|
Drug
|
Pharmacokinetic Considerations
|
Oral Dose |
Injectable Dose
|
Recommended Initial TD Dose
|
Target For Efficacy
|
Monitoring For Toxicity
|
|
Aminophylline
|
100% bioavailability for non-SR orals; injectable does not equal to oral doses; transdermal forms have been used successfully in human neonates. |
4mg/kg q 8-12h
|
4 mg/kg q 8-12 h
|
4 mg/kg q 8-12 h
|
Serum theophylline blood levels in therapeutic range. (These values are not firmly established for veterinary patients, but human range is 10-20 mcg/ml); evidence of controlled astma |
Tachycardias, arrhythmias, seizures, hyperthermia. |
|
Amitriptyline
|
48% oral bioavailablility (humans); extensive first pass hepatic extraction; accumulation after multiple doses; active metabolites must be conjugated with glucuronic acid to inactiveate (cats cannot do this). |
5-10mg per cat q 24h
|
None Published
|
1.25 mg/cat q 24 h; behaviorists who have utilized TD amitripytyline in cats advise careful monitoring to avoid accumulation. | Cessation of undesirable behavior; cessation of cystitis; onset of action as early as 3-5 days. | Dry mouth; gastric distress; constipation, ataxia, tachycardia, weakness, sedation, urinary retention. |
|
Amlodipine
|
Oral bioavailability 75% in humans, undetermined in cats; slowly but extensively metabolized to inactive compounds in the liver. |
0.625mg per cat q 24h
|
None Published
|
0.5mg per cat q 24 h | Reduction in blood pressure. | Hypotension, headache is reported most commonly in humans although this may be difficult to recognize in veterinary patients. |
|
Amoxicillin Clavulanate
|
Not recommended due to doses > 50 mg and possiblility of induction of bacterial resistance. |
62.5mg per cat q 24h
|
None Published
|
Not Recommended | Not Recommended | Not Recommended |
|
Atenolol
|
50% oral bioavailability; minimal (<50%) metabolism |
6.25mg per cat
|
None Published
|
3.25 mg per cat q 24 h | Reduction in pulse to 140-200 bpm. | Hypotension, bradycardia, bronchospasm, cardiac failure, hypoglycemia. |
|
Azithromycin
|
Not recommeded due to doses > 50 mg and possibility of induction of bacterial resistance. |
7-15mg/kg q 12h
|
None Published
|
Not Recommended | Eradication of bacterial infection. | Head tilt(otic toxicity), elevated hepatic enzymes |
|
Buprenorphine
|
Injectable form available; high degree of first pass extraction with gut wall and liver metabolism; conjugation with gllucuronide. |
.01-.03mg/kg up to q 8h
|
.005-.015mg/kg IM, IV | .01mg/kg q 8h | Apparent analgesia; animal benefiting from pain management. | Respiratory depression. |
|
Buspirone
|
Not recommended until further studies available. Extensive first pass extraction (95% of oral dose removed by hepatic extraction.) |
2.5mg per cat q 12h
|
None Published
|
Not Recommended | Cessation of undesirable behavior or phobia | Sedation, nausea, anorexia, tachycardia |
|
Butorphanol
|
Extensive first pass extraction (84% of oral dose removed by hepatic extraction) |
1mg per cat PO 1 12 h
|
.4mgkg SQ q 6h | .4mg/kg q 6h | Apparent analgesia; animal benefiting from pain management. | Overly sedated; respiratory depression. |
|
Carboplatin
|
Cytotoxic agent; not recommeded; tissue necrosis occurs at concentrations > .5 mg/ml. |
Not Recommended
|
Not Recommended
|
Not Recommended | Not Recommended | Not Recommended |
|
Chloramphenicol
|
Not recommended. High toxicity to humans; bacterial resistance, large doses preclude transdermal dosing. |
Not Recommended
|
Not Recommended
|
Not Recommended | Not Recommended | Not Recommended |
|
Cisapride
|
Oral bioavailability 35-40%; recommended extreme caution to caregiver who may be taking interacting drugs such as antihistamines and benzimidazole antibiotics. |
5mg per cat q 8-12h
|
None Published
|
2.5mg per cat q 12h | Resolution of ileus; evidence of colonic motility with no constipation or obstruction. | Diarrhea, abdominal pain and craming, arrhythmias from drug interactions. |
|
Clomipramine
|
Substantial first ass hepatic extraction; orl bioavailaility 50%; cats are very sensitive to TCDs; may accumulate in cats |
2.5mg per cat q 24h
|
None Published
|
1.25mg per cat q 24h | Cessation of undesirable behavior. | Excessive sedation; dry mouth; urinary retetion. |
|
Cyclophosphamide
|
Not recommended. Cytotoxic agent |
Not Recommended
|
Not Recommended
|
Not Recommended | Not Recommended | Not Recommended |
|
Cyproheptadine
|
Good oral bioavailability, extensive hepatic metabolism and conjugation with glucuronide with metabolites excreted in urine, accumulates in renal failure. |
2mg per cat q 12h
|
None Published
|
2mg per cat q 12 h monitor for accumulation | Evidence of appetite stimulation; relief of pruritis; cessation of undesirable behavior. | Excessive sedation, dry mouth, urinary retention. |
|
Digoxin
|
Not recommended. Narrow therapeutic index; cats are very sensitive to digoxin. Expoure potentially dangerous to caregiver. |
.007-.015mg/kg; q 24-48h Do not use for HCM in cats
|
None Published
|
Not Recommended
|
Achievement of theraeutic serum levels .9-2.0 nanogram/ml for cats. | Cats are very sensitive. Bradycardia, worsening of arrhythmias, serum levels > 2.0 nanogram/ml. |
|
Diltiazem
|
10% transdermal bioavailability in cats( compared to IV), extensive first pass hepatic extraction. (50-80% oral bioavailability in cats.) |
7.5mg per cat (non SR) q 8h
|
.25mg/kg IV bolus up to .75mg/kg | 7.5mg per cat q 12h | Reduction in pulse rate to 140-200 range. | Bradycardia, vomiting, heart block. |
|
Doxycycline
|
Known to irritate gastric and esophageal mucosa of cats; do not recommend rubbing this chemical into ears. Also a potent photosensitizer, do not recommend putting on ears that might be exosed to sunlight. Bacterial or rickettsial resistance to this drug from subtherapeutic concentrations woud leave few other alternatives in treating tick-bourne disease. |
5mg/kg q 12h
|
5mg/kg IV q 12h | Not Recommended | Not Recommended | Not Recommended |
|
Enalapril
|
Prodrug that is hepatically metabolized to active drug enalaprilat; 60% oral bioavailability. |
.25-.5mg/kg q 24h
|
None Published
|
.25mg/kg q 24h | Improvement of clinical signs of heart failure. | GI distress, hypotension. |
|
Enrofloxacin
|
Not recommended. Risk of retinal toxicity in cats; risk of inducing bacterial resistance; of hallucinations in caregiver. Raw chmical is FDA targeted high priority drug for regulatory action. |
2.5mg/kg q 12h DO NOT EXCEED 5mg/kg/day
|
2.5mg/kg SQ q 12h DO NOT EXCEED 5mg/kg/day | Not Recommended | Eradication of bacterial infection. | Pupillary dilation(early indicator of retinal toxicity); lameness (indicator of joint erosion in immature animals.) Seizures, behavior change(auditory and visual hallucinations commony reported in humans.) |
|
Fluoxetine
|
Not Recommended. Extremely long terminal half life in cats (60hr+); likely to accumulate. |
1-5mg per cat q 24h, obtain baseline labwork; assess after 1-4 weeks
|
None Published
|
Not Recommended | Eradication of bacterial infection. | Pupillary dilation (early indicator of retinal toxicity); lameness(indicator of joint erosion in immature animals.) Seizures, behavior change (auditory and visual hallucination commonly reported in humans.) |
|
Furosemide
|
Not recommended. Very unstable at acid pH. |
.5-2.0mg/kg per day
|
Up to 4.4mg/kg IV or Im to effect | Not Recommended | Improvement in respiratory rate and/or character; resolution of effusion or edema. | Head tilt(ototoxicity); electrolyte imbalances; weakness, lethargy. |
|
Glipizide
|
100% oral bioavailability in humans. |
2.5mg per cat q 12h
|
None Published
|
2.5mg per cat q 12h | Reduction in blood glucose <200. | GI distress, hypoglycemia, icterus, increased ALT; hyperglycemia from therapeutic failure. |
|
Insulin
|
Not recommended. Although, ther are anecdotal reports of efficacy, none of these cases have sustained an effect nor documented blood glucose levels during treatment. Risk of lipodystrophy also potentially increased due to larger surface area exposed to insulin. |
Not Available
|
Variable
|
Not Recommended | Achievement of blood glucose values. | Hypoglycemia (too much insulin deivered.) hyperglycemia (therapeutic failure). |
|
Methimazole
|
Oral bioavailability 45-98%, hepatic metabolism; large interpatient variation; alow 1-3 weeks for assesment. |
4mg per cat q 8-12h
|
None Published
|
2.5mg per cat q 12h | Reduction in serum T4 levels; improvement in clinical symptoms. | Worsening of vomiting; dermal excoriations; leukopenias, hepatopathies, thrombocytopenia. |
|
Metoclopramide
|
Large interpatient variation in oral bioavailability, may be as low as 30% in some patients, conjugation with glucuronide, may accumulate in cats. |
.2-.4mg/kg q 6-8h
|
.2-.4mg/kg SQ q 6-8h | .2-.4mg/kg q 8h | Cessation of vomiting. | Frenzied behavior; disorentation, constipation. |
|
Phenobarbital
|
Oral bioavailability 90%; conjugation with glucuronide; very polar; very low lipid solubility; t 1/2 34-43hrs in cats. |
2mg/kg q 12h
|
2-4mgkg IV bolus for status epilepticus persisting after diaepam. | 2mg/kg q 12h | Seizure free, serum plaxma concentrations of 10-30 mcg/ml. | Ataxia, overly sedated, lethargy, bone marrow suppression, immune medicated reactions, hepatotoxicity in dogs(cats not as likely to experience hepatotoxicity). |
|
Prednisolone
|
Not Recommended. Risk of epidermal attrophy is great. |
1-2mg/kg q 12-24h
|
1-3mg/kg IV or IM (prednisolone sodium succinate) | Not Recommended | Cessation of inflammator signs. | Epidermal or cartilage atrophy; igns of hyperadrenocorticism with chronic use; signs of diabetes mellitus. |