Albendazole

*antiparasitic (benzimidazole)

Brands/Synonyms : Albenil, Albex, Ovispec, Valbazen

Therapeutics

Soundalike Alert : 

Fomepizole – ethylene glycol antidote

Fenbendazole – other benzimidazole antiparasitic

Available Formulations

Oral solution 113.6 mg/mL

Indications

*Giardiasis 

Dosage (Dog) 25 mg/kg PO q 12h, Duration 2 days (4 doses total)

Expected Effects Complete elimination of Giardia cysts from feces

*Filaroides hirthi

Dosage (Dog) 50 mg/kg PO q 12h,  Duration 5 days (10 doses total)

Expected Effects  Full elimination of F. hirthi from pups of treated dams (0% infected), vs. 84% infected pups of nontreated dams

*Trichinosis

Pretreatment with milbemycin oxime for 10 days provided minimal if any increase in efficacy

Dosage (DogCat) 50 mg/kg PO q 12h.  Duration 7 days

Expected Effects  Marked reduction in muscle larva burden

*Oslerus (formerly Filaroides) osleri

Dosage (Dog) 9.5 mg/kg PO q 24h  Duration 55 days

Expected Effects

Resolution of clinical signs after 30 days of treatment

Bronchial nodules may persist

*Paragonimiasis

Dosage (Cat) 50-100 mg/kg PO q 24h ,Duration 14-21 days

Expected Effects

Elimination of Paragonimus ova in feces 9 days after start of treatment

Elimination of live flukes from lungs 4-5 weeks after start of treatment

Precautions

Contraindications:  Hypersensitivity to the drug, Neutropenia, Thrombocytopenia, Nonregenerative anemia

Adverse Side Effects : Myelotoxicosis/bone marrow toxicosis described as dose-related (dog) or idiosyncratic (cat) in single case reports - appears to be rare

Teratogenicity/Pregnancy/Lactation : Has teratogenic potential

Pearls

Giardiasis: fenbendazole appears safer and equally effective compared to albendazole

Trichinosis: albendazole treatment seems more effective in dogs than cats

Oslerus (Filaroides) osleri treatment protocol (55 days) is expected to cause bone marrow toxicosis

References PubMed – 9187723

Aluminum hydroxide

*phosphate binder; antacid

Brands/Synonyms : AlternaGEL, Alu-Cap, Aludrox, Amphojel, Dialume, Gaviscon, Nephrox, 

Therapeutics 

Interactions  In dogs, has interfered with absorption of other medications such as beta-blockers, tetracyclines, and fluoroquinolones

Antidote/Reversal Agent : Deferoxamine

Indications

*Chronic kidney disease 

Dosage (Cat) 27.5-40.5 mg/kg PO q 12h , Duration : As needed based on duration of hyperphosphatemia, 

Expected Effects Reduction of serum phosphate level.

* Chronic kidney disease due to renal dysplasia

Dosage (Dog) 50 mg/kg PO q 12h, Duration : 4 months in reported case; usually as needed

Expected Effects Reduction of serum phosphate level

* Primary hypoparathyroidism

Dosage (Cat) 20-130 mg/kg PO q 8-12h,  Duration : Indefinite, according to persistence of hyperphosphatemia (17 months in this case)

Expected Effects Reduction of serum phosphate level

Available Formulations 

Oral solution 60 mg/mL

Tab 300 mg

Precautions

Contraindications : Hypophosphatemia,  Hypersensitivity to the drug

Adverse Side Effects : In dogs, has caused aluminum toxicosis when given in doses of 145-200 mg/kg/day during chronic kidney disease.

Pearls

Generally begun low and titrated up according to response (serum phosphates level), while avoiding aluminum toxicosis

May decrease appetite

Aluminum toxicosis in dogs manifests as central neurologic signs progressing to obtundation and microcytosis, and is confirmed with a serum aluminum level (normal: 0.008-0.012 ppm)

References 

PubMed – 19000253

PubMed – 6681962

ACEPROMAZINE

- tranquilizer (phenothiazine)

Brands/Synonyms : PromAce

Indications

Dog

Premedication

0.01

mg/kg IV once

Dog

Premedication

0.05

mg/kg IV once

Dog

Antiemetic

0.05

mg/kg IM once

Dog

Airline flight sedative

0.5

mg/kg PO once

Cat

Urethral obstruction

0.25

mg/kg IM q 8h

Cat

Urethral obstruction

2.5

mg/CAT PO q 8h

Cat

Analgesia (mild, superficial)

0.1

mg/kg SC once

Cat

Tranquilization

0.1

mg/kg SC once

Cat

Analgesia (visceral)

0.05

Ineffective

mg/kg IV once

Therapeutics

Interactions : Potentiates effects of other CNS depressants

Antidote/Reversal Agent : For hypotension: circulatory volume expansion (IV fluid therapy) if needed; vasopressors (e.g., infusion of dopamine or phenylephrine)

Soundalike Alert : Apresoline – hydralazine, a vasodilator

Available Formulations

Inj

2, 10 mg/mL

Tab

10, 25 mg

Precautions

Contraindications

Organophosphate-induced tremors (acepromazine potentiates toxicity)

hypotension

systemic illness

hypersensitivity to the drug

Adverse Side Effects

Older patients may have excessively long duration of action (relative contraindication)

Caution with liver disease (prolonged/excessive effect)

Rare incidence of reverse sneezing

Rare mania/aggression

Mild hypotensive effects at 0.1 mg/kg SC, often accentuated if IV, older patients, or systemic illness

References

PubMed – 16822767

Pearls

Do not treat acepromazine-induced hypotension with epinephrine (furthers hypotension)

Effective premedication; mild decrease in blood pressure

Antiemetic effect: significant when given as premedication

Cortisol effects during transport stress: not minimized by acepromazine

Urethral obstruction nonintervention study shows effective relief of obstruction in 11/15 obstructed male cats

Urethral effects of acepromazine in cats are limited to preprostatic and prostatic urethra, but obstruction usually occurs in postprostatic urethra; therefore, benefit is likely due to sedation and not to direct urethral smooth muscle effects

Demonstrable mild antinociceptive effects

Given to 36 dogs with seizures; fewer seizures, challenging seizure-genic reputation

ACETYLSALICYLIC ACID

- nonsteroidal antiinflammatory, antiplatelet

Brands/Synonyms : Anacin, Aspirin, Bayer Children's Aspirin, Cortaba, Ecotrin, St. Joseph.

Indications

Dog

Anti-inflammatory

25

mg/kg PO q 8h

Dog

Antiplatelet

0.5

mg/kg PO q 12h

Cat

Anti-inflammatory

25

mg/kg PO q 48h

Cat

Antiplatelet

25

mg/kg PO q 72h

Cat

Antiplatelet

40

mg/CAT PO q 72h

Cat

Antiplatelet

5

mg/CAT PO q 72h

Therapeutics.

Interactions : Corticosteroids (potentiate gastrointestinal ulceration), aminoglycoside antibiotics, diuretics, and potentially nephrotoxic drugs (aggravate renal injury).

Therapeutic Target Serum Levels : 5-12 (cats and 12-18 (dogs) mg/dL;not clinically proven and rarely used.

Available Formulations : Tab 81 mg. baby, low-dose, Tab 325 mg

Precautions

Contraindications

Hypersensitivity to the drug

Anorexia

Dehydration

Platelet function disorder, thrombocytopenia, or coagulopathy

Gastrointestinal disease (relative contraindication)

For anti-inflammatory effects, many safer alternatives exist (same or greater anti-inflammatory effect with lower risk of adverse effects): carprofen, deracoxib, meloxicam, etc.

Adverse Side Effects

Gastrointestinal ulceration, especially if administered on an empty stomach or in a dehydrated animal

Renal injury

Teratogenicity/Pregnancy/Lactation

No teratogenic effects at clinical dosages

References

PubMed – 524304

PubMed – 20187838

Pearls

In dogs, antiplatelet effects occur at 0.5 mg/kg PO q 12h, but not at 0.5 mg/kg q 24h, 5 mg/kg q 12h, or 10 mg/kg q 12h; high serum salicylate levels are thought to antagonize the antiplatelet effect of lower dosages

In cats, antiplatelet effects have either been shown in vitro, or in retrospective studies; no convincing clinical efficacy of aspirin as an antithrombotic exists currently

In cats, no known benefit of microdose (5 mg/CAT) over minidose (40 mg/CAT) or original dose (81 mg/CAT)

AMPICILLIN + SULBACTAM

- Antibacterial (penicillin class + beta-lactamase inhibitor)

Indications

Dog

Post-operative bacterial infections

22

mg/kg IV q 8h

Cat

Infected wounds

20

mg/kg IM q 12h

Therapeutics

Interactions

Ampicillin inactivates gentamicin and other aminoglycosides in bottles/vials/joints (intra-articular injections), etc., so avoid combining in same syringe, fluid line, or any other compartment

Avoid coadministration with doxycycline, because doxycycline reduces cell protein synthesis required for formation of cell walls, the substrate on which penicillins act (i.e., coadministration predisposes to treatment failure)

Available Formulations

Inj

1.5, 3 g/vial

Precautions

Contraindications

Hypersensitivity to the drug, both humans handling the drug (penicillin allergy) and animals

Pearls

Beta-lactamase inhibitor combined with penicillin for IV use, similar to amoxicillin-clavulanate (oral)

Brands/Synonym

Unasyn

AMOXILLIN

- antibacterial (penicillin class)

Brands/Synonyms , Amoxi-Tabs, Amoxident, Amoxil, Amoxycillin,Amoram, Amoxsan

 Amoxi, Amoxi-Drops, Amoxi-Inject DisperMox, Galenamox, Moxatag

Therapeutics

Interactions

Synergistic antibacterial effect with aminoglycosides (but not synergistic for adverse/toxic effects)

Avoid coadministration with doxycycline, because doxycycline reduces cell protein synthesis required for formation of cell walls, the substrate on which penicillins act (i.e., coadministration predisposes to treatment failure)

Soundalike Alert

Ampicillin

Amoxicillin-clavulanic acid

Available Formulations

Tab

50, 100, 200, 250, 400, 500 mg

Cap

250, 500 mg

Oral solution

25, 50 mg/mL

Indications

Dog

Gram-positive aerobic bacterial infections (e.g., pyoderma)

10-20

mg/kg PO q 12h

Dog

Leptospirosis

22

mg/kg PO q 8h

Dog

Helicobacteriosis

50

mg/kg PO q 12h

Cat

Cat bite abscesses

11-22

mg/kg PO q 12h

Cat

Helicobacteriosis

20

mg/kg PO q 12h

Precautions

Contraindications

Hypersensitivity to the drug, both humans handling the drug (penicillin allergy) and animals receiving it

Resistant infections (common: 6% rate of single drug resistance and 28% rate of multidrug resistance including amoxicillin for E. coli infections in dogs)

Ineffective for borreliosis/Lyme disease

Lack of benefit in feline upper respiratory infection

Adverse Side Effects

Occasional anorexia, inappetence, vomiting, which resolve with discontinuation of the drug

Fanconi syndrome associated with amoxicillin treatment in a dog

Among the lowest reported rate of adverse effects (7.5%) for antibacterials according to owner surveys

Teratogenicity/Pregnancy/Lactation

Rodent studies suggest amoxicillin is generally safe in pregnancy and lactation

Pearls

Example of rate of bacterial resistance: 33% (130/396) of E. coli infections in dogs are 
resistant to amoxicillin

Renal excretion means heightened concentration of amoxicillin in urine, disproportionately 
more effective for bacterial cystitis

Endotoxemia reduces elimination by 2- to 3-fold in dogs; consider longer interdose interval 
if sepsis is suspected

Food, water reduce absorption of amoxicillin, but all tablets should be followed by an oral 
dose of water (and/or for practical reasons of compliance for many owners, a small treat) 
to ensure passage to the stomach

Oral amoxillin has far superior absorption compared to oral ampicillin

Anecdotal reports of greater incidence of immune-mediated hemolytic anemia in animals
treated with beta-lactam antibacterials like amoxicillin; judicious use of such 
antibacterials is recommended in general and in these patients in particular

References

PubMed – 20102505

PubMed – 8968890

PubMed – 18539493

PubMed – 7820765