minimal washout period of 2 weeks is recommended (the washout period may be longer if the drug has been used for a prolonged period of time).DOSESMammals: Rats: 5–20 mg/kg p.o. q24h.Birds: 1–2 mg/kg p.o. q12–24h; can be increased to 5 mg/kg if needed.Reptiles, Amphibians, Fish: No information available.Amoxicillin (Amoxycillin)(Amoxinsol, Amoxycare, Amoxypen, Bimoxyl, Clamoxyl, Duphamox, Vetremox) POM-VFormulations: Injectable: 150 mg/ml suspension. Oral: 40 mg, 200 mg, 250 mg tablets; suspension which when reconstituted provides 50 mg/ml. Topical: 100% w/w powder for top dressing (Vetremox).Action: Binds to penicillin-binding proteins involved in bacterial cell wall synthesis, thereby decreasing cell wall strength and rigidity, affecting cell division, growth and septum formation. These antimicrobials act in a time-dependent bactericidal fashion.Use: Active against certain Gram-positive and Gram-negative aerobic organisms and many obligate anaerobes but not against those that produce penicillinases (beta-lactamases), e.g. Escherichia coli, Staphylococcus aureus. The more difficult Gram-negative organisms (Pseudomonas, Klebsiella) are usually resistant. Amoxicillin is excreted well in bile and urine. Oral amoxicillin may be given with or without food. Since amoxicillin works in a time-dependent fashion, it is important to maintain levels above the MIC ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 18 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 19for a high percentage of the time. In practical terms this means that the dosing interval is critical and missing doses can seriously compromise efficacy. In ferrets it is used in combination with bismuth subsalicylate, ranitidine or omeprazole and metronidazole (‘triple therapy’) for treatment of Helicobacter mustelae infection. Used to treat bacterial diseases in fish.Safety and handling: Refrigerate oral suspension after reconstitution; discard if solutionbecomes dark or after 7 days.Contraindications: Avoid oral antibiotics in critically ill patients, as absorption from the GI tract may be unreliable. Do not administer penicillins to hamsters, guinea pigs, gerbils or chinchillas. Do not administer oral penicillins to rabbits.Adverse reactions: Nausea, diarrhoea and skin rashes are the commonest adverse effects. Drug interactions: Avoid concurrent use with bacteriostatic antibiotics (e.g. tetracycline, erythromycin, chloramphenicol). Do not mix in the same syringe as aminoglycosides. A synergistic effect is seen when beta-lactam and aminoglycoside antimicrobials are used concurrently.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 11 mg/kg p.o. q12h or 11 mg/kg s.c., i.m. q24h; Sugar gliders: 30 mg/kg p.o., i.m. q24h for 14 days (for dermatitis); Hedgehogs: 15 mg/kg p.o., s.c., i.m. q8–12h; Ferrets: 10–30 mg/kg s.c., p.o. q12h; Rabbits: 7 mg/kg s.c. q24h; Rats, Mice: 100–150 mg/kg i.m., s.c. q12h.Birds: 150–175 mg/kg i.m., s.c. q8–12h (q24h for long-acting preparations); Raptors, Parrots: 175 mg/kg p.o. q12h; Pigeons: 1–1.5 g/l drinking water (Vetremox pigeon) q24h for 3–5 days or 100–200 mg/kg p.o. q6–8h; Waterfowl: 1 g/l drinking water (Amoxinsol soluble powder) alternate days for 3–5 days or 300–500 mg/kg p.o. (in soft food) for 3–5 days; Passerines: 1.5 g/l drinking water for 3–5 days (Vetremox pigeon).Reptiles: 5–10 mg/kg i.m., p.o. q12–24h (most species); Chelonians: 5–50 mg/kg i.m., p.o. q12h.Amphibians: No information available.Fish: 40–80 mg/kg in feed q24h for 10 days or 12.5 mg/kg i.m. once (long-acting preparation) 12.References1 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford2 Wildgoose WH and Lewbart GA (2001) Therapeutics. In: BSAVA Manual of Ornamental Fish, 2nd edn, ed. WH Wildgoose, pp. 237–258. BSAVA Publications, GloucesterAmoxicillin/Clavulanate see Co-amoxiclav Amoxycillin see AmoxicillinZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 19 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets20Amphotericin B(Abelcet*, AmBisome*, Amphocil*, Fungizone*) POMFormulations: Injectable: 50 mg/vial powder for reconstitution.Action: Binds to sterols in fungal cell membrane creating pores and allowing leakage of contents.Use: Management of systemic fungal infections and leishmaniosis. Given the risk of severe toxicity it is advisable to reserve use for severe/potentially fatal fungal infections only. Abelcet, AmBisome, Amphocil are lipid formulations that are less toxic. Physically incompatible with electrolyte solutions. Lipid formulations are far less toxic than conventional formulations for i.v. use because the drug is targeted to macrophages, but these preparations are far more expensive. Solutions are usually given i.v. but if regular venous catheterization is problematic then an s.c. alternative has been used for cryptococcosis and could potentially be used for other systemic mycoses. Renal values and electrolytes should be monitored pre- and post- each treatment; urinalysis and liver function tests weekly. If considering use in patients with pre-existing renal insufficiency (where other treatment options have failed and benefits outweigh risks), consider lipid formulations, concurrent saline administration and dose reduction. Has been used topically in reptiles to treat pulmonary candidiasis. In amphibians, amphotericin B has been used as a water treatment for the management of chytridiomycosis in adult animals.Safety and handling: Keep in dark, although loss of drug activity is negligible for at least 8 hours in room light. After initial reconstitution (but not further dilution), the drug is stable for 1 week if refrigerated and stored in the dark. Do not dilute in saline. Pre-treatment heating of the reconstituted concentrated solution to 70°C for 20 min produces superaggregates which are less nephrotoxic. To produce a lipid-formulated product if not commercially available mix 40 ml sterile saline, 10 ml of lipid infusion (q.v.) and 50 mg of the reconstituted concentrated solution.Contraindications: Do not use in renal or hepatic failure.Adverse reactions: Include hypokalaemia, leading to cardiac arrhythmias, phlebitis, hepatic failure, renal failure, vomiting, diarrhoea, pyrexia, muscle and joint pain, anorexia and anaphylactoid reactions. Nephrotoxicity is a major concern; do not use other nephrotoxic drugs concurrently. Nephrotoxicity may be reduced by saline infusion (20 ml/kg over 60 minutes) prior to administration of amphotericin B. Fever and vomiting may be decreased by pre-treating with aspirin, diphenhydramine or an antiemetic. Amphotericin B is toxic to birds when administered systemically; administer fluids and monitor carefully if giving i.v. Care is needed if amphotericin B is nebulized as birds may ingest it when preening. Can cause bronchospasm in humans if nebulized. Amphotericin B is acutely toxic to Alytes muletensis tadpoles at 8 µg/ml.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 20 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 21Drug interactions: Amphotericin may increase the toxic effects of fluorouracil, doxorubicin and methotrexate. Flucytosine is synergistic with amphotericin B in vitro against Candida, Cryptococcus and Aspergillus.DOSESMammals: Ferrets: 0.4–0.8 mg/kg i.v. q7d for treatment of blastomycosis; Rabbits: 1 mg/kg i.v. q24h (desoxycholate form) or 5 mg/kg i.v. q24h (liposomal form); Guinea pigs: 1.25–2.5mg/kg s.c. q24h for cryptococcosis; Mice: 0.11 mg/kg s.c. q24h or 0.43 mg/kg p.o. q24h.Birds: Systemic fungal infections: 1–1.5 mg/kg i.v. q8–12h for 3–5 days (give with 10–15 ml/kg saline) or 1 mg/kg in 2 ml sterile water intratracheal q8–12h for 12 days then q48h for 5 weeks; Parrots: 100–300 mg/kg p.o. q12–24h for Macrorhabdus infection; Passerines: 100,000 IU/kg p.o. q8–12h or 1–5 g/l drinking water or 1 mg/ml in saline nebulized for 15 min q12h.Reptiles: 0.5–1 mg/kg i.v., intracoelomic q24–72h for 2–4 weeks, concurrent fluid therapy is advised due to potential nephrotoxicity; Respiratory infections: Nebulize 5 mg in 150 ml saline for 30–60 min q12h; may also use topically on lesions q12h.Amphibians: Internal mycoses: 1 mg/kg intracoelomic q24h; Batrachochytrium dendrobatidis sporangia and zoospores: 8–15 µg (micrograms)/ml in water for 48 h ab.Fish: No information available.Referencesa Holden WM, Ebert AR, Canning PF and Rollins-Smith LA (2014) Evaluation of amphotericin B and chloramphenicol as alternative drugs for treatment of chytridiomycosis and their impacts on innate skin defences. Applied Environmental Microbiology 80(13), 4034–4041b Martel A, Van Rooij P, Vercauteren G et al. (2011) Developing a safe antifungal treatment protocol to eliminate Batrachochytrium dendrobatidis from amphibians. Medical Mycology 49(2), 143–149Ampicillin(Amfipen, Ampicaps, Ampicare, Duphacillin) POM-VFormulations: Injectable: Ampicillin sodium 250 mg, 500 mg powders for reconstitution (human licensed product only); 150 mg/ml suspension, 100 mg/ml long-acting preparation. Oral: 500 mg tablets; 250 mg capsule.Action: Binds to penicillin-binding proteins involved in bacterial cell wall synthesis, thereby decreasing cell wall strength and rigidity, affecting cell division, growth and septum formation. It acts in a time-dependent bactericidal fashion.Use: Active against many Gram-positive and Gram-negative aerobic organisms and obligate anaerobes, but not against those that produce penicillinases (beta-lactamases), e.g. Escherichia coli, Staphylococcus aureus. The difficult Gram-negative organisms such as Pseudomonas aeruginosa and Klebsiella are usually resistant. ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 21 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets22Ampicillin is excreted well in bile and urine. Maintaining levels above the MIC is critical for efficacy and thereby prolonged dosage intervals or missed doses can compromise therapeutic response. Dose and dosing interval is determined by infection site, severity and organism. Oral bioavailability is reduced in the presence of food. Used to treat bacterial disease in fish.Safety and handling: After reconstitution the sodium salt will retain adequate potency for up to 8 hours if refrigerated, but use within 2 hours if kept at room temperature.Contraindications: Avoid the use of oral antibiotic agents in critically ill patients, as absorption from the GI tract may be unreliable. Do not administer penicillins to hamsters, guinea pigs, chinchillas or rabbits. Use with caution in gerbils and only when indicated by sensitivity testing. Adverse reactions: Nausea, diarrhoea and skin rashes are the commonest adverse effects. Drug interactions: Avoid the concurrent use of ampicillin with bacteriostatic antibiotics (e.g. tetracycline, erythromycin, chloramphenicol). Do not mix in the same syringe as aminoglycosides. A synergistic effect is seen when beta-lactam and aminoglycoside antimicrobials are used concurrently.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 20 mg/kg p.o., i.m., i.v. q8h; Ferrets: 5–30 mg/kg i.m., s.c. q12h; Rabbits, Chinchillas, Guinea pigs, Hamsters: do not use; Gerbils: 20–100 mg/kg s.c. q8h or 6–30 mg/kg p.o. q8h; Rats, Mice: 25 mg/kg i.m., s.c. q12h or 50–200 mg/kg p.o. q12h.Birds: 50–100 mg/kg i.v., i.m. q8–12h, 150–200 mg/kg p.o. q8–12h, 1–2 g/l drinking water, 2–3 g/kg in soft feed a.Reptiles: 10–20 mg/kg s.c., i.m. q24h (most species); Hermann’s tortoises: 50 mg/kg i.m. q12h.Amphibians: No information available.Fish: 50–80 mg/kg in feed q24h for 10 days 1.Referencesa Ensley PK and Janssen DL (1981) A preliminary study comparing the pharmacokinetics of ampicillin given orally and intramuscularly to psittacines: Amazon parrots (Amazond spp.) and Blue-naped parrots (Tanygnathus lucionensis). Journal of Zoo Animal Medicine 12(2), 42–471 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, OxfordAmprolium(Coxoid) AVM-GSLFormulations: Oral: 3.84% solution for dilution in water.Action: Thiamine analogue that disrupts protozoal metabolism.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 22 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 23Use: Coccidiosis in homing/racing pigeons and small mammals. Limit duration of therapy to 2 weeks.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Prolonged high doses can cause thiamine deficiency.Drug interactions: No information available.DOSESMammals: Ferrets: 19 mg/kg p.o. q72h; Rabbits: 20 mg/kg p.o. q24h for 2–4 weeks; Chinchillas: 10–15 mg/kg p.o. total daily dose divided q8–24h; Gerbils, Hamsters, Rats, Mice: 10–20 mg/kg p.o. total daily dose divided q8–24h.Birds: Pigeons: 28 ml of the concentrate in 4.5 l of drinking water for 7 days; in severe outbreaks continue with half-strength solution for a further 7 days; medicated water should be discarded after 24 hours. Passerines: 50–100 mg/l drinking water for 5 days or longer.Reptiles, Amphibians, Fish: No information available.Aniline green see Malachite greenApomorphine(Apometic, Apomorphine, APO-go*) POM, POM-VFormulations: Injectable: 10 mg/ml solution in 2 ml or 5 ml ampoules; 5 mg/ml, 10 mg/ml solutions in 10 ml pre-filled syringes.Action: Stimulates emesis through D2 dopamine receptors in the chemoreceptor trigger zone.Use: Induction of self-limiting emesis within a few minutes of administration in animals where vomiting is desirable, e.g. following the ingestion of toxic, non-caustic foreign material. Emesis generally occurs rapidly and within a maximum of 10 min. Further doses depress the vomiting centre and may not result in any further vomiting.Safety and handling: Normal precautions should be observed.Contraindications: Induction of emesis is contraindicated if strong acid or alkali has been ingested, due to the risk of further damage to the oesophagus. Induction of vomiting is contraindicated if the animal is unconscious, fitting, or has a reduced cough reflex, or if the poison has been ingested for >2 hours, or if the ingesta contains paraffin, petroleum products or other oily or volatile organic products, due to the risk of inhalation. Contraindicated in rabbits as they are unable to vomit. Contraindicated in rodents as their stomach walls lack the strength to tolerate forced emesis.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 23 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets24Adverse reactions: Apomorphine may induce excessive vomiting, respiratory depression and sedation.Drug interactions: In the absence of compatibility studies, apomorphine must not be mixed with other products. Antiemetic drugs, particularly antidopaminergics (e.g. phenothiazines) may reduce the emetic effects of apomorphine. Additive CNS or respiratory depression may occur when apomorphine is used with opiates or other CNS or respiratory depressants.DOSESMammals: Ferrets: 70 µg (micrograms)/kg s.c.Birds, Reptiles, Amphibians, Fish: No information available.Ara-C see CytarabineArnica(Arnicare*) GSLFormulations: Arnica montana tincture 0.9% w/v.Action: Arnica montana is an alpine plant that contains helenalin, which has anti-inflammatory properties.Use: First aid application for bruises resulting from a number of causes but especially those resulting from extravasation of non-toxic fluids from intravenous catheters. Also useful for peri-surgical bruising. Arnica has been found to be as effective as some NSAIDs (e.g. ibuprofen) in humans with hand arthritis and in reducing bruising following facelift surgery. However, some studies have shown no effect over placebo. No anti-infective properties; therefore skin infections require other specific therapy.Safety and handling: Wear gloves when applying cream as contact with the plant can cause skin irritation in some individuals.Contraindications: Do not apply to broken skin.Adverse reactions: Ingestion of large amounts of the plant can be poisonous. There are no reports of problems associated with the cream.Drug interactions: No information available.DOSESMammals, Birds: Apply sparingly to site of bruising twice daily. Anecdotally appears effective, with no recorded side effects.Reptiles, Amphibians, Fish: No information available.Ascorbic acid see Vitamin C Asparaginase, l-Asparginase see CrisantaspaseZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 24 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 25Aspirin (Acetylsalicyclic acid)(Aspirin BP* and component of many others) PFormulations: Oral: 75 mg, 300 mg tablets.Action: Produces irreversible inhibition of cyclo-oxygenase (COX) by acetylation, thereby preventing the production of both prostaglandins and thromboxanes from membrane phospholipids.Use: Prevention of arterial thromboembolism. Also can be used to control mild to moderate pain, although NSAIDs that are more selective for the COX-2 enzyme have a better safety profile; not an NSAID of choice for analgesia in small mammals. Administration of aspirin to animals with renal disease must be carefully evaluated. It is advisable to stop aspirin before surgery (at least 2 weeks) to allow recovery of normal platelet function and prevent excessive bleeding.Safety and handling: Normal precautions should be observed.Contraindications: Do not give aspirin to dehydrated, hypovolaemic or hypotensive patients or those with GI disease. Do not give to pregnant animals or animalsP (2000) Evaluation of medetomidine for short-term immobilization of domestic pigeons (Columba livia) and Amazon parrots (Amazona spp.). Journal of Avian Medicine and Surgery 14(1), 8–14h Sleeman JM and Gaynor J (2000) Sedative and cardiopulmonary effects of medetomidine and reversal with atipamezole in Desert tortoises (Gopherus agassizi). Journal of Zoo and Wildlife Medicine 31(1), 28–35Atracurium(Tracrium*) POMFormulations: Injectable: 10 mg/ml solution.Action: Inhibits the actions of acetylcholine at the neuromuscular junction by binding competitively to the nicotinic acetylcholine receptor on the post-junctional membrane.Use: Neuromuscular blockade during anaesthesia. This may be to improve surgical access through muscle relaxation, to facilitate positive pressure ventilation or for intraocular surgery. Atracurium has an intermediate duration of action (15–35 min) and is non-cumulative due to non-enzymatic (Hofmann) elimination. It is therefore suitable for administration to animals with renal or hepatic disease. Monitoring (using a nerve stimulator) and reversal of the neuromuscular blockade is recommended to ensure complete recovery before the end of anaesthesia. Hypothermia, acidosis and hypokalaemia will prolong the duration of action of neuromuscular blockade. Use the low end of the dose range in patients with myasthenia gravis and ensure that neuromuscular function is monitored during the period of the blockade and recovery using standard techniques.Safety and handling: Store in refrigerator.Contraindications: Do not administer unless the animal is adequately anaesthetized and facilities to provide positive pressure ventilation are available.Adverse reactions: Can precipitate the release of histamine after rapid i.v. administration, resulting in bronchospasm and hypotension. Diluting the drug in normal saline and giving the drug slowly i.v. minimizes these effects.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 28 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 29Drug interactions: Neuromuscular blockade is more prolonged when atracurium is given in combination with volatile anaesthetics, aminoglycosides, clindamycin or lincomycin.DOSESBirds: 0.25 mg/kg i.v. a.Mammals, Reptiles, Amphibians, Fish: No information available.Referencesa Nicholson A and Ilkiw JE (1992) Neuromuscular and cardiovascular effects of atracurium in isoflurane-anesthetized chickens. American Journal of Veterinary Research 53, 2337–2342Atropine(Atrocare) POM-VFormulations: Injectable: 0.6 mg/ml. Ophthalmic: 0.5%, 1% solution in single-use vials, 5 ml bottle; 1% ointment.Action: Blocks the action of acetylcholine at muscarinic receptors at the terminal ends of the parasympathetic nervous system, reversing parasympathetic effects and producing mydriasis, tachycardia, bronchodilation and general inhibition of GI function.Use: Prevent or correct bradycardia and bradyarrhythmias, to dilate pupils, in the management of organophosphate and carbamate toxicities, and in conjunction with anticholinesterase drugs during antagonism of neuromuscular block. Routine administration prior to anaesthesia as part of premedication is no longer recommended; it is better to monitor heart rate and give atropine to manage a low heart rate if necessary. Ophthalmic use is ineffective in birds and reptiles because of the complex arrangement of musculature in the iris and ciliary body. Atropine has a slow onset of action (10 min i.m., 2–3 min i.v.), therefore it is important to wait for an adequate period of time for the desired effect before redosing. The ophthalmic solution tastes very bitter and can cause hypersalivation; therefore the ophthalmic ointment preparation is preferred. Used for the treatment of organophosphate poisoning in fish.Safety and handling: The solution does not contain any antimicrobial preservative, therefore any remaining solution in the vial should be discarded after use. The solution should be protected from light.Contraindications: Glaucoma, lens luxation, keratoconjunctivitis sicca.Adverse reactions: Include sinus tachycardia (usually of short duration after i.v. administration), blurred vision from mydriasis, which may worsen recovery from anaesthesia, and drying of bronchial secretions. Atropine increases intraocular pressure and reduces tear production. Ventricular arrhythmias may be treated with lidocaine if severe. Other GI side effects such as ileus and vomiting are rare in small animals. May be associated with prolonged ileus in reptiles.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 29 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets30Drug interactions: Atropine is compatible (for at least 15 min) mixed with various medications but not with bromides, iodides, sodium bicarbonate, other alkalis or noradrenaline. The following may enhance the activity of atropine: antihistamines, quinidine, pethidine, benzodiazepines, phenothiazines, thiazide diuretics and sympathomimetics. Combining atropine and alpha-2 agonists is not recommended. Atropine may aggravate some signs seen with amitraz toxicity, leading to hypertension and gut stasis.DOSESMammals: Primates: 0.02–0.05 mg/kg s.c., i.m., i.v.; Sugar gliders: 0.01–0.02 mg/kg s.c., i.m.; Hedgehogs: 0.02 mg/kg s.c., i.m.; Ferrets: 0.02–0.04 mg/kg s.c., i.m., i.v.; Others: 0.04–0.1 mg/kg i.m., s.c.; Chinchillas, Guinea pigs: 0.1–0.2 mg/kg s.c., i.m.; Rabbits: Endogenous atropinase levels may make repeat injections q10–15min necessary; Rodents: Organophosphate poisoning may require up to 10 mg/kg i.v., i.m. q20min; Bradyarrhythmias: 0.01–0.03 mg/kg i.v.; low doses may exacerbate bradycardia; repetition of the dose will usually promote an increase in heart rate; 0.03–0.04 mg/kg i.m. can be given to prevent development of bradycardia during administration of potent opioids such as fentanyl.Birds: Organophosphate poisoning: 0.04–0.5 mg/kg i.v., i.m. q4h; Supraventricular bradycardia: 0.01–0.02 mg/kg i.v. once.Reptiles: 0.01–0.04 mg/kg i.m., i.v.; May be ineffective in green iguanas a.Amphibians, Fish: 0.1 mg/kg s.c., i.m., i.v., intraperitoneal as required (organophosphate toxicity) 1.Referencesa Pace L and Mader DR (2002) Atropine and glycopyrrolate, route of administration and response in the green iguana (Iguana iguana). Proceedings of the Association of Reptilian and Amphibian Veterinarians, pp. 791 Stoskopf MK (1998) Fish chemotherapeutics. Veterinary Clinics of North America: Small Animal Practice – Tropical Fish Medicine pp. 331–348Azathioprine(Azathioprine*, Imuran*) POMFormulations: Oral: 25 mg, 50 mg tablets.Action: Inhibits purine synthesis, which is necessary for cell proliferation especially of leucocytes and lymphocytes. It suppresses cell-mediated immunity, alters antibody production and inhibits cell growth.Use: Management of immune-mediated diseases. Often used in conjunction with corticosteroids. Routine haematology (including platelets) should be monitored closely: initially every 1–2 weeks; and every 1–2 months when on maintenance therapy. Use with caution in patients with hepatic disease. In animals with renal impairment, dosing interval should be extended. Clinical responses can take up to 6 weeks. Mycophenolic acid may be preferred if a more rapid response is required.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 30 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 31Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. Azathioprine tablets should be stored at room temperature in well closed containers and protected from light.Contraindications: Do not use in patients with bone marrow suppression or those at highrisk of infection.Adverse reactions: Bone marrow suppression is the most serious adverse effect. This may be influenced by the activity of thiopurine s-methyltransferase, which is involved in the metabolism of the drug and which can vary between individuals due to genetic polymorphism. Avoid rapid withdrawal.Drug interactions: Enhanced effects and increased azathioprine toxicity when used with allopurinol. Increased risk of azathioprine toxicity with aminosalicylates and corticosteroids.DOSESMammals: Ferrets: 0.5 mg/kg p.o. q48h to 5 mg/kg p.o. q24h for eosinophilic gastroenteritis (limited evidence); 0.9 mg/kg p.o. q24–72h with prednisolone and dietary management for inflammatory bowel disease.Birds, Reptiles, Amphibians, Fish: No information available.Azithromycin(Zithromax*) POMFormulations: Oral: 250 mg capsule; 200 mg/5 ml suspension (reconstitute with water).Action: Binds to the 50S bacterial ribosome (like erythromycin), inhibiting peptide bond formation and has bactericidal or bacteriostatic activity depending on the susceptibility of the organism. Azithromycin has a longer tissue half-life than erythromycin, shows better oral absorption and is better tolerated in humans.Use: Alternative to penicillin in allergic individuals as it has a similar, although not identical, antibacterial spectrum. It is active against Gram-positive cocci (some Staphylococcus species are resistant), Gram-positive bacilli, some Gram-negative bacilli (Haemophilus, Pasteurella), mycobacteria, obligate anaerobes, Chlamydophila, Mycoplasma and Toxoplasma. Some strains of Actinomyces, Nocardia and Rickettsia are also inhibited. Most strains of the Enterobacteriaceae (Pseudomonas, Escherichia coli, Klebsiella) are resistant. Useful in the management of respiratory tract, mild to moderate skin and soft tissue, and non-tubercular mycobacterial infections. Used to treat chlamydophilosis in birds. Has been used in primates (macaques) as an anti-malarial. Doses are empirical and subject to change as experience with the drug is gained. More work is needed to optimize the clinically effective dose rate. Azithromycin ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 31 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets32activity is enhanced in an alkaline pH; administer on an empty stomach where possible.Safety and handling: Normal precautions should be observed.Contraindications: Avoid in renal and hepatic failure in all species.Adverse reactions: In humans similar adverse effects to those of erythromycin are seen, i.e. vomiting, cholestatic hepatitis, stomatitis and glossitis, but the effects are generally less marked than with erythromycin.Drug interactions: Azithromycin may increase the serum levels of methylprednisolone, theophylline and terfenadine. The absorption of digoxin may be enhanced.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 25 mg/kg s.c. q24h ab; Ferrets: 5 mg/kg p.o. q24h for 5 days as part of a protocol for treatment of Helicobacter; Rabbits: 4–5 mg/kg i.m. q48h for 7 days is effective against syphilis; 50 mg/kg p.o. q24h azithromycin with 40 mg/kg p.o. q12h rifampin for staphylococcal osteomyelitis c; Prairie dogs: 15–30 mg/kg p.o. q24h for 15 days; Rats, Mice: 50 mg/kg p.o. q12h for 14 days.Birds: Chlamydophilosis: 40 mg/kg p.o. q24–48h for up to 45 days d; Mycoplasma: 50–80 mg/kg p.o. q24h for 3 days, then 4 days off; repeat for up to 3 weeks; Blue-and-gold macaws: 10 mg/kg p.o. q48h for susceptible infections e.Reptiles: 10 mg/kg p.o. q3d for skin infections; q5d for respiratory tract infections; q7d for liver and kidney infections f.Amphibians, Fish: No information available.Referencesa Puri SK and Singh N (2000) Azithromycin: antimalarial profile against blood- and sporozoite-induced infections in mice and monkeys. Experimental Parasitology 94(1), 8–14b Girard AE, Girard D, English AR et al. (1987) Pharmacokinetic and in vivo studies with azithromycin (CP-62,993), a new macrolide with an extended half-life and excellent tissue distribution. Antimicrobial Agents and Chemotherapy 31(12), 1948–1954c Shirtliff ME, Mader JT and Calhoun J (1999) Oral rifampin plus azithromycin or clarithromycin to treat osteomyelitis in rabbits. Clinical Orthopaedics and Related Research 359, 229–236d Sanchez-Migallon Guzman D, Diaz-Figueroa O, Tully T Jr et al. (2010) Evaluating 21-day doxycycline and azithromycin treatments for experimental Chlamydophila psittaci infection in cockatiels (Nymphicus hollandicus). Journal of Avian Medicine and Surgery 24(1), 35–45e Carpenter JW, Olsen JH, Randle-Port M, Koch DE, Isaza R and Hunter RP (2005) Pharmacokinetics of azithromycin in the blue-and-gold macaw (Ara ararauna) after intravenous and oral administration. Journal of Zoo and Wildlife Medicine 36(4), 606–609f Coke RL, Hunter RP, Isaza R, Koch DE. Goatley MA and Carpenter JW (2003) Pharmacokinetics and tissue concentrations of azithromycin in ball pythons (Python regius). American Journal of Veterinary Research 64(2), 225–228ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 32 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 33Aztreonam(Azactam*, Squibb*) POMFormulations: Injectable: 1 g, 2 g powder for solution.Action: Bactericidal by interfering with cell wall synthesis.Use: Treatment of Gram-negative bacterial infections in fish.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 100 mg/kg i.m., intraperitoneal q48h for 7 treatments 1.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Lewbart GA (2013) Exotic Animal Formulary, 4th edn, ed. JW Carpenter. Elsevier, MissouriZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 33 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets34Benazepril(Benefortin, Cardalis, Fortekor, Nelio, Prilben, Vetpril) POM-VFormulations: Oral: 2.5 mg, 5 mg, 20 mg tablets. Available in a compound preparation with spironolactone (Cardalis tablets) in the following formulations: 2.5 mg benazepril/20 mg spironolactone, 5 mg benazepril/40 mg spironolactone, 10 mg benazepril/80 mg spironolactone.Action: Angiotensin converting enzyme (ACE) inhibitor. It inhibits conversion of angiotensin I to angiotensin II and inhibits the breakdown of bradykinin. Overall effect is a reduction in preload and afterload via venodilation and arteriodilation, decreased salt and water retention via reduced aldosterone production and inhibition of the angiotensin-aldosterone-mediated cardiac and vascular remodelling. Efferent arteriolar dilation in the kidney can reduce intraglomerular pressure and therefore glomerular filtration. This may decrease proteinuria.Use: Treatment of congestive heart failure in most species and chronic renal insufficiency (anecdotal only). Often used in conjunction with diuretics when heart failure is present as most effective when used in these cases. Can be used in combination with other drugs to treat heart failure (e.g. pimobendan, spironolactone, digoxin). May reduce blood pressure in hypertension. Benazepril undergoes significant hepatic metabolism and may not need dose adjustment in renal failure. ACE inhibitors are more likely to cause or exacerbate prerenal azotaemia in hypotensive animals and those with poor renal perfusion (e.g. acute, oliguric renal failure). Use cautiously if hypotension, hyponatraemia or outflow tract obstruction are present. Regular monitoring of blood pressure, serum creatinine, urea and electrolytes is strongly recommended with ACE inhibitor treatment. Hypotension, azotaemia andhyperkalaemia are all indications to stop or reduce ACE inhibitor treatment in rabbits. The use of ACE inhibitors in animals with cardiac disease stems mainly from extrapolation from theoretical benefits and studies showing a benefit in other species with heart failure and different cardiac diseases (mainly dogs and humans).Safety and handling: Normal precautions should be observed.Contraindications: Do not use in cases of cardiac output failure.Adverse reactions: Potential adverse effects include hypotension, hyperkalaemia and azotaemia. Monitor blood pressure, serum creatinine and electrolytes when used in cases of heart failure. Dosage should be reduced if there are signs of hypotension (weakness, disorientation). Anorexia, vomiting and diarrhoea are rare. It is not recommended for breeding, or pregnant or lactating animals, as safety has not been established. In rabbits, treatment with ACE inhibitors can be associated with an increase in azotaemia.ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 34 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 35Drug interactions: Concomitant usage with potassium-sparing diuretics (e.g. spironolactone) or potassium supplements could result in hyperkalaemia. However, in practice, spironolactone and ACE inhibitors appear safe to use concurrently. There may be an increased risk of nephrotoxicity and decreased clinical efficacy when used with NSAIDs. There is a risk of hypotension with concomitant administration of diuretics, vasodilators (e.g. anaesthetic agents, antihypertensive agents) or negative inotropes (e.g. beta-blockers).DOSESMammals: Ferrets: 0.25–0.5 mg/kg p.o. q24h; Rabbits, Guinea pigs: Starting dose 0.05 mg/kg p.o. q24h. Dose may be increased to a maximum of 0.1 mg/kg; Rats: anecdotally, ACE inhibitors have been used to mitigate protein losing nephropathy in rats at 0.5–1.0 mg/kg p.o. q24h a.Birds, Reptiles, Amphibians, Fish: No information available.Referencesa Mudagal M, Patel J, Nagalakshmi NC and Asif Ansari M (2011) Renoprotective effects of combining ACE inhibitors and statins in experimental diabetic rats. DARU 19(5), 322–325Benzalkonium chloride (Quaternary ammonium compound)(Ark-Klens*)Formulations: 12.5% liquid.Action: Biocidal action thought to cause damage to cell membranes and leakage of cell contents.Use: Disinfection of equipment. Treatment of external bacterial infections of the skin and gills in fish. Quaternary ammonium compounds are more toxic at high temperatures and in water with low hardness, therefore dose rates should be reduced by 50%. Benzalkonium chloride has a low therapeutic index.Safety and handling: Irritant to skin and eyes.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 10 mg/l by immersion for 5–10 min; 0.5 mg/l by prolonged immersion 12.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford2 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, DordrechtZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 35 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets36BenzocaineFormulations: 100% powder for dissolution in acetone or ethanol.Action: Benzocaine is lipid soluble and is rapidly absorbed across the gills and skin, resulting in anaesthesia by impeding peripheral nerve signal transmission to the CNS.Use: Sedation, immobilization, anaesthesia and euthanasia of fish. Ideally, the drug should be used in water from the tank or pond of origin to minimize problems due to changes in water chemistry. The dry powder is poorly soluble in water and must be made into a stock solution with acetone or ethanol (e.g. 100 g/l) for more accurate dosing. Before use, the pH of the anaesthetic solution should be buffered with sodium bicarbonate to the same pH as the water of origin. The anaesthetic solution should be used on the day of preparation and be well aerated during use. Food should be withheld from fish for 12–24 h prior to anaesthesia to reduce the risk of regurgitation. The stage of anaesthesia reached is determined by the concentration used and the duration of exposure since absorption continues throughout the period of immersion. Potency decreases with higher temperatures. Different species vary in their response and may require difference concentrations. It is recommended to use the lower dose rates to test the selected drug concentration and exposure time with a small group before medicating large numbers. Fish may retain some movement during anaesthesia, making it less desirable to use during surgery. Anaesthetized fish should be returned to clean water from their normal environment to allow recovery. For euthanasia, use 5–10 times the normal anaesthetic dose and keep the fish in the solution for at least 60 minutes after respiration ceases.Safety and handling: The powder should be stored dry and stock solutions in the dark.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: Induction of anaesthesia: 25–200 mg/l by immersion; Maintenance of anaesthesia: 15–40 mg/l by immersion 1234.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford2 Ross LG and Ross B (1999) Anaesthesia and Sedative Techniques for Aquatic Animals. Blackwell Science, Oxford3 Sneddon LU (2012) Clinical anaesthesia and analgesia in fish. Journal of Exotic Pet Medicine 21, 32–434 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, DordrechtZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 36 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 37Benzyl penicillin see Penicillin GBetamethasone(Fuciderm, Norbet, Otomax, Betnesol*, Maxidex*) POM-V, POMFormulations: Injectable: 4 mg/ml solution for i.v. or i.m. use. Oral: 0.25 mg tablet. Topical: 0.1% cream with 0.5% fusidic acid. Ophthalmic/Otic: 0.1% solution; 0.88% mg/ml suspension with clotrimazole and gentamicin. Betamethasone is also present in varying concentrations in several topical preparations with or without antibacterials.Action: Alters the transcription of DNA, leading to alterations in cellular metabolism which causes reduction in inflammatory responses. Has high glucocorticoid but low mineralocorticoid activity. Betamethasone also antagonizes insulin and ADH.Use: Short-term relief of many inflammatory but non-infectious conditions. Long duration of activity and therefore not suitable for long-term daily or alternate-day use. On a dose basis, 0.12 mg betamethasone is equivalent to 1 mg prednisolone. Prolonged use of glucocorticoids suppresses the hypothalamic–pituitary axis, resulting in adrenal atrophy. Animals on chronic corticosteroid therapy should be given tapered decreasing doses when discontinuing the drug. The use of long-acting steroids in most cases of shock is of no benefit, and may be detrimental. Use glucocorticoids with care in rabbits as they are very sensitive to these drugs.Safety and handling: Wear gloves when applying cream.Contraindications: Do not use in pregnant animals. Systemic corticosteroids are generally contraindicated in patients with renal disease and diabetes mellitus. Topical corticosteroids are contraindicated in ulcerative keratitis.Adverse reactions: Catabolic effects of glucocorticoids lead to weight loss and cutaneous atrophy. Iatrogenic hyperadrenocorticism may develop. Vomiting, diarrhoea and GI ulceration may develop. Glucocorticoidsmay increase glucose levels and decrease serum T3 and T4 values. Impaired wound healing and delayed recovery from infections may be seen. Corticosteroids should be used with care in birds as there is a high risk of immunosuppression and side effects, such as hepatopathy and a diabetes mellitus-like syndrome. In rabbits, even small single doses can cause severe adverse reactions. Ferrets are particularly susceptible to GI ulceration, and concurrent gastric protectants may be advisable, especially in stressed animals.Drug interactions: There is an increased risk of GI ulceration if used concurrently with NSAIDs. Glucocorticoids antagonize the effect of insulin. Phenobarbital may accelerate the metabolism of corticosteroids and antifungals (e.g. itraconazole) may decrease it. There is an increased risk of hypokalaemia when used concurrently with acetazolamide, amphotericin and potassium-depleting diuretics (furosemide, thiazides).ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 37 03/09/2015 14:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets38DOSESMammals: 0.1 mg/kg s.c. q24h; Otic: 4 drops of polypharmaceutical to affected ear q12h; Ocular: 1 drop of ophthalmic solution to affected eye q6–8h; Skin: Apply cream to affected area q8–12h.Birds: Not recommended.Reptiles, Amphibians, Fish: No information available.Bethanecol(Myotonine*) POMFormulations: Oral: 10 mg tablets.Action: A muscarinic agonist (cholinergic or parasympathomimetic) that increases urinary bladder detrusor muscle tone and contraction.Use: Management of urinary retention with reduced detrusor tone. It does not initiate a detrusor reflex and is ineffective if the bladder is areflexic. Best given on an empty stomach to avoid GI distress.Safety and handling: Normal precautions should be observed.Contraindications: Do not use when urethral resistance is increased unless in combination with agents that reduce urethral outflow pressure (e.g. phenoxybenzamine).Adverse reactions: Vomiting, diarrhoea, GI cramping, anorexia, salivation and bradycardia (with overdosage). Treat overdoses with atropine.Drug interactions: No information available.DOSESMammals: Rabbits: 2.5–5 mg/kg p.o. q12h. Titrate doses upwards to avoid adverse effects.Birds, Reptiles, Amphibians, Fish: Not indicated.Bismuth salts (Bismuth carbonate, subnitrate and subsalicylate: tri-potassium di-citrato bismuthate (bismuth chelate))(De-Noltab*, Pepto-Bismol*) AVM-GSL, PFormulations: Oral: De-Noltab: tablets containing the equivalent of 120 mg bismuth oxide. Pepto-Bismol: bismuth subsalicylate suspension.Action: Bismuth is a gastric cytoprotectant with activity against spiral bacteria. Bismuth chelate is effective in healing gastric and duodenal ulcers in humans, due to its direct toxic effects on gastric Helicobacter pylori and by stimulating mucosal prostaglandin and ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 38 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 39bicarbonate secretion. It is often used in conjunction with an H2 receptor antagonist. Bismuth subsalicylate has a mild anti-inflammatory effect.Use: Acute oral poisoning, gastric ulceration and flatulent diarrhoea. Doses are empirical.Safety and handling: Normal precautions should be observed.Contraindications: Do not use where specific oral antidotes are being administered in cases of poisoning. Do not use if the patient is unconscious, fitting, or has a reduced cough reflex, or in cases of intestinal obstruction, or where enterotomy or enterectomy is to be performed.Adverse reactions: Avoid long-term use (except chelates) as absorbed bismuth is neurotoxic. Bismuth chelate is contraindicated in renal impairment. Nausea and vomiting reported in humans.Drug interactions: Absorption of tetracyclines is reduced by bismuth and specific antidotes may also be affected.DOSESMammals: Ferrets: Pepto-Bismol: 17.6 mg/kg or 0.25–1.0 ml/kg p.o. q4–8h. Rabbits: Pepto-Bismol: 0.3–0.6 ml/kg p.o. q4–6h.Birds, Reptiles, Amphibians, Fish: No information available.Bright green see Malachite green British anti-lewisite see DimercaprolBromhexine(Bisolvon) POM-VFormulations: Injectable: 3 mg/ml solution. Oral: 10 mg/g powder.Action: A bronchial secretolytic that disrupts the structure of acid mucopolysaccharide fibres in mucoid sputum and produces a less viscous mucus, which is easier to expectorate.Use: To aid the management of respiratory diseases.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESMammals: 0.3 mg/animal p.o. q24h or via nebulizer as 0.15 mg/ml for 20–30 minutes, 1–3 times daily.Birds: 1.5 mg/kg i.m., p.o. q12–24h a.ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 39 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets40Reptiles: 0.1–0.2 mg/kg p.o. q24h.Amphibians, Fish: No information availableReferencesa Sumano H, Gracia I, Capistrán A et al. (1995) Use of ambroxol and bromhexine as mucolytics for enhanced diffusion of furaltadone into tracheobronchial secretions in broilers. British Poultry Science 36(3), 503–507Bronopol(Pyceze) POM-VFormulations: Immersion: 500 mg/l liquid.Action: Inhibition of dehydrogenase activity, causing membrane damage.Use: Treat and control external fungal infection in fish and fish eggs.Safety and handling: Irritating to eyes, lungs and skin.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 20 mg/l by immersion for 30 min q24h for 14 treatments; Eggs: 50 mg/l by immersion for 30 min 1.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, OxfordBudesonide(Budenofalk*, Budenofalk Rectal Foam*, Entocort*, Pulmicort*) POMFormulations: Oral: 3 mg gastroresistant capsule, 3 mg capsule containing gastroresistant slow-release granules. Rectal: 2 mg (total dose) rectal foam, 0.02 mg/ml enema.Action: Anti-inflammatory and immunosuppressive steroid.Use: A novel steroid that is metabolized on its first pass through the liver in humans and therefore might be expected to have reduced systemic side effects. It has been suggested that it is may be effective as a monotherapy in ferrets with inflammatory bowel disease when compared with other steroids (such as prednisolone). Systemic side effects were still seen in some patients. The dosing of this drug is unclear as it comes in a capsule of 0.3 mg and the dose is extrapolated from humans (no real pharamcokinetic data/hepatic ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 40 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 41metabolism data available in small animals). The uncoated powder for inhalant use in people (for which no information is available in small animals) should not be used for oral administration because of hydrolysis by gastric acid.Safety and handling: Normal precautions should be observed.Contraindications: Intestinal perforation; severe hepatic impairment.Adverse reactions: In theory, the rapid metabolism should give minimal systemic adverse effects. However, signs of iatrogenic hyperadrenocorticism (hair loss, muscle wastage, elevation in liver enzymes, hepatomegaly, lethargy, polyphagia and polyuria/polydipsia) may develop. In theory sudden transfer from other steroid therapy might result in signs related to reductions in steroid levels. Corticosteroids can cause severe immunosuppression in rabbits; use with care.Drug interactions:Additive effect if given with other corticosteroids. The metabolism of corticosteroids may be decreased by antifungals. Avoid using with antacids, erythromycin, cimetidine, itraconazole and other drugs that inhibit the liver enzymes that metabolize budesonide.DOSESMammals: Ferrets: Doses of up to 1 mg/ferret p.o. q24h have been suggested for the management of IBD.Birds, Reptiles, Amphibians, Fish: No information available.Bupivacaine(Marcain*, Sensorcaine*) POMFormulations: Injectable: 2.5, 5.0, 7.5 mg/ml solutions, 2.5, 5.0 mg/ml solution with 1:200,000 adrenaline.Action: Reversible blockade of the sodium channel in nerve fibres produces local anaesthesia.Use: Provision of analgesia by perineural nerve blocks, regional and epidural techniques. Onset of action is significantly slower than lidocaine (20–30 min for epidural analgesia) but duration of action is relatively prolonged (6–8 h). Lower doses should be used when systemic absorption is likely to be high (e.g. intrapleural analgesia). Small volumes of bupivacaine can be diluted with normal saline to enable wider distribution of the drug for perineural blockade. Doses of bupivacaine up to 2 mg/kg q8h are unlikely to be associated with systemic side effects if injected perineurally, epidurally or intrapleurally. Combining bupivacaine with lidocaine can prolong the duration of the sensory block whilst limiting the duration of the motor block compared with administration of bupivacaine alone.Safety and handling: Normal precautions should be observed.Contraindications: Do not give i.v. or use for i.v. regional anaesthesia. Use of bupivacaine with adrenaline is not recommended ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 41 03/09/2015 14:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets42when local vasoconstriction is undesirable (e.g. end arterial sites) or when a significant degree of systemic absorption is likely.Adverse reactions: Inadvertent intravascular injection may precipitate severe cardiac arrhythmias that are refractory to treatment.Drug interactions: All local anaesthetics share similar side effects, therefore the dose of bupivacaine should be reduced when used in combination with other local anaesthetics.DOSESMammals:• Perineural: volume of injection depends on the site of placement and size of the animal. As a guide: 0.1 ml/kg for femoral, radial and sciatic nerve block; 0.15 ml/kg for combined ulnar, musculocutaneous, median and ulnar nerve blocks; 0.3 ml/kg for brachial plexus nerve block; 0.25–1 ml total volume for blockade of the infraorbital, mental, maxillary and mandibular nerves. Choose an appropriate concentration of bupivacaine to achieve a 1–2 mg/kg dose within these volume guidelines.• Epidural: 1.6 mg/kg (analgesia to level of L4), 2.3 mg/kg (analgesia to level of T11–T13); 1 mg/kg bupivacaine combined with preservative-free morphine 0.1 mg/kg. Limit the total volume of solution injected into the epidural space to 0.33ml/kg in order to limit the cranial distribution of drugs in the epidural space and prevent adverse pressure effects.• Interpleural: 1 mg/kg diluted with normal saline to a total volume of 1–5 ml depending on the size of the animal. The solution can be instilled via a thoracotomy tube. Dilution reduces pain on injection due to the acidity of bupivacaine.• Ferrets: 1–2 mg/kg local infusion; Rabbits: 1 mg/kg local infusion, do not exceed 2 mg/kg; Guinea pigs: 1–2 mg/kg for specific nerve blocks (may require dilution with saline for local infusion); Rats: 1–2 mg/kg local infusion or intradermally once.Birds: 15 min). Duration of effect is approximately 6 hours in rabbits and rodents. Buprenorphine is metabolized in the liver; some prolongation of effect may be seen with impaired liver function. The multidose preparation is unpalatable given sublingually due to the preservative. Be careful of species differences in effect in birds. Appears active for 2–5 hours in birds. Used for the relief of pain in fish, although it is considered to have poor analgesic properties in rainbow trout. In reptiles, studies show no evidence of analgesic efficacy.Safety and handling: Normal precautions should be observed.Contraindications: Combination with full mu agonists is not recommended for analgesia; therefore, do not use for premedication when administration of potent opioids during surgery is anticipated.Adverse reactions: As a partial mu agonist, side effects are rare after clinical doses. Pain on i.m. injection of the multidose preparation has been anecdotally reported. The taste of the multidose preparation is aversive for some species.Drug interactions: In common with other opioids, buprenorphine will reduce the doses of other drugs required for induction and maintenance of anaesthesia.DOSESWhen used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species.Mammals: Analgesia: Ferrets: 0.01–0.10 mg/kg s.c., i.m., i.v. q8–12h; Rabbits: 0.03–0.06 mg/kg s.c., i.m., i.v. q6–12h (dosesi.m. 1.Referencesa Cooper CS, Metcalf-Pate KA, Barat CE, Cook JA and Scorpio DG (2009) Comparison of side effects between buprenorphine and meloxicam used postoperatively in Dutch belted rabbits (Oryctolagus cuninculus). Journal of the American Association of Laboratory Animal Science 48(3), 279–285b Shafford HL and Schadt JC (2008) Effect of buprenorphine on the cardiovascular and respiratory response to visceral pain in conscious rabbits. Veterinary Anaesthesia and Analgesia 35(4), 333–340c Paul-Murphy J, Hess JC and Fialkowski JP (2004) Pharmacokinetic properties of a single intramuscular dose of buprenorphine in African Grey Parrots (Psittacus erithacus). Journal of Avian Medicine and Surgery 18(4), 224–228d Kummrow MS, Tseng F, Hesse L and Court M (2008) Pharmacokinetics of buprenorphine after single-dose subcutaneous administration in red-eared sliders (Trachemys scripta elegans). Journal of Zoo and Wildlife Medicine 39(4), 590–595e Koeller CA (2009) Comparison of buprenorphine and butorphanol analgesia in the eastern red-spotted newt (Notophthalmus viridescens). Journal of the American Association of Laboratory Animal Science 48(2), 171–175f Machin KL (1999) Amphibian pain and analgesia. Journal of Zoo and Wildlife Medicine 30, 2–101 Sneddon LU (2012) Clinical anaesthesia and analgesia in fish. Journal of Exotic Pet Medicine 21, 32–43Buserelin(Receptal) POM-VFormulations: Injectable: 4 µg (micrograms)/ml solution. Authorized for use in rabbits and certain large animal species.Action: Synthetic GnRH (gonadotrophin releasing hormone) analogue that stimulates LH and FSH production, thus causing oestrus to develop and progress.Use: To supplement natural LH in cases of ovulation failure or delay. Will also induce lactation postpartum in mammals. In males, it may stimulate testosterone secretion and is indicated in the management of genital hypoplasia and reduced libido. In ferrets it may be used in the management of signs of oestrus. In rabbits it is used to induce ovulation postpartum for insemination and to improve conception rates. Used in birds for chronic egg laying (must be combined with husbandry changes). Used in trout to facilitate stripping in both male and female fish in spawning condition, and reduce mortality due to egg binding.ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 44 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 45Safety and handling: Pregnant women should not administer the product.Contraindications: No information available.Adverse reactions: Anaphylactic reactions may occasionally occur.Drug interactions: No information available.DOSESMammals: Ferrets: 1.5 µg (micrograms)/ferret i.m. q24h for 2 days; Rabbits: 0.8 µg (micrograms)/rabbit s.c. at time of insemination or mating; Guinea pigs: 25 µg (micrograms)/guinea pig, repeat in 2 weeks.Birds: 0.5–1.0 µg (micrograms)/kg i.m. q48h, up to 3 times a.Reptiles, Amphibians: No information available.Fish: 3–4 µg (micrograms)/kg i.m. once, strip fish 2–3 days later.Referencesa Lovas EM, Johnston SD and Filippich LJ (2010) Using a GnRH agonist to obtain an index of testosterone secretory capacity in the cockatiel (Nymphicus hollandicus) and sulphur-crested cockatoo (Cacatua galerita). Australian Veterinary Journal 88, 52–56Butorphanol(Alvegesic, Dolorex, Torbugesic, Torbutrol, Torphasol) POM-VFormulations: Injectable: 10 mg/ml solution. Oral: 5 mg, 10 mg tablets.Action: Analgesia resulting from affinity for the kappa opioid receptor. Also has mu receptor antagonist properties and an antitussive action resulting from central depression of the cough mechanism.Use: Management of mild perioperative pain. Provision of sedation through combination with acepromazine or alpha-2 agonists. Potent antitussive agent indicated for the relief of acute or chronic non-productive cough associated with tracheobronchitis, tracheitis, tonsillitis or laryngitis resulting from inflammatory conditions of the upper respiratory tract. Butorphanol has a very rapid and relatively short duration of action; in different models analgesia has been shown to last between 45 minutes and 4 hours. Butorphanol is metabolized in the liver and some prolongation of effect may be seen with impaired liver function. Butorphanol is unlikely to be adequate for the management of severe pain. Higher doses of full mu agonists may be needed to provide additional analgesia after butorphanol but it is not necessary to wait 4h after butorphanol administration to give other opioids. Response to all opioids appears to be very variable between individuals; therefore assessment of pain after administration is imperative. Be careful of species differences in effect in birds. There is limited evidence of analgesic efficacy in most species of reptiles. Applicability in fish is uncertain.ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 45 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets46Safety and handling: Protect from light.Contraindications: Animals with diseases of the lower respiratory tract associated with copious mucous production. Premedication when administration of potent opioids during surgery is anticipated.Adverse reactions: As a kappa agonist/mu antagonist, side effects such as respiratory depression, bradycardia and vomiting are rare after clinical doses. Cough suppression following torbugesic tablets may be associated with mild sedation.Drug interactions: In common with other opioids, butorphanol will reduce the doses of other drugs required for induction and maintenance of anaesthesia. Combination with full mu agonists is not recommended for analgesia, addition of butorphanol will reduce analgesia produced from the full mu agonist.DOSESWhen used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species.Mammals: Analgesia: Primates: 0.01–0.02 mg/kg i.v., s.c., p.o. q4–6h; Ferrets: 0.1–0.5 mg/kg s.c. q4–6h; Rabbits: 0.1–0.5 mg/kg s.c. q4h; Chinchillas: 0.5–2 mg/kg s.c. q4h; Guinea pigs: 0.2–2 mg/kg s.c. q4h; Gerbils, Hamsters, Rats, Mice: 1–5 mg/kg s.c. q4h.Birds: Analgesia: 0.3–4 mg/kg i.m., i.v. q6–12h ab.Reptiles: Analgesia: Doses of 0.5–2 mg/kg i.m. q24h have been suggested. Bearded dragons, Green iguanas: 1.5 mg/kg i.m. q24h cd.Amphibians: Leopard frog: 0.2–0.4 mg/kg i.m.; Newt: 0.5 mg/l of water ef.Fish: Analgesia: 0.25–5 mg i.m. 1; Koi: 10 mg/kg i.m. g.Referencesa Guzman DS, Flammer K, Paul-Murphy JR, Barker SA and Tully TN Jr (2011) Pharmacokinetics of butorphanol after intravenous, intramuscular and oral administration in Hispaniolan Amazon parrots (Amazona ventralis). Journal of Avian Medicine and Surgery 25(3), 185–191b Paul-Murphy JR, Brunson DB and Miletic V (1999) Analgesic effects of butorphanol and buprenorphine in conscious African grey parrots (Psittacus erithacus erithacus and Psittacus erithacus timneh). American Journal of Veterinary Research 60(10), 1218–1221c Greenacre CB, Massi K and Schumacher J (2008) Comparative anti-nociception of various opioids and non-steroidal anti-inflammatory medications versus saline in the bearded dragon (Pogona vitticeps) using electrostimulation. Proceedings of the Association of Reptilian and Amphibian Veterinarians, pp. 87–88d Greenacre CB, Takle G, Schmacher JP et al. (2006) Comparative anti-nociception of morphine, butorphanol and buprenorphine versus saline in the green iguana (Iguana iguana) using electrostimulation. Journal of Herpetological Medicine and Surgery 16, 88–92e Koeller CA (2009) Comparison of buprenorphine and butorphanol analgesia in the eastern red-spotted newt (Notophthalmus viridescens). Journal of the American Association of Laboratory Animal Science 48(2), 171–175f Terril-Robb L, Suckow M and Grigdesby C (1996) Evaluation ofEaster Bush Campus, Roslin, Midlothian EH25 9RGRichard A. Saunders BSc(Hons) BVSc CBiol MSB CertZooMed DZooMed (Mammalian) MRCVSVeterinary Department, Bristol Zoo Gardens, Clifton, Bristol BS8 3HAWilliam H. Wildgoose BVMS CertFHP MRCVSMidland Veterinary Surgery, 655 High Road, Leyton, London E10 6RAZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 4 12/02/2015 09:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets vPrefaceWelcome to this ninth edition of the BSAVA Small Animal Formulary, where Exotic Pets have their own dedicated section that includes pet fish and amphibians for the first time. Selecting appropriate medication for exotic species can be a challenge, especially as there are very few licensed products available and use of the prescribing cascade is frequently necessary. In addition, appreciation of the important differences in physiology and metabolism between the species groups, which may make them respond to and process drugs very differently, is essential to avoid potential toxicity or lack of efficacy. Published dosing regimes that are evidence based and supported by appropriate pharmacokinetic and clinical efficacy trials are relatively scarce for exotic pets, and may not relate directly to the very wide range of species that can be encountered. Many of the published doses available in numerous texts on exotic species are essentially anecdotal and have become embedded, and are perpetuated by, repeated publication and subsequent self-reference. Although largely reliable, effective and safe, I feel it is important to be aware that these doses are not founded on clear evidence, other than extrapolation from other domestic species and/or perceived clinical efficacy. This edition makes it clear where doses are supported by a primary reference, and as information evolves and our knowledge base increases, updates will be available on the BSAVA website.We hope that this separation of information from that for cats and dogs makes it easier to negotiate doses for exotic pets and that this new format is informative and easy to use, enabling more confident treatment of exotic pets in practice.I would like to thank the dedicated hard work and expertise of my colleagues on the Editorial Panel who have reviewed each monograph for accuracy, relevance to exotic pets and primary evidence where available. I would also like to express sincere gratitude to the Publishing team at Woodrow House for their help, assistance and efficiency.Anna Meredith January 2015ZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 5 12/02/2015 09:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic PetsviForewordThe BSAVA Small Animal Formulary continues to be a flagship publication of the BSAVA. The first BSAVA Small Animal Formulary was published over 20 years ago, and each new edition brings innovation to enhance its relevance to clinical practice. Practices are seeing an increasing number of ‘exotic pet’ consultations across a wide range of species and this edition of the Formulary reflects that change and the importance BSAVA places on evidence based medicine in veterinary practice. There are few licensed products for the treatment of non-traditional companion animal species and this Formulary draws upon a wide range of published sources and expert opinion of common drug usages to provide a single referenced source of drug dosages across the range of small mammal, bird, amphibian, fish and reptile species. A particularly useful addition is the appendix detailing sedation and chemotherapy protocols for non-traditional companion animal species.This Formulary will continue to be regularly updated alongside its canine and feline counterpart and provides not only a great new benefit for BSAVA members, but also a method of dissemination of high quality information to the entire veterinary profession. This Formulary has been compiled by some of the leading species experts - another BSAVA product created by the profession for the profession.The BSAVA Small Animal Formulary, although primarily designed for the UK market, is held in high regard around the world. It is no mean task to bring together information from such a diverse range of species and the Editorial Panel and Anna Meredith are to be congratulated on what they have achieved. I am sure the BSAVA Small Animal Formulary: Part B – Exotic Pets will prove another essential addition to the practice library.Katie McConnell MA VetMB CertVR CertSAM MRCVSBSAVA President 2014–2015ZYXWVUTSRQPONMLKJIHGFEDCBA1 Prelims.indd 6 12/02/2015 09:22Introduction viiIntroductionNotes on the monographs• Name. The rINN generic name is used where this has been agreed. When a choice of names is available the more commonly used in the UK has been provided. The list of trade names is not necessarily comprehensive, and the mention or exclusion of any particular commercial product is not a recommendation or otherwise as to its value. Any omission of a product that is authorized for a particular small animal indication is purely accidental. All monographs were updated in the period March–September 2014. Products that are not authorized for veterinary use by the Veterinary Medicines Directorate are marked with an asterisk. Note that an indication that a product is authorized does not necessarily mean that it is authorized for all species and indications listed in the monograph; users should check individual data sheets. You may also wish to refer to the VMD’s Product Information Database (www.vmd.defra.gov.uk/ProductInformationDatabase/).• Formulations. Only medicines and formulations that are available in the UK have been included – many others are availableoutsidetheUKandsomemedicinesindifferentformulations. Common trade names of human medicines are provided. In many cases they are available as generic formulations and may be cheaper. However, be careful of assuming that the bioavailability of one brand is the same as that of another. Avoid switching between brands unnecessarily.• Action and Use. Veterinary surgeons using this publication are warned that many of the drugs and doses listed are not currently authorized by the Veterinary Medicines Directorate (VMD) or the European Agency for the Evaluation of Medicinal Products (EMEA) (either at all or for a particular species), or manufacturers’ recommendations may be limited to particular indications. The decision, and therefore the responsibility, for prescribing any drug for an animal lies solely with the veterinary surgeon. Expert assistance should be obtained when necessary. The ‘cascade’ and its implications are discussed below.• Safety and handling.Thissectiononlyoutlinesspecificrisksand precautions for a particular drug that are in addition to the general advice given below in the ‘Health and safety in dispensing’ section.• Contraindications and Adverse reactions. The list of adverse reactions is not intended to be comprehensive and is limited to thoseeffectsthatmaybeofclinicalsignificance.Theinformationfor both of these sections is taken from published veterinary and human references and not just from product literature.• Drug interactions. A listing of those interactions which may be ofclinicalsignificance.• Doses. These are based on those recommended by the manufacturers in their data sheets and package inserts, or are based on those given in published articles or textbooks, or are based on clinical experience. These recommendations should be INTRODUCTION2 Intro.indd 7 12/02/2015 09:27Introductionviiiused only as guidelines and should not be considered appropriate for every case. Clinical judgement must take precedence. Where possible, doses have been giventhe analgesic effects of butorphanol tartarate, xylazine hydrochloride and flunixin meglumine in leopard frogs (Rana pipiens). Contemporary Topics in Laboratory Animal Science 35, 54–56g Baker TR, Baker BB, Johnson SM and Sladky KK (2013) Comparative analgesic efficacy of morphine sulfate and butorphanol tartrate in koi (Cyprinus carpio) undergoing unilateral gonadectomy. Journal of the American Veterinary Medical Association 243(6), 882–8901 Sneddon LU (2012) Clinical anaesthesia and analgesia in fish. Journal of Exotic Pet Medicine 21, 32–43ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 46 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 47Butylscopolamine (Hyoscine)(Buscopan) POM-V, PFormulations: Injectable: 4 mg/ml butylscopolamine + 500 mg/ml metamizole in 100 ml multidose bottle (Buscopan Compositum); 20 mg/ml butylscopolamine only, in 2 ml ampoules. Oral: 10 mg tablet containing butylscopolamine only.Action: Inhibits M1 muscarinic acetylcholine receptors in the GI and urinary tracts causing smooth muscle relaxation but does not cross blood–brain barrier.Use: Control of gastrointestinal pain in rabbits. Control of pain associated with urinary obstruction in rabbits. Must only be used in combination with investigations into the cause of abdominal pain or definitive relief of urinary obstruction.Safety and handling: Avoid self-injection: metamizole can cause reversible but potentially serious agranulocytosis and skin allergies. Protect solution from light.Contraindications: Intestinal obstruction. Contraindicated for the treatment of gastrointestinal ileus in rabbits.Adverse reactions: Dry mouth, blurred vision, hesitant micturition and constipation at doses acting as gut neuromuscular relaxants. The i.m. route may cause a local reaction.Drug interactions: Metamizole should not be given to animals that have been treated with a phenothiazine, as hypothermia may result. Effects may be potentiated by concurrent use of other anticholinergic or analgesic drugs.DOSESMammals: Rabbits: 0.1 ml/kg i.v., i.m. q12h (Buscopan Compositum) as analgesic/antispasmolytic.Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBABb.indd 47 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets48Cabergoline(Galastop) POM-VFormulations: Oral: 50 µg/ml solution.Action: Potent selective inhibition of prolactin.Use: Has been used for pituitary adenomas in rats. May have beneficial effect in birds with chronic egg laying and other hormonal disorders related to high prolactin levels when combined with management changes. In birds it is also conjectured that its action could also be mediated via its effect as a dopamine agonist. Carbergoline does not seem reliably effective in inducing abortion in the rat, mouse or rabbit. Generally ineffective if given for short periods in rabbits due to lack of clearly defined oestrus.Safety and handling: Normal precautions should be observed.Contraindications: Should not be used in combination with hypotensive drugs or in animals in a hypotensive state.Adverse reactions: Not reported in exotic species. However, in dogs and cats vomiting or anorexia may occur after the first one or two doses in a small proportion of cases; there is no need to discontinue treatment unless vomiting is severe or it persists beyond the second dose. In some animals a degree of drowsiness may be seen in the first 2 days of dosing. May induce transient hypotension. Shown not to impair fertility in the male rat, non-tetragenic in mice and rabbits, and does not affect the latter phase of gestation or parturition in the female rat a.Drug interactions: Metoclopramide antagonizes the effects on prolactin.DOSESMammals: Rats: 10–50 µg (micrograms)/kg p.o. q12–24h or 600 µg/kg p.o. q72h for pituitary adenoma and associated mammary pathology.Birds: 10–50 µg (micrograms)/kg p.o. q24h 1.Reptiles, Amphibians, Fish: No information available.Referencesa Beltrame D, Longo M and Mazué G (1996) Reproductive toxicity of cabergoline in mice, rats and rabbits. Reproductive Toxicology 10(6), 471–4831 Chitty J, Raftery A and Lawrie A (2006) Use of cabergoline in companion psittacine birds. Proceedings of the Association of Avian Veterinarians pp. 65–57CaEDTA see Edetate calcium disodiumZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 48 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 49Calcium salts (Calcium borogluconate, Calcium carbonate, Calcium chloride, Calcium gluconate, Calcium lactate)((Calcichew*) Many cattle preparations, e.g. Calcibor. Minor component of Aqupharm No. 9 and No. 11. Several generic formulations.) POM-VFormulations: There are many formulations available; a selection is given here.• Injectable: 200 mg/ml calcium borogluconate solution equivalent to 15 mg/ml calcium formed from 168 mg/ml of calcium gluconate and 34 mg/ml boric acid (Calcibor 20); 100 mg/ml (10%) calcium chloride solution containing 27.3 mg/ml elemental calcium (= 1.36 mEq calcium/ml = 680 µmol/ml); 100 mg/ml calcium gluconate solution 10 ml ampoules containing 9 mg elemental calcium/ml (= mEq calcium/ml).• Oral: 600 mg calcium gluconate tablets (= 53.4 mg elemental calcium); 1250 mg chewable calcium carbonate tablets (Calcichew) (= 500 mg elemental calcium).• Note on other formulations: 11.2 mg calcium gluconate, 13.3 mg calcium borogluconate, 7.7 mg calcium lactate, 3.6 mg calcium chloride; each contains 1 mg elemental calcium = 0.5 mEq calcium.Action: Calcium is an essential element involved in maintenance of numerous homeostatic roles and key reactions including activation of key enzymes, cell membrane potentials and nerve and musculoskeletal function.Use: Management of hypocalcaemia and hyperkalaemic cardiotoxicity associated with urinary obstruction. Calcium gluconate and borogluconate are preferred for this. Serum calcium levels and renal function tests should be assessed before starting therapy. ECG monitoring during i.v. infusions is advised. Avoid using mixed electrolyte solutions intended for cattle use if possible. Treatment of hyperkalaemic cardiotoxicity with calcium rapidly corrects arrhythmias but effects are short-lived (5–10 min to effect) and i.v. glucose 0.5–1 g/kg ± insulin may be needed to decrease serum potassium. Parenteral calcium should be used very cautiously in dehydrated birds and reptiles and in patients receiving digitalis glycosides or those with cardiac or renal disease. Used before oxytocin in medical treatment of birds and reptiles with egg retention/dystocia. Calcium salts are given to many captive birds and reptiles as a routine dietary supplement.Safety and handling: Normal precautions should be observed.Contraindications: Ventricular fibrillation or hypercalcaemia. Calcium should be avoided in pregnancy unless there is a deficient state. Hyperkalaemia associated with hypoadrenocorticism is often associated with hypercalcaemia and therefore additional calcium is not recommended in those cases.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 49 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets50Adverse reactions: Hypercalcaemia can occur, especially in renal impairment or cardiac disease. Tissue irritation is common and can occur with injectable preparation regardless of route. Rapid injection may cause hypotension, cardiac arrhythmias and cardiac arrest. Perivascular administration is treated by stopping the infusion, infiltrating the tissue with normal saline and topical application of corticosteroids. Be careful using i.v. in dehydrated reptiles and birds as has been suggested to precipitate gout.Druginteractions: Patients on digitalis glycosides are more prone to develop arrhythmias if given i.v. calcium. All calcium salts may antagonize verapamil and other calcium-channel blockers. Calcium borogluconate is compatible with most i.v. fluids except those containing other divalent cations or phosphorus. Calcium borogluconate is reportedly compatible with lidocaine, adrenaline and hydrocortisone. Calcium chloride is incompatible with amphotericin B, cefalotin sodium and chlorphenamine. Calcium gluconate is incompatible with many drugs, including lipid emulsions, propofol, amphotericin B, cefamandole, naftate, cefalotin sodium, dobutamine, methylprednisolone sodium succinate and metoclopramide. Consult manufacturers’ data sheets for incompatibilities with other solutions.DOSESMammals: Primates: 200 mg/kg calcium gluconate s.c., i.m., i.v. once, repeat if necessary; 10–20 mg/kg calcium chloride i.v. slow infusion; Hedgehogs: Fracture repair: 0.5 mg/kg calcium gluconate (10%) i.m. as required; Hypocalcaemia: 50 mg/kg i.m.; Chinchillas, Guinea pigs: 100 mg/kg i.m., intraperitoneal once, repeat as necessary.Birds: Egg retention, hypocalcaemia: 150–200 mg/kg calcium borogluconate i.m., s.c., slow i.v. once; Hypocalcaemia: 5–10 mg/kg calcium gluconate i.m. q12h.Reptiles: Dystocia, hypocalcaemia: 100 mg/kg calcium borogluconate i.v., i.m., s.c. or 50–100 mg/kg calcium gluconate i.m., s.c. once, repeat as necessary.Amphibians: 1 mg/kg calcium glubionate p.o. q24h; Hypocalcaemic tetany: 100–200 mg/kg calcium gluconate s.c. once; Nutritional secondary hyperparathyroidism: 2.3% bath of calcium gluconate (with 2–3 IU/ml vitamin D3).Fish: No information available.Carbimazole(Vidalta) POM-VFormulations: Oral: 10 mg, 15 mg tablets in a sustained release formulation.Action: Carbimazole is metabolized to the active drug methimazole, which interferes with the synthesis of thyroid hormones.Use: Control of thyroid hormone levels in guinea pigs.ZYXWVUTSRQPONMLKJIHGFEDCBACc.indd 50 03/09/2015 14:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 51Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Vomiting and inappetence/anorexia may be seen but are often transient. Jaundice, cytopenias, immune-mediated diseases and dermatological changes (pruritus, alopecia and self-induced trauma) are reported but rarely seen. Treatment of hyperthyroidism can decrease glomerular filtration rate, thereby raising serum urea and creatinine values, and can occasionally unmask occult renal failure. Animals that have an adverse reaction to methimazole are likely also to have an adverse reaction to carbimazole.Drug interactions: Carbimazole should be discontinued before iodine-131 treatment. Do not use with low iodine prescription diets.DOSESMammals: Guinea pigs: 1–2 mg/kg p.o. q24h 1.Birds, Reptiles, Amphibians, Fish: No information available.References1 Künzel F, Hierlmeier B, Christian M and Reifinger M (2013) Hyperthyroidism in four guinea pigs: clinical manifestations, diagnosis and treatment. Journal of Small Animal Practice 54(12), 667–671Carbomer 980(Lubrithal) P, general saleFormulations: Ophthalmic: 0.2% (10 g tube, single-use vial), 0.25% (10 g tube) gel. This formulation is marketed specifically for small animals. Other formulations are widely available for general sale.Action: Mucinomimetic, replacing both aqueous and mucin components of the tear film.Use: Tear replacement and beneficial for management of quantitative (keratoconjunctivitis sicca (KCS) or dry eye) and qualitative tear film disorders. It has longer corneal contact time than the aqueous tear substitutes.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: It is tolerated well and ocular irritation is unusual.Drug interactions: No information available.DOSESMammals: 1 drop per eye q4–6h.Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 51 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets52Carboplatin(Carboplatin*, Paraplatin*) POMFormulations: Injectable: 10 mg/ml solution.Action: Binds to DNA to form intra- and interstrand crosslinks and DNA-protein crosslinks, resulting in inhibition of DNA synthesis and function.Use: May be of use in a number of neoplastic diseases including anal adenocarcinoma, squamous cell carcinoma, ovarian carcinoma, mediastinal carcinoma, pleural adenocarcinoma, nasal carcinoma and thyroid adenocarcinoma. The drug is highly irritant and must be administered via a preplaced i.v. catheter. Do not use needles or i.v. sets containing aluminium as precipitation of the drug may occur. This drug is generally now preferred over cisplatin due to reduced GI and renal toxicity. Use with caution in patients with abnormal renal function, active infections, hearing impairment or pre-existing hepatic disease. Has been used in renal adenocarcinoma in Budgerigars and squamous cell carcinoma (mixed with bird’s own plasma for intralesional use) and bile duct carcinoma in Amazon parrots. The health risks to owners of (particularly indoor) birds from such treatments need to be considered carefully before recommending chemotherapy in birds.Safety and handling: Potent cytotoxic drug that should only be prepared and administered by trained personnel. See specialist texts for further advice on chemotherapeutic agents.Contraindications: No information available.Adverse reactions: Include myelosuppression, nephrotoxicity, ototoxicity, nausea, vomiting, electrolyte abnormalities, neurotoxicity and anaphylactic reactions. However, produces fewer adverse reactions than cisplatin.Drug interactions: Concomitant use of aminoglycosides or other nephrotoxic agents may increase risk of nephrotoxicity. May adversely affect the safety and efficacy of vaccinations.DOSESBirds: 5 mg/kg i.v., intraosseous over 3 minutes; 5 mg/kg intralesional use (mixed with plasma to make a concentration of 10 mg/ml) for squamous cell carcinoma a.Mammals, Reptiles, Amphibians, Fish: No information available.Referencesa Filippich LJ, Charles BG, Sutton RH and Bucher AM (2004) Carboplatin pharmacokinetics following a single-dose infusion in sulphur-crested cockatoos (Cacatua galerita). Australian Veterinary Journal 82(6), 366–369ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 52 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 53Carnidazole(Spartrix*) AVM-GSLFormulations: Oral: 10 mg tablet.Action: Coccidiocidal; mode of action not known.Use: Pigeon canker (Trichomonas columbae); treat all birds in loft simultaneously. It should be used in conjunction with good loft hygiene, including disinfection of feed and water bowls.Safety and handling: Direct contact with the product must be avoided. Wear impermeable gloves when handling.Contraindications: Not to be used in birds intended for human consumption.Adverse reactions: No information available.Drug interactions: None known.DOSESBirds: Raptors: 25–30 mg/kg p.o., one dose normally sufficient but can be repeated next day if needed; Psittacids: 30–50 mg/kg p.o., repeat after 2 weeks; Pigeons: 12.5–25 mg p.o. once; Other birds: 20–30 mg/kg p.o. once.Mammals, Reptiles, Amphibians, Fish: No information available.Carprofen(Canidryl, Carprodyl, Dolagis, Rimadyl, Rimifin) POM-VFormulations: Injectable: 50 mg/ml. Oral: 20 mg, 50 mg, 100 mg tablets (in plain and palatable formulations).Action: Preferentially inhibits COX-2 enzyme, thereby limiting the production of prostaglandins involved in inflammation. Other non-COX-mediated mechanisms are suspected to contributeto the anti-inflammatory effect but these have not yet been identified.Use: Control of postoperative pain and inflammation following surgery and reduction of chronic inflammation, e.g. degenerative joint disease, osteoarthritis. All NSAIDs should be administered cautiously in the perioperative period. Although carprofen preferentially inhibits COX-2, it may still adversely affect renal perfusion during periods of hypotension. If hypotension during anaesthesia is anticipated, delay carprofen administration until the animal is fully recovered from anaesthesia and normotensive. Liver disease will prolong the metabolism of carprofen, leading to the potential for drug accumulation and overdose with repeated dosing. Prolonged long-term treatment should be under veterinary supervision. Use with caution in birds with dehydration, shock and renal dysfunction. Used for the relief of pain in fish. ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 53 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets54Safety and handling: Formulations that use palatable tablets can be extremely palatable. Animals have been reported to eat tablets spontaneously, resulting in overdose. Ensure that tablets are stored out of animal reach. Store injectable solution in the refrigerator; once broached the product is stable for use at temperatures up to 25°C for 28 days.Contraindications: Do not give to dehydrated, hypovolaemic or hypotensive patients or those with GI disease or blood clotting abnormalities. Administration of carprofen to animals with renal disease must be carefully evaluated and is not advisable in the perioperative period. Do not give to pregnant animals or animalsY, Nakazawa M et al. (2000) Low dose carvedilol inhibits progression of heart failure in rats with dilated cardiomyopathy. Pharmacology 130(7), 1489–1495CCNU see LomustineCefalexin (Cephalexin)(Cefaseptin, Cephacare, Ceporex, Rilexine, Therios) POM-VFormulations: Injectable: 180 mg/ml (18%) suspension. Oral: 50 mg, 75 mg, 120 mg, 250 mg, 300 mg, 500 mg, 600 mg, 750 mg tablets; granules which, when reconstituted, provide a 100 mg/ml oral syrup.Action: Binds to proteins involved in bacterial cell wall synthesis, thereby decreasing cell wall strength and rigidity, and affecting cell division. Resistant to some bacterial beta-lactamases, particularly those produced by Staphylococcus spp. As for other beta-lactam antibacterials, works in a time-dependent fashion.Use: Active against several Gram-positive and Gram-negative organisms (e.g. Staphylococcus, Pasteurella and Escherichia coli). Pseudomonas and Proteus are often resistant. Maintaining levels above the MIC is critical for efficacy and prolonged dosage intervals or missed doses can compromise therapeutic response. Dose and dosing interval is determined by infection site, severity and organism. In severe or acute conditions, doses may be doubled or given at more frequent intervals. Use in rabbits only when specifically indicated as can lead to antibiotic associated enterocolitis.Safety and handling: Reconstituted oral drops should be stored in the refrigerator and discarded after 10 days.Contraindications: Patients hypersensitive to penicillins may also be sensitive to cephalosporins (cross-hypersensitivity inas furosemide and NSAIDs.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Ferrets: 8 mg/kg s.c. every 2–3 days a.Birds, Reptiles: Initial data appear to show it is not practicable (half-lifeand liver to yield active drug giving oral bioavailability.Use: Higher activity against many Gram-negative organisms when compared to 1st generation cephalosporins. Good activity against a wider spectrum of Enterobacteriaceae (not Pseudomonas). Many obligate anaerobes also susceptible. It is a time-dependent antimicrobial, so maintaining levels above the MIC are important for efficacy. Limited applications in veterinary species and limited pharmacokinetic data make appropriate dose selection problematical.Safety and handling: Normal precautions should be observed.Contraindications: Patients hypersensitive to penicillins may also be sensitive to cephalosporins (cross-hypersensitivity inRedidrops*, Kemicetine*) POMFormulations: Injectable: 1 g powder for reconstitution. Topical: Ophthalmic 1% ointment; 0.5% solution. Oral: 250 mg capsules.Action: Bacteriostatic antimicrobial that acts by binding to the 50S ribosomal subunit of susceptible bacteria, preventing bacterial protein synthesis.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 65 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets66Use: Broad spectrum of activity against Gram-positive (e.g. Streptococcus, Staphylococcus), Gram-negative (e.g. Brucella, Salmonella, Haemophilus) and obligate anaerobic bacteria (e.g. Clostridium, Bacteroides fragilis). Other sensitive organisms include Chlamydophila, Mycoplasma (unreliable in treatment of ocular mycoplasmosis) and Rickettsia. Used in amphibians for chytridiomycosis; safe for larvae, metamorphs and adults. Resistant organisms include Nocardia and Mycobacterium. Acquired resistance may occur in Enterobacteriaceae. High lipid solubility makes it suitable for the treatment of intraocular infections. It will also access the CNS. However, due to concerns of resistance development and human toxicity use should be restricted to individual animals where there is a specific indication such as salmonellosis resistant to other antimicrobials or deep infections of the eye. Patients with hepatic or renal dysfunction may need adjustment to dose. Decrease dose or increase dosing interval in neonates. Use with caution or avoid in nursing animals, especially those with neonates, as crosses into milk.Safety and handling: Humans exposed to chloramphenicol may have an increased risk of developing a fatal aplastic anaemia. Products should be handled with care; use impervious gloves and avoid skin contact.Contraindications: In amphibians, chloramphenicol might dramatically alter the protective natural skin microbiome when used as an antifungal agent.Adverse reactions: Dose-related reversible bone marrow suppression can develop in all species. Unlike humans, the development of irreversible aplastic anaemia in veterinary species does not appear to be a significant problem. Other adverse effects include nausea, vomiting, diarrhoea and anaphylaxis.Drug interactions: Irreversible inhibitor of a large number of hepatic cytochrome P450-dependent enzymes and so increases plasma levels of pentobarbital, phenobarbital and oral hypoglycaemic agents. Recovery requires synthesis of new liver enzymes and can take up to 3 weeks. Rifampin accelerates the metabolism of chloramphenicol, thus decreasing serum levels. Chloramphenicol may inhibit activity of bactericidal antimicrobials such as the aminoglycosides and beta-lactams. May also be an inhibitory effect if used in combination with macrolide or lincosamide antimicrobials.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 50–100 mg/kg s.c., i.m., i.v. q8h; Sugar gliders: 50 mg/kg p.o., i.m. q12h; Hedgehogs: 30–50 mg/kg p.o. q12h; Ferrets: 25–50 mg/kg p.o., s.c., i.m., i.v. q12h; Rabbits: 50 mg/kg p.o., s.c. q12–24h; Mice: 50 mg/kg i.m., p.o. q12h, 200 mg/kg p.o. q12h or 0.5 mg/ml drinking water; Other rodents: 30–50 mg/kg i.v., i.m., s.c., p.o. q8–12h or, in drinking water, 1 mg/ml for Guinea pigs, 0.83 mg/ml for Gerbils. Ophthalmic: 1 drop q4–8h; ointment q8–12h.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 66 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 67Birds: 50 mg/kg i.v., i.m. q8h or 75 mg/kg p.o. q8h; Pigeons: 25 mg/kg p.o. q12h.Reptiles: Most species: 40–50 mg/kg i.m., s.c., p.o. q24h has been suggested; Rat snakes, King snakes, Indigo snakes: 50 mg/kg i.m. q12h; Boids: 50 mg/kg i.m. q12–24h; Water snakes (Nerodia spp.): 50 mg/kg i.m. q12–72h a.Amphibians: 50 mg/kg s.c., i.m., intracoelomic q12–24h or 10–20 mg/l as a bath bcd.Fish: No information available.Referencesa Clark CH, Rogers ED and Milton JL (1985) Plasma concentrations of chloramphenicol in snakes. American Journal of Veterinary Research 46(12), 2654–2657b Bishop PJ, Speare R, Poulter R et al. (2009) Elimination of the amphibian chytrid fungus Batrachochytrium dendrobatidis by Archey’s frog (Leiopelma archeyi). Diseases of Aquatic Organisms 84(1), 9–15c Holden WM, Ebert AR, Canning PF and Rollins-Smith LA (2014) Evaluation of amphotericin B and chloramphenicol as alternative drugs for treatment of chytridiomycosis and their impacts on innate skin defences. Applied Environmental Microbiology 80(13), 4034–4041d Young S, Speare R, Berger L and Skerratt LF (2012) Chloramphenicol with fluid and electrolyte therapy cures terminally ill green tree frogs (Litoria caerulea) with chytridiomycosis. Journal of Zoo and Wildlife Medicine 43(2), 330–337Chlorhexidine(Hibiscrub, Malaseb, Microbex, Savlon, Chlorohex*, CLX wipes*, Otodine*, TrizChlor*, Viatop*) POM-V, AVM-GSLFormulations: Topical shampoo: 2% chlorhexidine + 2% miconazole (Malaseb); 31.2 mg/ml chlorhexidine (Microbex); Cleansing solution: 1.5% chlorhexidine + cetrimide (Savlon); Surgical scrub solution: 4% chlorhexidine + isopropyl alcohol (Hibiscrub); Mouthwash: 0.12% chlorhexidine (Chlorohex); Topical gel: 0.06% chlorhexidine, aqua, raffinose, propylene glycol, saponins, triethanolamine, acrylates, phenoxyethanol, benzoic acid esters, allantoin (Viatop); Topical skin cleaner: Chlorhexidine, Tris-EDTA, zinc gluconate, glycerine, climbazole, benzyl alcohol, propylene glycol (CLX wipes); Ear cleaner: 0.15% chlorhexidine + EDTA (TrizChlor); Chlorhexidine, Tris-EDTA, lactic acid (Otodine).Action: Chemical antiseptic that disrupts bacterial cell membrane.Use: Topical treatment of bacterial, dermatophyte and Malassezia skin infections in animals as a shampoo (Malaseb). Topical treatment of Malassezia infections (Microbex). Washing surgical instruments, routine antisepsis for surgical operations (Savlon, Hibiscrub) and dental hygiene (Chlorohex). Topical treatment of mild pruritus (Viatop). Concurrent systemic antibacterial therapy is generally advised when treating bacterial skin infections. Leave in contact with the skin for 5–10 minutes prior to washing off. Ear cleaners for cleansing and removal of cerumen. Chlorhexidine as a single agent is not consistently effective as an antifungal.Safety and handling: Normal precautions should be observed.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 67 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets68Contraindications: Do not instil into ears where the integrity of the tympanum is unknown. Do not use on eyes.Adverse reactions: Ototoxic. May irritate mucous membranes.Drug interactions: Not known.DOSESMammals: Apply to affected area q8h at 0.5–2.0% concentrations. 0.05% solution in water can be used as a safe wound flush. When treating dermatophytosis continue treatment for 2 weeks after apparent clinical cure and negative fungal culture results. Otic: Dilute topical products to a 1.0% concentration and apply topically q8–12h.Birds: Apply 2–3 times weekly. May be used less frequently once infection is controlled.Reptiles: 0.05% solution in water has been suggested as a safe wound flush q24h.Amphibians, Fish: No information available.Chlorphenamine (Chlorpheniramine)(Piriton*) POM, GSLFormulations: Injectable: 10 mg/ml solution. Oral: 4 mg tablet, 0.4 mg/ml syrup.Action: Binds to H1 histamine receptors to prevent histamine binding.Use: Management of allergic disease and prevention and early treatment of anaphylaxis. Commonly used as premedication before transfusions and certain chemotherapeutic agents. Specific doses for animals have not been determined by pharmacokinetic studies. Use with caution in cases with urinary retention, angle-closure glaucoma and pyloroduodenal obstruction.Safetyand handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: May cause mild sedation. May reduce seizure threshold.Drug interactions: No information available.DOSESMammals: Primates: 0.5 mg/kg p.o. q24h; Ferrets: 1–2 mg/kg p.o. q8–12h; Rabbits: 0.2–0.4 mg/kg p.o. q12h; Rodents: 0.6 mg/kg p.o. q24h.Birds, Reptiles, Amphibians, Fish: No information available.Cholestyramine see ColestyramineZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 68 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 69Chorionic gonadotrophin (Human chorionic gonadotrophin, hCG)(Chorulon) POM-VFormulations: Injectable: 1500 IU powder for reconstitution.Action: In females induces follicular maturation, ovulation and development of the corpus luteum. This causes regression of ovarian cysts in guinea pigs. In males stimulates testosterone secretion.Use: Used to supplement or replace LH in cases of ovulation failure or delay, to induce lactation post-partum, or in females who fail to hold to mating. Used in ferrets to treat persistent oestrus. In male animals it may increase libido; may also assist the treatment of cryptorchidism before surgical castration, provided inguinal canal remains patent and therapy is started early. Used in amphibians for mating or release of sperm in males, followed with GnRH in 8–24h, and induction of ovulation in females (can be used with progesterone or PMSG).Safety and handling: Reconstituted vials do not contain any preservative and so should be discarded within 24 hours.Contraindications: No information available.Adverse reactions: Anaphylactic reactions may occasionally occur.Drug interactions: No information available.DOSESMammals: Primates: 250 IU i.m. once; Ferrets: 100 IU/ferret i.m. q14d for 2 doses; Rabbits: 20–25 IU/rabbit i.v. once to induce ovulation; Guinea pigs: 100 IU/kg i.m. weekly for 3 doses.Birds: 500–1000 IU/kg i.m. on days 1, 3 and 7 q3–6wk to inhibit egg laying a.Reptiles: No information available.Amphibians: 300–400 IU s.c., i.m. b.Fish: No information available.Referencesa Lightfoot TL (2000) Clinical use and preliminary data of chorionic gonadotropin administration in psittacines. Proceedings of the Annual Conference of the American Avian Veterinarians, pp. 17–21b Kouba AJ, del Barco-Trillo J, Vance CK, Milam C and Carr M (2012) A comparison of human chorionic gonadotropin and luteinizing hormone releasing hormone on the induction of spermiation and amplexus in the American toad (Anaxyrus americanus). Reproductive Biology and Endocrinology 10, 59Ciclosporin (Cyclosporin(e))(Atopica, Optimmune, Neoral*, Sandimmun*) POMFormulations: Ophthalmic: 0.2% ointment (Optimmune). Oral: 10 mg, 25 mg, 50 mg, 100 mg capsules; 100 mg/ml solution. Injectable: 50 mg/ml solution.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 69 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets70Action: T lymphocyte inhibition.Use: Used for disseminated idiopathic myositis and pure red cell aplasia in ferrets, and sebaceous adenitis in rabbits. No evidence of systemic or ocular toxicity following ocular administration but systemic absorption has been reported. Recommended that bacterial and fungal infections are treated before use. Whilst the nephrotoxicity seen in human patients does not appear to be common in animals, care should be taken in treating animals with renal impairment, and creatinine levels should be monitored regularly. Use with caution in patients with pre-existing infections and monitor for opportunistic infections.Safety and handling: Use gloves to prevent cutaneous absorption.Contraindications: Do not use in progressive malignant disorders. Do not give live vaccines during treatment or within a 2-week interval before or after treatment. The manufacturer does not recommend in diabetic animals.Adverse reactions: Hypertrichosis is common. There may be immediate discomfort on topical application (blepharospasm). Transient vomiting and diarrhoea may follow systemic administration; these are usually mild and do not require cessation of treatment. Infrequently observed adverse effects include: anorexia; mild to moderate gingival hyperplasia; papillomatous lesions of the skin; red and swollen pinnae; muscle weakness; and muscle cramps. These effects resolve spontaneously after treatment is stopped. Systemic treatment may be associated with an increased risk of malignancy.Drug interactions: The metabolism of ciclosporin is reduced, and thus serum levels increased, by various drugs that competitively inhibit or induce enzymes involved in its metabolism, particularly cytochrome P450, including diltiazem, doxycycline and imidazole antifungal drugs. In humans there is an increased risk of nephrotoxicity if ciclosporin is administered with aminoglycosides, NSAIDs, quinolones, or trimethoprim/sulphonamides; concomitant use of ciclosporin not recommended. Increased risk of hyperkalaemia if used with ACE inhibitors. As a substrate and inhibitor of the MDR 1 P-glycoprotein transporter, co-administration of ciclosporin with P-glycoprotein substrates such as macrocyclic lactones (e.g. ivermectin and milbemycin) could decrease the efflux of such drugs from blood–brain barrier cells, potentially resulting in signs of CNS toxicity. Ciclosporin has been shown to affect glucose metabolism and decrease the effects of insulin and to do so as much as low doses of glucocorticoids; therefore, use with caution in diabetic patients.DOSESMammals: Ferrets: 5 mg/kg p.o. q24h; Rabbits: 5 mg/kg p.o. q24h for idiopathic sebaceous adenitis; Rats: 10 mg/kg p.o. q24h.Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 70 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 71Cimetidine(Zitac, Cimetidine*, Dyspamet*, Tagamet*) POM-V, POMFormulations: Injectable: 100 mg/ml solution in 2 ml ampoule. Oral: 100 mg, 200 mg, 400 mg, 800 mg tablets; 40 mg/ml syrup.Action: Histamine (H2) receptor antagonist, blocking histamine-induced gastric acid secretion. Rapidly absorbed with high bioavailability; undergoes hepatic metabolism and renal excretion. Plasma half-life is about an hour.Use: Management of idiopathic, uraemic or drug-related erosive gastritis, gastric and duodenal ulcers, oesophagitis, and hypersecretory conditions secondary to gastrinoma or mast cell neoplasia. Efficacy against NSAID-induced ulcers is controversial. Reduction of vomiting due to gastritis and gastric ulceration is typically achieved in about 2 weeks but animals should be treated for at least 2 weeks after the remission of clinical signs, so minimum of 28 days recommended. If considered successful, medication can then be stopped. Rebound gastric acid secretion may be seen on cessation of cimetidine, so therapy should be tapered. A 2-week medication-free period should be allowed to see if vomiting occurs again. If the animal starts vomiting again after a medication-free period, treatment can be re-initiated, without risk for intolerance. Depending on the response, treatment can be adapted to the individual animal until the response is considered to be adequate and then continued at this level. Concomitant treatment with sucralfate may be helpful, and dietary measures should always be maintained. If used i.v., should be administered over 30 min to prevent cardiac arrhythmias and hypotension. Dosage should be reduced for animals with renal impairment. Less effective at reducing gastric acidity than more modern H2 blockers and proton pump inhibitors. Cimetidine has minimal prokinetic effects.Safety and handling: Normal precautions should be observed.Contraindications: No informationavailable.Adverse reactions: Rare, although hepatotoxicity and nephrotoxicity have been reported in humans. Adverse reactions are generally minor even at high doses. In humans cimetidine has been associated with headache, gynaecomastia and decreased libido.Drug interactions: Retards oxidative hepatic drug metabolism by binding to the microsomal cytochrome P450. May increase plasma levels of beta-blockers (e.g. propranolol), calcium-channel blockers (e.g. verapamil), diazepam, lidocaine, metronidazole, pethidine and theophylline. When used with other agents that cause leucopenia may exacerbate the problem. Sucralfate may decrease bioavailability; although there is little evidence to suggest this is of clinical importance it may be a wise precaution to administer sucralfate at least 2 hours before cimetidine. Stagger oral doses by 2 hours when used with other antacids, digoxin, itraconazole or maropitant.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 71 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets72DOSESMammals: Primates: 10 mg/kg p.o., s.c., i.m. q8h; Ferrets: 5–10 mg/kg i.m., s.c., p.o. q8h; Rabbits: 5–10 mg/kg p.o. q6–8h; Rodents: 5–10 mg/kg p.o., s.c., i.m., i.v. q6–12h.Birds: 5 mg/kg i.m., p.o. q8–12h.Reptiles: 4 mg/kg i.m., p.o. q8h.Amphibians, Fish: No Information available.Ciprofloxacin(Ciloxan*, Ciproxin*) POMFormulations: Oral: 100 mg, 250 mg and 500 mg tablets; 50 mg/ml suspension. Injectable: 2 mg/ml for i.v. infusion. Ophthalmic: 0.3% solution in 5 ml bottle; 0.3% ointment in 3.5 g tube.Action: Bactericidal through inhibition of bacterial DNA gyrase.Use: Ideally fluoroquinolone use should be reserved for infections where culture and sensitivity testing predicts a clinical response and where first- and second-line antimicrobials would not be effective. Broad-spectrum activity against wide range of Gram-negative and some Gram-positive aerobes; some activity against Mycoplasma and Chlamydophila. Active against many ocular pathogens, including Staphylococcus and Pseudomonas aeruginosa, although there is increasing resistance amongst staphylococci and streptococci. The eye drop formulation is also used in reptiles for the topical management of wounds or stomatitis.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: May cause local irritation after application. In humans the following are reported: local burning and itching; lid margin crusting; hyperaemia; taste disturbances; corneal staining, keratitis, lid oedema, lacrimation, photophobia, corneal infiltrates; nausea; and visual disturbances.Drug interactions: No information available.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 17.5 mg/kg p.o. q12h a; Sugar gliders: 10 mg/kg p.o. q12h; Hedgehogs: 5–20 mg/kg p.o. q12h; Ferrets: 10–30 mg/kg p.o. q24h; Rabbits: 10–20 mg/kg p.o. q24h or 1 drop to affected eye q6h; loading dose can be used 1 drop to affected eye q15min for 4 doses; Chinchillas, Guinea pigs: 5–25 mg/kg p.o. q12h; Hamsters: 10–20 mg/kg p.o. q12h; Other rodents: 7–25 mg/kg p.o. q12h.Birds: 5–20 mg/kg i.v., i.m., p.o. q12h b; Raptors: 50 mg/kg p.o. q12h c.Reptiles: Topical: 1 drop to affected eyes or in wounds or topical application for stomatitis; Systemic: 5–10 mg/kg p.o., s.c., i.m. q24h.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 72 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 73Amphibians: 10 mg/kg p.o. q24–48h for 7 days; 500–750 mg/75 litres as a bath for 6–8h q24h.Fish: No information available.Referencesa Nelson M, Stagg AJ, Stevens DJ, Brown MA, Pearce PC, Simpson AJ and Lever MS (2011) Post-exposure therapy of inhalational anthrax in the common marmoset. International Journal of Antimicrobial Agents 38(1), 60–64b Atta AH and Sharif L (1997) Pharmacokinetics of ciprofloxacin following intravenous and oral administration is broiler chickens. Journal of Veterinary Pharmacology and Therapeutics 20(4), 326–329c Isaza R, Budsberg SC, Sundlof SF and Baker B (1993) Disposition of ciprofloxacin in red-tailed hawks (Buteo jamaicensis) following a single oral dose. Journal of Zoo and Wildlife Medicine 24(4), 498–502Cisapride(Cisapride) POM-VFormulations: Various formulations (including tablets and suspensions) available as a veterinary special depending on requirements.Action: Gastrointestinal prokinetic agent related to metoclopramide but has no central antiemetic activity.Use: Primarily used in GI stasis in rabbits and herbivorous rodents (e.g. guinea pigs, chinchillas). Its license for humans was withdrawn due to potentially fatal cardiac arrhythmias and it is solely available to the veterinary profession on a named patient or named veterinary surgeon ‘special basis’.Safety and handling: Normal precautions should be observed.Contraindications: It should not be given within 2 hours of metoclopramide or ranitidine.Adverse reactions: Abdominal cramps and diarrhoea may develop, especially at higher doses or if used alongside other prokinetic agents. Fatal cardiac arrhythmias have not been reported in rabbits or rodents.Drug interactions: Opioid analgesics and antimuscarinics (e.g. atropine) may antagonize the effects of cisapride. In humans, it is known that drugs inhibiting the cytochrome P450 3A4 enzymes which metabolize cisapride (clarithromycin, erythromycin, itraconazole) when taken alongside cisapride have led to fatal arrhythmias.DOSESMammals: Primates: 0.2 mg/kg p.o. q12h a; Sugar gliders: 0.25 mg/kg p.o., i.m. q8–24h; Rabbits, Guinea pigs, Chinchillas: 0.1–1.0 mg/kg (typically 0.5 mg/kg) p.o. q8–12h.Birds, Reptiles, Amphibians, Fish: No information available.Referencesa Yogo K, Onoma M, Ozaki K et al. (2008) Effects of oral mitemcinal (GM-611), erythromycin, EM-574 and cisapride on gastric emptying in conscious rhesus monkeys. Digestive Diseases and Sciences 53(4), 912–918ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 73 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets74Clarithromycin(Klaricid*) POMFormulations: Oral: 250 mg, 500 mg tablets; 125 mg/5 ml suspension; 250 mg/5 ml suspension; 250 mg granules sachet (to be dissolved in water). Injectable: 500 mg vial for reconstitution.Action: Derived from erythromycin and with greater activity. Bactericidal (time-dependent) or bacteriostatic properties, depending on concentration and susceptibility. Binds to the 50S ribosome, inhibiting peptide bond formation.Use: Alternative to penicillin in penicillin-allergic humans as it has a similar, although not identical, antibacterial spectrum. Active against Gram-positive cocci (some Staphylococcus spp. resistant), Gram-positive bacilli, some Gram-negative bacilli (e.g. Pasteurella) and some spirochaetes (e.g. Helicobacter). Some strains of Actinomyces, Nocardia, Chlamydophila, Mycoplasma and Rickettsia also inhibited. Most strains of Enterobacteriaceae (Pseudomonas, Escherichia coli, Klebsiella) are resistant. Highly lipid-soluble and useful against intracellular pathogens. Particularly useful in management of respiratory tract infections, mild to moderate skin and soft tissue infections, and non-tubercular mycobacterial infections. For the latter used in combination with enrofloxacin and rifampin. Activity is enhanced in an alkaline pH; administer on an empty stomach. There is limited information regarding use in animals. Use with caution in animals with hepatic dysfunction. Reduce dose in animals with renal impairment. In ferrets it has been used successfully to treat pneumonia due to Mycobacterium abscessus and it can be used in combination with omeprazole or ranitidine and bismuth plus amoxicillin or metronidazolefor treatment of Helicobacter mustelae. In tortoises it has been used to resolve clinical signs in severe cases of mycoplasmosis.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: In humans similar adverse effects to those of erythromycin are seen, i.e. vomiting, cholestatic hepatitis, stomatitis and glossitis.Drug interactions: May increase serum levels of several drugs, including methylprednisolone, theophylline, omeprazole and itraconazole. The absorption of digoxin may be enhanced.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 10 mg/kg p.o. q12h a; Hedgehogs: 5.5 mg/kg p.o. q12h; Ferrets: 50 mg/kg p.o. q12–24h; Rabbits: 80 mg/kg p.o. q12h with rifampin at 40 mg/kg p.o. q12h for Staphylococcus osteomyelitis; Rats: 3.5–10 mg/kg p.o. q8–12h.Birds: 85 mg/kg p.o. q24h.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 74 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 75Reptiles: Desert tortoises: 15 mg/kg p.o. q48–72h bc. For longer term treatment (for individual species; however, sometimes generalizations are used. ‘Mammals’ includes ferrets, lagomorphs and rodents. Doses for small primates and other exotic mammals, such as African pygmy hedgehogs and sugar gliders, are given on a species basis only. ‘Birds’ includes psittacines, raptors, pigeons and others. ‘Reptiles’ includes chelonians, lizards and snakes. Amphibiansandpetfisharealsoincluded.Exceptwhereindicated, all doses given for reptiles assume that the animal is kept within its Selected Temperature Range (Ts). Animals that are maintainedatdifferenttemperaturesmayhavedifferentratesofmetabolism and therefore the dose (and especially the frequency) that is required may require alteration.• References. Primary references are given to support doses where available and are denoted by a letter. Such primary referencesdescribeapharmacokineticorclinicalefficacytrialinthat species or species group (not case reports). Primary references are generally not given where doses are considered verywellestablishedinthescientificliterature,particularlyforrabbits and rodents (e.g. from studies on laboratory mammals), or where the product is authorized in that species or species group.For some drugs, non-primary references are also given and are denoted by a number. These generally refer to sources of information such as textbooks where no other primary information can be found and the reference is deemed a useful resource in itself. All other doses can be assumed to be taken from other non-primary sources such as other formularies, book chapters or reviews, or are anecdotal.Distribution categoriesAuthorizedsmallanimalmedicinesnowfallwithinthefirstfourcategories below and all packaging supplied by drug manufacturers and distributors was changed in 2008. Medical products not authorizedforveterinaryuseretaintheirformerclassification(e.g.P,POM). Some nutritional supplements (nutraceuticals) are not consideredmedicinalproductsandthereforearenotclassified.Where a product does not have a marketing authorization it is designated ‘general sale’.AVM-GSL: Authorized veterinary medicine – general sales list (formerly GSL). This may be sold by anyone.NFA-VPS: Non-food animal medicine – veterinarian, pharmacist, SuitablyQualifiedPerson(SQP)(formerlyPMLcompanionanimalproducts and a few P products). These medicines for companion animals must be supplied by a veterinary surgeon, pharmacist or SQP. An SQP has to be registered with the Animal Medicines Training Regulatory Authority (AMTRA). Veterinary nurses can become SQPs but it is not automatic.INTRODUCTION2 Intro.indd 8 12/02/2015 09:27Introduction ixPOM-VPS: Prescription-only medicine – veterinarian, pharmacist, SQP (formerly PML livestock products, MFSX products and a few P products). These medicines for food-producing animals (including horses) can only be supplied on an oral or written veterinary prescription from a veterinary surgeon, pharmacist or SQP and can only be supplied by one of those groups of people in accordance with the prescription.POM-V: Prescription-only medicine – veterinarian (formerly POM products and a few P products). These medicines can only be supplied against a veterinary prescription that has been prepared (either orally or in writing) by a veterinary surgeon to animals under their care following a clinical assessment, and can only be supplied by a veterinary surgeon or pharmacist in accordance with the prescription.Exemptions for Small Pet Animals (ESPA): Schedule 6 of the VeterinaryMedicineRegulations2013(unofficiallyknownastheSmallAnimal Exemption Scheme) allows for the use of medicines in certain petspecies(aquariumfish,cagebirds,ferrets,homingpigeons,rabbits, small rodents and terrarium animals) the active ingredient of which has been declared by the Secretary of State as not requiring veterinary control. These medicines are exempt from the requirement for a marketing authorization and are not therefore required to prove safety,qualityorefficacy,butmustbemanufacturedtothesamestandards as authorized medicines and are subject to pharmacovigilance reporting.CD: Controlled Drug. A substance controlled by the Misuse of Drugs Act 1971 and Regulations. The CD is followed by (Schedule 1), (Schedule 2), (Schedule 3), (Schedule 4) or (Schedule 5) depending on the Schedule to The Misuse of Drugs Regulations 2001 (as amended) in which the preparation is included. You could be prosecuted for failure to comply with this act. Prescribers are reminded that there are additional requirements relating to the prescribing of Controlled Drugs. For more information see the BSAVA Guide to the Use of Veterinary Medicines at www.bsava.com.Schedule 1: Includes LSD, cannabis, lysergide and other drugs that are not used medicinally. Possession and supply are prohibited exceptinaccordancewithHomeOfficeAuthority.Schedule 2: Includes etorphine, morphine, papaveretum, pethidine, diamorphine (heroin), cocaine and amphetamine. Record all purchases and each individual supply (within 24 hours). Registers must be kept for 2 calendar years after the last entry. Drugs must be kept under safe custody (locked secure cabinet), except secobarbital. Drugs may not be destroyed except in the presence of a person authorized by the Secretary of State.Schedule 3: Includes buprenorphine, pentazocine, the barbiturates (e.g. pentobarbital and phenobarbital but not secobarbital – which is Schedule 2), tramadol and others. Buprenorphine, diethylpropion and INTRODUCTION2 Intro.indd 9 12/02/2015 09:27Introductionxtemazepam must be kept under safe custody (locked secure cabinet); it is advisable that all Schedule 3 drugs are locked away. Retention of invoices for 2 years is necessary.Schedule 4: Includes most of the benzodiazepines (temazepam is now in Schedule 3), and androgenic and anabolic steroids (e.g. clenbuterol). Exempted from control when used in normal veterinary practice.Schedule 5: Includes preparations (such as several codeine products) which, because of their strength, are exempt from virtually all Controlled Drug requirements other than the retention of invoices for 2 years.The prescribing cascadeVeterinary medicinal products must be administered in accordance with the prescribing cascade, as set out in the Medicines (Restrictions on the Administration of Veterinary Medicinal Products) Regulations 1994 as amended. These Regulations provide that when no authorized veterinary medicinal product exists for a condition in a particular species, veterinary surgeons exercising their clinical judgementmay,inparticulartoavoidunacceptablesuffering,prescribe for one or a small number of animals under their care other suitable medications in accordance with the following sequence:1 A veterinary medicine authorized for use in another species, or foradifferentuseinthesamespecies(‘off-label’use).2 A medicine authorized in the UK for human use or a veterinary medicinefromanothercountrywithanimportcertificatefromthe Veterinary Medicines Directorate (VMD).3 Amedicinetobemadeupatthetimeonaone-offbasisbyaveterinary surgeon or a properly authorized person.‘Off-label’ use of medicines‘Off-label’useistheuseofmedicinesoutsidethetermsoftheirmarketing authorization. It may include medicines authorized outside theUKthatareusedinaccordancewithanimportcertificateissuedby the VMD. A veterinary surgeon with detailed knowledge of the medical history and clinical status of a patient, may reasonably prescribeamedicine‘off-label’inaccordancewiththeprescribingcascade.Authorizedmedicineshavebeenscientificallyassessedagainststatutorycriteriaofsafety,qualityandefficacywhenusedinaccordance with the authorized recommendations on the product literature.some contain corticosteroids.Action: Topical imidazole with an inhibitory action on the growth of pathogenic dermatophytes, Aspergillus and yeasts by inhibiting cytochrome P450-dependent ergosterol synthesis.Use: Superficial fungal infections. Naso-sinal infections including aspergillosis, particularly in birds.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 77 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets78Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESMammals: Rabbits: Otic: Instil 3–5 drops in ear q12h; Topical: Apply to affected area and massage in gently q12h; if no improvement in 4 weeks re-evaluate therapy or diagnosis; Chinchillas, Guinea pigs, Hamsters, Rats, other small mammals: Topical application to defined lesions q12h for 3–6 weeks (anecdotal).Birds: Endoscopic: 10 mg/kg applied directly to fungal lesions. Nasal flush: 10 mg/ml (flush volume 20 ml/kg). Intratracheal: 2–3 ml of a 1% solution nebulized for periods of 1 hour q24h or topically.Reptiles: Apply topically to lesion q12h (anecdotal).Amphibians, Fish: No information available.Cloxacillin(Opticlox, Orbenin) POM-VFormulations: Ophthalmic: Cloxacillin benzathine ester 16.7% suspension.Action: Beta-lactamase-resistant penicillin which is bactericidal and works in a time-dependent fashion. Binds to penicillin-binding proteins involved in cell wall synthesis, thereby decreasing bacterial cell wall strength and rigidity, and affecting cell division, growth and septum formation.Use: Narrow spectrum antimicrobial. Less active than penicillin G or V against Streptococcus. Specifically indicated for ocular infections with beta-lactamase-producing Staphylococcus.Safety and handling: Normal precautions should be observed.Contraindications: Do not administer penicillins to hamsters, gerbils, guinea pigs, chinchillas or rabbits.Adverse reactions: No information available.Drug interactions: Avoid the concomitant use of bacteriostatic antibiotics (chloramphenicol, erythromycin, tetracycline).DOSESSee Appendix for guidelines on responsible antibacterial use.Birds: Apply 1/10th of a tube (0.3 g) q24h.Mammals, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 78 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 79Co-amoxiclav (Amoxicillin/Clavulanate, Amoxycillin/Clavulanic acid)(Clavabactin, Clavaseptin, Clavucil, Clavudale, Combisyn, Kesium, Nisamox, Noroclav, Synulox, Augmentin*) POM-V, POMFormulations: Injectable: 175 mg/ml suspension (140 mg amoxicillin, 35 mg clavulanate); 600 mg powder (500 mg amoxicillin, 100 mg clavulanate); 1.2 g powder (1 g amoxicillin, 200 mg clavulanate) for reconstitution (Augmentin). Oral: 50 mg, 250 mg, 500 mg tablets each containing amoxicillin and clavulanate in a ratio of 4:1. Palatable drops which when reconstituted with water provide 40 mg amoxicillin and 10 mg clavulanic acid per ml.Action: Amoxicillin binds to penicillin-binding proteins involved in bacterial cell wall synthesis, thereby decreasing cell wall strength and rigidity, affecting cell division, growth and septum formation. The addition of the beta-lactamase inhibitor clavulanate increases the antimicrobial spectrum against those organisms that produce beta-lactamase, such as Staphylococcus and Escherichia coli.Use: Active against Gram-positive and Gram-negative aerobic organisms and many obligate anaerobes. Penicillinase-producing Escherichia coli and Staphylococcus are susceptible, but difficult Gram-negative organisms such as Pseudomonas aeruginosa and Klebsiella are often resistant. Dose and dosing interval will be determined by infection site, severity and organism. The predominant bacterial infections in reptiles are Gram-negative and many are resistant to penicillins.Safety and handling: Tablets are wrapped in foil moisture-resistant packaging; do not remove until to be administered. Refrigerate oral suspension and i.v. solution after reconstitution. Discard oral suspension and i.v. formulation if they become dark or after 10 days. A small amount of discoloration of the i.v. solution is acceptable.Contraindications: Avoid oral antibiotic agents in critically ill patients, as absorption from the GI tract may be unreliable; such patients may require i.v. formulation. Avoid use in animals which have displayed hypersensitivity reactions to other antimicrobials within the beta-lactam family (which includes cephalosporins). Do not administer to hamsters, guinea pigs, gerbils, chinchillas and rabbits.Adverse reactions: Nausea, diarrhoea and skin rashes are the commonest adverse effects.Drug interactions: Avoid the concurrent use of amoxicillin with bacteriostatic antibiotics (e.g. tetracycline, erythromycin). Do not mix in the same syringe as aminoglycosides. Do not use with allopurinol in birds. Synergism may occur between the beta-lactam and aminoglycoside antimicrobials in vivo. ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 79 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets80DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 15 mg/kg p.o. q24h; Sugar gliders, Hedgehogs: 12.5 mg/kg p.o., s.c. q24h; Ferrets: 12.5–20 mg/kg i.m., s.c. q12h; Rats, Mice: 100 mg/kg p.o., s.c. q12h.Birds: 125–150 mg/kg p.o., i.v. q12h; 125–150 mg/kg i.m. q24h a.Reptiles, Amphibians, Fish: No information available.Referencesa Orosz SE, Jones MO, Cox SK, Zagaya NK and Frazier DL (2000) Pharmacokinetics of amoxicillin plus clavulanic acid in blue-fronted Amazon parrots (Amazona aestival aestival). Journal of Avian Medicine and Surgery 14(2), 107–112Codeine(Pardale-V, Codeine*) POMFormulations: Oral: 3 mg/5 ml paediatric linctus; 3 mg/ml linctus; 5 mg/ml syrup; 15 mg, 30 mg, 60 mg tablets.Action: Opioid analgesic.Use: Cough suppression, analgesia and diarrhoea. Pardale-V is a veterinary formulation with 400 mg paracetamol + 9 mg codeine. However, to deliver the dose of codeine listed below would result in a very high dose of paracetamol and therefore Pardale-V tablets cannot be recommended as a source of codeine for general usage.Safety and handling: Normal precautions should be observed.Contraindications: Renal insufficiency, hypoadrenocorticism, increased intracranial pressure, hypothyroidism. Care with severe respiratory compromise.Adverse reactions: Sedation, ataxia, respiratory depression and constipation.Drug interactions: No information available.DOSESAmphibians: 42–53 mg/kg s.c. shown to provide analgesia for >4 h a.Mammals, Birds, Reptiles, Fish: No information available.Referencesa Stevens CW (2011) Analgesia in amphibians: preclinical studies and clinical applications. Veterinary Clinics of North America: Exotic Animal Practice 14(1), 33–44Colchicine(Colchicine*) POMFormulations: Oral: 0.5 mg tablet.Action: Colchicine inhibits collagen synthesis, may enhance collagenase activity and blocks the synthesis and secretion of serum amyloid A.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 80 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 81Use: Management of fibrotic hepatic and pulmonary diseases, oesophageal stricture and renal amyloidosis. In birds, used for gout and hepatic cirrhosis/fibrosis. Due to the relatively high incidence of adverse reactions, this drug should be used with caution.Safety and handling: Protect from light.Contraindications: Pregnancy.Adverse reactions: Commoner adverse effects include vomiting, abdominal pain and diarrhoea.Rarely, renal damage, bone marrow suppression, myopathy and peripheral neuropathy may develop. Colchicine may increase serum ALP, decrease platelet counts and cause false-positive results when testing urine for RBCs and haemoglobin. Overdoses can be fatal.Drug interactions: Possible increased risk of nephrotoxicity and myotoxicity when colchicine given with ciclosporin. NSAIDs, especially phenylbutazone, may increase the risks of thrombocytopenia, leucopenia or bone marrow depression when used concurrently with colchicine. Many anticancer chemotherapeutics may cause additive myelosuppressive effects when used with colchicine.DOSESBirds: 0.04 mg/kg p.o. q12h 12.Mammals, Reptiles, Amphibians, Fish: No information available.References1 Hoefer H (1991) Hepatic fibrosis and colchicine therapy. Journal of the Association of Avian Veterinarians 5, 1932 Romano J (2013) Therapeutic review: colchicine. Journal of Exotic Pet Medicine 22(4), 405–408Colestyramine (Cholestyramine)(Questran*) POMFormulations: Oral: 4 g powder/sachet.Action: Ion exchange resin.Use: In rabbits and susceptible rodents for absorbing toxins produced in the GI tract following the development of overgrowth of Clostridium.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Constipation may develop.Drug interactions: Colestyramine reduces the absorption of digoxin, anticoagulants, diuretics and thyroxine.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 81 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets82DOSESMammals: Rabbits: 2 g/rabbit p.o. syringed gently with 20 ml water q24h; Guinea pigs: 1 g/guinea pig mixed with water p.o. q24h.Birds, Reptiles, Amphibians, Fish: No information available.Copper sulphate (Cupric sulphate)(Proprietary formulations are available)Formulations: Liquid for immersion.Action: No information available.Use: For the treatment of protozoan and monogenean ectoparasites, some fungi and bacteria in fish. It is strongly recommended that a proprietary formulation is used initially to avoid problems related to purity and enable accurate dosing. Copper has a low therapeutic index and is toxic to gill tissue. It is commonly used to treat diseases in marine aquaria by prolonged immersion but is toxic to invertebrates, elasmobranchs, algae and many plants. Although copper can be used to treat ectoparasites in freshwater fish, other remedies are safer. The solubility of copper is reduced at higher pH and it is absorbed or inactivated by high levels of calcareous materials and organic matter. Free copper ion levels must be maintained between 0.15–0.20 mg/l for the chemical to be effective – this requires monitoring using a commercial test kit then adjusting the dose initially twice daily. A stock solution is made by dissolving 1 gram of copper sulphate pentahydrate (CuSO4 5H2O) in 250 ml distilled water to produce 1 mg copper/ml and enables accurate dosing of the chemical. Copper can be removed using inactivated carbon.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in the presence of invertebrates.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 100 mg/l by immersion for 1–5 minutes; 0.15 mg/l by prolonged immersion until therapeutic effect (at least 10 days) 123; follow the manufacturer’s recommendations for proprietary formulations.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Lewbart GA (2013) Exotic Animal Formulary, 4th edn, ed. JW Carpenter. Elsevier, Missouri2 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford3 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, DordrechtZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 82 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 83Cordycepic acid see MannitolCrisantaspase (Asparaginase, l-Asparginase)(Asparginase*, Elspar*, Erwinase*) POMFormulations: Injectable: vials of 5,000 or 10,000 IU powder for reconstitution.Action: Lymphoid tumour cells are not able to synthesize asparagine and are dependent upon supply from the extracellular fluid. Crisantaspase deprives malignant cells of this amino acid, which results in cessation of protein synthesis and cell death.Use: Main indication is treatment of lymphoid malignancies.Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. Store in a refrigerator.Contraindications: Patients with active pancreatitis or a history of pancreatitis. History of anaphylaxis associated with previous administration.Adverse reactions: Anaphylaxis may follow administration, especially if repeated. Premedication with an antihistamine is recommended before administration. Gastrointestinal disturbances, hepatotoxicity and coagulation deficits may also be observed.Drug interactions: Administration with or before vincristine may reduce clearance of vincristine and increase toxicity; thus, if used in combination the vincristine should be given 12–24 hours before the enzyme.DOSESMammals: Ferrets: 10,000 IU/m2 s.c. weekly for the first 3 weeks as part of a chemotherapeutic protocol (see Appendix); Guinea pigs: 10,000 IU/m2 s.c., i.m. q3wk.Birds, Reptiles, Amphibians, Fish: No information available.Cupric sulphate see Copper sulphateCyclophosphamide(Cyclophosphamide*, Endoxana*) POMFormulations: Injectable: 100 mg, 200 mg, 500 mg, 1000 mg powder for reconstitution. Oral: 50 mg tablets.Action: Metabolites crosslink DNA resulting in inhibition of DNA synthesis and function. ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 83 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets84Use: Treatment of lymphoproliferative diseases, myeloproliferative disease and immune-mediated diseases. The use of cyclophosphamide in immune-mediated haemolytic anaemia is controversial and therefore it is not recommended as an immunosuppressant in the management of this disease. May have a role in management of certain sarcomas and carcinomas. Use with caution in patients with renal failure; dose reduction may be required. Has been used in lymphosarcoma in cockatoos and lymphoma in the green iguana.Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents.Contraindications: No information available.Adverse reactions: Myelosuppression, with the nadir usually occurring 7–14 days after the start of therapy; regular monitoring of WBCs recommended. A metabolite of cyclophosphamide (acrolein) may cause a sterile haemorrhagic cystitis. The cystitis may be persistent. This risk may be reduced by increasing water consumption or by giving furosemide to ensure adequate urine production. Other effects include vomiting, diarrhoea, hepatotoxicity, nephrotoxicity and a reduction in hair growth rate.Drug interactions: Increased risk of myelosuppression if thiazide diuretics given concomitantly. Absorption of orally administered digoxin may be decreased, may occur several days after dosing. Barbiturates increase cyclophosphamide toxicity due to increased rate of conversion to metabolites. Phenothiazines and chloramphenicol reduce cyclophosphamide efficacy. If administered with doxorubicin there is an increased risk of cardiotoxicity. Insulin requirements are altered by concurrent cyclophosphamide.DOSESMammals: Ferrets: Lymphoma: 10 mg/kg p.o., s.c. as part of chemotherapy protocols (see Appendix); Guinea pigs: 300 mg/m2 intraperitoneal q24h.Birds: Lymphosarcoma: 200 mg/m2 intraosseous q7d.Reptiles: 3 mg/kg i.v. q2wks as part of a chemotherapy protocol in onecase report in the green iguana.Amphibians, Fish: No information available.Cyclosporin(e) see CiclosporinCyproheptadine(Periactin*) POMFormulations: Oral: 4 mg tablet.Action: Binds to and blocks the activation of H1 histamine and serotonin receptors.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 84 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 85Use: Management of allergic disease and appetite stimulation. Maintenance of this collateral supply is important in recovery. Use with caution in cases with urinary retention, angle-closure glaucoma and pyloroduodenal obstruction. Specific doses for animals have not been determined by pharmokinetic studies and clinical effectiveness has not been established.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: May cause mild sedation, polyphagia, weight gain. May reduce seizure threshold.Drug interactions: No information available.DOSESMammals: Ferrets, Chinchillas, Guinea pigs: 0.5 mg p.o. q12h.Birds, Reptiles, Amphibians, Fish: No information available.Cytarabine (Cytosine arabinoside, Ara-C)(Cytarabine*, Cytosar-U*) POMFormulations: Injectable: 100 mg, 500 mg powders for reconstitution.Action: The active nucleotide metabolite ara-CTP is incorporated into DNA and inhibits pyrimidine and DNA synthesis. Cytarabine is therefore S phase-specific.Use: Management of lymphoma in the ferret.Safety and handling: Cytotoxic drug; see specialist texts for further advice on chemotherapeutic agents. After reconstitution, store at room temperature and discard after 48 hours or if a slight haze develops.Contraindications: Do not use if there is evidence of bone marrow suppression or substantial hepatic impairment.Adverse reactions: Vomiting, diarrhoea, leucopenia. As it is a myelosuppressant, careful haematological monitoring is required. Conjunctivitis, oral ulceration, hepatotoxicity and fever have also been seen.Drug interactions: Oral absorption of digoxin is decreased. Activity of gentamicin may be antagonized. Simultaneous administration of methotrexate increases the effect of cytarabine.DOSESMammals: Ferrets: 1 mg per ferret p.o., s.c. q24h for 2 days (see Appendix).Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBACd.indd 85 12/02/2015 09:30BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets86Deferoxamine (Desferrioxamine)(Desferal*) POMFormulations: Injectable: 500 mg vial for reconstitution.Action: Deferoxamine chelates iron, and the complex is excreted in the urine.Use: To remove iron from the body following poisoning. Also used for haemochromatosis (common in toucans, hornbills and softbills, though unusual in other birds).Safety and handling: Normal precautions should be observed.Contraindications: Avoid in severe renal disease.Adverse reactions: Administration i.m. is painful. Anaphylactic reactions and hypotension may develop if administered rapidly i.v.Drug interactions: No information available.DOSESBirds: Various doses proposed, ranging from 20 mg/kg p.o. q4h to 40 mg/kg i.m. q24h (mynahs) to 100 mg/kg p.o., s.c., i.m. q24h for up to 14 weeks a1.Mammals, Reptiles, Amphibians, Fish: No information available.Referencesa Dierenfeld E and Phalen DN (2006) A comparison of four regiments for treatment of iron storage disease using the European Starling (Sturnus vulgaris) as a model. Journal of Avian Medicine and Surgery 20(2), 74–791 Sheppard C and Dierenfeld E (2002) Iron storage disease in birds: speculation on etiology and implications for captive husbandry. Journal of Avian Medicine and Surgery 16(3), 192–197Delmadinone(Tardak) POM-VFormulations: Injectable: 10 mg/ml suspension.Action: Progestogens suppress FSH and LH production.Use: In birds it may be useful for behavioural regurgitation or behaviour associated with sexual frustration.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Possible adverse effects include a transient reduction in fertility and libido, polyuria and polydipsia, an increased appetite and hair colour change at the site of injection.Drug interactions: Cortisol response to ACTH stimulation is significantly suppressed after just one dose of delmadinone.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 86 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 87DOSESBirds: 1 mg/kg i.m. once.Mammals, Reptiles, Amphibians, Fish: No information available.Desferrioxamine see DeferoxamineDeslorelin(Suprelorin) POM-VFormulations: Implant containing 4.7 mg or 9.4 mg of active product.Action: Desensitizes GnRH receptors, thereby decreasing release of LH and FSH. This leads to reduction in testosterone and sperm production.Use: Chemical castration. There is a 14-day surge in testosterone followed by lowering of levels. Infertility is achieved from 6 weeks up to at least 6 months after initial treatment. Treated male animals should therefore still be kept away from females within the first 6 weeks following initial treatment. Any mating that occurs more than 6 months after the administration of the product may result in pregnancy. Disinfection of the site should be undertaken prior to implantation to avoid introduction of infection. If the hair is long, a small area should be clipped, if required. The product should be implanted subcutaneously in the loose skin on the back between the lower neck and the lumbar area. Avoid injection of the implant into fat, as release of the active substance might be impaired in areas of low vascularization. The biocompatible implant does not require removal. However, should it be necessary to end treatment, implants may be surgically removed. Implants can be located using ultrasonography. Deslorelin implants effectively prevent reproduction and the musky odour of intact male and female ferrets, and is therefore considered a suitable alternative for surgical neutering in these animals. Surgical neutering of ferrets has been implicated as an aetiological factor in the development of hyperadrenocorticism in this species. Deslorelin implants can be given to neutered ferrets to decrease the development or progression of adrenocortical disease. One implant per ferret may last 8.5–20.5 months. Anecdotally useful for some types of cystic ovarian disease in guinea pigs but duration of action is uncertain. Can be considered for oestrogen-induced mammary gland tumours in rats. The use of the implant in birds and reptiles has been reported for a range of behavioural and reproductive (e.g. excessive egg laying) disorders but results appear to be variable.Safety and handling: Pregnant women should not administer the product.Contraindications: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 87 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets88Adverse reactions: Moderate swelling at the implant site may be observed for 14 days. A significant decrease in testicle size will be seen during the treatment period. In very rare cases, a testicle may be able to ascend the inguinal ring.Drug interactions: No information available.DOSESMammals: Ferrets: 1 implant per animal for removal of reproductive behaviour and breeding, as well as treatment of adrenal gland hyperplasia. The 9.4 mg implant (authorized in males only) lasts approximately 3–4 years. The 4.7 mg implant is not authorized in either sex and lasts approximately 2 years. Females will come into oestrus for approximately 2 weeks after implantation; Others: Effects are variable and depend on the exactpathology, species and sex.Birds, Reptiles, Amphibians: 1 implant per animal regardless of size a1.Fish: No information available.Referencesa Petritz OA, Sanchez-Migallon Guzman D, Paul-Murphy J et al. (2013) Evaluation of the efficacy and safety of single administration of 4.7 mg deslorelin acetate implants on egg production and plasma sex hormones in Japanese quail (Coturnix coturnix japonica). American Journal of Veterinary Research 74(2), 316–3231 Keller KA, Beaufrère H, Brandão J et al. (2013) Long-term management of ovarian neoplasia in two cockatiels (Nymphicus hollandicus). Journal of Avian Medicine and Surgery 27(1), 44–52Dexamethasone(Aurizon, Dexadreson, Dexafort, Dexa-ject, Rapidexon, Voren, Dexamethasone*, Maxidex*, Maxitrol*) POM-VFormulations: Ophthalmic: 0.1% solution (Maxidex, Maxitrol). Maxitrol also contains polymyxin B and neomycin. Injectable: 2 mg/ml solution; 1 mg/ml, 3 mg/ml suspension; 2.5 mg/ml suspension with 7.5 mg/ml prednisolone. Oral: 0.5 mg tablet. (1 mg of dexamethasone is equivalent to 1.1 mg of dexamethasone acetate, 1.3 mg of dexamethasone isonicotinate or dexamethasone sodium phosphate, or 1.4 mg of dexamethasone trioxa-undecanoate.)Action: Alters the transcription of DNA, leading to alterations in cellular metabolism which cause reduction in inflammatory response.Use: Anti-inflammatory drug. Also used to prevent and treat anaphylaxis associated with transfusion or chemotherapeutic agents. Anti-inflammatory potency is 7.5 times greater than prednisolone. On a dose basis 0.15 mg dexamethasone is equivalent to 1 mg prednisolone. Dexamethasone has a long duration of action and low mineralocorticoid activity and is particularly suitable for short-term high-dose therapy in conditions where water retention would be a disadvantage. Unsuitable for long-term daily or alternate-day use. Animals on chronic therapy should be tapered off steroids when discontinuing the drug. Use shorter-acting preparations wherever possible in birds and rabbits. The use of long-acting steroids in most ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 88 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 89cases of shock and spinal injury is of no benefit and may be detrimental. Use glucocorticoids with care in rabbits as they are sensitive to these drugs. Used for the treatment of shock, trauma and chronic stress in fish.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in pregnant animals. Systemic corticosteroids are generally contraindicated in patients with renal disease and diabetes mellitus. Impaired wound healing and delayed recovery from infections may be seen. Topical corticosteroids are contraindicated in ulcerative keratitis.Adverse reactions: A single dose of dexamethasone or dexamethasone sodium phosphate suppresses adrenal gland function for up to 32 hours. Prolonged use of glucocorticoids suppresses the hypothalamic-pituitary axis (HPA), causing adrenal atrophy, elevated liver enzymes, cutaneous atrophy, weight loss, PU/PD, vomiting and diarrhoea. GI ulceration may develop. Hyperglycaemia and decreased serum T4 values may be seen in patients receiving dexamethasone. Corticosteroids should be used with care in birds as there is a high risk of immunosuppression and side effects, such as hepatopathy and a diabetes mellitus-like syndrome. Even small single doses, or the use of topical, ocular and aural preparations, can cause severe adverse effects in rabbits.Drug interactions: There is an increased risk of GI ulceration if used concurrently with NSAIDs. The risk of developing hypokalaemia is increased if corticosteroids are administered concomitantly with amphotericin B or potassium-depleting diuretics (furosemide, thiazides). Dexamethasone antagonizes the effect of insulin. Phenobarbital or phenytoin may accelerate the metabolism of glucocorticoids and antifungals (e.g. itraconazole) may decrease it.DOSESMammals: Ophthalmic: Apply small amount of ointment to affected eye(s) q6–24h or 1 drop of solution in affected eye(s) q6–12h. Primates: 0.5–2 mg/kg i.v., i.m., s.c. once (cerebral oedema); 0.25–1 mg/kg i.v., i.m., s.c. q24h (inflammation); Ferrets: 0.5–2.0 mg/kg s.c., i.m., i.v. q24h; 1 mg/kg i.m., i.v. once followed with prednisolone (post adrenalectomy); Rabbits: 0.2–0.6 mg/kg s.c., i.m., i.v. q24h; Guinea pigs: 0.6 mg/kg i.v., i.m., s.c. q24h (pregnancy toxaemia); Others: anti-inflammatory: 0.055–0.2 mg/kg i.m., s.c. q12–24h tapering dose over 3–14 days.Birds: 2–6 mg/kg i.v., i.m. q12–24h.Reptiles: Inflammation, non-infectious respiratory disease: 2–4 mg/kg i.m., i.v. q24h for 3 days.Amphibians: 1.5 mg/kg s.c., i.m. q24h.Fish: 1–2 mg/kg i.m., intraperitoneal or 10 mg/l for 60 minute bath q12–24h 1.References1 Stoskopf MK (1988) Fish chemotherapeutics. In: Veterinary Clinics of North America: Small Animal Practice, ed. MK Stoskopf, pp. 239–346. WB Saunders, PhiladelphiaZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 89 03/09/2015 14:22BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets90Dexmedetomidine(Dexdomitor) POM-VFormulations: Injectable: 0.1 mg/ml, 0.5 mg/ml solution.Action: Agonist at peripheral and central alpha-2 adrenoreceptors producing dose-dependent sedation, muscle relaxation and analgesia.Use: To provide sedation and premedication when used alone or in combination with opioid analgesics. Dexmedetomidine combined with ketamine can be used to provide a short duration (20–30 min) of surgical anaesthesia. Dexmedetomidine is the pure dextroenantiomer of medetomidine. As the levomedetomidine enantiomer is largely inactive, dexmedetomidine is twice as potent as the racemic mixture (medetomidine). Administration of dexmedetomidine reduces the biological load presented to the animal, resulting in quicker metabolism of concurrently administered anaesthetic drugs and a potentially faster recovery from anaesthesia. Dexmedetomidine is a potent drug that causes marked changes in the cardiovascular system, including an initial peripheral vasoconstriction that results in an increase in blood pressure and a compensatory bradycardia. After 20–30 min vasoconstriction wanes, while blood pressure returns to normal values. Heart rate remains low due to the central sympatholytic effect of alpha-2 agonists. These cardiovascular changes result in a fall in cardiac output; central organ perfusion is well maintained at the expense of redistribution of blood flow away from the peripheral tissues. Respiratory system function is well maintained; respiration rate may fall but is accompanied by an increased depth of respiration. Oxygen supplementation is advisable in all animals that have received dexmedetomidine for sedation. Combining dexmedetomidine with an opioid provides improved analgesia and sedation. Lower doses of dexmedetomidine should be used in combination with other drugs. Reversal of dexmedetomidine sedation or premedication with atipamezole at the end of the procedure shortens the recovery period, which is advantageous. Analgesia should be provided with other classes of drugs before atipamezole. High doses (>10 µg/kg) are associated with greater physiological disturbances than doses of 1–10 µg/kg. Using dexmedetomidine in combination with opioids in the lower dose range can provide good sedation and analgesia with minimal side effects. The lower concentration of dexmedetomidine is designed to increase the accuracy of dosing in smaller species.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in animals with cardiovascular or other systemic disease. Use of dexmedetomidine in geriatric patients is not advisable. It should not be used in pregnant animals, nor in animals likely to require or receiving sympathomimetic amines.Adversereactions: Causes diuresis by suppressing ADH secretion, a transient increase in blood glucose by decreasing endogenous insulin secretion, mydriasis and decreased intraocular pressure. ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 90 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 91Vomiting after i.m. administration is common, so dexmedetomidine should be avoided when vomiting is contraindicated (e.g. foreign body, raised intraocular pressure). Due to effects on blood glucose, use in diabetic animals is not recommended. Spontaneous arousal from deep sedation following stimulation can occur with all alpha-2 agonists, aggressive animals sedated with dexmedetomidine must still be managed with caution.Drug interactions: No information available.DOSESWhen used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species.Mammals: See Appendix. Ferrets: 0.04–0.1 mg/kg s.c., i.m.; Rabbits: 0.025–0.05 mg/kg i.v. or 0.05–0.15 mg/kg s.c., i.m.Birds: Buzzards: 0.1 mg atropine + 25 µg/kg dexmedetomidine i.m.; Kestrels: 0.05 mg atropine + 75 µg/kg dexmedetomidine i.m. as induction for isoflurane general anaesthesia a. Reversed when bird is stable with 250 µg atipamezole i.m.Reptiles: Usually combined with ketamine and/or opioids/midazolam to provide light anaesthesia (see Appendix).Amphibians, Fish: No information available.Referencesa Santangelo B, Ferrari D, Di Martino I et al. (2009) Dexmedetomidine chemical restraint of two raptor species undergoing inhalation anaesthesia. Veterinary Research Communications 33(1), 209–211Dextrose see GlucoseDiazepam(Dialar*, Diazemuls*, Diazepam Rectubes*, Rimapam*, Stesolid*, Tensium*, Valclair*, Valium*) POMFormulations: Injectable: 5 mg/ml emulsion (2 ml ampoules, Diazemuls). Oral: 2 mg, 5 mg, 10 mg tablets; 2 mg/5 ml solution. Rectal: 2 mg/ml (1.25, 2.5 ml tubes), 4 mg/ml (2.5 ml tubes) solutions; 10 mg suppositories.Action: Enhances activity of the major inhibitory central nervous system neurotransmitter, gamma-aminobutyric acid (GABA), through binding to the benzodiazepine site of the GABAA receptor.Use: Anticonvulsant, anxiolytic and skeletal muscle relaxant (e.g. urethral muscle spasm and tetanus). Diazepam is the drug of choice for the short-term emergency control of severe epileptic seizures and status epilepticus. In guinea pigs it may be used to reduce the excitability associated with extreme pruritus (e.g. with ectoparasitic infestations). It may also be used in combination with ketamine to offset muscle hypertonicity associated with ketamine, and with opioids and/or acepromazine for pre-anaesthetic medication in the ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 91 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets92critically ill. It provides very poor sedation or even excitation when used alone in healthy animals. Used in birds for the short-term management of feather plucking. Diazepam has a high lipid solubility, which facilitates its oral absorption and rapid central effects. Liver disease will prolong duration of action. In the short term repeated doses of diazepam or a constant rate infusion will lead to drug accumulation and prolonged recovery. Flumazenil (a benzodiazepine antagonist) will reverse the effects of diazepam. The development of dependence to benzodiazepines may occur after regular use, even with therapy of only a few weeks, and the dose should be gradually reduced in these cases if the benzodiazepine is being withdrawn.Safety and handling: Substantial adsorption of diazepam may occur on to some plastics and this may cause a problem when administering diazepam by continuous i.v. infusion. The use of diazepam in PVC infusion bags should be avoided; giving sets should be kept as short as possible and should not contain a cellulose propionate volume-control chamber. If diazepam is given by continuous i.v. infusion the compatible materials include glass, polyolefin, polypropylene and polyethylene.Contraindications: Benzodiazepines should be avoided in patients with CNS depression, respiratory depression, severe muscle weakness or hepatic impairment (as may worsen hepatic encephalopathy). They are also contraindicated in the long-term treatment of behavioural disorders due to the risks of disinhibition and interference with memory and learning.Adverse reactions: Sedation, muscle weakness and ataxia are common. Rapid i.v. injection or oral overdose may cause marked paradoxical excitation (including aggression) and elicit signs of pain; i.v. injections should be made slowly (over at least 1 minute for each 5 mg). Intramuscular injection is painful and results in erratic drug absorption. Rectal administration is effective for emergency control of seizures if i.v. access is not possible, but the time to onset is delayed to 5–10 min. The duration of action may be prolonged after repeated doses in rapid succession, in older animals, those with liver dysfunction, and those receiving beta-1 antagonists. Chronic dosing leads to a shortened half-life due to activation of the hepatic microsomal enzyme system and tolerance to the drug may develop. The propylene glycol formulation of injectable diazepam can cause thrombophlebitis, therefore the emulsion formulation is preferred for i.v. injection.Drug interactions: Do not dilute or mix with other agents. Due to extensive metabolism by the hepatic microsomal enzyme system, interactions with other drugs metabolized in this way are common. Cimetidine and omeprazole inhibit metabolism of diazepam and may prolong clearance. Concurrent use of phenobarbital may lead to a decrease in the half-life of diazepam. An enhanced sedative effect may be seen if antihistamines or opioid analgesics are administered with diazepam, and diazepam will reduce the dose requirement of other anaesthetic agents. When given with diazepam the effects of ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 92 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 93digoxin may be increased. Diazepam may be used in combination with tricyclic antidepressant therapy for the management of more severe behavioural responses.DOSESWhen used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species.Mammals: Primates: sedation and seizures: 0.5–1 mg/kg p.o., i.m.; Sugar gliders, Hedgehogs: sedation and seizures: 0.5–2 mg/kg p.o., s.c., i.m.; Ferrets: seizures: 2–5 mg/kg i.m. once; urethral sphincter muscle relaxation post urinary catheterization or obstruction: 0.5 mg/kg p.o., i.m., i.v. q6–8h; Rabbits: epileptic seizures, pre-anaesthetic sedation, muscle relaxation: 1–5 mg/kg i.v.; Guinea pigs: 0.5–5.0 mg/kg i.m. as required; Chinchillas, Hamsters, Gerbils, Rats, Mice: 2.5–5 mg/kg i.m., intraperitoneal once.Birds: Epileptic seizures: 0.1–1 mg/kg i.v., i.m. once; Appetite stimulant in raptors: 0.2 mg/kg p.o. q24h.Reptiles: Epileptic seizures: 2.5 mg/kg i.m., i.v.Amphibians, Fish: No information available.Diazoxide(Eudemine*) POMFormulations: Injectable: 15 mg/ml solution. Oral: 50 mg tablet.Action: A diuretic that causes vasodilation and inhibits insulin secretion by blocking calcium mobilization.Use: Used to manage hypoglycaemia caused by hyperinsulinism due to insulinoma in ferrets. In humans it is also used in the short-term management of acute hypertension.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: The commonest adverse effects are anorexia, vomiting and diarrhoea. Hypotension, tachycardia, bone marrow suppression, pancreatitis, cataracts and electrolyte and fluid retention may occur. Drug efficacy maydiminish over a period of months.Drug interactions: Phenothiazines and thiazide diuretics may increase the hyperglycaemic activity of diazoxide, whilst alpha-adrenergic blocking agents (e.g. phenoxybenzamine) may antagonize the effects of diazoxide.DOSESMammals: Ferrets: 5–30 mg/kg p.o. q12h.Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 93 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets94Dichlorophen(Dichlorophen Tablets BP) AVM-GSLFormulations: Oral: 500 mg tablet.Action: Cestocide which acts by interfering with oxidative phosphorylation.Use: Control of tapeworm infections. Effective against Taenia and Dipylidium but not Echinococcus. Affected worms are dislodged and disintegrate during their passage along the alimentary tract so they are not easily recognizable when passed 6–8h after dosing. Administer tablets whole or crushed in food.Safety and handling: Normal precautions should be observed.Contraindications: Do not repeat the treatment if vomiting occurs shortly after dosing. Do not administer to animals weighinghence a mild positive inotropic effect. Digoxin slows the heart rate by decreasing the rate of sinoatrial node firing and inhibiting AV nodal conduction. These effects result primarily from parasympathetic activation and sympathetic inhibition, although it may also have a modest direct depression of nodal tissue. The combination of a slower heart rate and increased force of contraction increases cardiac output in patients with supraventricular tachyarrhythmias. Digoxin improves baroreceptor reflexes that are impaired in heart failure.Use: Management of heart failure and supraventricular tachyarrhythmias. It is primarily used to control the ventricular rate in cases of heart failure with concurrent atrial fibrillation. Digoxin/diltiazem combination therapy results in more effective rate control than monotherapy. In ferrets and rabbits it is used in the treatment of dilated cardiomyopathy. Serum levels should be checked after 5–7 days, with a sample taken at least 8 hours post-pill. The bioavailability of digoxin varies between the different formulations: i.v. = 100%; tablets = 60%; and elixir = 75%. If toxic effects are seen or the drug is ineffective, serum levels of digoxin should be assessed; the ideal therapeutic level is a trough serum concentration in the region of 1 ng/ml to optimize beneficial effects and minimize toxic side effects, with a suggested range 0.6–1.2 ng/ml. Decreased dosages or an increase in dosing intervals may be required in geriatric patients, obese animals or those with significant renal dysfunction. The intravenous route is rarely indicated and, if used, should be done very slowly and with extreme care.Safety and handling: Normal precautions should be observed.Contraindications: Frequent ventricular arrhythmias or atrioventricular block.Adverse reactions: Hypokalaemia predisposes to toxicity in all species. Signs of toxicity include anorexia, vomiting, diarrhoea, depression or arrhythmias (e.g. AV block, bigeminy, paroxysmal ventricular or atrial tachycardias with block, and multiform ventricular premature contractions). Lidocaine and phenytoin may be used to control digoxin-associated arrhythmias. Intravenous administration may cause vasoconstriction.Drug interactions: Antacids, chemotherapy agents (e.g. cyclophosphamide, cytarabine, doxorubicin, vincristine), cimetidine and metoclopramide may decrease digoxin absorption from the GI tract. The following may increase the serum level, decrease the ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 97 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets98elimination rate or enhance the toxic effects of digoxin: amiodarone, antimuscarinics, diazepam, erythromycin, loop and thiazide diuretics (hypokalaemia), oxytetracycline, quinidine and verapamil. Spironolactone may enhance or decrease the toxic effects of digoxin.DOSESMammals: Primates: 0.02–0.12 mg/kg i.m., i.v. q12–24h; Hedgehogs: 0.01 mg/kg p.o. q12–24h; Ferrets: 5–10 µg (micrograms)/kg p.o. q12–24h; Rabbits: 3–30 µg/kg p.o. q24–48h; Hamsters: 0.05–0.1 mg/kg p.o. q12–24h.Birds: Raptors: 0.02–0.05 mg/kg p.o. q12h for 2–3 days then reduce to 0.01 mg/kg p.o. q12–24h; Pigeons, Parrots: 0.02–0.05 mg/kg p.o. q24h a.Reptiles, Amphibians, Fish: No information available.Referencesa Wilson RC, Zenoble RD, Horton Jr CR and Ramsey DT (1989) Single dose digoxin pharmacokinetics in the Quaker Conure (Myiopsitta monachus). Journal of Zoo and Wildlife Medicine 20(4), 432–434Diltiazem(Hypercard, Dilcardia SR*) POM-V, POMFormulations: Oral: 10 mg (Hypercard), 60 mg (generic) tablets. Long-acting preparations authorized for humans, such as Dilcardia SR (60 mg, 90 mg, 120 mg capsules), are available but their pharmacokinetics have been little studied in animals to date.Action: Inhibits inward movement of calcium ions through slow (l-type) calcium channels in myocardial cells, cardiac conduction tissue and vascular smooth muscle; vascular smooth muscle is more sensitive to diltiazem than myocardial tissues (relative activity of 7:1). Diltiazem causes a reduction in myocardial contractility (negative inotrope, although less effective than verapamil), depressed electrical activity (retarded atrioventricular conduction) and decreases vascular resistance (vasodilation of cardiac vessels and peripheral arteries and arterioles).Use: Used in ferrets and rabbits as in other species to control supraventricular tachyarrhythmias and for hypertrophic cardiomyopathy. Used to decrease the ventricular rate in atrial fibrillation either as monotherapy or in combination with digoxin. Digoxin/diltiazem combination therapy results in more effective rate control than monotherapy. Diltiazem is preferred to verapamil by many because it has effective antiarrhythmic properties with minimal negative inotropy. Diltiazem is less effective than amlodipine in the management of hypertension. Reduce the dose in patients with hepatic or renal impairment.Safety and handling: Normal precautions should be observed.Contraindications: Diltiazem is contraindicated in patients with second or third degree AV block, marked hypotension or sick sinus ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 98 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 99syndrome, and should be used cautiously in patients with systolic dysfunction or acute or decompensated congestive heart failure.Adverse reactions: No information available.Drug interactions: If diltiazem is administered concurrently with beta-adrenergic blockers (e.g. propranolol), there may be additive negative inotropic and chronotropic effects. The co-administration of diltiazem and beta-blockers is not recommended. The activity of diltiazem may be adversely affected by calcium salts or vitamin D. There are conflicting data regarding the effect of diltiazem on serum digoxin levels and monitoring of these levels is recommended if the drugs are used concurrently. Cimetidine inhibits the metabolism of diltiazem, thereby increasing plasma concentrations. Diltiazem enhances the effect of theophylline, which may lead to toxicity. It may affect quinidine and ciclosporin concentrations. Diltiazem may displace highly protein-bound agents from plasma proteins. Diltiazem may increase intracellular vincristine levels by inhibiting outflow of the drug from the cell.DOSESMammals: Ferrets: 1.5–7.5 mg/kg p.o. q12h; Rabbits: 0.5–1.0 mg/kg p.o. q12–24h 1.Birds, Reptiles, Amphibians, Fish: No information available.References1 Quesenbery K and Carpenter JW (2012) Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery 3rd edition. Saunders, PhiladelphiaDimercaprol (British anti-lewisite)(Dimercaprol*) POMFormulations: Injectable: 50 mg/ml solution in peanut oil.Action: Chelates heavy metals.Use: Treatment of acute toxicity caused by arsenic, gold, bismuth and mercury, and used as an adjunct (with edetate calcium disodium) in lead poisoning.Safety and handling: Normal precautions should be observed.Contraindications: Severe hepatic failure.Adverse reactions: Intramuscular injections are painful. Dimercaprol–metal complexes are nephrotoxic. This is particularly so with iron, selenium or cadmium; do not use for these metals. Alkalinization of urine during therapy may have protective effects for the kidney.Drug interactions: Iron salts should not be administered during therapy.DOSESBirds: 2.5 mg/kg i.m. q4h for 2 days then q12h until signs resolve 12.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 99 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets100Mammals, Reptiles, Amphibians, Fish: No information available.References1 De Francisco N, Ruiz Troya JD and Agüera EI (2003) Lead and lead toxicity in domestic and free livingbirds. Avian Pathology 32(1), 3–132 Richardson JA, Murphy LA, Khan SA and Means C (2001) Managing pet bird toxicoses. Exotic DVM 3(1), 23–27Dimethylsulfoxide (DMSO)(Rimso-50*) POMFormulations: Injectable: 50%, 90% liquid; medical grade only available as a 50% solution, other formulations are available as an industrial solvent. Topical: 70%, 90% gel; 70% cream.Action: The mechanism of action is not well understood. Antioxidant activity has been demonstrated in certain biological settings and is thought to account for the anti-inflammatory activity.Use: Management of otitis externa and haemorrhagic cystitis induced by cyclophosphamide. Although efficacy is unproven it has been used in the treatment of renal amyloidosis. In humans, DMSO is authorized for the treatment of interstitial cystitis. DMSO is very rapidly absorbed through the skin following administration by all routes and is distributed throughout the body. Metabolites of DMSO are excreted in the urine and faeces. DMSO is also excreted through the lungs and skin, producing a characteristic sulphuric odour. Humans given DMSO experience a garlic-like taste sensation after administration.Safety and handling: Should be kept in a tightly closed container because it is very hygroscopic. Gloves should be worn during topical application and the product should be handled with care.Contraindications: No information available.Adverse reactions: Adverse effects include local irritation and erythema caused by local histamine release. Administration i.v. of solutions with concentrations >20% may cause haemolysis and diuresis.Drug interactions: DMSO should not be mixed with other potentially toxic ingredients when applied to the skin because of profound enhancement of systemic absorption.DOSESBirds: May be applied topically to lesions (e.g. bumblefoot) as an anti-inflammatory prior to surgery. May be combined with other drugs as a carrying agent.Mammals, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 100 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 101Dimetridazole (Emtryl)(Octozin) ESPAFormulations: Immersion: 8.5% tablet for dissolution in water.Action: This is unclear, but it is thought to be absorbed by susceptible organisms and bind to DNA, affecting normal DNA function and causing cell death.Use: For the treatment of some protozoan endoparasites and ectoparasites in fish (e.g. those thought to cause ‘hole-in-the-head’ in cichlids and Ichthyophthirius). Banned from use in food-producing animals.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 28 mg/kg p.o. (in feed) q24h for 10 days 1; follow the manufacturer’s recommendations for proprietary formulations.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, DordrechtDimilin see DiflubenzuronDinoprost tromethamine (Prostaglandin F2)(Enzaprost, Lutalyse) POM-VFormulations: Injectable: 5 mg/ml solution.Action: Stimulates uterine contraction, causes cervical relaxation and inhibits progesterone production by the corpus luteum.Use: Used in the termination of pregnancy at any stage of gestation and to stimulate uterine contractions in the treatment of open pyometra. Possesses prokinetic effects on the caecum of the rabbit.Safety and handling: Pregnant woman and asthmatics should avoid handling this agent.Contraindications: Do not use for the treatment of closed pyometra as there is a risk of uterine rupture.Adverse reactions: Hypersalivation, panting, tachycardia, vomiting, urination, defecation, transient hyperthermia, locomotor incoordination ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 101 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets102and mild CNS signs have been reported. Such effects usually diminish within 30 min of drug administration. There is no adverse effect on future fertility. Severe adverse effects are reported in birds.Drug interactions: The effect of oxytocin would be potentiated by prostaglandins and inhibited by progestogens.DOSESMammals: Rabbits: 0.2 mg/kg single i.m. injection following 3 days of oral liquid paraffin to assist in emptying impacted caecal contents.Birds: Do not use.Reptiles, Amphibians, Fish: No information available.Dinoprostone (Prostaglandin E2)(Prostin E2*) POMFormulations: Topical: 0.4 mg/ml gel.Action: Stimulates uterine contraction, causes cervical relaxation and inhibits progesterone production by the corpus luteum.Use: Used to relax the vagina and induce uterine contractions in egg-bound birds.Safety and handling: Pregnant woman and asthmatics should avoid handling this agent.Contraindications: No information available.Adverse reactions: Uterine rupture may occur.Drug interactions: No information available.DOSESBirds: Apply a thin layer of gel to the cloacal mucosa once.Mammals, Reptiles, Amphibians, Fish: No information available.Diphenhydramine(Dreemon*, Nytol*) PFormulations: Oral: 25 mg tablet; 2 mg/ml solution. Other products are available of various concentrations and most contain other active ingredients.Action: The antihistaminergic (H1) effects are used to reduce pruritus and prevent motion sickness. It is also a mild anxiolytic and sedative.Use: In birds it is used in the management of allergic rhinitis, hypersensitivity reactions and allergic dermatopathies. In ferrets it is used before vaccination if a previous vaccine reaction has been encountered, or for prevention of sneezing or coughing when these interrupt eating or sleeping. In rabbits it may also be used to reduce possible nausea associated with torticollis. Liquid is very distasteful.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 102 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 103Safety and handling: Normal precautions should be observed.Contraindications: Urine retention, glaucoma and hyperthyroidism.Adverse reactions: No information available.Drug interactions: An increased sedative effect may occur if used with benzodiazepines or other anxiolytics/hypnotics. Avoid the concomitant use of other sedative agents. Diphenhydramine may enhance the effect of adrenaline and partially counteract anticoagulant effects of heparin.DOSESMammals: Primates: 5 mg/kg p.o., i.m. q8h; Ferrets: 0.5–2 mg/kg p.o., s.c. q8–12h for allergic reactions; for preventative management of vaccination reactions, give the high end of the dose range by i.m. injection prior to vaccination; Rabbits: 2 mg/kg p.o., s.c., i.m. q12h for torticollis 1; Guinea pigs: 1–5 mg/kg s.c. prn; Chinchillas, Hamsters, Rats, Mice: 1–2 mg/kg p.o., s.c. q12h.Birds: 2–4 mg/kg p.o. q12h.Reptiles, Amphibians, Fish: No information available.References1 Quesenbery K and Carpenter JW (2012) Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery 3rd edition. Saunders, PhiladelphiaDomperidone(Domperidone*, Motilium*) POMFormulations: Oral: 10 mg tablet, 1 mg/ml suspension.Action: A potent antiemetic with a similar mechanism of action to metoclopramide, but with fewer adverse CNS effects as it cannot penetrate the blood–brain barrier. It is gastrokinetic in humans and rabbits.Use: Treatment of vomiting and reduced gastrointestinal motility. In rabbits, it has a significant prokinetic action on gastric emptying.Safety and handling: Normal precautions should be observed.Contraindications: Intestinal obstruction or perforation.Adverse reactions: No information available.Drug interactions: No informationavailable.DOSESMammals: Rabbits: 0.5 mg/kg p.o. q12h. Contraindicated in GI obstruction.Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 103 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets104Dopamine(Dopamine*) POMFormulations: Injectable: 200 mg in 5 ml vial (40 mg/ml solution), 800 mg in a 5 ml vial (160 mg/ml solution).Action: Dopamine is an endogenous catecholamine and precursor of noradrenaline, with direct and indirect (via release of noradrenaline) agonist effects on dopaminergic and beta-1 and alpha-1 adrenergic receptors.Use: Improvement of haemodynamic status. Main indications are treatment of shock following correction of fluid deficiencies, acute heart failure, and support of blood pressure during anaesthesia. Dobutamine is preferred for support of systolic function in patients with heart failure. Dopamine is a potent and short-acting drug, therefore it should be given in low doses by continuous rate infusion, and accurate dosing is important. Dopamine should be diluted in normal saline to an appropriate concentration. At low doses (10 µg/kg/min) dopaminergic effects are overridden by the alpha effects, resulting in an increase in systemic vascular resistance and reduced peripheral blood flow. Dopamine has been shown to vasodilate mesenteric blood vessels via DA1 receptors. There may be an improvement in urine output but this may be entirely due to inhibition of proximal tubule sodium ion reabsorption and an improved cardiac output and blood pressure rather than directly improving renal blood flow. The dose of dopamine should be adjusted according to clinical effect, therefore monitoring of arterial blood pressure during administration is advisable. All sympathomimetic drugs have pro-arrhythmic properties, therefore ECG monitoring is advised.Safety and handling: Solution should be discarded if it becomes discoloured.Contraindications: Discontinue or reduce the dose of dopamine should cardiac arrhythmias arise.Adverse reactions: Extravasation of dopamine causes necrosis and sloughing of surrounding tissue due to tissue ischaemia. Should extravasation occur, infiltrate the site with a solution of 5–10 mg phentolamine in 10–15 ml of normal saline using a syringe with a fine needle. Nausea, vomiting, tachyarrhythmias and changes in blood pressure are the most common adverse effects. Hypotension may develop with low doses, and hypertension may occur with high doses. Sudden increases in blood pressure may cause a severe bradycardia. All dopamine-induced arrhythmias are most effectively treated by stopping the infusion.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 104 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 105Drug interactions: Risk of severe hypertension when monoamine oxidase inhibitors, doxapram and oxytocin are used with dopamine. Halothane may increase myocardial sensitivity to catecholamines. The effects of beta-blockers and dopamine are antagonistic.DOSESMammals: Guinea pigs: 0.08 mg/kg i.v. prn.Birds, Reptiles, Amphibians, Fish: No information available.Dorzolamide(CoSopt*, Dorzolamide*, Dorzolamide with Timolol*, Trusopt*) POMFormulations: Ophthalmic drops: 20 mg/ml (2%) (Dorzolamide, Trusopt), 2% dorzolamide + 0.5% timolol (CoSopt, Dorzolamide with Timolol); 5 ml bottle, single-use vials (CoSopt, Trusopt).Action: Reduces intraocular pressure by reducing the rate of aqueous humour production by inhibiting the formation of bicarbonate ions within the ciliary body epithelium.Use: In the control of all types of glaucoma, either alone or in combination with other topical drugs. It may be less tolerated than brinzolamide because of its less physiological pH of 5.6. The concurrent use of a topical and a systemic carbonic anhydrase inhibitor is not beneficial as there is no additional decrease in intraocular pressure compared with either route alone.Safety and handling: Normal precautions should be observed.Contraindications: Severe hepatic or renal impairment. Dorzolamide/timolol is not the drug of choice in uveitis or anterior lens luxation.Adverse reactions: Local irritation and blepharitis. Dorzolamide may cause more local irritation than brinzolamide. Dorzolamide/timolol causes miosis.Drug interactions: No information available.DOSESMammals: Rabbits: 1 drop/eye q8–12h; Rats: 1 drop 1% solution (dilute standard formulation with sterile water) q12h.Birds: 1 drop/eye q12h 1.Reptiles, Amphibians, Fish: No information available.References1 Fordham M, Rosenthal K, Durham A, Duda L and Komáromy AM (2010) Intraocular osteosarcoma in an Umbrella cockatoo (Cacatua alba). Veterinary Ophthalmology 13, 103–108ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 105 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets106Doxapram(Dopram-V) POM-VPS, POM-VFormulations: Injectable: 20 mg/ml solution. Oral: 20 mg/ml drops.Action: Stimulates respiration by increasing the sensitivity of aortic and carotid body chemoreceptors to arterial gas tensions.Use: Stimulates respiration during and after general anaesthesia. In neonatal animals, used to stimulate or initiate respiration after birth, particularly in those delivered by caesarean section. The dose should be adjusted according to the requirements of the situation; adequate but not excessive doses should be used. A patent airway is essential. Must not be used indiscriminately to support respiratory function. Severe respiratory depression should be controlled by tracheal intubation, followed by IPPV and then resolution of the initiating cause. Duration of effect in mammals is 15–20 minutes. Has also been used to aid assessment of laryngeal function under light anaesthesia. Not effective at stimulating respiration in the face of hypoxaemia (pre-oxygenation of hypoventilating neonates is recommended, along with removal of obstructive secretions). Used for the treatment of respiratory depression in fish.Safety and handling: Protect from light.Contraindications: Do not use in animals without a patent airway.Adverse reactions: Overdose can cause excessive hyperventilation, which may be followed by reduced carbon dioxide tension in the blood leading to cerebral vasoconstriction. This could result in cerebral hypoxia in some animals. Doxapram is irritant and may cause a thrombophlebitis, avoid extravasation or repeated i.v. injection into the same vein. Use doxapram injection with caution in neonates because it contains benzyl alcohol which is toxic. Overdosage signs include hypertension, skeletal muscle hyperactivity, tachycardia and generalized CNS excitation including seizures; treatment is supportive using short-acting i.v. barbiturates or propofol and oxygen. Effects in pregnant/lactating animals are not known.Drug interactions: Hypertension may occur with sympathomimetics. The use of theophylline concurrently with doxapram may cause increased CNS stimulation. As doxapram may stimulate the release of adrenaline, its use within 10 min of the administration of anaesthetic agents that sensitize the myocardium to catecholamines (e.g. halothane) should be avoided. Doxapram is compatible with 5% dextrose or normal saline, but is incompatible with sodium bicarbonate or thiopental. High doses administered during or after anaesthesia with halogenated hydrocarbon anaesthetics, such as halothane, may precipitate cardiac arrhythmias. Doxapraminjection should be used with extreme caution in animals that have been sedated with morphine. Administration of doxapram at 10 mg/kg to such animals may be followed by convulsions.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 106 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 107DOSESMammals: Primates, Hedgehogs, Ferrets, Rabbits, Chinchillas, Hamsters, Gerbils, Rats, Mice: 5–10 mg/kg i.v., i.m., intraperitoneal, sublingual once; Sugar gliders: 2 mg/kg i.v. once; Guinea pigs: 2–5 mg/kg i.v., s.c., intraperitoneal once.Birds: 5–20 mg/kg i.m., i.v., intratracheal, intraosseous once 1.Reptiles: 4–12 mg/kg i.m., i.v., p.o. once.Amphibians: No information available.Fish: 5 mg/kg i.v., intraperitoneal 23, topically to the gills 4.References1 Lierz M and Korbel R (2012) Anesthesia and analgesia in birds. Journal of Exotic Pet Medicine 21(1), 44–582 Hadfield C, Whitaker BR and Clayton LA (2007) Emergency and critical care of fish. Veterinary Clinics of North America: Exotic Animal Practice 10, 647–6753 Stoskopf MK (1988) Fish chemotherapeutics. Veterinary Clinics of North America: Small Animal Practice 18(2), 331–3484 Stoskopf MK (1993) Fish Medicine. Saunders, PhiladelphiaDoxepin(Sinepin*, Sinequan*, Zonalon*) POMFormulations: Oral: 25 mg, 50 mg capsules.Action: Doxepin blocks noradrenaline and serotonin re-uptake in the brain, resulting in antidepressive activity, while the H1 and H2 blockage result in antipruritic effects. Its metabolite, desmethyldoxepin, is also psychoactive.Use: Management of pruritus and psychogenic dermatoses where there is a component of anxiety, including compulsive disorders. Data are lacking as to its efficacy at the suggested doses. Used in birds for organophosphate toxicity. When used in birds it is important to monitor for cardiac arrhythmias.Safety and handling: Normal precautions should be observed.Contraindications: Hypersensitivity to tricyclic antidepressants, glaucoma, history of seizures or urinary retention and severe liver disease.Adverse reactions: Sedation, dry mouth, diarrhoea, vomiting, excitability, arrhythmias, hypotension, syncope, increased appetite, weight gain and, less commonly, seizures and bone marrow disorders have been reported in humans.Drug interactions: Should not be used with monoamine oxidase inhibitors or drugs which are metabolized by cytochrome P450 2D6, e.g. chlorphenamine and cimetidine.DOSESBirds: Feather plucking: 1–2 mg/kg p.o. q12h 1; organophosphate toxicity: 0.2 mg/kg i.m. q4h.Mammals, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 107 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets108References1 van Zeeland YRA, Spruit BM, Rodenburg TA et al. (2009) Feather damaging behaviour in parrots: a review with consideration of comparative aspects. Applied Animal Behaviour Science 121(2), 75–95Doxorubicin (Adriamycin)(Doxorubicin*) POMFormulations: Injectable: 10 mg, 50 mg powders for reconstitution; 10 mg, 50 mg/vial solutions.Action: Inhibits DNA synthesis and function.Use: Treatment of lymphoma in the ferret. Has been used to treat lymphoma in a green iguana. It may be used alone or in combination with other antineoplastic therapies. Premedication with i.v. chlorphenamine or dexamethasone is recommended. Doxorubicin is highly irritant and must be administered via a preplaced i.v. catheter. The reconstituted drug should be administered over a minimum period of 10 min into the side port of a freely running i.v. infusion of 0.9% NaCl. Do not use heparin flush. May need to reduce dose in patients with liver disease. Use with caution in patients previously treated with radiation as can cause radiation recall. See specialist texts for protocols and further advice.Safety and handling: Potent cytotoxic drug that should only be prepared and administered by trained personnel. See specialist texts for further advice on chemotherapeutic agents. After reconstitution the drug is stable for at least 48h at 4°C. A 1.5% loss of potency may occur after 1 month at 4°C but there is no loss of potency when frozen at –20°C. Filtering through a 0.22 µm filter will ensure adequate sterility of the thawed solution. Store unopened vials under refrigeration.Contraindications: Do not use in patients with existing cardiac or renal disease.Adverse reactions: Allergic reactions have been reported; acute anaphylactic reactions should be treated with adrenaline, steroids and fluids. Doxorubicin causes a dose-dependent cumulative cardiotoxicity in dogs (leading to cardiomyopathy and congestive heart failure), and this may be of concern in ferrets. The risk of cardiotoxicity is greatly increased when the cumulative dose is >240 mg/m2. It may also cause tachycardia and arrhythmias on administration; monitor with ECG and/or echocardiograms. Anorexia, vomiting, severe leucopenia, thrombocytopenia, haemorrhagic gastroenteritis and nephrotoxicity are the major adverse effects. A CBC and platelet count should be monitored whenever therapy is given. If the neutrophil count drops below 3 x 109/l or the platelet count drops below 50 x 109/l, treatment should be suspended. Once the counts have stabilized, doxorubicin can be restarted at the same dose. If haematological toxicity occurs again, or if GI toxicity is recurrent, the dose should be reduced by 10–25%. Extravasation ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 108 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 109injuries secondary to perivascular administration may be serious, with severe tissue ulceration and necrosis possible. Dexrazoxane can be used to treat extravasation if it occurs. Ice compresses may also be beneficial (applied for 15 min q6h).Drug interactions: Barbiturates increase plasma clearance of doxorubicin. The agent causes a reduction in serum digoxin levels. Do not mix doxorubicin with other drugs. Doxorubicin is incompatible with dexamethasone, 5-fluorouracil and heparin; concurrent use will lead to precipitate formation.DOSESMammals: Ferrets: 20 mg/m2 or 1–2 mg/kg i.v. every 3 weeks for a maximum of 5 doses. Also used for 2 doses as part of specific multi-drug protocols for lymphoma in ferrets (see Appendix and relevant specialist texts).Birds: No information available.Reptiles: 0.26–0.75 mg/kg i.v. reported as part of a successful chemotherapy protocol in a green iguana 1.Amphibians, Fish: No information available.References1 Folland DW, Johnston MS, Thamm DH and Reavill D (2011) Diagnosis and management of lymphoma in a green iguana (Iguana iguana). Journal of the American Veterinary Medical Association 239(7), 985–991Doxycycline(Doxyseptin 300, Ornicure, Pulmodox, Ronaxan, Vibramycin*, Vibravenos*) POM-VFormulations: Oral: 20 mg, 100 mg tablets (Ronaxan), 300 mg tablets (Doxyseptin); 260 mg/sachet powder (Ornicure). Injectable: 20 mg/ml long-acting injection (Vibravenos; import on an STC).Action: Bacteriostatic agent inhibiting protein synthesis at the initiation step by interacting with the 30S ribosomal subunit.Use: Antibacterial (including spirochaetes such as Helicobacter and Campylobacter), antirickettsial, antimycoplasmal and antichlamydial activity. It is the drug of choice to treat avian chlamydophilosis; treatment may be required for 6 weeks in birds. It is not affected by, and does not affect, renal function as it is excreted in faeces, and is therefore recommended when tetracyclines are indicated in animals with renal impairment. It is preferred by some authors to oxytetracycline for use in birds. Being extremely lipid-soluble, it penetrates well into prostatic fluid and bronchial secretions. Administer with food. Injection is very irritantUse of an unauthorized medicine provides none of these safeguards and may, therefore, pose potential risks that the authorization process seeks to minimize.Medicinesmaybeused‘off-label’foravarietyofreasonsincluding:• Noauthorizedproductissuitablefortheconditionorspecificsubpopulation being treated• Need to alter the duration of therapy, dosage, route of INTRODUCTION2 Intro.indd 10 12/02/2015 09:27Introduction xiadministration,etc.,totreatthespecificconditionpresented• Anauthorizedproducthasprovedineffectiveinthecircumstances of a particular case (all cases of suspected lack of efficacyofauthorizedveterinarymedicinesshouldbereportedtothe VMD).Responsibility for the use of a medicine ‘off-label’ lies solely with the prescribing veterinary surgeon. He or she should inform the ownerofthereasonwhyamedicineistobeused‘off-label’andrecord this reason in the patient’s clinical notes. When electing to use amedicine‘off-label’always:• Discuss all therapeutic options with the owner• Use the cascade to determine your choice of medicine• Obtain signed informed consent if an unauthorized product is to be used, ensuring that all potential problems are explained to the client• Administerunauthorizedmedicinesagainstapatient-specificprescription. Do not administer to a group of animals if at all possible.An‘off-label’medicinemustshowacomparativeclinicaladvantagetotheauthorizedproductinthespecificcircumstancespresented(whereapplicable).Medicinesmaybeused‘off-label’inthefollowingways (this is not an exhaustive list):• Authorized product at an unauthorized dose• Authorized product for an unauthorized indication• Authorized product used outwith the authorized age range• Authorized product administered by an unauthorized route• Authorized product used to treat an animal in an unauthorized physiological state, e.g. pregnancy (i.e. an unauthorized indication)• Productauthorizedforuseinhumansoradifferentanimalspecies to that being treated.Adverseeffectsmayormaynotbespecificforaspecies,andidiosyncraticreactionsarealwaysapossibility.Ifnoadverseeffectsarelisted,considerdatafromdifferentspecies.Whenusingnovelorunfamiliar drugs, consider pharmaceutical and pharmacological interactions. In some species, and with some diseases, the ability to metabolize/excrete a drug may be impaired/enhanced. Use the lowest dosethatmightbeeffectiveandthesafestrouteofadministration.Ensure that you are aware of the clinical signs that may suggest toxicity.Informationon‘off-label’usemaybeavailablefromawidevarietyofsources (see Further reading and useful websites).Drug storage and dispensingFor further information on the storage and dispensing of medicines see the BSAVA Guide to the Use of Veterinary Medicines available at www.bsava.com. Note the recent change in legislation, which states INTRODUCTION2 Intro.indd 11 12/02/2015 09:27Introductionxiithat veterinary surgeons may only supply a veterinary medicine from practice premises that are registered with the RCVS and that these premises must be inspected. It is recommended that, in general, medications are kept in and dispensed in the manufacturer’s original packaging.Medicinescanbeadverselyaffectedbyadversetemperatures, excessive light, humidity and rough handling. Loose tablets or capsules that are repackaged from bulk containers should be dispensed in child-resistant containers and supplied with a package insert (if one exists). Tablets and capsules in foil strips should be sold in their original packaging or in a similar cardboard box for smaller quantities. Preparations for external application shouldbedispensedincolouredflutedbottles.Oralliquidsshouldbedispensed in plain glass bottles with child-resistant closures.All medicines should be labelled. The label should include:• The owner’s name and address• Identificationoftheanimal• Date (and, if applicable, the expiry date)• Product name (and strength)• Total quantity of the product supplied in the container• Instructions for dosage• Practice name and address• The name of the veterinary surgeon who prescribed the medication (if not an authorized use)• Anyspecificpharmacyprecautions(includingstorage,disposal,handling)• The wording ‘Keep out of reach of children’ and ‘For animal treatment only’• Any other necessary warnings.The words ‘For external use only’ should be included on labels for products for topical use. All labels should be typed. If this information cannotbefittedonasinglelabelthenitispermissibletoincludetheinformation on a separate sheet.For medicines that are not authorized for veterinary use, and even for some that are, it is useful to add to the label or on a separate informationsheetthelikelyadverseeffects,druginteractionsandtheaction to be taken in the event of inadvertent mis-dosing or incorrect administration written in plain English.In order to comply with the current Veterinary Medicines Regulations, records of all products supplied on prescription must be kept for 5 years. When a batch is brought into use in a practice, the batch number and date should be recorded. It is not necessary to record the batch number of each medication used for a given animal.Health and safety in dispensingAll drugs are potentially poisonous to humans as well as animals. Toxicity may be mild or severe and includes carcinogenic and INTRODUCTION2 Intro.indd 12 12/02/2015 09:27Introduction xiiiteratogeniceffects.Warningsaregiveninthemonographs.However,risks to humans dispensing medicines are not always well characterized and idiosyncratic reactions may occur. It is good practice for everyone to wear protective clothing (including gloves) when directly handling medicines, not to eat or drink (or store food or drink) near medicines, and to wash their hands frequently when working with medicines. Gloves, masks and safety glasses should be worn if handling potentially toxic liquids, powders or broken tablets. Do not break tablets of antineoplastic cytotoxic drugsanduselaminarflowcabinetsforthepreparationanddispensing of these medications.Many prescribers and users of medicines are not aware of the carcinogenic potential of the drugs they are handling. Below are lists of medicines included in the BSAVA Formulary that are known or potential carcinogens or teratogens. The lists are not all-inclusive: they include only those substances that have been evaluated. Most of the drugs are connected only with certain kinds of cancer. The relative carcinogenicity of the agents varies considerably and some do not cause cancer at all times or under all circumstances. Some may only be carcinogenic or teratogenic if a person is exposed in a certain way (for example, ingesting as opposed to touching the drug). For more detailed information refer to the International Agency for Research on Cancer (IARC) or the National Toxicology Program (NTP) (information is available on their respective websites).Examples of drugs known or suspected to be human carcinogens (c) or teratogens (t):ACE inhibitors (t), e.g. benazepril, enalaprilAndrogenic (anabolic) steroids (t, c)Antibiotics (c), e.g. metronidazole, chloramphenicolAntibiotics (t) e.g. aminoglycosides, doxycycline, trimethoprim, sulphonamidesAntifungals(c),e.g.fluconazole,itraconazoleAntineoplastic drugs (c, t) – allAntithyroid drugs (t), e.g. carbimazole/methimazoleBeta-blockers (t)Deferoxamine (t)Diltiazem (t)Finasteride (t)Immunosuppressives (c), e.g. azathioprine, ciclosporinMethotrexate (t)Misoprostol (t)NSAIDs (t)Penicillamine (t)Phenoxybenzamine (c)Progesterone (c) and some oestrogens (c)Vitamin A (t)Note that most carcinogens are also likelyin birds: must alternate injection sites or divide dose if large volume to inject.Safety and handling: Normal precautions should be observed.Contraindications: Do not administer to pregnant animals. Do not administer if there is evidence of oesophagitis or dysphagia.ZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 109 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets110Adverse reactions: Nausea, vomiting and diarrhoea. Oesophagitis and oesophageal ulceration may develop; administer with food or a water bolus to reduce this risk. Administration during tooth development may lead to discoloration of the teeth, although the risk is less than with other tetracyclines.Drug interactions: Absorption of doxycycline is reduced by antacids, calcium, magnesium and iron salts, although the effect is less marked than seen with water-soluble tetracyclines. Phenobarbital and phenytoin may increase its metabolism, thus decreasing plasma levels. Do not use in combination with bactericidal antimicrobials.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 3–4 mg/kg p.o. q12h; Hedgehogs: 2.5–10 mg/kg p.o., s.c., i.m. q12h; Rabbits: 2.5–4 mg/kg p.o. q24h; Rats, Mice: 5 mg/kg p.o. q12h; Other rodents: 2.5 mg/kg p.o. q12h or 70–100 mg/kg s.c., i.m. of the long-acting preparation (Vibravenos); however, this is not currently permitted under the STA required to import this product 1.Birds: Raptors: 50 mg/kg p.o. q12h, 100 mg/kg i.m. q7d (Vibravenos); Parrots: 15–50 mg/kg p.o. q24h, 1000 mg/kg in soft food/dehulled seed, 75–100 mg/kg i.m. q7d (Vibravenos; lowest dose rate for macaws) abcd; course of treatment with doxycycline for chlamydophilosis = 45 days; Passerines/Pigeons: 40 mg/kg p.o. 12–24h, 200–500 mg/l in water (soft or deionized water only).Reptiles: 50 mg/kg i.m. once, then 25 mg/kg i.m. q72h.Amphibians: 50 mg/kg i.m. q7d.Fish: No information available.Referencesa Flammer K and Papich M (2005) Assessment of plasma concentrations and effects of injectable doxycycline in three psittacine species. Journal of Avian Medicine and Surgery 19(3), 216–224b Flammer K and Whitt-Smith D (2001) Plasma concentrations of doxycycline in selected psittacine birds when administered in water for potential treatment of Chlamydophila psittaci infection. Journal of Avian Medicine and Surgery 15(4), 276–282c Powers LV, Flammer K and Papich M (2000) Preliminary investigation of doxycycline plasma concentrations in Cockatiels (Nymphicus hollandicus) after administration by injection or in water or feed. Journal of Avian Medicine and Surgery 14(1), 23–30d Saturation T (2008) Administration of doxycycline in drinking water for treatment of spiral bacterial infection in Cockatiels. Journal of Zoo and Wildlife Medicine 39(3), 499–5011 Quesenbery K and Carpenter JW (2012) Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery 3rd edition. Saunders, PhiladelphiaZYXWVUTSRQPONMLKJIHGFEDCBADd.indd 110 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 111Edetate calcium disodium (CaEDTA)(Ledclair*) POMFormulations: Injectable: 200 mg/ml solution.Action: Heavy metal chelating agent.Use: Lead 1 and zinc poisoning. Dilute strong solution to a concentration of 10 mg/ml in 5% dextrose before use. Blood lead levels may be confusing, therefore monitor clinical signs during therapy. Measure blood lead levels 2–3 weeks after completion of treatment in order to determine whether a second course is required or if the animal is still being exposed to lead. Ensure there is no lead in the GI tract before administering (e.g. use laxatives) nor any residual heavy metals elsewhere (e.g. powdered zinc in coat or an environmental source).Safety and handling: Normal precautions should be observed.Contraindications: Use with caution in patients with impaired renal function.Adverse reactions: Reversible nephrotoxicity is usually preceded by other clinical signs of toxicity (e.g. depression, vomiting, diarrhoea). Injections are painful.Drug interactions: No information available.DOSESMammals: Ferrets: 20–30 mg/kg s.c. q12h; Rabbits: 27.5 mg/kg s.c. q6h; Rodents: 25–30 mg/kg s.c. q6–12h. Repeat treatment for 5 days on, 5 days off until blood lead or zinc levels are normal when measured at the end of the period off treatment.Birds: 35–50 mg/kg i.m., s.c. q12h for 5 days followed by 2 days of no treatment, then repeat until metal particles are no longer visible on radiographs a. 100 mg/kg i.m. weekly has been proposed in zinc toxicosis.Reptiles: 10–40 mg/kg i.m. q12h has been suggested.Amphibians, Fish: No information available.Referencesa Sears J, Cooke SW, Cooke ZR and Heron TJ (1989) A method for the treatment of lead poisoning in the mute swan (Cygnus olor) and its long-term success. British Veterinary Journal 145(6), 586–5951 Clarke EGC (1973) Lead poisoning in small animals. Journal of Small Animal Practice 14(4), 183–194Emamectin benzoate(Lice-Solve) ESPAFormulations: Immersion: 10 g, 100 g sachets of powder containing 1.4% emamectin.Action: Irreversibly binds to and opens GABA and glutamate-gated channels, leading to flaccid paralysis and death of the parasite.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 111 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets112Use: Treatment of crustacean parasites of fish (Argulus, Ergasilus spp.). For use in closed water systems. Turn off UV and carbon filters for 24 h after adding the product to the water. Ensure good aeration of the water during treatment. Emamectin rapidly biodegrades in sunlight. Do not dispose of down drains or in waterways.Safety and handling: Normal precautions should be observed.Contraindications: Do not use at the same time as other fish or pond treatments. Do not use in ponds containing orfe (Leuciscus spp.) or turtles.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 56 µg (micrograms)/l by prolonged immersion, repeat after 1 month.Mammals, Birds, Reptiles, Amphibians: No information available.Emodepside(Profender) POM-VFormulations: Topical: 21.4 mg/ml emodepside with praziquantel solution in spot-on pipettes.Action: Stimulates presynaptic secretin receptors resulting in paralysis and death of the parasite.Use: Treatment of roundworms (adult and immature) and tapeworms (adult) including Toxocara cati, Toxascaris leonina, Ancylostoma tubaeforme, Aelurostrongylus abstrusus, Dipylidium caninum, Taenia taeniaeformis, Echinococcus multilocularis. Do not shampoo until substance has dried. Treatment of a variety of reptile endoparasites including oxyurids, ascarids, strongylids, trichostrongylids and capillarids.Safety and handling: Women of child-bearing age should avoid contact with this drug or wear disposable gloves when using it.Contraindications: Studies in rabbits and rats suggest it may interfere with fetal development in utero.Adverse reactions: Ingestion may result in salivation or vomiting. Harmful to aquatic animals.Drug interactions: Possible interaction with P-glycoprotein substrates/inhibitors.DOSESMammals: Rabbits: 0.14 ml/kg topically once (reported for Trichostrongylus colubriformis) 1. Do not use if the rabbit is pregnant.Birds: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 112 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 113Reptiles: 1.12 ml/kg, corresponding to 24 mg emodepside and 96 mg praziquantel/kg, topically once a.Amphibians, Fish: No information available.Referencesa Schilliger L, Betremieux O, Rochet J, Krebber R and Schaper R (2009) Absorption and efficacy of a spot-oncombination containing emodepside plus praziquantel in reptiles. Revue de Médecine Vétérinaire 160(12), 557–5611 Mencke N and Bach T (2007) Managing gastrointestinal helminths in small animals. Compendium of Continuing Education for Practicing Veterinarians 29, 13–16Emtryl see DimetridazoleEnalapril(Enacard) POM-VFormulations: Oral: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg tablets.Action: Angiotensin converting enzyme (ACE) inhibitor. It inhibits conversion of angiotensin I to angiotensin II and inhibits the breakdown of bradykinin. Overall effect is a reduction in preload and afterload via venodilation and arteriodilation, decreased salt and water retention via reduced aldosterone production and inhibition of the angiotensin-aldosterone-mediated cardiac and vascular remodelling. Efferent arteriolar dilation in the kidney can reduce intraglomerular pressure and therefore glomerular filtration. This may decrease proteinuria.Use: Treatment of congestive heart failure caused by mitral regurgitation or dilated cardiomyopathy. Often used in conjunction with diuretics when heart failure is present as most effective when used in these cases. Can be used in combination with other drugs to treat heart failure (e.g. pimobendan, spironolactone, digoxin). May be beneficial in cases of chronic renal insufficiency, particularly protein-losing nephropathies. May reduce blood pressure in hypertension. ACE inhibitors are more likely to cause or exacerbate prerenal azotaemia in hypotensive animals and those with poor renal perfusion (e.g. acute, oliguric renal failure). Use cautiously if hypotension, hyponatraemia or outflow tract obstruction are present. Regular monitoring of blood pressure, serum creatinine, urea and electrolytes is strongly recommended with ACE inhibitor treatment. Hypotension, azotaemia and hyperkalaemia are all indications to stop or reduce ACE inhibitor treatment in rabbits.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in cases of cardiac output failure.Adverse reactions: Potential adverse effects include hypotension, hyperkalaemia and azotaemia. Monitor blood pressure, serum creatinine and electrolytes when used in cases of heart failure. Dosage should be reduced if there are signs of hypotension (weakness, ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 113 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets114disorientation). Anorexia, vomiting and diarrhoea are rare. It is not recommended for breeding, pregnant or lactating animals, as safety has not been established. In rabbits, treatment with ACE inhibitors can be associated with an increase in azotaemia and significant hypotension; treatment should start at the lower end of the range.Drug interactions: Concomitant treatment with potassium-sparing diuretics (e.g. spironolactone) or potassium supplements could result in hyperkalaemia. However, in practice, spironolactone and ACE inhibitors appear safe to use concurrently. There may be an increased risk of nephrotoxicity and decreased clinical efficacy when used with NSAIDs. There is a risk of hypotension with concomitant administration of diuretics, vasodilators (e.g. anaesthetic agents, antihypertensive agents) or negative inotropes (e.g. beta-blockers).DOSESMammals: Primates: 0.3 mg/kg p.o. q24h; Sugar gliders, Hedgehogs: 0.5 mg/kg p.o. q24h; Ferrets: 0.25–0.5 mg/kg p.o. q24–48h; Rabbits: 0.25–0.5 mg/kg p.o. q24–48h; Rodents: 0.5–1.0 mg/kg p.o. q24h.Birds: 1.25 mg/kg p.o. q12h 1.Reptiles, Amphibians, Fish: No information available.References1 Pees M and Krautwald-Junghanns M-E (2009) Cardiovascular physiology and diseases of pet birds. Veterinary Clinics of North America: Exotic Animal Practice 12(1), 81–97Enilconazole(Imaverol) POM-VPSFormulations: Topical: 100 mg/ml (10%) liquid.Action: Inhibition of cytochrome P450-dependent synthesis of ergosterol in fungal cells, causing increased cell wall permeability and allowing leakage of cellular contents.Use: Fungal infections of the skin and nasal aspergillosis. Has been shown to inhibit zoospores of Batrachochytrium dendrobatidis in vitro but there is no information on systemic clinical treatment of amphibians with chytridiomycosis.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Hepatotoxic if swallowed. Avoid contact with eyes.Drug interactions: No information available.DOSESMammals: Rabbits: Dilute (1:50 in water) and apply topically to lesions every 1–3 days for 3–4 applications and then check success of therapy with fungal culture; Hamsters: 0.2% rinse topically q7d until fungal cultures negative.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 114 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 115Birds: Dilute 1 volume of 10% solution with 10 volumes of water and give 0.5 ml/kg/day intratracheally for 7–14 days a.Reptiles: Apply topically to lesions correctly diluted (1:50 dilution with water) q48–72h.Amphibians, Fish: No information available.Referencesa Perelman B, Smith B, Bronstein D, Gur-Lavie A and Kuttin ES (1992) Use of azole compounds for the treatment of experimental aspergillosis in turkeys. Avian Pathology 21(4), 591–599Enrofloxacin(Baytril, Enrocare, Enrotab, Enrotron, Enrox, Enroxil, Floxabactin, Floxibac, Powerflox, Quinoflox, Xeden, Zobuxa) POM-VFormulations: Injectable: 25 mg/ml, 50 mg/ml, 100 mg/ml solutions. Oral: 15 mg, 50 mg, 150 mg, 250 mg tablets; 25 mg/ml solution.Action: Enrofloxacin is a bactericidal antimicrobial which inhibits bacterial DNA gyrase. The bactericidal action is concentration-dependent, meaning that pulse-dosing regimens may be effective, particularly against Gram-negative bacteria.Use: Ideally fluoroquinolone use should be reserved for infections where culture and sensitivity testing predicts a clinical response and where first- and second-line antimicrobials would not be effective. Active against Mycoplasma and many Gram-positive and Gram-negative organisms, including Pasteurella, Staphylococcus, Pseudomonas aeruginosa, Klebsiella, Escherichia coli, Mycobacterium, Proteus and Salmonella. Relatively ineffective against obligate anaerobes. Fluoroquinolones are highly lipophilic drugs that attain high concentrations within cells in many tissues and are particularly effective in the management of soft tissue, urogenital (including prostatic) and skin infections. For the treatment of non-tubercular mycobacterial disease, enrofloxacin can be combined with clarithromycin and rifampin. Administration by i.v. route is not authorized but has been used in cases of severe sepsis. If this route is used, administer slowly as the carrier contains potassium. Dilute solution for injection 1 in 4 with water if dosing small mammals orally. Switch to oral medications in birds as soon as possible. Used for the treatment of bacterial disease in fish, particularly those caused by Gram-negative organisms.Safety and handling: Normal precautions should be observed.Contraindications: Fluoroquinolones are relatively contraindicated in growing small mammals as cartilage abnormalities have been reported in young mice, rats, guinea pigs and rabbits after administration of fluoroquinolones similar to enrofloxacin.Adverse reactions: In birds, joint lesions have been induced in nestling pigeons with high doses of enrofloxacin, and in all species, ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 115 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets116muscle necrosis may be seen following i.m. administration. Enrofloxacin should be used with caution in epileptics until further information is available, as in humans they potentiate CNS adverseeffects when administered concurrently with NSAIDs. Excitation and diarrhoea have been reported in Galapagos tortoises.Drug interactions: Adsorbents and antacids containing cations (Mg2+, Al3+) may bind to fluoroquinolones and prevent their absorption from the GI tract. The absorption of fluoroquinolones may also be inhibited by sucralfate and zinc salts; separate doses of these drugs by at least 2 hours. Fluoroquinolones increase plasma theophylline concentrations. Cimetidine may reduce the clearance of fluoroquinolones and so should be used with caution in combination with these drugs. Efficacy may be reduced due to chelation when used as a bath treatment for fish in hard water with high levels of divalent metal cations (Ca2+, Mg2+).DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Ferrets: 5–10 mg/kg p.o., s.c., i.m. q12h or 10–20 mg/kg p.o., s.c., i.m. q24h; Rabbits: 10–20 mg/kg p.o., s.c., i.v. q24h; Rodents: 5–20 mg/kg s.c., p.o. q12–24h; Others: 5–10 mg/kg s.c., p.o. q12h or 20 mg/kg s.c., p.o. q24h.Birds: 10 mg/kg p.o., i.m. q12h (licensed dose) or 100–200 mg/l drinking water ab.Reptiles: Variable absorption when given p.o. so i.m. administration may be more appropriate in critically ill animals. Most species: 5–10 mg/kg i.m., p.o. q24–48h; Indian star tortoises: 5 mg/kg i.m. q12–24h c; Gopher tortoises: 5 mg/kg i.m. q24–48h d; Red-eared sliders: 5 mg/kg i.m. or 10 mg/kg p.o., i.m., s.c., intracoelomic q24h or 500 mg/l as a 6–8 h bath q24h e; Savannah monitors: 10 mg/kg i.m. q5d; Green iguanas: 5 mg/kg p.o., i.m. q24h; Burmese pythons: 10 mg/kg i.m., then q48h f; Pit vipers: 10 mg/kg i.m. q48–72h g.Amphibians: 5–10 mg/kg p.o., s.c., i.m. q24h.Fish: 5–10 mg/kg i.m., intraperitoneal, p.o. q24–48h for 7 doses or 2.5–5 mg/l by immersion for 5 h q24–48h for 5–7 treatments hi.Referencesa Flammer K, Aucoin DP and Whitt DA (1991) Intramuscular and oral disposition of enrofloxacin in African grey parrots following single and multiple doses. Journal of Veterinary Pharmacology and Therapeutics 14(4), 359–366b Flammer K, Aucoin DA, Whitt DA and Prus SA (1990) Plasma concentrations of enrofloxacin in African grey parrots treated with medicated water. Avian Diseases 34(4), 1017–1022c Raphael BL, Papich M and Cook RA (1994) Pharmacokinetics of enrofloxacin after a single intramuscular injection in Indian star tortoises (Geochelone elegans). Journal of Zoo and Wildlife Medicine 25, 88–94d Prezant RM, Isaza R and Jacobson ER (1994) Plasma concentrations and disposition kinetics of enrofloxacin in Gopher tortoises (Gopherus Polyphemus). Journal of Zoo and Wildlife Medicine 25, 82–87e James SB, Calle PP, Raphael BL et al. (2003) Comparison of injectable versus oral enrofloxacin pharmacokinetics in red-eared slider turtles (Trachemys scripta elegans). Journal of Herpetological Medicine and Surgery 13(1), 5–10f Young LA, Schumacher J, Papich MG and Jacobson ER (1997) Disposition of enrofloxacin and its metabolite ciprofloxacin after intramuscular injection in juvenile Burmese pythons (Python molurus bivittatus). Journal of Zoo Wildlife and Medicine 28(1), 71–79ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 116 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 117g Waxman S, Prados AP, de Lucas JJ et al. (2014) Pharmacokinetic behavior of enrofloxacin and its metabolite ciprofloxacin in Urutu pit vipers (Bothrops altematus) after intramuscular administration. Journal of Zoo Wildlife and Medicine 45(1), 78–85h Lewbart G, Papich MG and Whitt-Smith D (2005) Pharmacokinetics of florfenicol in the red pacu (Piaractus brachypomum) after single dose intramuscular administration. Journal of Veterinary Pharmacology and Therapeutics 28, 317–319i Lewbart G, Vaden S, Deen J et al. (1997) Pharmacokinetics of enrofloxacin in the red pacu (Colossoma brachypomum) after intramuscular, oral and bath administration. Journal of Veterinary Pharmacology and Therapeutics 20, 124–128Ephedrine(Enurace, Ephedrine hydrochloride*) POM-V, POMFormulations: 10 mg, 15 mg, 30 mg, 50 mg tablets; 3 mg/ml, 30 mg/ml solutions for injection; 0.5% and 1% nasal drops.Action: Non-catecholamine sympathomimetic stimulates alpha- and beta-adrenergic receptors directly, and indirectly through endogenous release of noradrenaline. Also causes contraction of internal urethral sphincter muscles and relaxation of bladder muscles. Compared to more powerful sympathomimetics, e.g. oxymetazoline and xylometazoline, there is less of a rebound effect. Use: Treatment of hypotension during anaesthesia. As well as constricting peripheral vessels, accelerates heart rate and can therefore assist in bradycardia. Also used orally in the treatment of urinary incontinence and nasal congestion. Can be used in conjunction with phenylpropanolamine. Polyuria should be excluded before treatment is given for urinary incontinence, as many conditions that cause polyuria would be exacerbated by ephedrine. Use with caution in animals with cardiovascular disease, partial urethral obstruction, hypertension, diabetes mellitus, hyperadrenocorticism, hyperthyroidism or other metabolic disorders.Safety and handling: Pregnant women should take particular care to wear gloves for administration.Contraindications: Do not use in pregnant or lactating patients or those with glaucoma.Adverse reactions: Even at recommended therapeutic doses may cause more generalized sympathetic stimulation (panting, mydriasis, CNS stimulation) and cardiovascular effects (tachycardia, atrial fibrillation and vasoconstriction). May also cause reduction of the motility and tone of the intestinal wall.Drug interactions: Synergistic with other sympathomimetics. Volatile anaesthetics will enhance the sensitivity of the myocardium to the effects of ephedrine. Concomitant use with cardiac glycosides (digoxin) and tricyclic antidepressants (amitriptyline) can cause arrhythmias. Will enhance effects of theophylline and may cause hypertension when given with MAO inhibitors (e.g. selegeline).DOSESMammals: Guinea pigs 1 mg/kg i.v. prn (for anaphylaxis).Birds, Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 117 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets118Epinephrine see Adrenaline Epoetin alfa, Epoetin beta see Erythropoietin Equine chorionic gonadotrophin see Serum gonadotrophinErythromycin(Erythrocin, Erythromycin*, Erythroped*) POM-V, POMFormulations: Injectable: 200 mg/ml solution; 1 g/vial powder for reconstitution. Oral: 250 mg, 500 mg tablets/capsules; 25 mg/ml suspension; powder authorized for chickens.Action: May be bactericidal (time-dependent) or bacteriostatic, depending upon drug concentration and bacterial susceptibility. It binds to the 50S ribosome, inhibiting peptide bond formation.Use: Has a similar antibacterial spectrum to penicillins. It is active against Gram-positive cocci (some Staphylococcus species are resistant), Gram-positive bacilli and some Gram-negative bacilli (Pasteurella). Some strains of Actinomyces, Nocardia, Chlamydophila and Rickettsia are also inhibited by erythromycin. Most of the Enterobacteriaceae (Pseudomonas, Escherichia coli, Klebsiella) are resistant. It is used in hamsters to treat proliferative ileitis (Lawsonia intracellularis) and in ferrets to control Campylobacter infection, although it may not eliminate intestinal carriage of this organism. Being a lipophilic weak base, it is concentrated in fluids that are more acidic than plasma, including milk, prostatic fluid and intracellular fluid. Resistance to erythromycin can be quite high, particularly in staphylococcal organisms. Erythromycin acts as a GI prokinetic by stimulating motilin receptors. Different esters of erythromycin are available. It islikely that the kinetics and possibly the toxicity will differ, depending on the ester used. Erythromycin’s activity is enhanced in an alkaline pH. As the base is acid-labile it should be administered on an empty stomach. Used for the treatment of bacterial diseases in fish, where possible.Safety and handling: Normal precautions should be observed.Contraindications: In humans the erythromycin estolate salt has been implicated in causing cholestatic hepatitis. Although not demonstrated in veterinary medicine, this salt should be avoided in animals with hepatic dysfunction.Adverse reactions: The commonest adverse effect is GI upset. Care should be taken in cases of hepatic or renal impairment. Erythromycin can cause enterotoxaemia in rodents (especially chinchillas and guinea pigs) and rabbits. Its use as a prokinetic in these species is not advised. Use as a immersion treatment may be harmful to biological filtration systems and is not advised.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 118 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 119Drug interactions: Erythromycin may enhance the absorption of digoxin from the GI tract and increase serum levels of cisapride, methylprednisolone, theophylline and terfenadine. The interactions with cisapride and terfenadine proved particularly significant in human medicine, leading to fatal or near-fatal arrhythmias in some patients receiving both drugs. Erythromycin should not be used in combination with other macrolide, lincosamide or chloramphenicol antimicrobials as antagonism may occur.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Primates: 75 mg/kg p.o. q12h; Hedgehogs: 10 mg/kg p.o., i.m. q12h; Ferrets: 10 mg/kg p.o. q6h; Hamsters, Rats, Mice: 20 mg/kg p.o. q12h or 0.13 mg/ml drinking water.Birds: 20 mg/kg i.m., s.c. q8h; 60 mg/kg p.o. q12h or 125 mg/l of drinking water; 200 mg/kg soft feed.Reptiles, Amphibians: No information available.Fish: 10–20 mg/kg i.m. q24h for 1–3 treatments or 100–200 mg/kg p.o. q24h for 7–21 days 12.References1 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford2 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, DordrechtErythropoietin (Epoetin alfa, Epoetin beta)(Eprex*, Neorecormon*) POMFormulations: Injectable: 1000 IU, 2000 IU, 5000 IU powders for reconstitution; 2000 IU/ml, 4000 IU/ml, 10,000 IU/ml, 40,000 IU/ml solutions. Eprex is epoetin alfa. Neorecormon is epoetin beta.Action: Stimulates division and differentiation of red blood cells.Use: Recombinant human erythropoietin (r-HuEPO) is predominantly used to treat anaemia associated with chronic renal failure, although it is also used to treat anaemic human patients with cancer and rheumatoid arthritis. Erythropoietin is not indicated in conditions where high serum concentrations of the hormone already exist (e.g. haemolytic anaemia, anaemia due to blood loss), where the anaemia is due to iron deficiency or where systemic hypertension is present. Monitoring and/or supplementation of iron may be necessary, especially if response to treatment is poor. Darbepoetin may be a better choice in many cases.Safety and handling: Normal precautions should be observed.Contraindications: Conditions where high serum concentrations of erythropoietin already exist. ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 119 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets120Adverse reactions: Local and systemic allergic reactions may rarely develop (skin rash at the injection site, pyrexia, arthralgia and mucocutaneous ulcers).Drug interactions: No information available.DOSESMammals: Primates: 50–100 IU/kg s.c., i.v. 3 times a week; Ferrets, Rabbits: epoetin alfa: 50–150 IU/kg i.m., s.c. q48–72h.q48h. Once desired PCV reached, administer q7d for at least 4 weeks for maintenance.Birds, Reptiles, Amphibians, Fish: No information available.Etherified starch(eloHAES*, HAES-steril*, Hemohes*, Tetraspan*, Venofundin*, Volulyte*, Voluven*) POMFormulations: Injectable: 6%, 10% solutions.Action: Promotes retention of the fluid in the vascular system through the exertion of oncotic pressure.Use: Expansion and maintenance of blood volume in various forms of shock including hypovolaemic, haemorrhagic and septic shock. The duration of plasma expansion is dependent on various factors including molecular weight and molar substitution ratio. Plasma persistence of colloidal molecules may be prolonged (up to 24 h). Hetastarch administration increases plasma volume, generally by at least the volume administered but it can be up to 172%. Initial plasma expansion may be greater with pentastarch but the duration of action is shorter. In humans the half-life of hetastarch varies with time after administration and dose, and administration of consecutive doses increases the half-life significantly. In rabbits there is evidence that hetastarch may reduce postoperative adhesion formation. Tetrastarches are closer to pentastarches in terms of molecular weight, plasma persistence and duration of effect. May be of use in some cases of hydrocoelom in amphibians. Newer developed etherified starches (e.g. Voluven, Volulyte) have minimized the effects on serum biochemistry, blood-typing and cross-matching. Etherified starch should be used with caution in animals with bleeding disorders. Use with caution in animals with congestive heart failure or renal insufficiency as it increases the risk of circulatory overload.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Higher doses of hetastarch (20–30 ml/kg) have been associated with increases in bleeding time and the factor VIII complex is consistently decreased after hetastarch administration.Drug interactions: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 120 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 121DOSESMammals: Ferrets: Hetastarch: 10–20 ml/kg i.v. infusion; Rabbits: Hetastarch: 10–20 ml/kg i.v. infusion; Rats: Hetastarch: 1–10 ml/kg i.v. infusion.Birds, Reptiles: No information available.Amphibians: Bath for no more than 1 hour (hydrocoelom).Fish: No information available.Ethylene glycol monophenyl ether see PhenoxyethanolEugenol (Isoeugenol, Oil of clove)(Koi calm) ESPAFormulations: Immersion: Oil for dissolution in water.Action: Produces anaesthesia by impeding peripheral nerve signal transmission to the CNS.Use: For the sedation, immobilization, anaesthesia and euthanasia of fish. Ideally, the drug should be used in water from the tank or pond of origin to minimize problems due to changes in water chemistry. Over-the-counter preparations contain about 1 g eugenol per ml but are poorly soluble in water and must be made into a stock solution (e.g. 1:10 with 95% ethanol produces 100 mg/ml) for more accurate dosing. The anaesthetic solution should be used on the day of preparation and be well aerated during use. Food should be withheld from fish for 12–24 h before anaesthesia to reduce the risk of regurgitation. The stage of anaesthesia reached is determined by the concentration used and the duration of exposure since absorption continues throughout the period of immersion. Different species vary in their response and may require different concentrations. It is recommended to use the lower dose rates to test the selected drug concentration and exposure time with a small group before medicating large numbers. Fish may retain some movement during anaesthesia, making it less desirable to use during surgery. Anaesthetized fish should be returned to clean water from their normal environment toallow recovery. For euthanasia, use 5–10 times the normal anaesthetic dose and keep the fish in the solution for at least 60 minutes after respiration ceases.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Cardiorespiratory depression and death have been noted in some tropical marine fish (e.g. tangs, surgeonfish).Drug interactions: No information available. ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 121 12/02/2015 09:31BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets122DOSESFish: Anaesthesia: 40–120 mg/l by immersion; Euthanasia: 500–1000 mg/ml by immersion or undiluted 10 drops/l (whisk to thoroughly mix with water) by immersion 1234. Follow manufacturer’s recommendations for proprietary formulations.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Harms CA and Lewbart GA (2000) Surgery in fish. Veterinary Clinics of North America: Exotic Animal Practice 3(3), 759–7742 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford3 Ross LG (2001) Restraint, anaesthesia and euthanasia. In: BSAVA Manual of Ornamental Fish, 2nd edn, ed. WH Wildgoose, pp. 75–84. BSAVA Publications, Gloucester4 Sneddon LU (2012) Clinical anaesthesia and analgesia in fish. Journal of Exotic Pet Medicine 21, 32–43ZYXWVUTSRQPONMLKJIHGFEDCBAEe.indd 122 12/02/2015 14:43BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 123Famciclovir(Famvir*) POMFormulations: Oral: 125 mg, 250 mg tablet.Action: Inhibits viral replication (viral DNA polymerase); depends on viral thymidine kinase for phosphorylation.Use: Famciclovir is a pro-drug for penciclovir, which is closely related to aciclovir. Famciclovir is virostatic and is unable to eradicate latent viral infection. Has been used experimentally in ducks to control hepatitis B virus infection.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Little information available. A dose of 90 mg/kg caused no changes in liver enzymes (single dose) but adversely affected the conjunctival goblet cell density and therefore the quality of the tear film.Drug interactions: No information available.DOSESBirds: Ducklings: 10 mg/kg p.o. q24h a.Mammals, Reptiles, Amphibians, Fish: No information available.Referencesa Lin E, Luscombe C, Colledge D, Wang YY and Locarnini S (1998) Long-term therapy with the guanine nucleoside analog penciclovir controls chronic duck hepatitis B virus infection in vivo. Antimicrobial Agents and Chemotherapy 42(8), 2132–2137Famotidine(Pepcid*) POMFormulations: Oral: 20 mg, 40 mg tablets.Action: Potent histamine (H2) receptor antagonist blocking histamine-induced gastric acid secretion. It is many times more potent than cimetidine, but has poorer oral bioavailability (37%).Use: Management of gastric and duodenal ulcers, idiopathic, uraemic or drug-related erosive gastritis, oesophagitis, and hypersecretory conditions secondary to gastrinoma, mast cell neoplasia or short bowel syndrome. Reduction of vomiting due to gastric ulceration is typically achieved in about 2 weeks. However, animals should be treated for at least 2 weeks after the remission of clinical signs, so a minimum treatment duration of 28 days is recommended. Currently cimetidine is the only antiulcer drug with a veterinary market authorization. Has little effect on GI motility in humans.Safety and handling: Normal precautions should be observed.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 123 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets124Contraindications: No information available.Adverse reactions: In humans famotidine has fewer side effects than cimetidine.Drug interactions: Famotidine is devoid of many of the interactions of the H2 related antagonist cimetidine.DOSESMammals: Primates: 0.5–0.8 mg/kg p.o. q24h; Ferrets: 0.25–0.5 mg/kg p.o., i.v., s.c. q24h; Rabbits: 0.5 mg/kg p.o., s.c., i.v. q12h; Chinchillas: 0.5 mg/kg s.c. q24h; Guinea pigs: 0.4 mg/kg p.o., s.c. q24h.Birds, Reptiles, Amphibians, Fish: No information available.Febantel see PyrantelFenbendazole(Bob Martin Easy to Use Wormer, Granofen, Lapizole, Panacur, Zerofen) NFA-VPSFormulations: Oral: 222 mg/g granules (22%); 20 mg/ml oral suspension (2%); 25 mg/ml oral suspension (2.5%); 100 mg/ml oral suspension (10%); 187.5 mg/g oral paste (18.75%).Action: Inhibits fumarate reductase system of parasites thereby blocking the citric acid cycle and also reduces glucose absorption by the parasite.Use: Treatment of oxyurids, ascarids (including larval stages), hookworms, whipworms, tapeworms (Taenia), Oslerus osleri, Aelurostrongylus abstrusus, Angiostrongylus vasorum, Capillaria aerophila, Ollulanus tricuspis, Physaloptera rara and Paragonimus kellicotti infections. Fenbendazole has 100% efficacy in clearing Giardia cysts. It is used in rabbits for the treatment of Encephalitozoon cuniculi. Unlike some other benzimidazoles, fenbendazole is safe to use in pregnant animals. Used for the treatment of non-encysted gastrointestinal nematodes, some cestodes (Bothriocephalus) and external monogenean parasites in fish.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Birds, especially vultures and storks ab, and some raptors, are more sensitive to adverse reactions affecting bone marrow, intestinal and liver functions. In pigeons and doves c, mortality of 50% has occurred at doses of 20 mg/kg p.o. given on 3 consecutive days. Vomiting, depression and death within 96 h are recorded in some raptors. Feather damage also reported in pigeons. Has been associated with profound leucopenia in Testudo hermanni following two courses of 50 mg/kg fenbendazole given daily for 5 days per course. Avoid in reptiles with suspected septicaemia. Some ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 124 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 125species of fish (e.g. discus) may react adversely to some formulations of fenbendazole by immersion. The sudden death of a large burden of nematodes may cause tissue damage or intestinal blockage.Drug interactions: No information available.DOSESMammals: Primates: 50 mg/kg p.o. q24h for 3 days; Sugar gliders: 20–50 mg/kg p.o. q24h for 3 days, repeat in 14 days; Hedgehogs: 25 mg/kg p.o., repeat at 14 and 28 days; Rabbits: E. cuniculi: 20 mg/kg p.o. q24h for 28 days d; Oxyuriasis: 50ppm (50 mg/kg) in feed for 5 days e; Other small mammals: 20–50 mg/kg p.o. q24h for 5 consecutive days; the higher end of the range is suggested for giardiasis only.Birds:• Nematodes f: 20–100 mg/kg p.o., administer 2 doses separated by 10 days; capillariasis: 25 mg/kg p.o. q24h for 5 consecutive days; Pigeons: 16 mg/kg p.o. once, repeat after 10 days if necessary or 10–20 mg/kg p.o. q24h for 3 days, repeat after 2 weeks; Passerines: 20 mg/kg p.o. q24h for 3 doses. Not advisable to give more than 50 mg/kg in unfamiliar species.• Giardiasis g: 50 mg/kg p.o. q24h for 3 doses.Reptiles:• Nematodes: 50–100 mg/kg p.o., per cloaca once or 20–25 mg/kg p.o., per cloaca q24h over 3–5 day course h; Repeated doses have been advised but may be unnecessary as complete effect may not be seen until 31 days post-treatment i.• Giardiasis and flagellates: 50 mg/kg p.o. q24h for 3–5 days.Amphibians: 100 mg/kg p.o., repeat in 2 weeks.Fish: External monogenean parasites: 25 mg/l by immersion for 12 h; Gastrointestinal nematodes: 50 mg/kg p.o. q24h for 2 days, repeat in 14 days 123.Referencesa Bonar CJ, Lewandowski AH and Schaul J (2003)Suspected fenbendazole toxicosis in two vulture species (Gyps afrixanus, Torgos tracheliotus) and Marabou storks (Leptoptilos crumeniferus). Journal of Avian Medicine and Surgery 17(1), 16–19b Weber MA, Terrell SP, Neiffer DL, Miller MA and Mangold BJ (2002) Bone marrow hypoplasia and intestinal crypt cell necrosis associated with fenbendazole administration in five painted storks. Journal of the American Veterinary Medical Association 221(3), 417–419c Howard LL, Papendick R, Stalis IH et al. (2002) Fenbendazole and albendazole toxicity in pigeons and doves. Journal of Avian Medicine and Surgery 16(3), 203–210d Suter C, Müller-Doblies UU, Hatt JM and Deplazes P (2001) Prevention and treatment of Encephalitozoon cuniculi infection in rabbits with fenbendazole. Veterinary Record 148(15), 478–480e Düwel D and Brech K (1981) Control of oxyuriasis in rabbits by fenbendazole. Laboratory Animal 15(2), 101–105f Lawrence K (1983) Efficacy of fenbendazole against nematodes of captive birds. Veterinary Record 112, 433–434g Yazwinski TA, Andrews P, Holtzen H, Presson B, Wood N and Johnson Z (1986) Dose-titration of fenbendazole in the treatment of poultry nematodiasis. Avian Diseases 30(4), 716–718h Holt PE (1982) Efficacy of fenbendazole against the nematodes of reptiles. Veterinary Record 110, 302–304i Giannetto S, Brianti E, Poglayen G et al. (2007) Efficacy of oxfendazole and fenbendazole against tortoise (Testudo hermanni) oxyurids. Parasitology Research 100, 1069–1073ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 125 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets1261 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford2 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers, Dordrecht3 Whitaker BR (1999) Preventative programs for fish. In: Zoo and Wild Animal Medicine: Current Therapy 4, ed. ME Fowler and RE Miller, pp. 163–181. WB Saunders, PhiladelphiaFentanyl(Fentadon, Recuvyra, Durogesic*, Fentanyl*, Fentora*, Sublimaze*) POM-V CD SCHEDULE 2, POM CD SCHEDULE 2Formulations: Oral: 100 µg, 200 µg, 400 µg, 600 µg, 800 µg tablets. Injectable: 50 µg/ml solution. Transdermal: 50 mg/ml solution; 12.5 µg/h, 25 µg/h, 50 µg/h, 75 µg/h, 100 µg/h patches.Action: Synthetic pure mu (OP3) receptor agonist.Use: Very potent opioid analgesic (50 times more potent than morphine) used to provide profound intraoperative analgesia. Can also be used at low dose rates for postoperative analgesia. Use of potent opioids during anaesthesia contributes to a balanced anaesthesia technique, therefore the dose of other concurrently administered anaesthetic agents should be reduced. Fentanyl has a rapid onset of action after i.v. administration and short duration of action (10–20 min depending on dose). After prolonged administration (>4 hours) or high doses its duration of action is significantly prolonged as the tissues become saturated. It can be used intraoperatively to provide analgesia by intermittent bolus doses or by a continuous rate infusion. Postoperatively fentanyl can be given by continuous rate infusion to provide analgesia, doses at the low end of the dose range should be used and respiratory function monitored. Its clearance is similar to morphine whilst its elimination half-life is longer, reflecting its higher lipid solubility and volume of distribution.Safety and handling: Veterinary surgeons must undergo training in order to become authorized to prescribe transdermal fentanyl and receive the drug from veterinary wholesalers. The transdermal solution of fentanyl is very concentrated with the potential to cause opioid overdose (associated with respiratory depression) if absorbed systemically by humans (e.g. through contact with the skin or mucosal surfaces such as the eyes and mouth). Personal protective clothing consisting of latex or nitrile gloves, eye protection and suitable protective clothing must be worn when handling the product. Following application to the skin, the site must not be touched for at least 5 min until the solution is dry. It is advisable to wear gloves when handling animals to which transdermal fentanyl has been applied for up to 72 hours following application or to wash hands immediately after handling the animal in this time window. Owners should be advised that childrenhave been published. Prolonged respiratory depression in the recovery period can be avoided by the administration of a partial mu agonist (buprenorphine) at the end of the procedure. This will reverse respiratory depression induced by fentanyl and provide continued analgesia. Small mammals should be weighed before drug administration, accurate dosing is imperative to prevent overdose. Oxygen supplementation via a face mask is recommended during sedation and anaesthesia of all animals.Safety and handling: Normal precautions should be observed.Contraindications: Animals with pre-existing respiratory compromise.Adverse reactions: Respiratory depression can occur when given in high doses, particularly during the recovery period. Administration of buprenorphine in the recovery period can ameliorate respiratory depression and sedation, and provide ongoing analgesia. Measures should be taken to maintain normothermia during the sedation/anaesthesia and recovery period.Drug interactions: No information available.DOSESWhen used for sedation is generally given as part of a combination. See Appendix for sedation protocols in all species.Mammals: Primates: 0.3 ml/kg i.m.; Rabbits: 0.1–0.5 ml/kg i.m.; Guinea pigs: 0.5–1 ml/kg i.m.; Rats: 0.2–0.5 ml/kg i.m., intraperitoneal; Mice: 0.1–0.5 ml/kg intraperitoneal.Birds, Reptiles, Amphibians, Fish: No information available.Finasteride(Proscar*) POMFormulations: Oral: 5 mg tablet.Action: Competitively inhibits dihydrotestosterone (DHT) production within the prostate. DHT is the main hormonal stimulus for the development of benign prostatic hyperplasia.Use: Treatment of benign prostatic hyperplasia associated with adrenal gland disease.Safety and handling: Women of child-bearing age should avoid handling crushed or broken tablets as finasteride is potentially teratogenic.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 128 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 129Contraindications: Do not use in breeding ferrets.Adverse reactions: Secreted into semen and causes fetal anomalies.Drug interactions: No information available.DOSESMammals: Ferrets: 5 mg/kg p.o. q24h.Birds, Reptiles, Amphibians, Fish: No information available.Fipronil(Certifect, Effipro, Eliminall, Felevox, Fipronil, Fiprospot, Frontline) NFA-VPS, POM-VFormulations: Topical: 10% w/v fipronil spot-on pipettes in a wide range of sizes (Effipro, Frontline); with S-methoprene (Frontline Combo); with S-methoprene and amitraz (Certifect). Also 0.25% w/v fipronil spray in alcohol base (Effipro and Frontline sprays) in a range of sizes.Action: Fipronil interacts with ligand-gated (GABA) chloride channels, blocking pre- and postsynaptic transfer of chloride ions, resulting in death of parasites on contact.Use: Treatment of fleas, lice and ticks in mammals and birds. Treatment of mites and ticks in reptiles. Has been used to treat Hirstiella mites in green iguanas, but still needs further safety evaluation in other species. Beware of use in juvenile reptiles and immediately after skin slough due to increased permeability of skin and associated toxicity. Treatment of the environment is also recommended. Care with overuse of alcohol-based spray in birds a.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in rabbits. May be harmful to aquatic organisms.Adverse reactions: Local pruritus or alopecia may occur at the site of application.Drug interactions: A low dose of amitraz has been shown to have a synergistic effect on the speed of tick kill, thus reducing the risk of transmission for tick-borne pathogens.DOSESMammals: Ferrets: spray 3–6 ml/kg (6–12 pumps/kg 100 ml application) q30–60d; Rodents: 7.5 mg/kg topically (15 pumps/kg 100 ml application) q30–60d. Other mammals: apply lightly q14d. Do not use in rabbits.Birds: Use spray form q30–60d. Apply to cotton wool and dab behind head, under wings and at base of tail (raptors/parrots) or lightly under each wing (pigeon/passerine).Reptiles: Spray on to cloth first then wipe over surface of reptile q7–14d until negative for ectoparasites. Beware of use in debilitated ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 129 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets130reptiles, those which have recently shed their skin and in small species where overdosage and toxicity may occur.Amphibians, Fish: Not indicated.Referencesa Kitulagodage M, Astheimer LB and Buttemer WA (2008) Diacetone alcohol, a dispersant solvent, contributes to acute toxicity of a fipronil-based insecticide in a passerine bird. Ecotoxicology and Enviromental Safety 71(2), 597–600Florfenicol(Florocol, Nuflor) POM-VFormulations: Injectable: 300 mg/ml, 450 mg/ml solution. Oral: 500 mg/g powder.Action: Bacteriostatic antimicrobial that acts by binding to the 50S ribosomal subunit of susceptible bacteria, preventing bacterial protein synthesis.Use: Treatment of bacteria diseases in fish.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: No information available.Drug interactions: No information available.DOSESFish: 40–50 mg/kg i.m., intraperitoneal q24h or 5–20 mg/kg p.o. q24h for 10 days 1234.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Bishop Y (1998) The Veterinary Formulary. Pharmaceutical Press, London2 Lewbart G, Papich MG and Whitt-Smith D (2005) Pharmacokinetics of florfenicol in the red pacu (Piaractus brachypomum) after single dose intramuscular injection. Journal of Veterinary Pharmacology and Therapeutics 28, 317–3193 Stoskopf MK (1999) Fish pharmacotherapeutics. In: Zoo and Wild Animal Medicine: Current Therapy 4, ed. ME Fowler and RE Miller, pp. 182–189. WB Saunders, Philadelphia4 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers. DordrechtFlubendazole(Anti Fluke & Wormer, Flukasol Suspension, Fluke-M, Flubenol*) ESPAFormulations: Immersion: 5% powder (Fluke-M);formation. Flucloxacillin is bactericidal and works in a time-dependent fashion.Use: Stable in gastric acid so can be given orally but food significantly reduces its bioavailability. It is less active than penicillin G or V against Streptococcus and obligate anaerobic bacteria, and is indicated for the treatment of infections caused by beta-lactamase-producing Staphylococcus. Patients with significant renal or hepatic dysfunction may need dosage adjustment. The amount of sodium in flucloxacillin sodium may be clinically important for patients on restricted sodium intakes. Although flucloxacillin is absorbed from the GI tract, food has a significant inhibitory effect on its bioavailability; doses must be given on an empty stomach therefore limiting potential use in rabbits and rodents. As flucloxacillin kills in a time-dependent fashion, dosing regimens should be designed to maintain tissue concentrations above the MIC throughout the interdosing interval. Use with care in hepatic disease or hepatic impairment.Safety and handling: Normal precautions should be observed.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 131 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets132Contraindications: Do not administer to hamsters, gerbils, guinea pigs, chinchillas or rabbits. Do not administer to animals with a history of sensitivity to beta-lactam antimicrobials.Adverse reactions: Nausea, diarrhoea and skin rashes are the commonest adverse effects. Cholestatic hepatitis has been reported in humans.Drug interactions: Avoid the concomitant use of bacteriostatic antibiotics. The aminoglycosides (e.g. gentamicin) may inactivate penicillins when mixed together in parenteral solutions. A synergistic effect is seen when beta-lactam and aminoglycoside antimicrobials are used concurrently.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Rats: 200 mg/kg s.c. q8h.Birds, Reptiles, Amphibians, Fish: No information available.Fluconazole(Diflucan*, Fluconazole*) POMFormulations: Oral: 50 mg, 150 mg, 200 mg capsules; 40 mg/ml suspension. Injectable: 2 mg/ml solution.Action: Inhibition of the synthesis of ergosterol in fungal cell membranes, thus causing increased cell wall permeability and allowing leakage of cellular contents.Use: Effective against Blastomyces, Candida, Cryptococcus, Coccidioides, Histoplasma and Microsporum canis infections and variably effective against Aspergillus and Penicillium infections. Has been used for treatment of dermatophytosis in green iguanas. In amphibians, it prolonged survival in frogs with chytridiomycosis but did not prevent mortality. It attains therapeutic concentrations in the CNS and respiratory tract. It is excreted by the kidney, producing high concentrations in urine. Reduce dose in animals with renal impairment and liver disease. This drug should be used until clinical signs have resolved and the organism is no longer present; this may take up to 2 months in some cases. Safety and handling: Normal precautions should be observed.Contraindications: Do not use in pregnant/lactating animals.Adverse reactions: Adverse effects may include nausea and diarrhoea. May be hepatotoxic. May cause vomiting in birds.Drug interactions: Fluconazole (due to inhibition of cytochrome P450-dependent liver enzymes) may increase plasma theophylline concentrations. In humans, fluconazole has led to terfenadine toxicity when the two drugs were administered together. Fluconazole increases ciclosporin blood levels.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 132 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 133DOSESMammals: Rabbits: 25–43 mg/kg i.v. infusion (slow) q12h; 37.5 mg/kg p.o. q12h for Aspergillus keratitis; 5 mg/kg p.o. q24h for cryptococcal meningitis.Birds: 10–20 mg/kg p.o. q24–48h a.Reptiles: 5 mg/kg p.o. q24h (iguanas with dermatophytosis).Amphibians: 60 mg/kg p.o. q24h. Baths at 25 mg/l prolonged survival in frogs with chytridiomycosis but did not prevent mortality b.Fish: No information available.Referencesa Flammer K and Papich M (2006) Pharmacokinetics of fluconazole after oral administration of single and multiple doses in African grey parrots. American Journal of Veterinary Research 67(3), 417–422b Berger L, Speare R, Marantelli G and Skerratt LF (2009) A zoospore inhibition technique to evaluate the activity of antifungal compounds against Batrachochytrium dendrobatidis and unsuccessful treatment of experimentally infected green tree frogs (Litoria caerulae) by fluconazole and benzalkonium chloride. Research in Veterinary Science 87(1), 106–110Fludrocortisone(Florinef*) POMFormulations: Oral: 0.1 mg tablets.Action: Aldosterone analogue that increases potassium excretion and sodium retention but which also has some glucocorticoid properties.Use: Treatment of adrenocortical insufficiency (post-adrenalectomy). Fludrocortisone is about 125 times more potent as a mineralocorticoid than is hydrocortisone but it is also about 12 times more potent as a glucocorticoid (and therefore about 3 times more potent than prednisolone). Monitor sodium and potassium concentrations separately (not just the ratio) 4–6 hours post-pill. Supplemental doses of prednisolone may be required at times of metabolic or physical stress.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Hypertension, oedema (including cerebral oedema) and hypokalaemia with overdosages. Long-term overdose may result in clinical signs of hypercortisolism.Drug interactions: Hypokalaemia may develop if fludrocortisone is administered concomitantly with amphotericin B or potassium-depleting diuretics (furosemide, thiazides).DOSESMammals: Ferrets: post-adrenalectomy: 0.05–0.1 mg/kg p.o. q24h.Birds, Reptiles, Amphibians, Fish: No information available. ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 133 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets134Fluoxetine(Reconcile, Prozac*) POM-V, POMFormulations: Oral: 8 mg, 16 mg, 20 mg, 32 mg, 64 mg tablets; 4 mg/ml liquid. Liquid formulation and some tablet sizes are available in the UK but not under veterinary authorization. Veterinary formulation (Reconcile) only available in certain European regions (not the UK).Action: Fluoxetine and its primary metabolite norfluoxetine block serotonin re-uptake in the brain, resulting in antidepressive activity and a raising in motor activity thresholds. It also has minor noradrenaline re-uptake inhibition properties.Use: Has been used to control feather picking and other compulsive type behaviours in psittacines but relapse following the discontinuation of therapy is common. Should be used with a specifically constructed behaviour modification plan and with caution.Safety and handling: Normal precautions should be observed.Contraindications: Known sensitivity to fluoxetine or other SSRIs, history of seizures.Adverse reactions: Common reactions include lethargy, decreased appetite and vomiting, which may result in minor weight loss. Trembling, restlessness and other GI disturbances may also occur and must be distinguished from a paradoxical increase in anxiety which has been reported in some cases. Owners should be warned of a potential increase in aggression in response to medication.Drug interactions: Fluoxetine should not be used within 2 weeks of treatment with an MAOI (e.g. selegiline) and an MAOI should not be used within 6 weeks of treatment with fluoxetine. Fluoxetine, like other SSRIs, antagonizes the effects of anticonvulsants and so is not recommended for use with epileptic patients or in association with other agents which lower seizure threshold, e.g. phenothiazines.Caution is warranted if fluoxetine is used concomitantly with aspirin or other anticoagulants since the risk of increased bleeding in the case of tissue trauma may be increased.DOSESMammals: Primates: 0.45–2.0 mg/kg p.o. q24h a; Rats: 1–1.5 mg/kg p.o. q24h.Birds: 1–4 mg/kg p.o. q24h.Reptiles, Amphibians, Fish: No information available.Referencesa Fontenot MB, Musso MW, McFatter RM and Anderson GM (2009) Dose finding study of fluoxetine and venlafaxine for the treatment of self-injurious and stereotypic behaviour in rhesus macaques (Macaca mulatta). Journal of the American Association for Laboratory Animal Science 48(2), 176–184ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 134 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 135Flurbiprofen(Ocufen*) POMFormulations: Ophthalmic: 0.03% solution in single-use vials.Action: Inhibits prostaglandin synthesis producing an anti-inflammatory and analgesic action. Prostaglandins also play a role in the miosis produced during intraocular surgery by constricting the iris sphincter independently of cholinergic mechanisms.Use: Before cataract surgery. It is also useful for anterior uveitis and ulcerative keratitis when topical corticosteroids are contraindicated. Topical NSAIDs have the potential to increase intraocular pressure and should be used with caution in animals predisposed to glaucoma.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: As with other topical NSAIDs, flurbiprofen may cause local irritation. Topical NSAIDs can be used in ulcerative keratitis but with caution as they can delay epithelial healing. Topical NSAIDs have been associated with an increased risk of corneal ‘melting’ (keratomalacia) in humans, although this has not been reported in the veterinary literature. Regular monitoring is advised.Drug interactions: Ophthalmic NSAIDs may be used safely with other ophthalmic pharmaceuticals, although concurrent use of drugs which adversely affect the corneal epithelium (e.g. gentamicin) may lead to increased corneal penetration of the NSAID. The concurrent use of topical NSAIDs with topical corticosteroids has been identified as a risk factor in humans for precipitating corneal problems.DOSESMammals, Birds, Reptiles: 1 drop per eye q6–12h depending on severity of inflammation. 1 drop q30min for 4 doses preoperatively (presurgical protocols vary widely).Amphibians, Fish: No information available.Fluticasone(Flixotide*) POMFormulations: Inhalational: 50 µg, 125 µg, 250 µg metered inhalations (Evohaler).Action: Binds to specific nuclear receptors and affects gene transcription such that many aspects of inflammation are suppressed.Use: Used as an inhaled corticosteroid in the management of inflammatory airway disease. Administer via commercially available chambers and masks specifically designed for veterinary use. Not useful for acute bronchospasm (and cases of fluticasone-induced bronchospasm reported in humans).ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 135 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets136Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Inhaled steroids are known to suppress the hypothalamic-pituitary-adrenal axis, although they are considered generally safer than systemic steroids.Drug interactions: No information available.DOSESMammals: Rabbits: 50–250 µg (micrograms)/rabbit q12–24h via feline spacer chamber administration.Birds, Reptiles, Amphibians, Fish: No information available.Formaldehyde (Formalin, Formol, Methanediol, Methanol)(FMG Mixture, Formaldehyde 30% Solution, Protoban) ESPAFormulations: Immersion: proprietary formulations are available (Formaldehyde 30% Solution); also available in combination with malachite green (FMG Mixture, Protoban).Action: A biocide causing cell death by cross-linking with proteins.Use: Treatment of protozoan and some monogenetic ectoparasites of fish. It has some effect on fungal infections of fish eggs (water mould) but little activity against most bacteria. Formalin is an aqueous solution of 37–40% formaldehyde gas (= 100% formalin); diluted solutions are described according to the content of formalin, not formaldehyde. It is strongly recommended that a proprietary formulation is used initially to avoid problems related to purity and to enable accurate dosing. Dilute the measured dose 1:100 before adding to the fish tank or pond. Formalin can be irritating to the gills and chemically removes dissolved oxygen from the water, thus extra aeration must be provided. Do not use in water >27°C. It is usually supplied with 12–15% methanol to stabilize the solution and prevent the formation of paraformaldehyde, which appears as a white precipitate and is toxic to fish. Toxicity is increased at higher temperatures, low pH and low water hardness. Formaldehyde is toxic to some species of elasmobranchs (e.g. sharks, rays), plants and algae. Considered to have a synergistic effect with malachite green against protozoan ectoparasites.Safety and handling: Formalin must be handled with care; wear protective gloves and use a respirator. It is volatile and irritating, carcinogenic and may cause contact hypersensitivity to skin and airways. Use in well-ventilated areas. Should be stored in dark bottles above 4°C to prevent paraformaldehyde formation.Contraindications: Do not mix with potassium permanganate.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 136 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 137Adverse reactions: Fish gasping at the surface in water with low dissolved oxygen.Drug interactions: No information available.DOSESFish: All doses based on full strength formalin (= 37% formaldehyde): 0.125–0.25 ml/l by immersion for 30–60min q24h for 2–3 days or 0.015–0.025 ml/l by prolonged immersion q48h for 3 treatments 1234; follow the manufacturer’s recommendations for proprietary formulations.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Bishop Y (1998) The Veterinary Formulary. Pharmaceutical Press, London2 Herwig N (1979) Handbook of Drugs and Chemicals Used in the Treatment of Fish Diseases. Charles C Thomas, Illinois3 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford4 Treves-Brown KM (2000) Applied Fish Pharmacology. Kluwer Academic Publishers. DordrechtFormalin see Formaldehyde Formol see FormaldehydeFramycetin(Canaural) POM-VFormulations: Topical: 5 mg/g suspension (Canaural also contains fusidic acid, nystatin and prednisolone).Action: Aminoglycosides inhibit bacterial protein synthesis and require an oxygen-rich environment to be effective, thus they are ineffective in low-oxygen sites (abscesses, exudates), making all obligate anaerobic bacteria resistant. They are bactericidal and their mechanism of killing is concentration-dependent, leading to a marked post-antibiotic effect, allowing pulse-dosing regimens which may limit toxicity.Use: Treatment of aural infections. Framycetin is particularly effective against Gram-negative bacteria, although the combination preparation Canaural has a broad spectrum of activity.Safety and handling: Normal precautions should be observed.Contraindications: Do not use in animals with a perforated tympanum. Do not use in conjunction with other products known to be ototoxic.Adverse reactions: Aminoglycosides are potentially ototoxic, and ataxia, deafness and nystagmus may be observed where drops have been administered with a perforated tympanum. Local irritation.Drug interactions: No information available. ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 137 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets138DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Widely used anecdotally for the treatment of otitis externa in several species and for parasitic otitis (Otodectes) in the ferret at a dose of 2–10 drops per ear q12h. Corticosteroid-free preparations are preferred for the treatment of otitis in the rabbit, to avoid the systemic effects of corticosteroids.Birds, Reptiles, Amphibians, Fish: No information available.Furosemide (Frusemide)(Dimazon, Frusecare, Frusedale, Frusol*) POM-V, POMFormulations: Injectable: 50 mg/ml solution. Oral: 20 mg, 40 mg, 1 g tablets; 40 mg/5 ml oral solution.Action: Loop diuretic, inhibiting the Na+/K+/Cl– cotransporter in the thick ascending limb of the loop of Henle. The net effect is a loss of sodium, potassium, chloride and water in the urine. It also increases excretion of calcium, magnesium and hydrogen as well as renal blood flow and glomerular filtration rate. Transient venodilation may occur following i.v. administration and in some species, bronchodilation may occur; the exact mechanism for both is unclear. Although the avian nephron does not possess a Loop of Henle, furosemide still appears effective in birds; however, the mechanism of action is not well understood. The exact mechanism of action in reptiles is also unclear, although it does appear to have a diuretic effect.Use: Management of congestive heart failure (acute and chronic), non-cardiogenic oedema, hypercalcuric nephropathy, acute renal failure, hyperkalaemia and hypertension. Use with caution in patients with severe electrolyte depletion, hepatic failure and diabetes mellitus.Safety and handling: Normal precautions should be observed.Contraindications: Dehydration and anuria. Do not use in dehydrated or hyperuricaemic birds.Adverse reactions: Hypokalaemia, hypochloraemia, hypocalcaemia, hypomagnesaemia and hyponatraemia; dehydration, polyuria/polydipsia and prerenal azotaemia occur readily. A marked reduction in cardiac output can occur in animals with severe pulmonary disease, low-output heart failure, hypertrophic cardiomyopathy, pericardial or myocardial disorders, cardiac tamponade and severe hypertension. Other adverse effects include ototoxicity, GI disturbances, leucopenia, anaemia, weakness and restlessness.Drug interactions: Nephrotoxicity/ototoxicity associated with aminoglycosides may be potentiated when furosemide is also used. Furosemide may induce hypokalaemia, thereby increasing the risk of digoxin toxicity. Increased risk of hypokalaemia if furosemide given with acetazolamide, corticosteroids, thiazides and theophylline. Concurrent administration of NSAIDs with furosemide may decrease ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 138 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 139efficacy and may predispose to nephrotoxicity, particularly in patients with poor renal perfusion. Furosemide may inhibit the muscle relaxation qualities of tubocurarine, but increase the effects of suxamethonium.DOSESMammals: Primates, Sugar gliders: 1–4 mg/kg p.o., i.m., s.c. q8h; Hedgehogs: 2.5–5 mg/kg p.o., i.m., s.c. q8h; Ferrets: 1–4 mg/kg i.v., i.m., p.o. q8–12h; Rabbits: 1–4 mg/kg i.v., i.m. q4–6h initially; maintenance doses are often 1–2 mg/kg p.o. q8–24h; Rodents: 1–4 mg/kg s.c., i.m. q4–6h or 5–10 mg/kg s.c., i.m. q12h.Birds: 0.1–6.0 mg/kg i.m., s.c., i.v. q6–24h 1.Reptiles: 5 mg/kg i.m. q12–24h.Amphibians: Not indicated.Fish: No information available.References1 Watson M (2011) Furosemide. Journal of Exotic Pet Medicine 20(1), 60–63Fusidic acid(Canaural, Fuciderm, Fucithalmic Vet) POM-VFormulations: Topical: 5 mg/g fusidate suspension (Canaural also contains framycetin, nystatin and prednisolone); 0.5% fusidic acid + 0.1% betamethasone cream (Fuciderm); 1% fusidic acid viscous solution (Fucithalmic Vet).Action: Inhibits bacterial protein synthesis.Use: Active against Gram-positive bacteria, particularly Staphylococcus pseudintermedius. It is used topically in the management of staphylococcal infections of the conjunctiva, skin or ear. Fusidic acid is able to penetrate skin and penetrate the cornea gaining access to the anterior chamber of the eye. The carbomer gel vehicle in the ocular preparation may also be efficacious as a surface lubricant.Safety and handling: Avoid contamination of the container on application.Contraindications: Do not use preparations containing corticosteroids in pregnant animals, birds and rabbits.Adverse reactions: No information available.Drug interactions: No information available.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Rabbits: 1 drop per eye q12–24h (Fucithalmic Vet).Birds: Skin: apply a thin layer q24h; Ophthalmic: 1 drop per affected eye q12–24h.Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBAFf.indd 139 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets140Gabapentin (Gabapentinum)(Neurontin*) POMFormulations: Oral: 100 mg, 300 mg, 400 mg capsules; 600 mg, 800 mg film-coated tablets; 50 mg/ml solution.Action: Gabapentin is an analogue of the neurotransmitter gamma-aminobutyric acid (GABA). The precise mechanism of action of gabapentin is unknown; however, it has been suggested that it mediates its anticonvulsive effect by increasing synaptic levels of GABA in the CNS, most likely through increased synthesis of GABA. Gabapentin has also been demonstrated to decrease the influx of calcium ions into neurons via a specific subunit of voltage-dependent calcium channels. It is believed that some of the therapeutic effect of gabapentin is mediated through binding to these channels. Gabapentin does not interact with sodium-dependent channels and demonstrates no affinity for the common neurotransmitter receptors, including benzodiazepine, glutamate, glycine and dopamine. The mode of action of the analgesic effect of gabapentin is unknown.Use: Adjunctive therapy in the treatment of seizures refractory to treatment with conventional therapy. Also treatment of neuropathic pain, particularly if insensitive to opioid analgesics. After multiple dosing, peak plasma concentrations of gabapentin are usually achieved within 2 hours of a dose and steady state achieved within 1–2 days. Gabapentin therapy should only be withdrawn slowly. Monitoring of serum levels in human patients does not appear useful. Use with caution in patients with renal impairment, behavioural abnormalities or severe hepatic disease.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: The most commonly reported adverse effect is mild sedation and ataxia. False-positive readings have been reported with some urinary protein tests in human patients taking gabapentin. Hepatic toxicity has been reported as a rare side effect in human patients.Drug interactions: The absorption of gabapentin from the GI tract is reduced by antacids containing aluminium with magnesium; it is recommended that gabapentin is taken at least 2 hours after the administration of such an antacid. Cimetidine has been reported to reduce the renal clearance of gabapentin but the product information does not consider this to be of clinical importance.DOSESMammals: Ferrets: 3–5 mg/kg p.o. q8h; Rabbits: 2–5 mg/kg p.o. q8h; Hamsters: 50 mg/kg p.o. q24h; Rats: 30 mg/kg p.o. q8h.Birds: 10–11 mg/kg p.o. q12–24h.Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFEDCBAGg.indd 140 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition:to be teratogens.INTRODUCTION2 Intro.indd 13 12/02/2015 09:27xivNOTES2 Intro.indd 14 12/02/2015 09:27BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 1Acepromazine (ACP)(ACP) POM-VFormulations: Injectable: 2 mg/ml solution. Oral: 10 mg, 25 mg tablets.Action: Phenothiazine with depressant effect on the CNS, thereby causing sedation and a reduction in spontaneous activity.Use: Sedation or pre-anaesthetic medication in small mammals and other exotic species. ACP raises the threshold for cardiac arrhythmias and has antiemetic properties. Sedation is unreliable when ACP is used alone; combining ACP with an opioid drug improves sedation (neuroleptanalgesia) and the opioid provides analgesia. The depth of sedation is dose-dependent up to a plateau (0.1–5 mg/kg dependant on species and size). Increasing the dose above this does little to improve the predictability of achieving adequate sedation but increases the risk of incurring adverse effects, the severity of adverse effects and the duration of action of any effects (desirable or adverse) that arise. Onset of sedation is 20–30 min after i.m. administration; clinical doses cause sedation for up to 6 hours. The oral dose of ACP tablets required to produce sedation varies between individual animals and high doses can lead to very prolonged sedation.Safety and handling: Normal precautions should be observed.Contraindications: Hypotension due to shock, trauma or cardiovascular disease. Avoid in animalsPart B – Exotic Pets 141Gelatine (Oxypolygelatine, Polygeline)(Gelofusine, Haemaccel) POM-VFormulations: Injectable: 4% solution of succinylated gelatine in 0.7% sodium chloride (Gelofusine); 35 g/dl degraded urea-linked gelatine with NaCl, KCl, CaCl2 (Haemaccel).Action: Promotes retention of fluid in the vascular system through the exertion of oncotic pressure.Use: The expansion and maintenance of blood volume in various forms of shock including hypovolaemic and haemorrhagic shock. The main difference between gelatine-based solutions and other synthetic colloids is that they have lower molecular weights (and hence are excreted rapidly), appear to have few antigenic or anticoagulative effects. The plasma half-life of most gelatines is approximately 8 hours (oxypolygelatine 2–4 hours), so that the duration of plasma expansion is much shorter than with etherified starch. There appears to be little effect on coagulation or blood loss following gelatine administration. Use with caution in animals with congestive heart failure or renal insufficiency as will increase risk of circulatory overload.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Anaphylactoid reactions to gelatine solutions are rare; it is uncertain whether these reactions represent a specific immune response. In human medicine there are concerns over the safety of these solutions when used in patients with kidney disease.Drug interactions: No information available.DOSESMammals: Infuse a volume similar to the estimated blood loss. In normal circumstances do not exceed replacement of >25% of circulating blood volume with gelatines in a 24 h period.Birds, Reptiles, Amphibians, Fish: No information available.Gentamicin(Clinagel Vet, Easotic, Genta, Otomax, Tiacil, Genticin*) POM-V, POMFormulations: Injectable: 40 mg/ml solution for i.v., i.m., s.c. injection (human preparation), 100 mg/ml solution for i.v., i.m., s.c. injection (Genta). Ophthalmic/aural solution: 0.5% solution (Tiacil); 0.3% ophthalmic gel (Clinagel). Gentamicin is a component of some topical ear preparations.Action: Aminoglycosides inhibit bacterial protein synthesis and require an oxygen-rich environment to be effective, thus they are ZYXWVUTSRQPONMLKJIHGFEDCBAGg.indd 141 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets142ineffective in low-oxygen sites (abscesses, exudates), making all obligate anaerobic bacteria resistant. They are bactericidal and their mechanism of killing is concentration-dependent, leading to a marked post-antibiotic effect, allowing pulse-dosing regimens which may limit toxicity.Use: Active against Gram-negative bacteria, but some staphylococcal and streptococcal (Streptococcus faecalis) species are also sensitive. All obligate anaerobic bacteria and many haemolytic streptococci are resistant. Use in domestic animals is limited by nephrotoxicity and, more rarely, ototoxicity and neuromuscular blockade. Microbial resistance is a concern, although many bacteria resistant to gentamicin may be susceptible to amikacin. Consider specific glomerular filtration rate measurements to assess risk prior to initiating therapy. The trough serum level should be allowed to fall below 2 µg/ml. When used for ‘blind’ therapy of undiagnosed serious infections, gentamicin is usually given in conjunction with a penicillin and/or metronidazole. Aminoglycosides are more active in an alkaline environment. Geriatric animals or those with reduced renal function should only be given this drug systemically when absolutely necessary, although the move to dosing q24h should reduce the likelihood of nephrotoxicity. Use with caution in rabbits, birds and reptiles. Fluid therapy is essential during treatment of reptiles; monitor uric acid levels in birds and reptiles. Used for the treatment of bacterial disease in fish.Safety and handling: Normal precautions should be observed.Contraindications: Do not use the aural preparation if the tympanum is perforated. Do not use in conjunction with other drugs considered to be nephrotoxic.Adverse reactions: Gentamicin delays epithelial healing of corneal ulcers and may cause local irritation. Nephrotoxicity and ototoxicity are potential side effects. Cellular casts in urine sediment are an early sign of impending nephrotoxicity; however, urine must be examined immediately to detect their presence and their absence is not a guarantee of safety. Serum creatinine levels rise later and fatal acute renal failure may be inevitable when they do. Gentamicin should not be used during pregnancy. In rabbits oral administration (including in impregnated beads) can cause fatal enteritis. Known nephrotoxicity in some aglomerular species of fish (e.g. toadfish).Drug interactions: Avoid concurrent use of other nephrotoxic, ototoxic or neurotoxic agents (e.g. amphotericin B, furosemide). Increase monitoring and adjust dosages when these drugs must be used together. Aminoglycosides may be chemically inactivated by beta-lactam antibiotics (e.g. penicillins, cephalosporins) or heparin when mixed in vitro. The effect of non-depolarizing muscle relaxants (e.g. atracurium, pancuronium, vecuronium) may be enhanced by aminoglycosides. Synergism may occur when aminoglycosides are used with beta-lactam antimicrobials. Activity may be reduced if used in conjunction with bacteriostatic antimicrobials.ZYXWVUTSRQPONMLKJIHGFEDCBAGg.indd 142 12/02/2015 09:32BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 143DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Ophthalmic: 1 drop per eye q6–8h. Severe ocular infections may require dosing q1–2h. A fortified topical solution (100 mg gentamicin in 5 ml of 0.3% solution, making 14.3 mg/ml) can be used. Otic: 1–3 drops (depending on weight of the animal) in affected ear or apply ointment to affected area q12h. Primates: 2–4 mg/kg i.m. q12h; Sugar gliders: 1.5–2.5 mg/kg s.c., i.m. q12h; Hedgehogs: 2 mg/kg s.c., i.m. q8h; Ferrets: 2–5 mg/kg i.v. (over 30 min), i.m., s.c. q12–24h; topically q6–8h; Rabbits: 4–8 mg/kg s.c., i.m., i.v. q24h; can be incorporated into antibiotic-impregnated beads (1 g/20 g methylmethacrylate) in surgical sites (e.g. in rabbits following abscess debridement). Beads may require surgical removal at a later date; Guinea pigs: 6 mg/kg s.c. q24h; Rats and Mice: 4–20 mg/kg i.m. q12–24h; Other rodents: 2–5 mg/kg s.c., i.m. q12–24h. Ensure adequate renal function and hydration status before use. All species: nebulize 50 mg in 10 ml saline for 15 min q8–12h.Birds: 2–10 mg/kg i.v., i.m. q6–12h; topically q6–8h; nebulize 50 mg in 10 ml saline for 15 min q8–12h a.Reptiles: Chelonians: 2–4 mg/kg i.m. q72h b; may also be nebulized at dilution of 10–20 mg gentamicin/15 ml saline for 15–20 min q8–12h for respiratory tract infections in chelonians and lizards; Most snakes: 2.5 mg/kg i.m. q72h; Blood pythons: 2.5 mg/kg i.m. once, then 1.5 mg/kg i.m. q96h c.Amphibians: 3 mg/kg i.m. q24h; 1 mg/ml solution as 8 h bath q24–48h; 2 mg/ml dilution topically q6–8h for ocular disease d.Fish: 2.5 mg/kg i.m. q2–3d 12.Referencesa Ramsey EC and Vulliet R (1993) Pharmacokinetic properties of gentamicin and amikacin in the cockatiel. Avian Diseases 37(2), 628–634b Beck K, Loomis M, Lewbart GL et al. (1995) Preliminary comparison of plasma concentrations of gentamicin injected into the cranial and caudal limb musculature of the Eastern box turtle (Terrapene carolina carolina). Journal of Zoo and Wildlife Medicine 26(2), 265–268c Hilf M, Swanson D, Wagner R and Yu VL (1991) A new dosing schedule for gentamicin in blood pythons (Python curtus): a pharmacokinetic study. Research in Veterinary Science 50(2), 127–130d Teare JA, Wallace RSSkin: 5% ointment in 10 g, 25 g tubes.Action: Inhibits viral replication (viral DNA polymerase); depends on viral thymidine kinase for phosphorylation.Use: Treat herpesvirus infections in various avian species (e.g. Pacheco’s disease in psittacine birds). Has been used for prophylaxis of psittacine herpesvirus in outbreaks. In reptiles, it is used to treat chelonian herpesvirus infections.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: Ocular irritation may occur and the frequency of application should be reduced if this develops. Treatment should not be continued for >3 weeks. May cause vomiting in birds.Drug interactions: No information available.DOSESMammals: No information available.Birds: Raptors: 330 mg/kg p.o. q12h for 7–14 days 1; Psittacids: 20–40 mg/kg i.m. q12h or 80 mg/kg p.o. q8h for 7 days a or 400 mg/kg in food in aviaries b.Reptiles: Testudo species: 80 mg/kg p.o. q8-24h; topically to oral lesions q8–24h. There is a suggestion that q8h dosing is more successful than q24h dosing c; Terrapene species: 40 mg/kg p.o. q24h d.Amphibians, Fish: No information available.Referencesa Norton TM, Gaskin J, Kollias GV, Homer B, Clark CH and Wilson R (1991) Efficacy of acyclovir against herpesvirus infection in Quaker parakeets. American Journal of Veterinary Research 52(12), 2007–2009b Cross G (1995) Antiviral therapy. Seminars in Avian Exotic Pet Medicine 4, 96–102ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 4 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 5c Gaio C, Rossi T, Villa R et al. (2007) Pharmacokinetics of acyclovir after a single oral administration in marginated tortoises (Testudo marginata). Journal of Herpetological Medicine and Surgery 17, 8–11d Allender MC, Mitchell MA, Yarborough J and Cox S (2013) Pharmacokinetics of a single oral dose of acyclovir and valacyclovir in North American box turtles (Terrapene species). Journal of Veterinary Pharmacology and Therapeutics 36(2), 205–2081 Huckabee JR (2000) Raptor therapeutics. Veterinary Clinics of North America: Exotic Animal Practice 3, 91–116ACP see AcepromazineAcriflavine (Acriflavinium chloride)(Acriflavin, Acriflavine) ESPAFormulations: Immersion: dry powder. Liquid: proprietary liquid formulations, occasionally mixed with proflavine.Action: No information available.Use: Treatment of external fungal, bacterial and parasitic diseases in fish. Some bacterial resistance exists and acriflavine is considered to be less effective than other medications. It is strongly recommended that a proprietary formulation is used initially to avoid problems related to purity and enable accurate dosing.Safety and handling: Powdered formulation is irritant and potentially mutagenic.Contraindications: No information available.Adverse reactions: May cause reproductive failure in some species (e.g. guppies). Will kill aquatic plants.Drug interactions: No information available.DOSESFish: 5 mg/l by immersion for 3–5 days, 10 mg/l by immersion for 2 h or 500 mg/l for 30 min 123; use proprietary formulations at the manufacturer’s recommended dose rate.Mammals, Birds, Reptiles, Amphibians: No information available.References1 Herwig N (1979) Handbook of Drugs and Chemicals Used in the Treatment of Fish Diseases. Charles C. Thomas Publishers, Illinois2 Noga EJ (2010) Fish Disease – Diagnosis and Treatment, 2nd edn. Wiley-Blackwell, Oxford3 Stoskopf MK (1998) Fish chemotherapeutics. Veterinary Clinics of North America: Small Animal Practice – Tropical Fish Medicine pp. 331–348Acriflavinium chloride see Acriflavine ACTH see Tetracosactide Activated charcoal see CharcoalZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 5 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets6Adrenaline (Epinephrine)(Adrenaline*, Epinephrine*) POMFormulations: Injectable: Range of concentrations for injection: 0.1–10 mg/ml, equivalent to 1:10,000 to 1:100.Action: Adrenaline exerts its effects via alpha-1, -2 and beta-1 and -2 adrenoreceptors.Use: Cardiac resuscitation, status asthmaticus and to offset the effects of histamine release in severe anaphylactoid reactions. The ophthalmic preparation is used in open angle glaucoma. The effects of adrenaline vary according to dose. Infusions of low doses mainly result in beta-adrenergic effects (increases in cardiac output, myocardial oxygen consumption, and a reduced threshold for arrhythmias with peripheral vasodilation and a fall in diastolic blood pressure). At high doses alpha-1 effects predominate, causing a rise in systemic vascular resistance, diverting blood to the central organs; however, this may improve cardiac output and blood flow. Adrenaline is not a substitute for fluid replacement therapy. Respiratory effects include bronchodilation and an increase in pulmonary vascular resistance. Renal blood flow is moderately decreased. The duration of action of adrenaline is short (2–5 min). Beware of using in animals with diabetes mellitus (monitor blood glucose concentration), hypertension or hyperthyroidism. Use with caution in hypovolaemic animals. Overdosage can be fatal so check dose, particularly in small patients. Intracardiac injection is not recommended. Used for the treatment of cardiac arrest in fish. Use in anaesthetized reptiles is debatable as it has been suggested to increase hypoxia by diverting blood away from the lungs.Safety and handling: Do not confuse adrenaline vials of different concentrations. Adrenaline is sensitive to light and air: do not use if it is pink, brown or contains a precipitate. It is unstable in 5% dextrose.Contraindications: The use of human adrenaline pen injections is not recommended for the treatment of suspected anaphylaxis. The doses in such pens are usually too small to be effective in most normal animals and by the time the animal has collapsed would be unlikely to have any effect on outcome. If such pen injections are administered by owners, then, in common with medical practice, patients must be carefully monitored for at least 6 hours.Adverse reactions: Increases myocardial oxygen demand and produces arrhythmias including ventricular fibrillation. These may be ameliorated by administering oxygen and slowing the heart rate with beta-2 antagonists. Other adverse effects include tachycardia, arrhythmias, dry mouth and cold extremities. Repeated injections can cause necrosis at the injection site.Drug interactions: Toxicity may occur if used with other sympathomimetic amines because of additive effects. The effects of adrenaline may be potentiated by antihistamines and thyroxine. ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 6 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 7Propranolol may block the beta effects of adrenaline, thus facilitating an increase in blood pressure. Alpha blocking agents or diuretics may negate or diminish the pressor effects. When adrenaline is used with drugs that sensitize the myocardium (e.g. high doses of digoxin) monitor for signs of arrhythmias. Hypertension may result if adrenaline is used with oxytocic agents.DOSESMammals: Ferrets: 20 µg (micrograms)/kg s.c., i.m., i.v., intratracheal; Rabbits: cardiac resuscitation: 100 µg (micrograms)/kg i.v., repeated and/or higher doses (up to 200 µg/kg) may be required at intervals of 2–5 min; Guinea pigs: 3 µg (micrograms)/kg i.v.; Other rodents: 10 µg (micrograms)/kg i.v. as required.Birds: 0.1–1.0 mg/kg i.m., i.v., intraosseous, intracardiac, intratracheal.Reptiles: 0.5 mg/kg i.v., intraosseous; 1 mg/kg intratracheal diluted in 1 ml/100 g body weight.Amphibians: No information available.Fish: 0.2–0.5 mg/kg i.m., i.v., intraperitoneal, intracardiac1.References1 Stoskopf MK (1993) Fish Medicine. Saunders, PhiladelphiaAglepristone(Alizin) POM-VFormulations: Injectable: 30 mg/ml solution.Action: Progesterone receptor blockage leads to reduced progesterone support for pregnancy.Use: Termination of pregnancy in mammals. No specific information is available for exotic mammal species. In bitches confirmed as pregnant, a partial abortion may occur in up to 5% and a similar situation may occur in other mammals; owners should be warned. A clinical examination (uterine palpation) is always recommended after treatment in order to confirm termination. After induced abortion an early return to oestrus is frequently observed (the oestrus-to-oestrus interval may be significantly shortened). Can also be used for the treatment of pyometra in some mammals, although recurrence is fairly common.Safety and handling: Use with care. Accidental injection may be a hazard to women who are pregnant or intending to become pregnant.Contraindications: Consider avoiding in animals with diagnosed or suspected hypoadrenocorticism or diabetes mellitus.Adverse reactions: Transient pain at the injection site; any local inflammation produced resolves uneventfully. In animals treated in the later stages of gestation, abortion may be accompanied by the physiological signs of parturition, i.e. fetal expulsion, anorexia, mammary congestion.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 7 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets8Drug interactions: Aglepristone binds to glucocorticoid receptors and may therefore interfere with the actions of glucocorticoids; however, the clinical significance of this is unclear.DOSESMammals: Rabbits: pregnancy termination: 10 mg/kg on days 6 and 7 post implantation; Guinea pigs: pyometra/metritis: 10 mg/kg on days 1, 2 and 8.Birds, Reptiles, Amphibians, Fish: No information available.Alfaxalone(Alfaxan) POM-VFormulations: Injectable: 10 mg/ml solution; the alfaxalone is solubilized in a cyclodextrin.Action: Anaesthesia induced by the CNS depressant effect of the alfaxalone.Use: Induction agent used before inhalational anaesthesia, or as a sole anaesthetic agent for examination or surgical procedures. As with all i.v. anaesthetic drugs, premedication will reduce the dose required for induction and maintenance of anaesthesia. The drug should be given slowly and to effect in order to prevent inadvertent overdose. Analgesia is insufficient for surgery: other analgesic drugs such as opioids should be incorporated into the anaesthetic protocol. Alfaxalone is shorter acting and causes less excitement during recovery than the alfaxalone/alfadalone combination previously available. Alfaxalone can be given i.m. or s.c. to provide sedation. Do not use in combination with other i.v. anaesthetic agents. Used for the induction and maintenance of anaesthesia in fish; the alfaxalone/alphadalone combination previously available has been used parenterally in large fish.Safety and handling: Does not contain an antimicrobial preservative; thus it is recommended that the remainder of an opened bottle is discarded after single use within 24 hours.Contraindications: No information available.Adverse reactions: In mammals a slight increase in heart rate can occur immediately after i.v. injection as a compensatory response to maintain blood pressure in the face of mild hypotension. This effect can be minimized by slow i.v. injection. As with all anaesthetic drugs, respiratory depression can occur with overdoses.Drug interactions: No information available.DOSESSee Appendix for sedation protocols in all species.Mammals: Unpremedicated: Small primates (e.g. Marmosets): 12 mg/kg i.m. a; Ferrets: 9–12 mg/kg i.v., i.m.; Rabbits: 1–3 mg/kg i.v. or 3–6 mg/kg i.m. bcdefg; Guinea pigs: 40 mg/kg i.m., intraperitoneal; Other ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 8 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 9rodents: 20 mg/kg i.m. or 120 mg/kg intraperitoneal; Rabbits: 3 mg/kg i.m. following premedication with medetomidine at 0.25 mg/kg s.c.Birds: For large birds and those with a dive response: 2–4 mg/kg i.v. to effect 12.Reptiles: 2–4 mg/kg i.v., intraosseous for induction (light sedation) up to 30 mg/kg i.m. for surgical anaesthesia but effects are dependent on species and temperature; Chelonians: Horsfield tortoises, Red-eared sliders: 10 mg/kg i.m. (light sedation) up to 20 mg/kg i.m. for surgical anaesthesia hi; Macquarie river turtles: 9 mg/kg i.v. j; Lizards, Snakes:LJ, Bailey KM, Harms CA, Lewbart GA and Posner LP (2014) The efficacy of alfaxalone for immersion anesthesia in koi carp (Cyprinus carpio). Veterinary Anaesthesia and Analgesia 41(4), 398–4051 Jones KL (2012) Therapeutic review: alfaxalone. Journal of Exotic Pet Medicine 4, 347–3532 Lierz M and Korbel R (2012) Anaesthesia and analgesia in birds. Journal of Exotic Pet Medicine 21(1), 44–58ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 9 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets10Alfentanil(Rapifen*) POM CD SCHEDULE 2Formulations: Injectable: 0.5 mg/ml solution, available in 2 ml or 10 ml vials; 5 mg/ml solution.Action: Pure mu agonist of the phenylpiperidine series.Use: Very potent opioid analgesic (10–20 times more potent than morphine) used to provide intraoperative analgesia during anaesthesia. Use of such potent opioids during anaesthesia contributes to a balanced anaesthesia technique but they must be administered accurately. It has a rapid onset (15–30 seconds) and short duration of action. It is best given using continuous rate infusions. The drug is not suited to provision of analgesia in the postoperative period.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: A reduction in heart rate is likely whenever alfentanil is given; atropine can be administered to counter bradycardia if necessary. Respiratory depression leading to cessation of spontaneous respiration is likely following administration. Do not use unless facilities for positive pressure ventilation are available (either manual or automatic). Rapid i.v. injection can cause a severe bradycardia, even asystole. In rabbits, seizures have been noted with the use of alfentanil as part of a midazolam, medetomidine and alfentanil combination.Drug interactions: Alfentanil reduces the dose requirements of concurrently administered anaesthetics, including inhaled anaesthetics, by at least 50%. In humans it is currently recommended to avoid giving alfentanil to patients receiving monoamine oxidase inhibitors due to the risk of serotonin toxicity.DOSESMammals: Rabbits: 0.03–0.07 mg/kg i.v.Birds, Reptiles, Amphibians, Fish: No information available.Allopurinol(Zyloric*) POMFormulations: Oral: 100 mg, 300 mg tablets.Action: Xanthine oxidase inhibition decreases formation of uric acid by blocking the conversion of hypoxanthine to xanthine, and of xanthine to uric acid.Use: Treatment of hyperuricaemia and articular gout in birds and reptiles. It should be remembered that, unlike mammals, uric acid is the natural end-product of protein metabolism in birds and reptiles. ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 10 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 11Therefore use of allopurinol is symptomatic only and the primary cause should be addressed. Ensure patients are adequately hydrated. Clinical response is variable in birds (e.g. studies in red-tailed hawks showed no significant effect on plasma uric acid levels). The dosage should be reduced as plasma uric acid levels decrease.Safety and handling: Normal precautions should be observed.Contraindications: No information available.Adverse reactions: In humans, allopurinol may enhance the effects of azathioprine and theophylline. In red-tailed hawks, doses of 50 mg/kg and 100 mg/kg have been reported as toxic and causing renal failure.Drug interactions: No information available.DOSESMammals: No information available.Birds: 10–30 mg/kg p.o. q12h (all species) ab; Pigeons: 830 mg/l drinking water; Psittacids: 10 mg/30 ml drinking water.Reptiles: 10–20 mg/kg p.o. q24h (most species); Chelonians: 50 mg/kg p.o. q24h for 30 days then q72h c; Green iguanas: 25 mg/kg p.o. q24h d.Amphibians, Fish: No information available.Referencesa Lumeij JT, Sprang EPM and Redig PT (1998) Further studies on allopurinol-induced hyperuricaemia and visceral gout in Red-tailed hawks (Buteo jamaicensis). Avian Pathology 24(4), 390–393b Poffers J, Lumeij JT, Timmermans-Sprang EP and Redig PT (2002) Further studies on the use of allopurinol to reduce plasma uric acid concentrations in the Red-tailed hawk (Buteo jamaicensis) hyperuricaemic model. Avian Pathology 31(6), 567–572c Kolle P (2001) Efficacy of allopurinol in European tortoises with hyperuricaemia. Proceedings of the Association of Reptilian and Amphibian Veterinarians, pp. 186–186d Hernandez-Divers SJ, Martinez-Jimenez D, Bush S, Latimer KS, Zwart P and Kroeze EJ (2008) Effects of allopurinol on plasma uric acid levels in normouricaemic and hyperuricaemic green iguanas (Iguana iguana). Veterinary Record 162(4), 112–115Alphaxalone see AlfaxaloneAluminium antacids (Aluminium hydroxide)(Alucap*. With alginate: Acidex*, Gastrocote*, Gaviscon Advance*, Peptac*. With magnesium salt: Asilone*, Maalox*, Mucogel*) P, GSLFormulations: Oral: Aluminium hydroxide is available as a dried gel. Other products are composite preparations containing a variety of other compounds including magnesium oxide, hydroxide or trisilicate, potassium bicarbonate, sodium carbonate and bicarbonate, alginates and dimeticone. Aluminium hydroxide content varies.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 11 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets12Action: Neutralizes gastric hydrochloric acid. May also bind bile acids and pepsin and stimulate local prostaglandin (PGE-1) production. Also binds inorganic phosphate (PO43–) in the GI tract, making it unavailable for absorption.Use: Management of gastritis and gastric ulceration. In renal failure, to lower serum phosphate levels in animals with hyperphosphataemia. Frequent administration is necessary to prevent rebound acid secretion. Phosphate-binding agents are usually only used if low-phosphate diets are unsuccessful. Monitor serum phosphate levels at 10–14 day intervals and adjust dosage accordingly if trying to normalize serum concentrations. Thoroughly mix the drug with food to disperse it throughout the GI tract and to increase its palatability.Safety and handling: Long-term use (many years) of oral aluminium products in humans has been associated with aluminium toxicity and possible neurotoxicity. This is unlikely to be a problem in veterinary medicine.Contraindications: No information available.Adverse reactions: Constipation may occur. This is an effect of the aluminium compound and is counteracted by inclusion of a magnesium salt.Drug interactions: Do not administer digoxin, tetracycline or fluoroquinolone products orally within 2 hours of aluminium salts as their absorption may be impaired.DOSESMammals: Rabbits: 30–60 mg/kg p.o. q8–12h; Guinea pigs: 20–40 mg/animal p.o. prn for hyperphosphataemia due to renal failure.Birds: 30–90 mg/kg p.o. q12h.Reptiles: 100 mg/kg p.o. q24h.Amphibians, Fish: No information available.Aluminium hydroxide see Aluminium antacidsAmantadine(Lysovir*, Symmetrel*) POMFormulations: Oral: 100 mg capsule; 10 mg/ml syrup.Action: Provides analgesia through NMDA antagonist action which may potentiate the effects of other analgesics.Use: Adjunctive analgesic in animals that are unresponsive to opioids, or that require chronic pain relief in a home environment (e.g. osteoarthritis or cancer pain).Safety and handling: Normal precautions should be observed.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 12 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 13Contraindications: No information available.Adverse reactions: In humans minor GI and CNS effects have been reported, although these have not been reported in animals.Drug interactions: No informationavailable.DOSESMammals: Ferrets: 3–5 mg/kg (anecdotal). May have a role in the treatment of neuropathic pain in rabbits and rodents at canine doses (3–5 mg/kg p.o. q24h) 1.Birds, Reptiles, Amphibians, Fish: No information available.References1 Suckow MA, Stevens KA and Wilson RP (2012) The Laboratory Rabbit, Guinea Pig, Hamster and Other Rodents. Academic Press, PhiladelphiaAmethocaine see TetracaineAmikacin(Amikacin*, Amikin*) POMFormulations: Injectable: 50 mg/ml, 250 mg/ml solutions.Action: Aminoglycosides inhibit bacterial protein synthesis. They are bactericidal and their mechanism of killing is concentration-dependent, leading to a marked post-antibiotic effect, allowing prolonged dosing intervals (which may reduce toxicity).Use: Active against many Gram-negative bacteria, Staphlococcus aureus and Nocardia spp., including some that may be resistant to gentamicin. Streptococci and anaerobes are usually resistant. Its use is only indicated after sensitivity testing has been performed and the organism shown to be resistant to other aminoglycosides such as gentamicin. Activity at low oxygen sites may be limited. Movement across biological membranes may also be limited, hence systemic levels require parenteral administration, and access to sites such as the CNS and ocular fluids is very limited. Monitoring serum amikacin levels should be considered to ensure therapeutic levels and minimize toxicity, particularly in neonates, geriatric patients and those with reduced renal function. Monitoring renal function is also advisable during treatment of any animal. Intravenous doses should be given slowly, generally over 30–60 min. Concurrent fluid therapy is advised.Safety and handling: Normal precautions should be observed.Contraindications: If possible avoid use in animals with reduced renal function.Adverse reactions: Nephrotoxic and ototoxic. Oral doses can cause fatal enterotoxaemia in rabbits. Use with caution in birds, as it is toxic.ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 13 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets14Drug interactions: Synergism may occur in vivo when aminoglycosides are combined with beta-lactam antimicrobials. Avoid the concurrent use of other nephrotoxic, ototoxic or neurotoxic agents (e.g. amphotericin B, furosemide). Aminoglycosides may be inactivated in vitro by beta-lactam antibiotics (e.g. penicillins, cephalosporins) or heparin; do not give these drugs in the same syringe. Can potentiate neuromuscular blockade so avoid use in combination with neuromuscular blocking agents.DOSESSee Appendix for guidelines on responsible antibacterial use.Mammals: Ferrets: 8–16 mg/kg i.v., i.m., s.c. q8–24h; Rabbits: 2–10 mg/kg i.v., i.m., s.c. q8–12h; Rodents: 5–15 mg/kg i.v., i.m., s.c. q8–12h. Concurrent fluid therapy advised, especially if hydration status poor or uncertain.Birds: 10–20 mg/kg i.m., s.c., i.v. q8–12h or 6 mg/ml via nebulization (may be given in combination with acetylcysteine) ab.Reptiles: Gopher tortoises: 5 mg/kg i.m. q48h c; Gopher snakes: 5 mg/kg i.m. once, then 2.5 mg/kg i.m. q72h at 25°C d; concurrent fluid therapy is advised due to potential nephrotoxicity; Ball pythons: 3.48 mg/kg i.m. once e.Amphibians: Bullfrogs: 5 mg/kg i.m. q36h f.Fish: 5 mg/kg i.m. q72h for 3 treatments 12.Referencesa Gronwall R, Brown MP and Clubb S (1989) Pharmacokinetics of amikacin in African grey parrots. American Journal of Veterinary Research 50(2), 250–252b Ramsay EC and Vulliet R (1993) Pharmacokinetic properties of gentamicin and amikacin in the cockatiel. Avian Diseases 37(2), 628–634c Caligiuri R, Kollias GV, Jacobson E, McNab B, Clark CH and Wilson RC (1990) The effects of ambient temperature on amikacin pharmacokinetics in gopher tortoises. Journal of Veterinary Pharmacology and Therapeutics 13, 287–291d Mader DR, Conzelman GM Jr and Baggot JD (1985) Effects of ambient temperature on the half-life and dosage regimen of amikacin in the gopher snake. Journal of the American Veterinary Medical Association 187(11), 1134–1136e Johnson JH, Jensen JM, Brumbaugh GW and Booth DM (1997) Amikacin pharmacokinetics and the effects of ambient temperature on the dosing regimen in ball pythons (Python regius). Journal of Zoo Wildlife and Medicine 28(1), 80–88f Letcher J and Papich M (1994) Pharmacokinetics of intramuscular administration of three antibiotics in bullfrogs (Rana catesbeiana). Proceedings of the Association of Reptilian and Amphibian Veterinarians/American Association of Zoo Veterinarians Conference, pp. 79–931 Stoskopf MK (1993) Fish Medicine. Saunders, Philadelphia2 Wildgoose WH and Lewbart GA (2001) Therapeutics. In: BSAVA Manual of Ornamental Fish, 2nd edn, ed. WH Wildgoose, pp. 237–258. BSAVA Publications, GloucesterAmino acid solutions(Duphalyte, Aminoplasmal*, Aminoven*, Clinimix*, Glamin*, Hyperamine*, Intrafusin*, Kabiven*, Kabiven Peripheral*, Nutriflex*) POM, POM-VFormulations: Injectable: synthetic crystalline l-amino acid solutions for i.v. use only. Numerous human products are available, varying in concentrations of amino acids. Most products also ZYXWVUTSRQPONMLKJIHGFEDCBAAa.indd 14 12/02/2015 09:28BSAVA Small Animal Formulary 9th edition: Part B – Exotic Pets 15contain electrolytes. Some products contain varying concentrations of glucose.Action: Support protein anabolism, arrest protein and muscle wasting, and maintain intermediary metabolism.Use: Amino acid solutions supply essential and non-essential amino acids for protein production. They are used parenterally in patients requiring nutritional support but unable to receive enteral support. The authorized veterinary preparation (Duphalyte) contains insufficient amino acids to meet basal requirements for protein production and is intended as an aid for i.v. fluid support. All products are hyperosmolar. The use of concentrated amino acid solutions for parenteral nutrition support should not be undertaken without specific training and requires central venous access and intensive care monitoring. Parenteral nutrition may also be able to meet the patient’s requirements for fluids, essential electrolytes (sodium, potassium, magnesium) and phosphate. Additionally if treatment is prolonged, vitamins and trace elements may need to be given. Intravenous lines for parenteral nutrition should be dedicated for that use alone and not used for other medications. As many of the available amino acids solutions contain potassium, the maximal acceptable rates of infusion will depend on the potassium content of the amino acid preparation.Safety and handling: Normal precautions should be observed.Contraindications: Dehydration, hepatic encephalopathy, severe azotaemia, shock, congestive heart failure and electrolyte imbalances.Adverse reactions: The main complications of parenteral nutrition are metabolic, including hyperglycaemia, hyperlipidaemia, hypercapnia, acid–base disturbances and electrolyte disturbances. Other complications include catheter-associated thrombophlebitis, bacterial colonization of the catheter and resulting bacteraemia and septicaemia. Potentially life-threatening electrolyte imbalances including hypophosphataemia may also be seen (also referred to as refeeding syndrome). As with other hyperosmolar solutions, severe tissue damage could occur if extravasated, though this has not been reported.Drug interactions: Consult specific product data sheet(s).DOSESMammals: Rabbits, Rodents: Anecdotally, these products have been used either alone or diluted with lactated Ringer’s solution at a 1:5 ratio and given at a total volume of approximately 100 ml/kg/day.Birds: Up to 10 ml/kg/day.Reptiles, Amphibians, Fish: No information available.ZYXWVUTSRQPONMLKJIHGFED