11_Small animal formulary

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 85

VetBooks.ir Safety and handling: Normal precautions should be observed. A
Contraindications: None known. B
Adverse reactions: None known. C
Drug interactions: No information available. D
DOSES E
Dogs, Cats: May be applied daily–weekly. F
References G
H
Cavana P, Petit JY, Perrot S et al. (2015) Efficacy of a 2% climbazole shampoo for I
reducing Malassezia population sizes on the skin of naturally infected dogs. Journal de J
Mycologie Medicale 25, 268–273 K
L
Clindamycin M
N
(Antirobe, Clinacin, Clindacyl, Clindaseptin, Mycinor) O
POM-V P
Q
Formulations: Oral: 25 mg, 75 mg, 150 mg, 300 mg capsules and R
S
tablets; 25 mg/ml solution. T
U
Action: Lincosamide antibiotic that binds to the 50S ribosomal V
W
subunit, inhibiting peptide bond formation. May be bactericidal or X
bacteriostatic depending on susceptibility. Y
Z
Use: Bone and joint infections associated with Gram-positive

bacteria; pyoderma; toxoplasmosis; and infections associated with
the oral cavity. Active against Gram-positive cocci (including
penicillin-resistant staphylococci), many obligate anaerobes,
mycoplasmas and Toxoplasma gondii. Attains high concentrations
in bone and bile. Being a weak base, it becomes ion-trapped (and
therefore concentrated) in fluids that are more acidic than plasma,
such as prostatic fluid, milk and intracellular fluid. There is complete
cross-resistance between lincomycin and clindamycin, and partial
cross-resistance with erythromycin. Use with care in individuals
with hepatic or renal impairment.

Safety and handling: Normal precautions should be observed.
Contraindications: No information available.
Adverse reactions: Colitis, vomiting and diarrhoea are reported.

Although not a major problem in dogs and cats, discontinue drug if
diarrhoea develops. In cats may be associated with oesophagitis
and oesophageal stricture; therefore, consider following solid
dosage forms such as tablet administration with a small water or
food bolus.

Drug interactions: May enhance the effect of non-depolarizing

muscle relaxants, (e.g. tubocurarine) and may antagonize the effects
of neostigmine and pyridostigmine. Do not administer with macrolide,
chloramphenicol or other lincosamide antimicrobials as these
combinations are antagonistic.

86 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A DOSES

See Appendix for guidelines on responsible antibacterial use.
Dogs:
B
• 5.5 mg/kg p.o. q12h or 11 mg/kg q24h; in severe infection can
increase to 11 mg/kg q12h.
C • Toxoplasmosis: 25 mg/kg p.o. daily in divided doses.

D Cats:
• 5.5 mg/kg p.o. q12h or 11 mg/kg q24h.
E • Toxoplasmosis: 25 mg/kg p.o. daily in divided doses.

F ReferencesBeatty JA, Swift N, Foster DJ et al. (2006) Suspected clindamycin-associated oesophageal
injury in cats: five cases. Journal of Feline Medicine and Surgery 8, 412–419

G

H Clodronate
I (Bonefos*, Loron*) POM
Formulations: Oral: 400 mg capsule.
J Action: Adsorbed on to hydroxyapatite crystals and ingested by

K osteoclasts. Metabolized in the cell to compounds that compete with
ATP, leading to apoptosis of the cell and thus slowing the rate of bone
destruction. This class of drugs may also decrease intestinal
L absorption of calcium and influence vitamin D3 metabolism.

M Use: Treatment of acute moderate to severe hypercalcaemia when

other therapies are ineffective, or in the long-term therapy of chronic

N hypercalcaemia. Few reports of use in dogs and no reports of use in

cats. Excretion reduced in chronic renal failure; dose adjustment may

O be required. Recent literature has evaluated liposome encapsulated

clodronate for immune-mediated haemolytic anaemia and malignant

P histiocytosis in dogs.

Q Safety and handling: Normal precautions should be observed.
Contraindications: Use with caution in patients with pre-existing

R renal disease.

S Adverse reactions: Nausea, diarrhoea, hypocalcaemia,

hypophosphataemia, hypomagnesaemia and hypersensitivity reactions.

T Drug interactions: Reduced absorption if administered with
antacids, calcium and iron salts; administer 2 hours apart.
U Concurrent use of aminoglycosides and/or loop diuretics may result

V in severe hypocalcaemia.

DOSES

W Dogs: 5–14 mg/kg slow i.v. over a minimum of 2 hours (diluted according

to the manufacturer’s instructions) or 10–30 mg/kg p.o. q8–12h.
X Cats: No information available.

Y ReferencesUlutas B, Voyvoda H, Pasa S et al. (2006) Clodronate treatment of vitamin D-induced
hypercalcemia in dogs. Journal of Veterinary Emergency and Critical Care 16 141–145

Z Whitley NT and Day MJ (2011) Immunomodulatory drugs and their application to the manage-
ment of canine immune-mediated disease. Journal of Small Animal Practice 52, 70–85

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 87

VetBooks.ir Clofazimine A
B
(Clofazimine*) POM C
D
Formulations: Oral: 100 mg capsule. E
Action: Not entirely clear but appears to be bactericidal and has F
G
membrane disrupting properties. H
I
Use: Mycobacterial infections including feline leprosy. Limited J
K
information available with most derived from human medicine. For L
feline mycobacterial infection long-term treatment is required and M
combination therapy is utilized, e.g. with clarithromycin and N
doxycycline or fluoroquinolones. Monitor hepatic and renal function O
during treatment. Use with caution in hepatic and renal impairment. P
Q
Safety and handling: Normal precautions should be observed. R
Contraindications: No information available. S
Adverse reactions: In humans the major adverse effects are T
U
nausea, diarrhoea, discoloration of skin, eyes and body fluids and V
renal and hepatic impairment (monitor functions during therapy). W
Photosensitization can also occur and treated animals should be X
housed indoors. Y
Z
Drug interactions: No information available.
DOSES

See Appendix for guidelines on responsible antibacterial use.

Dogs, Cats: 4–8 mg/kg p.o. q24h for 2–6 months. For the

management of mycobacterial infections, the drug is generally used
in combination therapy with other antimicrobials including
fluoroquinolones and clarithromycin. Refer to specialist texts.

Clomipramine

(Clomicalm) POM-V

Formulations: Oral: 5 mg, 20 mg, 80 mg tablets.
Action: Both clomipramine and its primary metabolite

desmethylclomipramine are active in blocking serotonin and
noradrenaline reuptake in the brain, with resultant anxiolytic,
antidepressant and anticompulsive effects.

Use: Licensed for use in association with a behaviour modification

plan for the management of separation-related disorders in dogs.
Also used in management of a wider range of anxiety-related
disorders in dogs and cats, including ‘compulsive behaviours’, noise
fears and urine spraying. Care required before use in animals with a
history of constipation, epilepsy, glaucoma, urinary retention or
arrhythmias. Can be used with benzodiazepines. Has been reported
in the treatment of cataplexy in the dog, with resolution of signs after
3-months treatment.

88 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Safety and handling: Normal precautions should be observed.
Contraindications: Patients sensitive to tricyclic or serotonin
B
reuptake inhibitor antidepressants. Do not give with, or within 2 weeks
of, monoamine oxidase inhibitors (e.g. selegiline). Not recommended

C for use in male breeding animals, as testicular hypoplasia may occur.

D Adverse reactions: May cause sporadic vomiting, changes in

appetite or lethargy. Vomiting may be reduced by co-administration
E with a small quantity of food.
Drug interactions: May potentiate the effects of the antiarrhythmic
F
drug quinidine, anticholinergic agents (e.g. atropine), other CNS
active drugs (e.g. barbiturates, benzodiazepines, general
G anaesthetics, neuroleptics), sympathomimetics (e.g. adrenaline) and

H coumarin derivatives. Simultaneous administration with cimetidine
may lead to increased plasma levels of clomipramine. Plasma levels
of certain antiepileptic drugs, e.g. phenytoin and carbamazepine,
I may be increased by co-administration with clomipramine.

J DOSES
Dogs: 1–2 mg/kg p.o. q12h.

K Cats: 0.25–1 mg/kg p.o. q24h.

L Clonazepam

M (Klonopin*, Linotril*, Rivotril* and several others) POM

N Formulations: Oral: 0.25 mg, 0.5 mg, 1.0 mg, 2 mg tablets.

O Action: Long-acting benzodiazepine with anticonvulsant, muscle

relaxant and anxiolytic properties. Enhances activity of gamma-
aminobutyric acid (GABA), through binding at the benzodiazepine site
P of the GABAA receptor. In addition, affects glutamate decarboxylase

Q activity.
Use: Management of muscular hypertonicity (episodic falling) in the
R Cavalier King Charles Spaniel and as an anxiolytic for behaviour
modification in both cats and dogs and for hyperaesthesia in cats.

S It has been used to treat epilepsy in cats but more suitable
medications are available, including phenobarbital, imepitoin

T (although to date there have been no publications on its efficacy in
cats), levetiracetam and diazepam. Tolerance may develop following

U prolonged therapy, with reduction in clinical effect. Care is required
when withdrawing clonazepam after prolonged therapy and the dose

V should be tapered off.

W Safety and handling: Normal precautions should be observed.
Contraindications: Avoid use in patients with marked CNS
X depression, respiratory depression, severe muscle weakness or
hepatic impairment (may worsen hepatic encephalopathy).

Y Adverse reactions: Generally mild; sedation and respiratory
suppression at higher doses are the most important. In cats, potential
Z adverse effects include acute hepatic necrosis, sedation and ataxia.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 89

VetBooks.ir Drug interactions: Drugs that result in hepatic enzyme induction, A
B
e.g. phenobarbital and phenytoin, may accelerate metabolism of C
clonazepam. Antifungal imidazoles may increase clonazepam levels. D
E
DOSES F
Dogs: 0.5 mg/kg p.o. q8–12h (suggested starting dose but there is a G
H
wide range of recommendations). I
J
Cats: 0.5 mg/cat p.o. q12–24h (suggested starting dose but there is a K
L
wide range of recommendations). M
N
References O
P
Garosi LS, Platt SR and Shelton GD (2002) Hypertonicity in Cavalier King Charles Q
Spaniels. Journal of Veterinary Internal Medicine 16, 330 R
Moesta A (2014) Animal behavior case of the month. Spinning. Journal of the American S
Veterinary Medical Association 244, 1149 –1152 T
U
Clonidine V
W
(Catapres*) POM X
Y
Formulations: Injectable: 150 µg (micrograms)/ml solution. Z

Oral: 25 µg tablets.

Action: Stimulates the secretion of growth hormone releasing

hormone (GHRH) from the hypothalamus.

Use: To assess the pituitary’s ability to produce growth hormone (GH).

The dose required to elicit a response has not been well established in
dogs and not at all in other veterinary species. Specialist texts should
be consulted if attempting a clonidine stimulation test. Assessment of
plasma insulin-like growth factor-1 (IGF-1) concentration in a single
sample is a useful screening test for growth hormone disorders. Also
used in dogs to control panic responses and high arousal frustration
responses. Effect develops in about 30 minutes and lasts for 3–4
hours, so often needs to be used tactically. Can be used over longer
term but may take 1–2 weeks to see full response. Withdrawal must be
done gradually to avoid hypertension.

Safety and handling: Normal precautions should be observed.
Contraindications: Due to effects on blood glucose, use in diabetic

animals is not recommended.

Adverse reactions: Transient sedation and bradycardia may develop.
Drug interactions: Care should be exercised when using with drugs

that also lower blood pressure or heart rate. Should not be used
concurrently with barbiturates, opiates or hypotensive agents, (e.g.
beta-blockers).

DOSES
Dogs:

• Growth hormone stimulation: 3–10 µg (micrograms)/kg i.v. once.
• Behavioural modification: 0.05 mg/kg q12h (often with food).

Cats: No information available.

90 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Clopidogrel
B (Clopidogrel*, Plavix*) POM

C Formulations: Oral: 75 mg tablets.
Action: Clopidogrel irreversibly binds to the ADP(2Y12) receptor on
D platelets, preventing both primary and secondary platelet
aggregation in response to stimuli.

E Use: Thromboprophylaxis in cats and dogs. Commonly used to
reduce the risk of thrombus formation in cats with advanced cardiac
F disease, to reduce the risk of thromboembolism in cats with a

G pre-existing thrombus, or recurrence of embolism in cats with a
previous arterial thromboembolic event. Recent evidence (FATCAT
H study) suggests clopidogrel is superior compared with aspirin in

delay of feline recurrent thromboembolic events secondary to cardiac
I disease. May be used in conjunction with aspirin (as the drugs act on

different parts of the platelet activation cycle). May be substituted for
J aspirin if aspirin is not tolerated. Use with care in patients with renal

or hepatic impairment.

K Safety and handling: Normal precautions should be observed.

L Contraindications: Bleeding disorders, GI ulceration.

M Adverse reactions: Tablet formulations for humans are film-coated,

which needs to be broken for appropriate dosing in cats. Many cats
dislike the taste of the tablets when the film-coating is broken so it is
N recommended that the tablet be administered in a gelatin capsule to

O improve patient compliance. In humans, skin reactions have been
reported. Overdoses will be expected to lead to bleeding disorders.

P Drug interactions: High risk of bleeding complications if used with
anticoagulants.
Q
DOSES

R Dogs: 2–4 mg/kg p.o. q24h.
Cats: 18.75 mg/cat p.o. q24h.

S References
T Hogan DF, Fox PR, Jacob K et al. (2015) Secondary prevention of cardiogenic arterial
thromboembolism in the cat: The double-blind, randomized, positive-controlled feline
arterial thromboembolism; clopidogrel versus aspirin trial (FATCAT). Journal of Veterinary

U Cardiology 17(S1), 306–317

V Clotrimazole

W (Canesten*, Clotrimazole*, Lotriderm*) POM

X Formulations: Topical: 1% cream; 1% solution. Many other
products available; some contain corticosteroids.
Y Action: Topical imidazole with an inhibitory action on the growth of
pathogenic dermatophytes, Aspergillus and yeasts by inhibiting
Z cytochrome P450-dependent ergosterol synthesis.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 91

VetBooks.ir Use: Superficial fungal infections. Naso-sinal infections including A
B
aspergillosis. C
D
Safety and handling: Normal precautions should be observed. E
Contraindications: No information available. F
Adverse reactions: No information available. G
Drug interactions: No information available. H
DOSES I
Dogs, Cats: J
K
• Otic: instil 3–5 drops in ear q12h. L
• Topical: apply to affected area and massage in gently q12h; if no M
N
improvement in 4 weeks re-evaluate therapy or diagnosis. O
• Nasal: instil 10 g (dogs up to 10 kg) or 20 g (dogs >10 kg) of 1% P
Q
cream in each frontal sinus via trephine holes. Alternatively, instil R
25 ml (in dogs up to 10 kg) or 50 ml (in dogs >10 kg) of a 1% S
solution in polyethylene glycol into each nasal cavity, with nares T
and nasopharynx sealed by Foley catheters and turning every U
15 min. A combination of both approaches may be used. Do not V
use this route if cribiform plate not intact. W
X
References Y
Z
Sissener TR, Bacon NJ, Friend E et al. (2006) Combined clotrimazole irrigation and depot
therapy for canine nasal aspergillosis. Journal of Small Anim al Practice 47, 312–315

Cloxacillin

(Opticlox, Orbenin) POM-V

Formulations: 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: No information available.
Adverse reactions: No information available.
Drug interactions: Avoid the concomitant use of bacteriostatic

antibiotics (chloramphenicol, erythromycin, tetracycline).

DOSES

See Appendix for guidelines on responsible antibacterial use.

Dogs, Cats: Apply ⅟₁₀ of a tube (0.3 g) q24h.

92 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Co-amoxiclav (Amoxicillin/Clavulanate,

B Amoxycillin/Clavulanic acid)

C (Clavabactin, Clavaseptin, Clavucill, Clavudale,
Combimox, Kesium, Nisinject, Noroclav, Synuclav,
D Synulox, Twinox, Augmentin*) POM-V, POM

E Formulations: Injectable: 175 mg/ml suspension (140 mg
amoxicillin, 35 mg clavulanate); 600 mg powder (500 mg amoxicillin,
F 100 mg clavulanate); 1.2 g powder (1 g amoxicillin, 200 mg

G clavulanate) for reconstitution (Augmentin). Oral: 40/10 mg, 50/12.5
mg, 200/50 mg, 250/62.5 mg, 400/100 mg, 500/125 mg tablets each
containing amoxicillin and clavulanate in a ratio of 4:1. Palatable
H drops which when reconstituted with water provide 40 mg

I amoxicillin and 10 mg clavulanic acid per ml. Note variation in
labelling of products. The preparation size may be labelled in relation
to amoxicillin quantity only or the combined amoxicillin/clavulanic
J acid quantity.

K Action: Amoxicillin binds to penicillin-binding proteins involved in
bacterial cell wall synthesis, thereby decreasing cell wall strength and

L rigidity, affecting cell division, growth and septum formation. The
addition of the beta-lactamase inhibitor clavulanate increases the

M antimicrobial spectrum against those organisms that produce
beta-lactamase, such as Staphylococcus and Escherichia coli.

N Use: Active against Gram-positive and Gram-negative aerobic
organisms and many obligate anaerobes. Beta-lactamase-producing
O Escherichia coli and Staphylococcus are susceptible, but difficult

P 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. May be an
Q appropriate choice for surgical prophylaxis, please refer to separate

R surgical prophylaxis guidelines but also please refer to the adverse
reactions comment below.

S Safety and handling: Tablets are wrapped in foil moisture-resistant
packaging; do not remove until to be administered. Refrigerate oral
T suspension and i.v. solution after reconstitution. Discard oral

U 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.

V Contraindications: Avoid oral antibiotic agents in critically ill

patients, as absorption from the GI tract may be unreliable; such

W patients may require i.v. formulation. Avoid use in animals which have

displayed hypersensitivity reactions to other antimicrobials within the

X beta-lactam family (which includes cephalosporins).

Y Adverse reactions: Nausea, diarrhoea and skin rashes are the

commonest adverse effects. Significantly, the last couple of years
has seen an increasing number of reports of adverse reactions
Z associated with the soluble intravenous preparations particularly

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 93

VetBooks.ir during use as surgical prophylaxis. This has included signs of allergic A
oedema, allergic pruritis and development of urticaria. Anecdotally, B
some centres have opted to use alternative preparations such as the C
2nd generation cephalosporin cefuroxime. D
E
Drug interactions: Avoid the concurrent use of amoxicillin with F
G
bacteriostatic antibiotics (e.g. tetracycline, erythromycin). Do not mix H
in the same syringe as aminoglycosides. Synergism may occur I
between the beta-lactam and aminoglycoside antimicrobials in vivo. J
K
DOSES L
M
See Appendix for guidelines on responsible antibacterial use. N
O
Dogs, Cats: P
Q
• Parenteral: 8.75 mg/kg (combined) i.v. q8h, i.m., s.c. q24h. R
• Oral: 12.5–25 mg/kg (combined) p.o. q8–12h. S
(Doses up to 25 mg/kg i.v. q8h are used to treat serious infections in T
humans.) U
V
Codeine W
X
(Pardale-V, Codeine*) POM Y
Z
Formulations: 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. Never administer Pardale-V to cats.

Adverse reactions: Sedation, ataxia, respiratory depression and

constipation. May cause CNS stimulation in cats.

Drug interactions: No information available.
DOSES
Dogs: 0.5–2 mg/kg p.o. q12h. Do not use Pardale-V for codeine at

this dose rate.

Cats: 0.5–2 mg/kg p.o. q12h. Do not use formulation with

paracetamol.

References

KuKanich B (2010) Pharmacokinetics of acetaminophen, codeine, and the codeine
metabolites morphine and codeine-6-glucuronide in healthy Greyhound dogs. Journal of
Veterinary Pharmacology and Therapeutics 33, 15–21

94 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Colchicine
B (Colchicine*) POM

C Formulations: Oral: 0.5 mg tablet.
Action: Colchicine inhibits collagen synthesis, may enhance collagenase

D activity and blocks the synthesis and secretion of serum amyloid A.

E Use: Management of fibrotic hepatic and pulmonary diseases,

oesophageal stricture and renal amyloidosis (including that caused by
‘Shar pei fever’). Reported to reduce granulation tissue formation after
F endotracheal stent placement. Only very limited and anecdotal

G evidence for its efficacy as an antifibrotic in dogs. No evidence for its
efficacy as an antifibrotic in cats. Due to the relatively high incidence of
adverse reactions, this drug should be used with caution. Prophylactic
H use in Shar pei fever cannot be recommended at this time.

I Safety and handling: Protect from light.

J Contraindications: Pregnancy, severe renal impairment.

K Adverse reactions: Adverse effects include vomiting, abdominal

pain and diarrhoea. Rarely, renal damage, bone marrow suppression,
myopathy and peripheral neuropathy may develop. Colchicine may
L increase serum ALP, decrease platelet counts and cause false-

M positive results when testing urine for RBCs and haemoglobin.
Overdoses can be fatal.

N Drug interactions: Possible increased risk of nephrotoxicity and

myotoxicity when colchicine given with ciclosporin. NSAIDs, especially
O phenylbutazone, may increase the risks of thrombocytopenia,

leucopenia or bone marrow depression when used concurrently with
P colchicine. Many anticancer chemotherapeutics may cause additive

myelosuppressive effects when used with colchicine.
Q DOSES

R Dogs: Initial dose 0.01 mg/kg p.o. q24h and, if no adverse GI effects,

increase in incremental amounts every 3–4 days to a maximum dose
of 0.03 mg/kg p.o. q12h.
S
Cats: Not recommended.
T

U Colestyramine (Cholestyramine)
V (Questran*) POM

Formulations: Oral: 4 g powder/sachet.
W Action: Ion-exchange resin.

X Use: In dogs for the reduction of serum cholesterol in idiopathic

hypercholesterolaemia and for bile acid sequestration (may help

Y alleviate diarrhoea in cases of fat malabsorption). May be used in

digoxin overdose in dogs.

Z Safety and handling: Normal precautions should be observed.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 95

VetBooks.ir Contraindications: No information available. A
Adverse reactions: Constipation may develop. May cause taurine B
C
depletion in cats. D
E
Drug interactions: Colestyramine reduces the absorption of F
G
digoxin, anticoagulants, diuretics and thyroxine. H
I
DOSES J
Dogs: 1–2 g/dog p.o. q12h. K
Cats: No information available. L
M
Crisantaspase see Asparaginase N
O
Cyclophosphamide P
Q
(Cyclophosphamide*, Endoxana*) POM R
S
Formulations: Injectable: 100 mg, 200 mg, 500 mg, 1000 mg T
U
powder for reconstitution. Oral: 50 mg tablets. V
W
Action: Metabolites cross-link DNA resulting in inhibition of DNA X
Y
synthesis and function. Z

Use: 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 no longer recommended as an
immunosuppressant drug. May have a role in management of certain
sarcomas and carcinomas when included in metronomic
chemotherapy protocols. Use with caution in patients with renal
failure; dose reduction may be required.

Safety and handling: Cytotoxic drug; see Appendix and

specialist texts for further advice on chemotherapeutic agents.

Contraindications: No information available.
Adverse reactions: Myelosuppression, with the nadir usually

occurring 5–14 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 and may lead to bladder fibrosis and/or transitional cell
carcinoma. This risk may be reduced by increasing water
consumption and 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.

96 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A DOSES

See Appendix for chemotherapy protocols and conversion of
body weight to body surface area.
B
Dogs:
• Lymphoid neoplasia: generally 50 mg/m2 p.o. q48h or 4
C consecutive days/week; or 200–250 mg/m2 p.o or i.v. q3wk.

D • Metronomic chemotherapy: 10–15 mg/m2 p.o. q24h.

• Multiple myeloma in patients refractory to melphalan: 1 mg/kg
E p.o. q24h.

• Macroglobulinaemia in patients refractory to chlorambucil:
F 1 mg/kg p.o. q24h.
Cats:
G • Lymphoid neoplasia: as for dogs, except 200–300 mg/m2 in ‘high

dose’ COP regimes.
H • Immune-mediated disease: 2.5 mg/kg p.o. q24h (or equivalent).

Not commonly used; chlorambucil is usually preferred.
I References
J Cotter SM (1983) Treatment of lymphoma and leukaemia with cyclophosphamide,
vincristine, and prednisolone: I. treatment of dogs. Journal of the American Animal
Hospital Association 19, 159 –165

K Teske E, van Straten G, van Noort R et al. (2002) Chemotherapy with cyclophosphamide,
vincristine and prednisolone (COP) in cats with malignant lymphoma: new results with an
old protocol. Journal of Veterinary Internal Medicine 16, 179 –186

L

M Cyclosporin(e) see Ciclosporin

N Cyproheptadine
O (Periactin*) POM

P Formulations: Oral: 4 mg tablet.
Action: Binds to and blocks the activation of H1 histamine and

Q serotonin receptors.

R Use: Management of allergic disease and appetite stimulation. Also

used in cats with aortic thromboembolism as serotonin, along with
other mediators, is involved in collateral vasoconstriction.
S Maintenance of this collateral supply is important in recovery. Use

T with caution in cases with urinary retention, angle-closure glaucoma
and pyloroduodenal obstruction. Specific doses for dogs and cats
have not been determined by pharmokinetic studies and clinical
U effectiveness has not been established.

V Safety and handling: Normal precautions should be observed.

W Contraindications: No information available.

X Adverse reactions: May cause mild sedation, polyphagia, weight

gain. May reduce seizure threshold.

Y Drug interactions: No information available.

Z DOSES
Dogs, Cats: 0.1–0.5 mg/kg p.o. q8–12h.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 97

VetBooks.ir Cytarabine (Cytosine arabinoside, Ara-C) A
B
(Cytarabine*, Cytosar-U*) POM C
D
Formulations: Injectable: 100 mg, 500 mg powders for E
F
reconstitution. G
H
Action: The active nucleotide metabolite ara-CTP is incorporated I
J
into DNA and inhibits pyrimidine and DNA synthesis. Cytarabine is K
therefore S-phase-specific. L
M
Use: Management of lymphoproliferative and myeloproliferative N
O
disorders. For dogs diagnosed with lymphoma and bone marrow P
involvement, addition of cytarabine into a VCAA combination Q
protocol may improve survival time. Cytarabine is widely used for R
the treatment of granulomatous meningoencephalitis (GME) and S
other suspected immune-mediated encephalitides in the dog. T
There is currently no general agreement on the best treatment U
protocol, but combination therapy of prednisolone and cytarabine V
is widely reported. W
X
Safety and handling: Cytotoxic drug; see Appendix and Y
Z
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, neurotoxicity, hepatotoxicity and fever
have also been seen. Calcinosis cutis has been reported at the site of
injection in three dogs.

Drug interactions: Oral absorption of digoxin is decreased. Activity

of gentamicin may be antagonized. Simultaneous administration of
methotrexate increases the effect of cytarabine.

DOSES

See Appendix for chemotherapy protocols and conversion of
body weight to body surface area.

Dogs, Cats:

• Lymphoproliferative neoplastic disease: 100 mg/m2 divided and
given i.v. or s.c over 2–4 days, or 100 mg/m2 by continuous i.v.
infusion over 24–96h, or 20 mg/m2 intrathecally q1–5d.

• MUA/GME: 50 mg/m2 s.c. q12h for 4 doses. Repeat at 3, 7, 11,
16, 21, 27 and 33 weeks (if clinical benefit seen), then stop.

References

Ruslander D, Moore AS, Gliatto JM et al. (1994) Cytosine arabinoside as a single agent for
the induction of remission in canine lymphoma. Journal of Veterinary Internal Medicine 8,
29 9 – 301
Zarfoss M, Schatzberg S, Venator K et al. (2006) Combined cytosine arabinoside and
prednisone therapy for meningoencephalitis of unknown aetiology in 10 dogs. Journal of
Small Animal Practice 47, 588–595

98 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Dacarbazine
B (Carboxamide*, Dacarbazine*, DTIC*, Imidazole*) POM

C Formulations: Injectable: 100 mg, 200 mg, 500 mg powders for

reconstitution.

D Action: Methylates nucleic acids and inhibits DNA, RNA and protein
synthesis.

E Use: Management of lymphoproliferative diseases (e.g. relapsed
lymphoma), melanoma and soft tissue sarcoma. Use with caution in
F patients with renal or hepatic insufficiency. Can cause severe pain

G and extensive tissue damage with extravasation, and therefore must
be administered via a preplaced i.v. catheter.

H Safety and handling: Cytotoxic drug; see Appendix and
specialist texts for further advice on chemotherapeutic agents.
I
Contraindications: Bone marrow suppression. Not recommended
J in cats, as unknown whether they can metabolize it adequately.

K Adverse reactions: May be severe; include myelosuppression,

intense nausea and vomiting (consider premedication with an
L antiemetic).
Drug interactions: Phenobarbital increases the metabolic

M activation of dacarbazine. Do not use with other myelosuppressive
drugs.

N DOSES
See Appendix for chemotherapy protocols and conversion of
O body weight to body surface area.

P Dogs: 200–250 mg/m2 i.v. q24h on days 1–5. Repeat cycle q21–28d.

Or, dependent upon the chemotherapy protocol, 800–1000 mg/m2 i.v.
over a 6–8h period, may repeat q21d provided the bone marrow has
Q recovered.

R Cats: Not recommended.

S ReferencesVan Vechten M, Helfand SC and Jeglum KA (1990) Treatment of relapsed canine lymphoma
with doxorubicin and dacarbazine. Journal of Veterinary Internal Medicine 4, 187–191

T

U Dactinomycin (Actinomycin-D)
V (Cosmegen*, Dactinomycin*, Lyovac*) POM

W Formulations: Injectable: 0.5 mg powder for reconstitution.
Action: An antibiotic antineoplastic that inhibits DNA synthesis and
X function. Inhibition of RNA and protein synthesis may also contribute
to cytotoxic effects.

Y Use: Has been used in rescue protocols for canine lymphoma and
also in some sarcomas and carcinomas. Use with caution with
Z pre-existing bone marrow depression, hepatic dysfunction or

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 99

VetBooks.ir infection. The drug is vesicant and tissue damage will result A
from extravasation, and therefore must be administered via a B
preplaced catheter. C
D
Safety and handling: Potent cytotoxic drug that should only be E
F
prepared and administered by trained personnel. See Appendix and G
specialist texts for further advice on chemotherapeutic agents. H
I
Contraindications: No information available. J
Adverse reactions: Myelosuppression is the main dose-limiting K
L
toxicity. GI and hepatic toxicity may also occur. Can increase the risk M
of urate stone formation in susceptible breeds. N
O
Drug interactions: May add to cardiotoxicity if used concurrently or P
Q
sequentially with doxorubicin. R
S
DOSES T
U
See Appendix for chemotherapy protocols and conversion of V
body weight to body surface area. W
X
Dogs: 0.5–0.75 mg/m2 slow i.v. (over 20 min) q2–3wk. Y
Cats: No information available. Z
References

Alvarez FJ, Kisseberth WC, Gallant SL et al. (2006) Dexamethasone, melphalan,
actinomycin D, cytosine arabinoside (DMAC) protocol for dogs with relapsed lymphoma.
Journal of Veterinary Internal Medicine 20, 1178–1183
Siedlecki CT, Kass PH, Jakubiak MJ et al. (2006) Evaluation of an actinomycin-D-
containing combination chemotherapy protocol with extended maintenance therapy for
canine lymphoma. Canadian Veterinary Journal 47, 52–59

Danazol

(Danazol*, Danol*) POM

Formulations: Oral: 100 mg, 200 mg capsules.
Action: Danazol is a synthetic androgen with weak androgenic

properties that produces immunosuppression thought to be mediated
through a reduction in macrophage cell surface immunoglobulin
receptors and a decrease in the amount of antibody on target cells.
May alter insulin requirements in animals with diabetes mellitus.

Use: Adjunct therapy for canine immune-mediated haemolytic

anaemia and thrombocytopenia. The onset of action may be slow,
with the effects taking several weeks to become apparent. Not
commonly used due to unpredictable efficacy. Danazol is used in
human medicine to improve peripheral blood counts in dyskeratosis
congenita and Fanconi’s anaemia by an unknown mechanism. There
is ongoing research to see if danazol will have a place in the
management of other myelodysplastic syndromes in people.

Safety and handling: Should be handled with gloves as it is

teratogenic.

Contraindications: Avoid use in patients with cardiac, renal or

hepatic impairment. Do not use in pregnant animals.

100 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Adverse reactions: Teratogenic. May cause hepatotoxicity. Other

effects result from suppression of the pituitary–ovarian axis and
direct androgenic actions: virilization in females, increased muscle
B mass, testicular atrophy, alopecia.

C Drug interactions: Synergistic action with corticosteroids. Inhibits

metabolism of ciclosporin. Do not administer with anticoagulants as

D may decrease synthesis of coagulation factors in the liver. May

decrease total serum T4 and increase T3 uptake.

E DOSES

F See Appendix for immunosuppression protocols.

Dogs: 4–10 mg/kg p.o. q12h, although an initial dose of 5 mg/kg
q8–12h is suggested.
G
Cats: 5 mg/kg p.o. q12h.

H

I Dantrolene
J (Dantrium*) POM

Formulations: Oral: 25 mg, 100 mg capsules. Injectable: Vials of
K 20 mg dantrolene powder, 3 g mannitol and sodium hydroxide for
reconstitution.
L Action: Uncouples the excitation contraction process by preventing
the release of calcium ions from the sarcoplasmic reticulum in
M striated muscle. As vascular smooth muscle and cardiac muscle are

N not primarily dependent on calcium release for contraction they are
not usually affected.

O Use: Management of muscle spasms (e.g. urethral muscle spasm,

tetanus). Prevention (oral) or treatment (i.v.) of malignant
hyperthermia. Each vial should be reconstituted with 60 ml of water.
P Before administration the solution must be clear and without visible

Q particles. Protect prepared solution from light; use within 6 hours.

Safety and handling: Normal precautions should be observed.
R Contraindications: No information available.

S Adverse reactions: Injectable preparation has pH 9.5 and is highly

irritant when extravasated. Ideally administer via a large vein or inject
into a fast-running infusion to reduce the likelihood of
T thrombophlebitis. A diuresis follows i.v. administration, reflecting its

U formulation with mannitol. Chronic use is associated with hepatitis
and pleural effusion; monitor liver function during therapy.
Generalized muscle weakness, including the respiratory muscles, has
V been reported after overdose; initiate symptomatic supportive

W therapy and monitor the patient carefully, particularly with respect to
efficacy of respiration.

X Drug interactions: Do not combine with calcium-channel blockers.

Y DOSES
Dogs, Cats:
• Malignant hyperthermia: 2–5 mg/kg i.v.
Z • Other indications: 0.5–2 mg/kg p.o. q12h.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 101

VetBooks.ir Dapsone A
B
(Dapsone*) POM C
D
Formulations: Oral: 25 mg, 100 mg tablets. E
Action: Proposed mechanisms include inhibition of the neutrophilic- F
G
cytotoxic system and interference with the alternate complement H
pathway. Also decreases antibody production and lysozymal enzyme I
synthesis. As an antibacterial, inhibits dihydropteroate synthase in J
susceptible organisms. K
L
Use: Treatment of subcorneal pustular dermatitis, vasculitis and M
N
pemphigus. There is a lag phase of 4–8 weeks after starting O
treatment before effects are seen. Monitoring complete blood and P
platelet counts, chemistry analyses and urinalyses every 2–3 weeks Q
for the first 4 months is recommended, at which point the frequency R
of monitoring can be reduced to every 3–4 months. S
T
Safety and handling: Normal precautions should be observed. U
Contraindications: No information available. V
Adverse reactions: Side effects include anaemia, neutropenia, W
X
thrombocytopenia and hepatotoxicities. Cats have a greater Y
sensitivity to dapsone, with a higher incidence of haemolytic anaemia Z
and neurotoxicity.

Drug interactions: No information available.
DOSES
Dogs: 1 mg/kg q8–24h.
Cats: Do not use.

Darbepoetin

(Aranesp*) POM

Formulations: Injectable: 10–500 µg pre-filled syringes for injection.
Action: Stimulates division and differentiation of RBCs. Darbepoetin

is a derivative of human erythropoietin, which has been chemically
modified to prolong its half-life. It may be less prone to produce
anti-EPO antibodies than other rhEPO.

Use: Treatment of anaemia associated with chronic renal failure,

although it is also used to treat anaemic human patients with cancer
and rheumatoid arthritis, and cats with FeLV-associated anaemia.
Monitoring and/or supplementation of iron may be necessary,
especially if the response to treatment is poor.

Safety and handling: Normal precautions should be observed.
Contraindications: Conditions where high serum concentrations of

erythropoietin already exist (e.g. haemolytic anaemia, anaemia due to
blood loss), where anaemia is due to iron deficiency or where
uncontrolled systemic hypertension is present.

102 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Adverse reactions: Local and systemic allergic reactions may

rarely develop (skin rash at the injection site, pyrexia, arthralgia and
mucocutaneous ulcers). The production of cross-reacting anti-EPO
B antibodies can cause pure red cell aplasia.

C Drug interactions: No information available.

D DOSES
Dogs, Cats: For stimulating erythropoiesis (induction dose):

E 0.25–1 µg (micrograms)/kg s.c. weekly until PCV is normal, then

increasing dose interval for maintenance. Some authors recommend

F starting at the 1 µg (microgram)/kg dose for improved efficacy.

G ReferencesChalhoub S et al. (2012) The Use of Darbepoetin to Stimulate Erythropoiesis in Anemia of
Chronic Kidney Disease in Cats: 25 Cases. Journal of Veterinary Internal Medicine 26,

H 363–369
Polzin DJ (2013) Evidence-based step-wise approach to managing chronic kidney disease

I in dogs and cats. Journal of Veterinary Emergency and Critical Care 23, 205–215

J Deferoxamine (Desferrioxamine)

K (Desferal*) POM

L Formulations: Injectable: 500 mg vial for reconstitution.

M Action: Deferoxamine chelates iron, and the complex is excreted in

the urine.

N Use: To remove iron from the body following poisoning.

O Safety and handling: Normal precautions should be observed.
Contraindications: Avoid in severe renal disease.
P Adverse reactions: Administration i.m. is painful. Anaphylactic
Q reactions and hypotension may develop if administered rapidly i.v.
Drug interactions: No information available.
R DOSES

S Dogs, Cats: Iron toxicity: 10 mg/kg i.m., slow i.v. q4–8h or 15 mg/kg/h
i.v. infusion. Maximum 80 mg/kg or 6 g in 24 hours.

T

U Delmadinone
V (Tardak) POM-V

W Formulations: Injectable: 10 mg/ml suspension.
Action: Progestogens suppress FSH and LH production.
X Use: Used in the treatment of hypersexuality (male dog and cat),
prostatic hypertrophy, anal adenomas and hormonally driven canine
Y aggression. Dogs that show a reduced level of aggression when

Z treated with delmadinone will not automatically show the same
behavioural response to surgical castration because the drug also

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 103

VetBooks.ir has a central calming effect. In situations of fear- or anxiety-related A
aggressive behaviour, the surgical approach can exacerbate the B
behaviour. C
D
Safety and handling: Normal precautions should be observed. E
Contraindications: No information available. F
Adverse reactions: Possible adverse effects include a transient G
H
reduction in fertility and libido, polyuria and polydipsia, an increased I
appetite and hair colour change at the site of injection. J
K
Drug interactions: Cortisol response to ACTH stimulation is L
M
significantly suppressed after just one dose of delmadinone. N
O
DOSES P
Dogs: Benign prostatic hypertrophy: 1.5–2 mg/kg (dogs <10 kg); Q
R
1–1.5 mg/kg (10–20 kg); 1 mg/kg (>20 kg) i.m., s.c. repeated after 8 S
days if no response. Animals that respond to treatment may need T
further treatment after 3–4 weeks. U
V
Cats: Hypersexuality: 1.5 mg/kg repeated after 8 days if no response. W
X
Animals that respond to treatment may need further treatment after Y
3–4 weeks. Z

References

Albouy M, Sanquer A, Maynard L et al. (2008) Efficacies of osaterone and delmadinone in
the treatment of benign prostatic hyperplasia in dogs. Veterinary Record 163, 179–183

Deltamethrin

(Scalibor Protectorband) NFA-VPS

Formulations: Topical: 4% deltamethrin collar: 0.76 g (for small and

medium dogs), 1 g (for large dogs).

Action: Acts as a sodium ‘open channel blocker’ resulting in

muscular convulsions and death in arthropods. It also repels ticks
and insects.

Use: Control of tick infestation (Ixodes ricinus, Rhipicephalus

sanguineus) and prevention of feeding by phlebotomine sandflies and
mosquitoes (Culex pipiens pipiens) on dogs for up to 6 months. May
have additional repellant activity against fleas but should not be
relied on for flea control.

Safety and handling: Wash hands after fitting the collar. Avoid

letting children, in particular those under 2-years of age, touch the
collar, play with it or put it into their mouth. Highly toxic to aquatic
animals (remove collar before letting dog swim in rivers) and bees,
also toxic to birds.

Contraindications: Do not use on dogs <7 weeks old. Avoid use in

dogs with skin lesions. Do not use on cats.

Adverse reactions: Rarely, dermatitis around the neck, GI and

neuromuscular disturbances can occur. Diazepam should be
administered in the event of accidental ingestion.

104 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Drug interactions: No information available.
DOSES
B Dogs: Prevention against ticks, sandflies and mosquitoes: One collar

C q5–6months.

D Cats: Do not use.

E l-Deprenyl see Selegiline

F Desferrioxamine see Deferoxamine

G
H Deslorelin
I (Suprelorin) POM-V
Formulations: Implant containing 4.7 mg (6 months) or 9.4 mg (12
J
months) of active product.

K Action: GnRH superagonist. Receptors are stimulated in the first 2
weeks after application, but then die down through overstimulation,
L thereby decreasing release of LH and FSH. This leads to cessation of
testosterone and sperm production.
M Use: Chemical castration. There is a 14-day surge in testosterone
followed by lowering of levels. Infertility is achieved from 6 weeks up
N to at least 6 months after initial treatment. Treated dogs should

O therefore still be kept away from bitches in heat within the first 6
weeks following initial treatment. Rarely, matings may occur during
the 6 months but no pregnancy results. Any mating that occurs
P more than 6 months after the administration of the product may

Q result in pregnancy. However, it is not necessary to keep bitches
away from treated dogs following subsequent implantations,
provided that the product is administered every 6 or 12 months. The
R ability of dogs to sire offspring following their return to normal

S plasma testosterone levels, after the administration of the product,
has not been investigated. Dogs <10 kg may not recover their
testosterone concentrations for 18 months. Disinfection of the site
T should be undertaken prior to implantation to avoid introduction of

U 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.
V Avoid injection of the implant into fat, as release of the active

W 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
X removed. Implants can be located using ultrasonography. Deslorelin

Y has a positive effect on the bladder wall and can be used in cases
of sphincter mechanism incontinence either on its own or in
combination with phenylpropanolamine. In tom cats deslorelin
Z implants cause chemical castration for 2–4 years.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 105

VetBooks.ir Safety and handling: Pregnant women should not administer the A
B
product. If used in poultry, must be lifetime egg withhold. C
D
Contraindications: Do not use in bitches. E
Adverse reactions: Moderate swelling at the implant site may be F
G
observed for 14 days. A significant decrease in testicle size will be H
seen during the treatment period. I
J
Drug interactions: No information available. K
DOSES L
Dogs: 1 implant per male dog repeat after 6 or 12 months (depending M
N
on size of implant). O
P
Cats: 1 implant (4.7 mg) per male cat. Q
References R
S
Fontaine C (2015) Long-term contraception in a small implant: A review of Suprelorin T
(deslorelin) studies in cats. Journal of Feline Medicine and Surgery 17, 766–771 U
Greer M (2012) Deslorelin implant for urinary incontinence treatment in a neutered male V
dog, a case study. Abstract from the Proceedings of the 7th International Symposium on W
Canine and Feline Reproduction (ISCFR), Whistler, Canada X
Y
Desmopressin Z

(DDAVP*, Desmospray*, Desmotabs*) POM

Formulations: Intranasal: 100 µg/ml solution; 10 µg metered spray.

Injectable: 4 µg/ml solution. Oral: 100 µg, 200 µg tablets.

Action: Binds to and stimulates ADH receptors in the collecting

ducts of the kidney. Desmopressin, a vasopressin analogue, has a
longer duration of action than vasopressin and, unlike vasopressin,
has no vasoconstrictor activity. Also increases von Willebrand factor,
factor VIII and plasminogen concentrations.

Use: Diagnosis and treatment of central diabetes insipidus, and used

to boost plasma levels of factor VIII and von Willebrand factor in
patients with mild to moderate haemophilia A or von Willebrand’s
disease. Severe forms of these diseases are not successfully treated
with desmopressin. Further advice on the use of this drug in the
modified water deprivation test should be obtained from BSAVA
Manual of Canine and Feline Endocrinology and specialist laboratories.
Assess adrenocortical function before performing the test.

Safety and handling: Normal precautions should be observed.
Contraindications: Do not perform the modified water deprivation

test in patients with renal disease, dehydration or hypercalcaemia.

Adverse reactions: No information available.
Drug interactions: No information available.
DOSES
Dogs:

• Coagulopathies: 1–4 µg (micrograms)/kg i.v. once; dilute in 20 ml
saline and administer over 10 min.

106 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A • Diabetes insipidus diagnosis: (using modified water deprivation
test): 1–4 µg (micrograms)/dog i.v. once.
• Diabetes insipidus treatment: 1–4 µg (micrograms)/dog i.v., i.m.
B or 5–20 µg/dog or 0.05–0.2 ml/dog intranasally or on to the

C conjunctiva q8–24h, or 5 µg/kg p.o. q8–24h initially (maximum
dose 400 µg p.o. q8h). The dose and frequency of dosing can be
increased or decreased according to response.
D
Cats: 5 µg (micrograms)/cat or 0.05 ml (1–2 drops) intranasally or on
to the conjunctiva q8–24h, or 5 µg/cat p.o. q8–24h initially. The dose
E and frequency of dosing can be increased or decreased according to

F response.
References
G Shiel RE (2015) Desopressin in the modified water deprivation test. In: BSAVA Manual of

Canine and Feline Endocrinology 4th edn, ed. CT Mooney and ME Peterson, pp. 19–23.
H BSAVA Publications, Gloucester

I Desoxycortone pivalate

J (Desoxycortisone pivalate)
K (Zycortal) POM-V

L Formulations: Injectable: 25 mg/ml for subcutaneous injection.
Action: Mineralocorticoid.

M Use: Replacement therapy for mineralocorticoid deficiency in dogs
and cats with primary hypoadrenocorticism. It is important that
N Addison’s disease has been definitively diagnosed before starting

O treatment. Any dog presenting with severe hypovolaemia, dehydration,
pre-renal azotaemia and inadequate tissue perfusion (also known as
‘Addisonian crisis’) must be rehydrated with intravenous fluid (saline)
P therapy before starting treatment with the veterinary medicinal product.

Q Use lower doses in dogs with congestive heart disease, severe renal
disease, primary hepatic failure or oedema. Many dogs when given the
authorized dose of 2.2 mg/kg require lower doses subsequently. For
R this reason many authorities start at the lower dose of 1.5 mg/kg s.c.

S particularly in larger dogs. Subsequent dose reduction or increase may
still be necessary and the final dose can be between 1.0 and 2.7 mg/kg.
T (See references online for advice on switching from fludrocortisone).
Safety and handling: Normal precautions should be observed. The

U vials, once opened are stable for several months. Before use, shake

gently to resuspend the product and continue to move the loaded

V syringe before injection to prevent precipitation.

W Contraindications: None.
Adverse reactions: Rarely, pain is seen on injection but repeated
X injections are not painful in the same animal. Overdoses may cause
polyuria and hypokalaemia.

Y Drug interactions: Avoid concurrent use of aldosterone antagonists
(spironolactone) and other drugs that may reduce potassium (e.g.
Z ACE inhibitors).

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 107

VetBooks.ir DOSES A
Dogs: Initial dose 1.5 mg–2.2 mg/kg. See note above. B
Cats: Initial dose 2.2 mg/kg. Experience is limited but higher doses C
D
seem to be needed. E
F
References G
H
Kintzer PP and Peterson ME (1997) Treatment and long-term follow-up of 205 dogs with I
hypoadrenocorticism. Journal of Veterinary Internal Medicine 11, 43–49 J
K
Dexamethasone L
M
(Aurizon, Dexadreson, Dexafort, Dexa-ject, Duphacort, N
Rapidexon, Voren, Dexamethasone*, Maxidex*, Maxitrol*) O
POM-V, POM P
Q
Formulations: Ophthalmic: 0.1% solution (Maxidex, Maxitrol). R
S
Maxitrol also contains polymyxin B and neomycin. Injectable: T
2 mg/ml solution; 1 mg/ml, 3 mg/ml suspension; 4 mg/ml (1.32 mg/ml U
sodium phosphate and 2.67 mg/ml of the phenylpropionate salts) V
(Voren); 2.5 mg/ml suspension with 7.5 mg/ml prednisolone. Topical: W
0.9 mg/ml suspension with clotrimazole and marbofloxacin (Aurizon). X
Oral: 0.5 mg tablet. (1 mg of dexamethasone is equivalent to 1.1 mg Y
of dexamethasone acetate, 1.3 mg of dexamethasone isonicotinate Z
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 and in the assessment of adrenal

function in suspected hyperadrenocorticism (HAC) and the
emergency treatment of hypoadrenocorticism. 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. Consult
specialist texts and laboratories for advice on the performance and
interpretation of dexamethasone suppression tests. The use of
long-acting steroids in most cases of shock and spinal injury is of no
benefit and may be detrimental.

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.

108 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Adverse reactions: A single dose of dexamethasone or

dexamethasone sodium phosphate suppresses adrenal gland
function for up to 32 hours. Prolonged use of glucocorticoids
B suppresses the hypothalamic–pituitary axis (HPA), causing adrenal

C 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
D patients receiving dexamethasone.

E Drug interactions: There is an increased risk of GI ulceration if
used concurrently with NSAIDs. The risk of developing hypokalaemia
F is increased if corticosteroids are administered concomitantly with

G amphotericin B or potassium-depleting diuretics (furosemide,
thiazides). Dexamethasone antagonizes the effect of insulin. The
metabolism of corticosteroids may be enhanced by phenytoin or
H phenobarbital and decreased by antifungals such as itraconazole.

I DOSES

See Appendix for immunosuppression protocols.
J Dogs:
• Ophthalmic: Apply small amount of ointment to affected eye(s)
K q6–24h or 1 drop of solution in affected eye(s) q6–12h.
• Otic: 10 drops to ear once daily for 7–14 days (authorized dose;
L many authorities use less).
• Cerebral oedema: 2–3 mg/kg i.v., then 1 mg/kg s.c. q6–8h, taper
M off.
• Hypoadrenocorticism: 0.2 mg/kg i.v. repeat daily until able to use
N oral medication.
• Inflammation: 0.01–0.16 mg/kg i.m., s.c., p.o. q24h for 3–5 days
O maximum.
• Prevention and treatment of anaphylaxis: 0.5 mg/kg i.v. once.
P • Immunosuppression: 0.3–0.64 mg/kg i.m., s.c., p.o. q24h for up
to 5 days.
Q • Assessment of adrenal function: low dose dexamethasone
suppression test (0.015 mg/kg i.v.).
R Cats:
• Ophthalmic, cerebral oedema, inflammation, anaphylaxis,

S immunosuppression: doses as for dogs.
• Assessment of adrenal function: dexamethasone suppression

T test (0.15 mg/kg i.v.). Note difference to dogs.

U Dexmedetomidine

V (Dexdomitor, Sedadex, Sileo) POM-V

W Formulations: Injectable: 0.1 mg/ml, 0.5 mg/ml solution. Oral gel
X 0.1 mg/ml.

Action: Agonist at peripheral and central alpha-2 adrenoreceptors
Y producing dose-dependent sedation, muscle relaxation and analgesia.

Z Use: To provide sedation and premedication when used alone or in

combination with opioid analgesics. For the alleviation of acute noise

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 109

VetBooks.ir anxiety. Dexmedetomidine combined with ketamine is used to A
provide a short duration (20–30 min) of surgical anaesthesia in cats. B
Dexmedetomidine is also being increasingly used in very low doses C
to manage emergence excitation in dogs and cats during recovery D
from anaesthesia and for the provision of analgesia when E
administered by constant rate infusion. A gel formulation has also F
been developed for application to the oral mucosa of dogs for the G
control of fear and anxiety associated with noise. Dexmedetomidine H
is the pure dextroenantiomer of medetomidine. As the I
levomedetomidine enantiomer is largely inactive, dexmedetomidine is J
twice as potent as the racemic mixture (medetomidine). K
Administration of dexmedetomidine reduces the biological load L
presented to the animal, resulting in quicker metabolism of M
concurrently administered anaesthetic drugs and a potentially faster N
recovery from anaesthesia. Dexmedetomidine is a potent drug that O
causes marked changes in the cardiovascular system, including an P
initial peripheral vasoconstriction that results in an increase in blood Q
pressure and a compensatory bradycardia. After 20–30 minutes R
vasoconstriction wanes, while blood pressure returns to normal S
values. Heart rate remains low due to the central sympatholytic effect T
of alpha-2 agonists. These cardiovascular changes result in a fall in U
cardiac output; central organ perfusion is well maintained at the V
expense of redistribution of blood flow away from the peripheral W
tissues. Respiratory system function is well maintained; respiration X
rate may fall but is accompanied by an increased depth of Y
respiration. Oxygen supplementation is advisable in all animals that Z
have received dexmedetomidine for sedation. The duration of
analgesia from a 5 µg (micrograms)/kg dose of dexmedetomidine is
approximately 1 hour. 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. The authorized dose
range of dexmedetomidine for dogs and cats is very broad. High
doses (>10 µg (micrograms)/kg) are associated with greater
physiological disturbances than doses of 1–10 µg (micrograms)/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 dogs <20 kg body
weight and cats.

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.

Adverse reactions: Causes diuresis by suppressing ADH

secretion, a transient increase in blood glucose by decreasing

110 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A endogenous insulin secretion, mydriasis and decreased intraocular
pressure. Vomiting after i.m. administration is common, so
dexmedetomidine should be avoided when vomiting is
B contraindicated (e.g. foreign body, raised intraocular pressure). Due

C 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
D sedated with dexmedetomidine must still be managed with caution.

E Drug interactions: No information available.

F DOSES

When used for sedation is generally given as part of a combination.
G See Appendix for sedation protocols in cats and dogs.
Dogs:
H • Control of noise related anxiety: 125 µg (micrograms)/m2 applied

to the oral mucosa as a gel 30–60 minutes before the onset of
I the noise stimulus, or after the first signs. Dosing can be

repeated after 2–3 hours for a maximum of occasions.
J Dogs, Cats:
• Premedication: 3–10 µg (micrograms)/kg i.v., i.m, s.c. in

K combination with an opioid (use lower end of dose range i.v.).
• Emergence excitation: 1 µg (microgram)/kg i.v. can be given to

L manage emergence excitation during recovery from
anaesthesia, although administration around the time of

M extubation will prolong the recovery period from anaesthesia
and treated animals should be monitored carefully.
N • Perioperative analgesia and rousable sedation: 1–2 µg

O (micrograms)/kg/h constant rate infusion is indicated, although
the efficacy of analgesia will be improved in most animals if
dexmedetomidine is used as an adjunct to opioid analgesia.
P
References
Q Granholm M, Mckusick BC, Westerholm FC et al. (2007) Evaluation of the clinical efficacy
and safety of intramuscular and intravenous doses of dexmedetomidine and medetomidine
in dogs and their reversal with atipamezole. Veterinary Record 160, 891–897

R Pelkonen O, Puurunen J, Arvela P et al. (1991) Comparative effects of medetomidine
enantiomers on in vitro and in vivo microsomal drug metabolism. Pharmacology and

S Toxicology 69, 189–194

T Dexrazoxane

U (Cardioxane*, Zinecard*) POM

V Formulations: Intravenous: 500 mg vials which when correctly
reconstituted produce a 20 mg/ml solution for infusion.
W Action: Prevents the formation of anthracycline-iron complex free
radicals thought to be the cause of anthracycline induced
X cardiotoxicity and extravasation reactions.

Y Use: Used to manage complications associated with the use of

anthracycline chemotherapeutics.

Z Safety and handling: Wear gloves when handling.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 111

VetBooks.ir Contraindications: Unknown. A
Adverse reactions: Myelosuppression is documented in humans; it B
C
may also decrease the clinical efficacy of anthracycline anti- D
neoplastic agents. E
F
Drug interactions: Unknown. G
DOSES H
Dogs: I
J
• Extravasation injury: terminate doxorubicin infusion and administer K
1000 mg/m2 i.v. into a separate infusion (ideally within 6 hours). L
Repeat on day 2 (1000 mg/m2 i.v.) and day 3 (500 mg/m2 i.v.). M
N
• Prevention of doxorubicin cardiotoxicity: 10 minutes prior to O
doxorubicin infuse 10 times the doxorubicin dose i.v. over P
5–10 minutes. Q
R
Cats: Unknown. S
References T
U
FitzPatrick WM, Dervisis NG and Kitchell BE (2010) Safety of concurrent administration of V
dexrazoxane and doxorubicin in the canine cancer patient. Veterinary and Comparative W
Oncology 8, 273–282 X
Venable RO, Saba CF, Endicott MM et al. (2012) Dexrazoxane treatment of doxorubicin Y
extravasation injury in four dogs. Journal of the American Veterinary Medical Association Z
240, 304–307

Dextrose see Glucose

Diazepam

(Diazemuls*, Diazepam Rectubes*, Stesolid*, Valium* and
several others) POM

Formulations: 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 dogs and cats. The anti-seizure effect in the dog
is only maintained for around 20 minutes and should always be used
as part of a balanced emergency seizure protocol; not effective as
maintenance anti-seizure medication in the dog due to its short
half-life. In cats the half-life is longer and it may be effective as a
maintenance medication. Diazepam is indicated in dogs with marked
spinal pain due to muscle spasm, in combination with conventional
analgesics. It may also be used in combination with ketamine to offset

112 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A muscle hypertonicity associated with ketamine, and with opioids
and/or acepromazine for pre-anaesthetic medication in the critically
ill. It provides very poor sedation or even excitation when used alone
B in healthy animals. Diazepam is used in behavioural medicine for

C anxiety and fear-related disorders in dogs and cats, especially where
there are signs of panic. In addition, its amnesic properties mean it
can be used during or immediately following an aversive experience to
D minimize the impact of such exposure. Best if used approximately 30

E minutes before a fear-inducing event. Higher range doses are required
for amnesic activity. Although it has been used for the management of
urine spraying in cats, a high relapse rate upon withdrawal should be
F expected. It is used in cats as an appetite stimulant. Diazepam has a

G 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
H will lead to drug accumulation and prolonged recovery in both species

I but particularly in cats in which it may also cause liver injury.
Flumazenil (a benzodiazepine antagonist) will reverse the effects of
diazepam. The development of dependence to benzodiazepams may
J occur after regular use, even with therapy of only a few weeks, and the

K dose should be gradually reduced in these cases if the
benzodiazepine is being withdrawn. Chronic dosing leads to a
shortened half-life due to activation of the hepatic microsomal enzyme
L system and tolerance to the drug may develop in dogs.

M Safety and handling: Substantial adsorption of diazepam may
occur on to some plastics and this may cause a problem when
N administering diazepam by continuous i.v. infusion. The use of

O 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
P continuous i.v. infusion the compatible materials include glass,

Q polyolefin, polypropylene and polyethylene.

Contraindications: Benzodiazepines should be avoided in patients
R with CNS depression, respiratory depression, severe muscle
weakness or hepatic impairment (as may worsen hepatic
S encephalopathy). They are also contraindicated in the long-term
treatment of canine and feline behavioural disorders due to the risks
T of disinhibition and interference with memory and learning.

U 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
V in normal dogs; i.v. injections should be made slowly (over at least

W 1 min 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
X time to onset is delayed to 5–10 min. The duration of action may be

Y prolonged after repeated doses in rapid succession, in older
animals, those with liver dysfunction, and those receiving beta-1
antagonists. Fulminant hepatic necrosis in cats has been
Z associated with repeated oral administration. The propylene glycol

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 113

VetBooks.ir formulation of injectable diazepam can cause thrombophlebitis, A
therefore the emulsion formulation is preferred for i.v. injection. B
C
Drug interactions: Do not dilute or mix with other agents. Due to D
E
extensive metabolism by the hepatic microsomal enzyme system, F
interactions with other drugs metabolized in this way are common. G
Cimetidine and omeprazole inhibit metabolism of diazepam and may H
prolong clearance. Concurrent use of phenobarbital may lead to a I
decrease in the half-life of diazepam. An enhanced sedative effect J
may be seen if antihistamines or opioid analgesics are administered K
with diazepam, and diazepam will reduce the dose requirement of L
other anaesthetic agents. When given with diazepam the effects of M
digoxin may be increased. Diazepam may be used in combination N
with tricyclic antidepressant therapy for the management of more O
severe behavioural responses. P
Q
DOSES R
S
When used for sedation is generally given as part of a combination. T
See Appendix for sedation protocols in cats and dogs. U
V
Dogs: W
X
• Anxiolytic: 0.5–2.0 mg/kg p.o as required. Y
• Sedation and premedication: 0.2–0.5 mg/kg i.v., i.m. Z
• Skeletal muscle relaxation: 2–10 mg/dog p.o. q8–12h.
• Emergency management of seizures, including status epilepticus:

bolus dose of 0.5–1 mg/kg i.v. or intrarectally (if venous access is
not available). Time to onset of clinical effect is 2–3 min for i.v.
use; therefore, repeat every 10 min if no clinical effect, up to 3
times. Additional doses may be administered if appropriate
supportive care facilities are available (for support of respiration).
Constant rate i.v. infusion for control of status epilepticus or
cluster seizures: initial rate 0.5–2 mg/kg/h, titrated to effect.

Cats:

• Anxiolytic: 0.2–0.4 mg/kg p.o. q8h.
• Appetite stimulant: 0.1–0.2 mg/kg i.v. once.
• Behavioural modification of urine spraying and muscle relaxation:

1.25–5 mg/cat p.o. q8h. The dose should be gradually increased
to achieve the desired effect without concurrent sedation.
• Emergency management of seizures including status
epilepticus: bolus dose of 0.5–1 mg/kg i.v. or intrarectally if
venous access is not available. Time to onset of clinical effect
is 2–3 min for i.v. use, therefore, repeat every 10 min if there is
no clinical effect, up to maximum of 3 times. Constant rate i.v.
infusion for the control of status epilepticus or cluster seizures:
initial rate of 0.5 mg/kg/h. Care should be taken in cats to avoid
overdosing; if cats demonstrate excessive sedation then
diazepam should be discontinued. Consider monitoring liver
parameters.

References

Ferreira JP, Dzikit TB, Zeiler GE et al. (2015) Anaesthetic induction and recovery
characteristics of a diazepam–ketamine combination compared with propofol in dogs.
Journal of the South African Veterinary Association 86, 1258
Patterson EN (2014) Status epilepticus and cluster seizures. Veterinary Clinics of North
America: Small Animal Practice 44, 1103–1112

114 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Diazoxide
B (Eudemine*) POM

C Formulations: Injectable: 15 mg/ml solution (special order). Oral:

50 mg tablet.

D Action: A diuretic that causes vasodilation and inhibits insulin
secretion by blocking calcium mobilization.

E Use: Used to manage hypoglycaemia caused by hyperinsulinism in
dogs. In humans it is also used in the short-term management of
F acute hypertension.

G Safety and handling: Normal precautions should be observed.

H Contraindications: No information available.

I Adverse reactions: The commonest adverse effects are anorexia,

vomiting and diarrhoea. Hypotension, tachycardia, bone marrow
suppression, pancreatitis, cataracts and electrolyte and fluid retention
J may occur. Drug efficacy may diminish over a period of months.

K Drug interactions: Phenothiazines and thiazide diuretics may
increase the hyperglycaemic activity of diazoxide, while alpha-

L adrenergic blocking agents (e.g. phenoxybenzamine) may antagonize
the effects of diazoxide.

M DOSES

N Dogs:

• Hypoglycaemia: 3.3 mg/kg p.o. q8h initially, increasing gradually
O to 20 mg/kg p.o. q8h.

• Hypertension: 1–3 mg/kg rapid i.v. injection (<30 seconds);
P maximum single dose of 150 mg.
Cats: No information available.
Q

R Dichlorophen
S (Various authorized proprietary products) AVM-GSL

T Formulations: Oral: 250 mg, 500 mg, 750 mg tablets.
Action: Cestocide which acts by interfering with oxidative
U phosphorylation.

V Use: Control of tapeworm infections in dogs and cats >6 months old.

Effective against Taenia and Dipylidium but not Echinococcus. Affected
worms are dislodged and disintegrate during their passage along the
W alimentary tract so they are not easily recognizable when passed

X 6–8 hours after dosing. Administer tablets whole or crushed in food.
Safety and handling: Normal precautions should be observed.
Y Contraindications: Do not repeat the treatment if vomiting occurs
shortly after dosing. Do not administer to animals weighing <1.25 kg
Z or under 6 months of age. Do not repeat the treatment in <10 days.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 115

VetBooks.ir Adverse reactions: Vomiting may be seen. Rarely, salivation, A
B
hyperaesthesia and loss of coordination. C
D
Drug interactions: No information available. E
DOSES F
Dogs, Cats: 250 mg total dose (dogs, cats <2.5 kg), 500 mg/2.5 kg G
H
(larger animals) p.o. Give maximum 6 tablets at one time, and give the I
rest 3 hours later if there is no vomiting. The tablets are best J
administered immediately before the main feed of the day and may K
be given whole or crushed and given in food. Animals should be L
treated every 4–6 months. M
N
Diclofenac O
P
(Voltarol Ophtha*, Voltarol Ophtha Multidose*) POM Q
R
Formulations: Ophthalmic: 0.1% solution in 5 ml bottle and in S
T
single-use vial. U
V
Action: COX inhibitor that produces local anti-inflammatory effects. W
Use: Used in cataract surgery to prevent intraoperative miosis and X
Y
reflex (axonal) miosis caused by ulcerative keratitis. Used to control Z
pain and inflammation associated with corneal surgery and in
ulcerative keratitis when topical corticosteroid use is contraindicated.

Safety and handling: Normal precautions should be observed.
Contraindications: No information available.
Adverse reactions: As with other topical NSAIDs, diclofenac may

cause local irritation. Topical NSAIDs should be used with caution in
ulcerative keratitis as they can delay epithelial healing. Topical
NSAIDs, and most specifically diclofenac, have been associated with
an increased risk of corneal ‘melting’ (keratomalacia) in humans,
although this has not been reported in the veterinary literature.
Topical NSAIDs have the potential to increase intraocular pressure
and should be used with caution in dogs and cats with glaucoma.
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.

DOSES
Dogs, Cats: 1 drop q30min for 2 hours prior to cataract surgery (there

is a wide variation in protocols for cataract surgery).

References

Dorbandt DM, Labelle AL, Mitchell MA et al. (2016) The effects of topical diclofenac,
topical flurbiprofen, and humidity on corneal sensitivity in normal dogs. Veterinary
Ophthalmology. doi: 10.1111/vop.12386
Lanuza R, Rankin AJ, KuKanich B et al. (2015) Evaluation of systemic absorption and renal
effects of topical ophthalmic flurbiprofen and diclofenac in healthy cats. Veterinary
Ophthalmology 19(S1), 24–29

116 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Digoxin
B (Digoxin*, Lanoxin*, Lanoxin PG*) POM
Formulations: Oral: 62.5 µg, 125 µg, 250 µg tablets; 50 µg/ml elixir.
C
Injectable: 250 µg/ml.

D Action: Acts as an antiarrhythmic. Digoxin slows the ventricular

response rate (heart rate) in atrial fibrillation by having a
vagomimmetic effect, predominantly acting at the AV node therefore
E slowing AV nodal conduction. May also be used in other

F supraventricular tachyarrhythmias. Also, has a secondary mild
positive inotropic effect. Inhibits Na+–K+ ATPase, leading to an
increase in intracellular sodium. Sodium is exchanged for calcium,
G resulting in an increase in intracellular calcium and hence positive

H inotropic effect. The combination of a slower heart rate and increased
force of contraction increases cardiac output in patients with
supraventricular tachyarrhythmias. Digoxin improves baroreceptor
I reflexes that are impaired in heart failure.

J Use: Management of supraventricular tachyarrhythmias. It is

primarily used to control the ventricular rate in cases of heart failure
K with concurrent atrial fibrillation. Effective to decrease the ventricular

rate in dogs with atrial fibrillation either as monotherapy or in
L combination with diltiazem. Digoxin/diltiazem combination therapy

results in more effective rate control than monotherapy. Serum levels
M should be checked after 7–10 days, with a sample taken at 6–8 hours

post-pill. The bioavailability of digoxin varies between the different
N formulations: tablets approx. 60%; elixir approx. 75%; and i.v. approx.

100%. If toxic effects are seen or the drug is ineffective, serum levels
O of digoxin should be assessed; the ideal therapeutic level is a trough

serum concentration in the region of 1 ng/ml to optimize beneficial
P effects and minimize toxic side effects, with a suggested range

0.6–1.2 ng (nanograms)/ml. The dose shown below achieves a
Q therapeutic serum digoxin concentration (1.0–2.0 ng/ml) while

minimizing adverse effects in dogs. Decreased dosages or an
R increase in dosing intervals may be required in geriatric patients,

obese animals or those with significant renal dysfunction. The
S intravenous route is rarely indicated and, if used, should be
administered very slowly and with extreme care.
T Safety and handling: Normal precautions should be observed.

U Contraindications: Frequent ventricular arrhythmias or

atrioventricular block. Considered to be contraindicated in cases of

V feline hypertrophic cardiomyopathy.

W Adverse reactions: Cats are more sensitive to the toxic effects of

digoxin than dogs. Hypokalaemia predisposes to toxicity in all
species. Signs of toxicity include anorexia, vomiting, diarrhoea,
X depression or trigger arrhythmias (e.g. AV block, bigeminy,

Y paroxysmal ventricular or atrial tachycardias with block, and
multiform ventricular premature contractions). Lidocaine and
phenytoin may be used to control digoxin-associated arrhythmias.
Z Intravenous administration may cause vasoconstriction.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 117

VetBooks.ir Drug interactions: Antacids, chemotherapy agents (e.g. A
B
cyclophosphamide, cytarabine, doxorubicin, vincristine), cimetidine C
and metoclopramide may decrease digoxin absorption from the GI D
tract. The following may increase the serum level, decrease the E
elimination rate or enhance the toxic effects of digoxin: F
amiodarone, antimuscarinics, diazepam, erythromycin, loop and G
thiazide diuretics (hypokalaemia), oxytetracycline, quinidine and H
verapamil. Spironolactone may enhance or decrease the toxic I
effects of digoxin. J
K
DOSES L
Dogs: Tablets: 2.5–7 µg (micrograms)/kg p.o. q12h based on lean M
N
body weight (decrease dose by 10% for elixir). Maximum dose 0.25 O
mg/dog p.o. q12h. Start at lower end of dose range and up-titrate P
carefully based on clinical response and serum therapeutic levels. Q
Only use i.v. if essentially indicated i.v.: 2.2–4.4 µg (micrograms)/kg R
i.v. q12h. S
T
Cats: Tablets: 10 µg (micrograms)/kg p.o. q24–48h, equating to ⅟₄ of a U
V
125 µg tablet q24–48h. Start at lower dose range and titrate up. Only W
use i.v. if essentially indicated: 1–1.6 µg (micrograms)/kg i.v. q12h. X
Y
References Z

Gelzer ARM, Kraus MS, Rishniw M et al. (2009) Combination therapy with digoxin and
diltiazem controls ventricular rate in chronic atrial fibrillation in dogs better than digoxin or
diltiazem monotherapy: A Randomized Crossover Study in 18 Dogs. Journal of Veterinary
Internal Medicine 23, 499–508

Diltiazem

(Hypercard, Adizem*, Dilcardia*, Diltiazem*, Slozem*,
Tildiem*) POM-V, POM

Formulations: Oral: 10 mg (Hypercard), 60 mg (generic) modified

release (-MR) tablets. Long-acting (-SR) 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. Injectable: 10 mg/ml (check concentration prior to
use as strength may vary).

Action: Diltiazem is a non-dyhydropyridine calcium-channel blocker. It

inhibits inward movement of calcium ions through slow (l-type) calcium
channels in myocardial cells, cardiac conduction tissue and vascular
smooth muscle. Diltiazem is less potent than the dihydropyridine
calcium channel blockers (e.g. amlodipine) at causing vasodilation of
coronary and peripheral vessels. Diltiazem causes a reduction in
myocardial contractility (negative inotrope, although less marked than
verapamil), depressed electrical activity (retarded atrioventricular
conduction) and decreases vascular resistance (vasodilation of cardiac
vessels and peripheral arteries and arterioles).

Use: Primarily used to control supraventricular tachyarrhythmias in

dogs and cats. It is authorized for use in cats with hypertrophic
cardiomyopathy. Effective to decrease the ventricular rate in dogs

118 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A with 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
B verapamil by many because it has effective antiarrhythmic

C properties with minimal negative inotropy. Diltiazem is less effective
than amlodipine in the management of hypertension. In cats with
hypertrophic cardiomyopathy beta-adrenergic blockers are now
D more commonly used than diltiazem. Reduce the dose in patients

E with hepatic or renal impairment.
Safety and handling: Normal precautions should be observed.
F Contraindications: Diltiazem is contraindicated in patients with
second or third degree AV block, marked hypotension or sick sinus
G syndrome, and should be used cautiously in patients with systolic

H dysfunction or acute or decompensated congestive heart failure.
Adverse reactions: In dogs, bradycardia is the commonest
I
adverse effect, while in cats it is vomiting. Lethargy can be seen in
both species.
J
Drug interactions: If diltiazem is administered concurrently with
K beta-adrenergic blockers (e.g. propranolol), there may be additive
negative inotropic and chronotropic effects. The co-administration
L of diltiazem and beta-blockers is not recommended. The activity of
diltiazem may be adversely affected by calcium salts or vitamin D.
M There are conflicting data regarding the effect of diltiazem on serum
digoxin levels and monitoring of these levels is recommended if the
N drugs are used concurrently. Cimetidine inhibits the metabolism of
diltiazem, thereby increasing plasma concentrations. Diltiazem
O enhances the effect of theophylline, which may lead to toxicity. It
may affect quinidine and ciclosporin concentrations. Diltiazem may
P displace highly protein-bound agents from plasma proteins.
Diltiazem may increase intracellular vincristine levels by inhibiting
Q outflow of the drug from the cell.

R DOSES
Dogs: 0.05–0.25 mg/kg i.v. over 1–2 min, 0.5–2.0 mg/kg p.o. q8h for
-MR products or up to 3.0 mg/kg p.o. q12h for sustained/extended
S release preparations (little evidence established with -SR released

T products). Lower doses are preferred in the presence of heart
failure. Long-acting preparations have been used at a
dose of 10 mg/kg p.o. q24h but there is little experience with
U such formulations in animals. In refractory supraventricular

V tachyarrhythmias doses up to 4 mg/kg p.o. q8h have been reported.

Cats: 0.05–0.25 mg/kg i.v. over 1–2 min, 0.5–2.5 mg/kg p.o. q8h, or
W one 10 mg tablet for cats of 3–6.25 kg p.o. q8h.

X ReferencesGelzer ARM, Kraus MS, Rishniw M et al. (2009) Combination therapy with digoxin and
diltiazem controls ventricular rate in chronic atrial fibrillation in dogs better than digoxin or

Y diltiazem monotherapy: A Randomized Crossover Study in 18 Dogs. Journal of Veterinary
Internal Medicine 23, 499–508

Z Johnson LM, Atkins CE, Keene BW et al. (1996) Pharmacokinetic and pharmacodynamic
properties of conventional and CD-formulated diltiazem in cats. Journal of Veterinary
Internal Medicine 10, 316–320

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 119

VetBooks.ir Dimercaprol (British anti-lewisite) A
B
(Dimercaprol*) POM C
D
Formulations: Injectable: 50 mg/ml solution in peanut oil. E
Action: Chelates heavy metals. F
Use: Treatment of acute toxicity caused by arsenic, gold, bismuth G
H
and mercury, and used as an adjunct (with edetate calcium disodium) I
in lead poisoning. J
K
Safety and handling: Normal precautions should be observed. L
Contraindications: Severe hepatic failure. M
Adverse reactions: Intramuscular injections are painful. Dimercaprol- N
O
metal complexes are nephrotoxic. This is particularly so with iron, P
selenium or cadmium; do not use for these metals. Alkalinization of Q
urine during therapy may have protective effects for the kidney. R
S
Drug interactions: Iron salts should not be administered during T
U
therapy. V
W
DOSES X
Dogs, Cats: Heavy metal toxicity: 2.5–5 mg/kg i.m. q4h for 2 days, Y
Z
then progressively increase dosing interval to q12h until recovery.
(Note: the 5 mg/kg dose should only be used on the first day when
severe acute intoxication occurs.) Aggressive supportive therapy
should be maintained throughout the treatment period.

References

Bahri EL (2003) Dimercaprol. Compendium on Continuing Education for the Practising
Veterinarian – North American Edition 25, 698–700

Dimethylsulfoxide (DMSO)

(Rimso-50*) POM

Formulations: 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.

120 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Safety and handling: Should be kept in a tightly closed container

because it is very hygroscopic. Gloves should be worn during topical
B application and the product should be handled with care.
Contraindications: No information available.
C Adverse reactions: Changes in refractive index and lens opacities
have been seen in dogs given high doses of DMSO chronically;
D these are slowly reversible upon discontinuation of the drug. Other

E 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.
F
Drug interactions: DMSO should not be mixed with other
G potentially toxic ingredients when applied to the skin because of
profound enhancement of systemic absorption.
H DOSES

I Dogs:

• Otic: 4–6 drops of a 60% solution in affected ear q12h for up to
14 days.
J • Renal amyloidosis: 80 mg/kg s.c. 3 times/week; 125–300 mg/kg

K p.o. q24h.
• Topical: apply 90% solution to affected areas q8–12h. Total daily
dose should not exceed 20 ml. Do not apply for longer than 14 days.
L
Cats: No information available.

M Dinetofuran
N
(Vectra 3D) POM-V
O Formulations: Topical spot-on available in 5 sizes: 6.4 mg
P dinotefuran/kg, 0.6 mg pyriproxyfen/kg and 46.6 mg permethrin/kg.
Action: Flea adulticide. Nicotinic acetylcholine receptor agonist.
Q Synergist activity with permethrin observed in vitro.

R Use: For the treatment and prevention of ticks and fleas. The product

has repellent activity against sandflies, mosquitoes and stable flies.

S Safety and handling: Do not smoke when handling product.

T Contraindications: Not for dogs <7 weeks or <1.5 kg.
Adverse reactions: In rare cases, behavioural disorder signs such
U as hyperactivity, vocalization or anxiety, lethargy or anorexia,
vomiting and diarrhoea and neurological signs such as muscle tremor
V have been reported.
Drug interactions: No information available.
W DOSES

X Dogs: One spot-on monthly.
Cats: Not for use in cats.

Y References
Z Halos L, Fourie JJ, Fankhauser B et al. (2016) Knock-down and speed of kill of a
combination of fipronil and permethrin for the prevention of Ctenocephalides felis flea
infestation in dogs. Parasites and Vectors 9, doi: 10.1186/s13071-016-1345-4

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 121

VetBooks.ir Dinoprost tromethamine A
B
(Prostaglandin F2) C
D
(Enzaprost, Lutalyse) POM-V E
F
Formulations: Injectable: 5 mg/ml solution. G
Action: Stimulates uterine contraction, causes cervical relaxation. H
Use: Stimulation of uterine contractions in the treatment of open I
J
pyometra. K
L
Safety and handling: Pregnant women and asthmatics should M
N
avoid handling this agent. O
P
Contraindications: Do not use for the treatment of closed pyometra Q
R
as there is a risk of uterine rupture. S
T
Adverse reactions: Hypersalivation, panting, tachycardia, vomiting, U
V
urination, defecation, transient hyperthermia, locomotor W
incoordination and mild CNS signs have been reported. Such effects X
usually diminish within 30 minutes of drug administration. There is no Y
adverse effect on future fertility. Z

Drug interactions: No information available.
DOSES
Dogs: Open pyometra: 0.1–0.25 mg/kg s.c. q12h until the uterus is

empty; usually 3–5 days treatment required.

Cats: 0.1 or 0.25 mg/kg s.c. q12–24h.

Dioctyl sodium sulfosuccinate see Docusate
sodium

Diphenhydramine

(Benadryl*, Nytol*) P

Formulations: 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: Management of night-time activity in cats and compulsive

scratching. Control of mild anxiety conditions in dogs and cats,
including anxiety related to car travel.

Safety and handling: Normal precautions should be observed.
Contraindications: Urine retention, glaucoma and hyperthyroidism.

122 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Adverse reactions: Paradoxical excitement may be seen in cats.
Drug interactions: An increased sedative effect may occur if used
B
with benzodiazepines or other anxiolytics/hypnotics. Avoid the
concomitant use of other sedative agents. Diphenhydramine may

C enhance the effect of adrenaline and partially counteract
anticoagulant effects of heparin.

D DOSES

E Dogs:

• Anti-emesis: 2–4 mg/kg p.o. q6–8h.
F • Suppression of pruritus: 1–2 mg/kg p.o. q8–12h.
Cats: 2–4 mg/kg p.o. q6-8h, 1 mg/kg i.v., i.m. q8h.

G

H Diphenoxylate (Co-phenotrope)
I (Co-phenotrope*, Lomotil* (with atropine)) POM

J Formulations: Oral: 2.5 mg diphenoxylate + 0.025 mg atropine tablet.
Action: Increases intestinal segmental smooth muscle tone,
K decreases the propulsive activity of smooth muscle, and decreases
electrolyte and water secretion into the intestinal lumen. Atropine is
L added in a sub-therapeutic dose to discourage abuse by
diphenoxylate overdose.
M Use: Management of acute diarrhoea and irritable bowel syndrome in
dogs. Concurrent correction of water and electrolyte imbalance is
N indicated while investigations into the cause of the diarrhoea are

O undertaken. Little is known about the safety and efficacy of
diphenoxylate in cats.

P Safety and handling: Normal precautions should be observed.

Q Contraindications: Intestinal obstruction.

R Adverse reactions: Sedation, constipation and ileus. Do not use in

animals with liver disease, intestinal obstruction, neoplastic or toxic
bowel disease.
S
Drug interactions: Diphenoxylate may potentiate the sedative
T effects of barbiturates and other tranquillizers.

U DOSES
Dogs: 0.05–0.1 mg/kg diphenoxylate p.o. q6–8h.
V Cats: No information available.

W Dipyrone see Metamizole

X

Y

Z

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 123

VetBooks.ir Dirlotapide A
B
(Slentrol) POM-V C
D
Formulations: Oral: 5 mg/ml solution. E
Action: Causes a reduced uptake of dietary lipids, dose-dependent F
G
decrease in serum cholesterol and triglyceride, and an increased H
presence of triglyceride-containing droplets in enterocytes. Also has I
an appetite-decreasing effect. J
K
Use: Aid to the management of overweight and obese adult dogs. L
M
Should be used as part of an overall weight management N
programme. In clinical trials, treated animals rapidly regained O
weight following cessation of treatment when diet was not P
restricted. Treatment should be given with food. Duration of Q
treatment must not exceed 12 months. Drug therapy does not R
always provide an additional advantage over dietary energy S
restriction alone in cases struggling to lose weight. T
U
Safety and handling: Light-sensitive. Store in the original container. V
Contraindications: Do not use in dogs that are pregnant, lactating, W
X
<18 months of age or have impaired liver function. Do not use in Y
dogs in which overweight or obesity is caused by a concomitant Z
systemic disease (e.g. hypothyroidism, hyperadrenocorticism). Do
not use in cats.

Adverse reactions: Vomiting, diarrhoea or softened stools may

occur during treatment. Reversible decreases in serum albumin,
globulin, total protein, calcium and alkaline phosphatase and
increases in ALT, AST and potassium may occur. Risk of hepatic
lipidosis in cats.

Drug interactions: Unknown at this time but could be considerable

with fat-soluble drugs, therefore do not mix with other drugs.

DOSES
Dogs: Weight control: 0.05 mg/kg initial body weight per day (0.01

ml/kg/day). After 2 weeks of therapy, the initial dose should be
increased by 100% for a further 2 weeks. Following these initial 4
weeks of therapy, dogs should be weighed monthly during
treatment with the product and dose adjustments made according
to effect. The aim is to achieve a 3% weight loss per month. If this is
not achieved then the dose can be increased by 50%, up to a
maximum dose of 0.2 ml/kg. If weight loss is excessive then the
dose should be reduced by 25%. A mean weight loss of about
18–20% after 6 months of therapy can be anticipated.

Cats: Do not use.
References

Wren JA, Gossellin J and Sunderland SJ (2007) Dirlotapide: a review of its properties and
role in the management of obesity in dogs. Journal of Veterinary Pharmacology and
Therapeutics 30 (S1), 11–16 (plus many other articles in the same supplement).

124 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Dobutamine
B (Dobutamine*, Dobutrex*, Posiject*) POM

C Formulations: Injectable: 12.5 mg/ml, 50 mg/ml solution (NB: check

vial strength prior to administration).

D Action: Dobutamine is a direct-acting synthetic catecholamine and

derivative of isoprenaline with direct beta-1 adrenergic agonist effects

E and mild beta-2 and alpha-1 adrenergic effects at standard doses.

Positive inotropy results primarily from stimulation of the beta-1

F adrenoreceptors of the heart, while producing less marked

chronotropic, arrhythmogenic and vasodilatory effects. Dobutamine

G does not cause the release of endogenous noradrenaline.

H Use: Short-term inotropic support of patients with heart failure due to

systolic dysfunction (e.g. dilated cardiomyopathy), septic and
cardiogenic shock. It is used to support myocardial function during
I anaesthesia in animals that are hypotensive when reduced myocardial

J contractility is suspected as the primary cause. Dobutamine is a potent
and short-acting drug, therefore, it should be given in low doses by
continuous rate infusion; accurate dosing is important. The dose of
K dobutamine should be adjusted according to clinical effect, therefore,

L monitoring of arterial blood pressure during administration is
advisable. All sympathomimetic drugs have proarrhythmic properties,
therefore, the ECG should be monitored during drug infusion. The dose
M should be titrated upwards until improvement in blood pressure,

N perfusion or clinical status is seen, or adverse effects (usually
tachyarrhythmias) develop. The beneficial effects of dobutamine
O diminish over 48 hours due to down regulation of beta receptors.
Safety and handling: Dilute to a 25 µg (micrograms)/ml solution in

P dextrose or normal saline and store solution in the fridge when not in

use. Degradation of dobutamine solution causes a pink discoloration.

Q The reconstituted solution is stable for at least 24 hours, after which

time, discoloured solutions should be discarded.

R Contraindications: Avoid in patients with a cardiac outflow
S obstruction (e.g. aortic stenosis).
Adverse reactions: Dobutamine is short-acting, therefore, adverse

T reactions such as tachycardia, proarrhythmia and hypertension can
usually be managed by stopping the drug infusion. Hypokalaemia can

U develop with prolonged use; this can predispose to tachyarrhythmias.
Complex ventricular arrhythmias may also be treated with lidocaine.

V Use cautiously in cases of atrial fibrillation as may increase ventricular
rate. Prior and concurrent treatment with digoxin is recommended.

W Nausea, vomiting and seizures (particularly in cats) are also possible.

X Drug interactions: Diabetic patients treated with dobutamine may

experience increased insulin requirements. Increased systemic
vascular resistance may develop if dobutamine is administered with
Y beta-blocking drugs such as propranolol, doxapram or monoamine

Z oxidase inhibitors (e.g. selegiline). Concomitant use with halothane
may result in an increased incidence of arrhythmias.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 125

VetBooks.ir DOSES A
Dogs: Lower end of dose range 2.5–5 µg (micrograms)/kg/min i.v. by B
C
constant rate infusion. Start at the bottom end of the dose range and D
increase slowly until the desired effect is achieved. Higher end dose E
ranges up to 20 µg (micrograms)/kg/min i.v. by constant rate infusion F
have been reported. Adverse effects (tachycardia, arrhythmia) are G
more commonly seen at doses >10 µg/kg/min. Administer with an i.v. H
infusion pump or other i.v. flow controlling device. I
J
Cats: 1–5 µg (micrograms)/kg/min i.v. by constant rate infusion. Start K
L
at the bottom end of the dose range and increase slowly until the M
desired effect is achieved. Adverse effects are more commonly seen N
at doses >2.5 µg/kg/min. Administer with an i.v. infusion pump or O
other i.v. flow controlling device. Doses over 5 µg (micrograms)/kg/ P
min i.v. by constant rate infusion are reported; may cause seizures. Q
R
References S
T
Boller M, Boller E M, Oodegard S et al. (2012) Small animal cardiopulmonary resuscitation U
requires a continuum of care: proposal for a chain of survival for veterinary patients. V
Journal of the American Veterinary Medicine Association 240, 26–28 W
X
Docusate sodium (Dioctyl sodium Y
Z
sulfosuccinate, DSS)

(Co-danthrusate*, Dioctyl*, Docusol*, Norgalax*, Waxsol*) P

Formulations: Oral: 100 mg capsule (Dioctyl); 2.5 mg/ml liquid

(Docusol Paediatric Solution), 10 mg/ml liquid (Docusol), 50 mg
dantron plus 60 mg docusate/5 ml (Co-danthrusate). Rectal: 120 mg
enema (Norgalax). Topical: 0.5% docusate in water-miscible base
(Waxsol). Docusate is also a component of many other mixed
topical preparations.

Action: Anionic surfactant acting as emulsifying, wetting and

dispersing agent.

Use: Constipation and ceruminous otitis.
Safety and handling: Normal precautions should be observed.
Contraindications: Intestinal obstruction.
Adverse reactions: Avoid the concurrent use of docusate and

mineral oil.

Drug interactions: No information available.
DOSES
Dogs:

• Constipation: 50–100 mg p.o. q12–24h or 10–15 ml of 5%
solution mixed with 100 ml of water instilled per rectum prn.

• Otitis: a few drops in the affected ear q8–12h or 5–15 min prior to
flushing.

Cats:

• Constipation: 50 mg p.o. q12–24h or 2 ml of a 5% solution mixed
with 50 ml of water instilled per rectum prn.

• Otitis: dose as for dogs.

126 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Dog appeasing pheromone
B (Adaptil) general sale

C Formulations: Plug-in diffuser, topical environmental spray, collar.

NOT to be confused with Adaptil tablets which are a nutraceutical.

D Action: The mixture is based on derivatives of the dermal secretions

produced by the bitch after whelping, which help to keep pups within

E the safety of the den. The signal causes an innate emotional bias in

the perception of the environment and does not require learning. A

F similar signal appears to form part of the social signal regulating

maintenance of stable social groups of adult dogs. Associated limbic

G activity is believed to help antagonize the effect of certain perceived

potential threats in the environment, but does not cause sedation or

H reduce the startle response.

I Use: Helps control signs of stress associated with separation, noise

sensitivity, travel, introduction to a new home, visits to a novel
environment (e.g. veterinary clinic) and other anxiogenic
J circumstances (e.g. kennels). The diffuser should be placed in the

K room most frequently occupied by the dog or where the
inappropriate behaviour most frequently occurs. For behavioural
problems involving over-attachment to the owner, a treatment period
L of 3 months is recommended. The spray can be used inside and

M outside the home environment. It can be used in cars, hospitalization
cages, kennels, indoor pens or refuge areas, and applied directly on
to bedding. The collar formulation is particularly useful to help control
N reactions which occur outside the home. If multiple dogs are affected

O by a problem, each dog should wear a collar and/or possibly a
diffuser considered for problems based around the home. Do not
spray directly on to animals or near an animal’s face. The collar
P formulation should not be used for animals with a known reactivity to

Q collars. Avoid contact with water when the collar is in use as this may
wash out the active ingredients.

R Safety and handling: Normal precautions should be observed.

S Contraindications: No information available.

T Adverse reactions: No information available.
Drug interactions: None known, although anecdotally an

U apparently synergistic action with benzodiazepines has been

reported in some instances. Can be used safely alongside

V psychopharmacy.

W APPLICATION
Dogs: The diffuser is active over an area of approximately 50–70 m2,
although this may be reduced in the presence of air-conditioning. If
X the total target area exceeds this, a second diffuser should be used;

Y a collar may be preferable in the case of an air-conditioned
environment. One vial will last for approximately 4 weeks of
continuous use. It should not be repeatedly switched on and off.
Z Follow manufacturer’s instructions for each formulation. In the house,

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 127

VetBooks.ir DAP spray can complement the use of the diffuser device where a A
more local application is needed. Spray 8–10 pumps of DAP on to the B
required surface 15 minutes before the effect is required, and before C
the dog is introduced into the environment, to allow the alcohol D
carrier to evaporate. The effect should last for 1–2 hours, although E
each animal will respond individually. The application can be renewed F
after 1–2 hours or when the effects appear to be reducing. G
H
Cats: Not applicable. I
J
Domperidone K
L
(Domperidone*, Motilium*) POM M
N
Formulations: Oral: 10 mg tablet; 1 mg/ml suspension. O
Action: Antiemetic with a similar mechanism of action to P
Q
metoclopramide, but with fewer adverse CNS effects as it cannot R
penetrate the blood–brain barrier. It is gastrokinetic in humans but S
may not be a prokinetic in dogs. It has also been shown to enhance T
the innate cell-mediated immune response. U
V
Use: Treatment of vomiting; however, maropitant is authorized for W
X
veterinary use and there is more clinical experience with Y
metoclopramide and ondansetron. A strategic domperidone-based Z
treatment programme has shown some efficacy in reducing the risk
of developing clinical canine leishmaniosis in a high prevalence area.

Safety and handling: Normal precautions should be observed.
Contraindications: Intestinal obstruction or perforation.
Adverse reactions: There is little information on the use of this drug

in veterinary medicine, but it may cause gastroparesis in dogs.

Drug interactions: No information available.
DOSES
Dogs:

• Vomiting: 2–5 mg per animal q8h.
• Preventive strategy for leishmaniosis in a high prevalence area:

0.5 mg/kg q24h for 30 consecutive days, repeated every 4
months.

Cats: Vomiting: 2–5 mg per animal q8h.
References

Sabaté D, Llinás J, Homedes J et al. (2014) A single-centre, open-label, controlled,
randomized clinical trial to assess the preventive efficacy of a domperidone-based
treatment programme against clinical canine leishmaniasis in a high prevalence area.
Preventive Veterinary Medicine 115, 56–63

128 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Dopamine
B (Dopamine*) POM

C Formulations: Injectable: 200 mg in 5 ml vial (40 mg/ml solution),

800 mg in a 5 ml vial (160 mg/ml solution) (NB: check vial strength
prior to administration).
D
Action: Dopamine is an endogenous catecholamine and precursor
E of noradrenaline, with direct and indirect (via release of noradrenaline)

agonist effects on dopaminergic and beta-1 and alpha-1 adrenergic
F receptors.
Use: Improvement of haemodynamic status. Main indications are
G
treatment of shock following correction of fluid deficiencies, acute heart
failure, and support of blood pressure during anaesthesia. Dobutamine
H is preferred for support of systolic function in patients with heart failure.

I 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
J appropriate concentration. At low doses (<10 µg (micrograms)/kg/min)

dopamine acts on dopaminergic and beta-1 adrenergic receptors,

K causing vasodilation, increased force of contraction and heart rate,
and resulting in an increase in cardiac output and organ perfusion;

L systemic vascular resistance remains largely unchanged. At higher
doses (>10 µg (micrograms)/kg/min) dopaminergic effects are

M overridden by the alpha effects, resulting in an increase in systemic
vascular resistance and reduced peripheral blood flow. Dopamine has

N been shown to vasodilate mesenteric blood vessels via DA1 receptors.
There may be an improvement in urine output but this may be entirely

O due to inhibition of proximal tubule sodium ion reabsorption and an
improved cardiac output and blood pressure rather than directly

P improving renal blood flow. The dose of dopamine should be adjusted
according to clinical effect, therefore, monitoring of arterial blood
Q pressure during administration is advisable. All sympathomimetic drugs
have pro-arrhythmic properties, therefore ECG monitoring is advised.
R Safety and handling: Solution should be discarded if it becomes
discoloured.
S
Contraindications: Discontinue or reduce the dose of dopamine
T should cardiac arrhythmias arise.
Adverse reactions: Extravasation of dopamine causes necrosis
U
and sloughing of surrounding tissue due to tissue ischaemia. Should
extravasation occur, infiltrate the site with a solution of 5–10 mg
V phentolamine in 10–15 ml of normal saline using a syringe with a fine

W 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
X doses. Sudden increases in blood pressure may cause a severe

Y bradycardia. All dopamine-induced arrhythmias are most effectively
treated by stopping the infusion.

Z Drug interactions: Risk of severe hypertension when monoamine

oxidase inhibitors, doxapram and oxytocin are used with dopamine.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 129

VetBooks.ir Halothane may increase myocardial sensitivity to catecholamines. A
The effects of beta-blockers and dopamine are antagonistic. B
C
DOSES D
Dogs: 2–10 µg (micrograms)/kg/min i.v. as a constant rate infusion; E
F
titrate to effect. Ensure adequate volume replacement prior to use. G
H
Cats: 1–5 µg (micrograms)/kg/min i.v. as a constant rate infusion; I
J
titrate to effect. Ensure adequate volume replacement prior to use. K
(NB: in dogs and cats a CRI of 1–10 µg (micrograms)/kg/min i.v. will L
have predominantly beta-1 effects and from 10-15 µg (micrograms)/ M
kg/min i.v. will have beta-1 and alpha-1 effects. Monitor closely for N
adverse effects during administration.) O
P
Dorzolamide Q
R
(CoSopt*, Dorzolamide*, Dorzolamide with Timolol*, S
Trusopt*) POM T
U
Formulations: Ophthalmic drops: 20 mg/ml (2%) (Dorzolamide, V
W
Trusopt), 2% dorzolamide + 0.5% timolol (CoSopt, Dorzolamide with X
Timolol); 5 ml bottle, single-use vials (CoSopt, Trusopt). Y
Z
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 in dogs and cats, either

alone or in combination with other topicals. Dorzolamide/timolol
combination may be more effective in dogs than either drug alone. It
may be less tolerated than brinzolamide because of its less
physiological pH of 5.6.

Safety and handling: Normal precautions should be observed.
Contraindications: Severe hepatic or renal impairment. Timolol

causes miosis and is therefore not the drug of choice in uveitis or
anterior lens luxation.

Adverse reactions: Local irritation, blepharitis, keratitis.

Dorzolamide may cause more local irritation than brinzolamide.
Timolol can cause bradycardia and hypotension. Rarely, dorzolamide
has been reported to cause hypokalaemia in cats as a result of
systemic absorption.

Drug interactions: No information available.
DOSES
Dogs, Cats: 1 drop/eye q8–12h.
References

Beckwith-Cohen B, Bentley E, Gasper DJ et al. (2015) Keratitis in six dogs after topical
treatment with carbonic anhydrase inhibitors for glaucoma. Journal of American
Veterinary Medical Association 247, 1419–1426
Thiessen CE, Tofflemire KL, Makielski KM et al. (2016) Hypokalemia and suspected renal
tubular acidosis associated with topical carbonic anhydrase inhibitor therapy in a cat.
Journal of Veterinary Emergency and Critical Care 26, 870–874

130 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Doxapram
B (Dopram-V) POM-VPS, POM-V

C Formulations: Injectable: 20 mg/ml solution. Oral: 20 mg/ml drops.
Action: Stimulates respiration by increasing the sensitivity of aortic

D and carotid body chemoreceptors to arterial gas tensions.

E Use: Stimulates respiration during and after general anaesthesia. In

neonatal puppies and kittens, used to stimulate or initiate respiration

F after birth, particularly in animals delivered by caesarean section. The

dose should be adjusted according to the requirements of the

G situation; adequate but not excessive doses should be used. A patent

airway is essential. Must not be used indiscriminately to support

H respiratory function. Severe respiratory depression should be

controlled by tracheal intubation, followed by IPPV and then resolution

I of the initiating cause. Duration of effect in mammals is 15–20

minutes. Has also been used to aid assessment of laryngeal function

J under light anaesthesia. Not effective at stimulating respiration in the

face of hypoxaemia (pre-oxygenation of hypoventilating neonates is

K recommended, along with removal of obstructive secretions).

L Safety and handling: Protect from light.
Contraindications: Do not use in animals without a patent airway.
M Adverse reactions: Overdose can cause excessive hyper­
ventilation, which may be followed by reduced carbon dioxide
N tension in the blood leading to cerebral vasoconstriction. This could

O result in cerebral hypoxia in some animals. Doxapram is irritant and

may cause a thrombophlebitis, avoid extravasation or repeated i.v.
P injection into the same vein. Use doxapram injection with caution in

neonates because it contains benzyl alcohol which is toxic.
Q Overdosage symptoms include hypertension, skeletal muscle

hyperactivity, tachycardia and generalized CNS excitation including
R seizures; treatment is supportive using short-acting i.v. barbiturates
or propofol and oxygen. Effects in pregnant/lactating animals are
S not known.

T Drug interactions: Hypertension may occur with

sympathomimetics. The use of theophylline concurrently with
doxapram may cause increased CNS stimulation. As doxapram may
U stimulate the release of adrenaline, its use within 10 minutes of the

V 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
W with sodium bicarbonate or thiopental. High doses administered

X during or after anaesthesia with halogenated hydrocarbon
anaesthetics, such as halothane, may precipitate cardiac
arrhythmias. Doxapram injection should be used with extreme
Y caution in dogs that have been sedated with morphine.

Z Administration of doxapram at 10 mg/kg to such animals may be
followed by convulsions.

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 131

VetBooks.ir DOSES A
Dogs, Cats: B
C
• Post-anaesthetic use: 2–5 mg/kg i.v., repeat according to need. D
• Neonates: 1–2 drops under the tongue (oral solution) or 0.1 ml i.v. E
F
(injectable solution) into the umbilical vein; this should be used G
once only. H
• For assessment of laryngeal function: 1–2 mg/kg i.v. I
J
References K
L
Bairam A, Marchal F, Crance JP et al. (1993) Effects of doxapram on carotid M
chemoreceptor activity in newborn kittens. Biology of the Neonate 64, 26–35 N
Tobias KM, Jackson AM and Harvey RC (2004) Effects of doxapram HCl on laryngeal O
function of normal dogs and dogs with naturally occurring laryngeal paralysis. Veterinary P
Anaesthesia and Analgesia 31, 258–263 Q
R
Doxepin S
T
(Sinepin*, Sinequan*, Zonalon*) POM U
V
Formulations: Oral: 25 mg, 50 mg capsules. W
Action: Doxepin blocks noradrenaline and serotonin reuptake in the X
Y
brain, resulting in antidepressive activity, while the H1 and H2 Z
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 canine acral lick dermatitis
and compulsive disorders. Data are limited as to its efficacy at the
suggested doses, and other agents e.g. amitriptyline or clomipramine
(which is an authorized preparation in dogs) may be preferable.

Safety and handling: Normal precautions should be observed.
Contraindications: Hypersensitivity to tricyclic antidepressants,

glaucoma, history of seizure 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.

DOSES
Dogs: 3–5 mg/kg p.o. q8–12h, maximum dose 150 mg q12h.
Cats: 0.5–1.0 mg/kg p.o. q12–24h.

132 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A Doxorubicin (Adriamycin)
B (Doxorubicin*) POM

C Formulations: Injectable: 10 mg, 50 mg powders for reconstitution;

10 mg, 50 mg/vial solutions.

D Action: Inhibits DNA synthesis and function.

E Use: Treatment of lymphoma, soft tissue sarcomas, osteosarcoma

and haemangiosarcoma, and may have a role in the management of
carcinomas in the dog and soft tissue sarcomas in the cat. It may be
F used alone or in combination with other antineoplastic therapies.

G 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
H should be administered over a minimum period of 10 minutes into

I the side port of a freely running i.v. infusion of 0.9% NaCl. Do not

use heparin flush. Use with care in breeds predisposed to
J cardiomyopathy. May need to reduce dose in patients with liver

disease. Use with caution in patients previously treated with
K radiation as can cause radiation recall. See specialist texts for

protocols and further advice.

L Safety and handling: Potent cytotoxic drug that should only be
prepared and administered by trained personnel. See Appendix
M and specialist texts for further advice on chemotherapeutic

N agents. After reconstitution the drug is stable for at least 48 hours at
4ºC. A 1.5% loss of potency may occur after 1 month at 4ºC but there
is no loss of potency when frozen at –20ºC. Filtering through a
O 0.22 µm filter will ensure adequate sterility of the thawed solution.

P Store unopened vials under refrigeration.
Contraindications: Do not use in patients with existing cardiac

Q disease. Do not use in cats with renal disease/dysfunction.

R Adverse reactions: Allergic reactions have been reported; acute

anaphylactic reactions should be treated with adrenaline, steroids
and fluids. Doxorubicin causes a dose-dependent cumulative
S cardiotoxicity in dogs (leading to cardiomyopathy and congestive

T heart failure). 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 clinical exam/
U auscultation, ECG and/or echocardiograms. Anorexia, vomiting,

V severe leucopenia, thrombocytopenia, haemorrhagic
gastroenteritis and nephrotoxicity (in cats if dosages >100 mg/m2)
are the major adverse effects. A CBC and platelet count should be
W monitored whenever therapy is given. If neutrophil count drops

X below 3 x 109/l or platelet count drops below 50 x 109/l, treatment
should be suspended. Once counts have stabilized, doxorubicin
can be restarted at the same dose. If haematological toxicity
Y occurs again, or if GI toxicity is recurrent, the dose should be

Z reduced by 10–25%. Extravasation injuries secondary to
perivascular administration may be serious, with severe tissue

BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline 133

VetBooks.ir ulceration and necrosis possible. Dexrazoxane can be used to treat A
extravasation if it occurs. Ice compresses may also be beneficial B
(applied for 15 min q6h). Dogs with the ABCB1 (MDR-1) mutation C
may be at higher risk of toxicity. D
E
Drug interactions: Barbiturates increase plasma clearance of F
G
doxorubicin. Concurrent administration with cyclophosphamide H
increases the risk of nephrotoxicity in cats. The agent causes a I
reduction in serum digoxin levels. Do not mix doxorubicin with J
other drugs. Doxorubicin is incompatible with dexamethasone, K
5-fluorouracil and heparin; concurrent use will lead to precipitate L
formation. Do not use with spinosad: increased risk of toxicity. M
N
DOSES O
P
See Appendix for chemotherapy protocols and conversion of Q
body weight to body surface area. R
S
Dogs: 30 mg/m2 i.v. q3wk. In dogs weighing <10 kg a dose of 1 mg/kg T
U
should be used. Maximum total dose not to exceed 240 mg/m2. V
W
Cats: 1 mg/kg or 20–25 mg/m2 i.v. q3–5wk. Maximum total dose not X
Y
to exceed 240 mg/m2. Z

References

Lori JC, Stein TJ and Thamm DH (2010) Doxorubicin and cyclophosphamide for the
treatment of canine lymphoma: a randomized, placebo-controlled study. Veterinary and
Comparative Oncology 8, 188–195

Doxycycline

(Ronaxan) POM-V

Formulations: Oral: 20 mg, 100 mg tablets.
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 (e.g. Mycoplasma
haemofelis) and antichlamydial activity. It is the drug of choice to
treat feline chlamydophilosis; treatment may be required for 3–4
weeks in cats. 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. Being
extremely lipid-soluble, it penetrates well into prostatic fluid and
bronchial secretions. Administer with food.

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.

Adverse 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.

134 BSAVA Small Animal Formulary 9th edition: Part A – Canine and Feline

VetBooks.ir A 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.
B Phenobarbital and phenytoin may increase its metabolism, thus

C decreasing plasma levels. Do not use in combination with
bactericidal antimicrobials.

D DOSES

See Appendix for guidelines on responsible antibacterial use.

E Dogs, Cats: 10 mg/kg p.o. q24h with food.

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

W

X

Y

Z