Milprazon 12.5mg/125mg Tablets for Dogs Weighing at least 5kg

Milprazon 12.5mg/125mg Tablets for Dogs Weighing At Least 5kg.

In dogs: for the treatment of mixed infections by adult cestodes and nematodes of the
following species:
- Cestodes:
Dipylidium caninum
Taenia spp.
Echinococcus spp.
Mesocestoides spp.
- Nematodes:
Ancylostoma caninum
Toxocara canis
Toxascaris leonina
Trichuris vulpis
Crenosoma vulpis (Reduction of the level of infection)

Angiostrongylus vasorum (Reduction of the level of infection by immature adult (L5)
and adult parasite stages; see specific treatment and disease prevention schedules
under section "Amounts to be administered and administration route")
Thelazia callipaeda (see specific treatment schedule under section "Amounts to
be administered and administration route")
The product can also be used in the prevention of heartworm disease (Dirofilaria
immitis) if concomitant treatment against cestodes is indicated.

Contraindications
Do not use in dogs weighing less than 5 kg.
Do not use in case of hypersensitivity to the active substances or to any of the
excipients.
See also point "Special precautions for use".

Special warnings for each target species
Parasite resistance to any particular class of anthelmintic may develop following
frequent, repeated use of an anthelmintic of that class.

Special precautions for use
Special precautions for use in animals
Studies with milbemycin oxime indicate that the margin of safety in certain dogs of
Collie or related breeds is less than in other breeds. In these dogs, the recommended
dose should be strictly observed.
The tolerance of the product in young puppies from these breeds has not been
investigated.
Clinical signs in Collies are similar to those seen in the general dog population when
overdosed.
Treatment of dogs with a high number of circulating microfilariae can sometimes lead
to the appearance of hypersensitivity reactions, such as pale mucous membranes,
vomiting, trembling, laboured breathing or excessive salivation. These reactions are
associated with the release of proteins from dead or dying microfilariae and are not a
direct toxic effect of the product. The use in dogs suffering from microfilaremia is thus
not recommended.
In heartworm risk-areas, or in the case it is known that a dog has been travelling to
and from heartworm risk regions, before using the product, a veterinary consultation
is advised to exclude the presence of any concurrent infestation of Dirofilaria immitis.
In the case of a positive diagnosis, adulticidal therapy is indicated before
administering the product.
Echinococcosis represents a hazard for humans. In case of Echinococcosis, specific
guidelines on the treatment and follow up and on the safeguard of persons have to
be followed. Experts or institutes of parasitology should be consulted.

No studies have been performed with severely debilitated dogs or individuals with
seriously compromised kidney or liver function. The product is not recommended for
such animals or only according to a benefit/risk assessment by the responsible
veterinarian.
In dogs less than 4 weeks old, tape worm infection is unusual. Treatment of animals
less than 4 weeks old with a combination product may therefore not be necessary.

Special precautions to be taken by the person administering the veterinary medicinal
product to animals
Wash hands after use.
In the event of accidental ingestion of the tablets, particularly by a child, seek medical
advice immediately and show the package leaflet or the label to the doctor.
Part tablets should be returned to the open blister pocket and inserted into the outer
carton.

Adverse reactions (frequency and seriousness)
On very rare occasions, systemic signs (such as lethargy), neurological signs (such
as muscle tremors and ataxia) and/or gastrointestinal signs (such as emesis,
diarrhoea, anorexia and drooling) have been observed in dogs after administration of
the combination of milbemycin oxime and praziquantel.

Use during pregnancy, lactation or lay
The product may be used in breeding dogs including pregnant and lactating bitches.

Interaction with other medicinal products and other forms of interaction
No interactions were observed when the recommended dose of the macrocyclic
lactone selamectin was administered during treatment with the combination of
milbemycin oxime and praziquantel at the recommended dose. In the absence of
further studies, caution should be taken in the case of concurrent use of the product
and other macrocyclic lactones. Also, no such studies have been performed with
reproducing animals.

Amounts to be administered and administration route
Oral use.
Dogs should be weighed to ensure accurate dosing.
Minimum recommended dose rate: 0.5 mg of milbemycin oxime and 5 mg of
praziquantel per kg are given once orally.
The product should be administered with or after some food.
Depending on the bodyweight of the dog, the practical dosing is as follows:

Body weight Tablets
5 – 25 kg 1 tablet
>25 – 50 kg 2 tablets
>50 – 75 kg 3 tablets

In cases when heartworm disease prevention is used and at the same time treatment
against tapeworm is required, the product can replace the monovalent product for the
prevention of heartworm disease.
For treatment of Angiostrongylus vasorum infections, milbemycin oxime should be
given four times at weekly intervals. It is recommended, where concomitant treatment
against cestodes is indicated, to treat once with the product and continue with the
monovalent product containing milbemycin oxime alone, for the remaining three
weekly treatments.
In endemic areas administration of the product every four weeks will prevent
angiostrongylosis by reducing immature adult (L5) and adult parasite burden, where
concomitant treatment against cestodes is indicated.
For the treatment of Thelazia callipaeda, milbemycin oxime should be given in 2
treatments, seven days apart. Where concomitant treatment against cestodes is
indicated, the product can replace the monovalent product containing milbemycin
oxime alone.

Overdose (symptoms, emergency procedures, antidotes), if necessary
No data available.

Withdrawal period(s)
Not applicable.

PHARMACOLOGICAL PROPERTIES
Pharmacotherapeutic group: Endectocides, Macrocyclic lactones
ATCvet code: QP54AB51

Pharmacodynamic properties
Milbemycin oxime belongs to the group of macrocyclic lactones, isolated from the
fermentation of Streptomyces hygroscopicus var. aureolacrimosus. It is active against
mites, against larval and adult stages of nematodes as well as against larvae of
Dirofilaria immitis.
The activity of milbemycin is related to its action on invertebrate neurotransmission:
Milbemycin oxime, like avermectins and other milbemycins, increases nematode and
insect membrane permeability to chloride ions via glutamate-gated chloride ion
channels (related to vertebrate GABAA and glycine receptors). This leads to
hyperpolarisation of the neuromuscular membrane and flaccid paralysis and death of
the parasite.
Praziquantel is an acylated pyrazino-isoquinoline derivative. Praziquantel is active
against cestodes and trematodes. It modifies the permeability for calcium Ca2+) in the membranes of the parasite inducing an imbalance in the membrane
structures, leading to membrane depolarisation and almost instantaneous contraction
of the musculature (tetany), rapid vacuolization of the syncytial tegument and
subsequent tegumental disintegration (blebbing), resulting in easier expulsion from
the gastrointestinal tract or death of the parasite.

Pharmacokinetic particulars
After oral administration of praziquantel in the dog, after a small amount of food, peak
serum levels of parent are rapidly attained (Tmax approximately 0.25-2.5 hours) and
decline quickly (t1/2 approximately 1 hour); there is a substantial hepatic first-pass
effect, with very rapid and almost complete hepatic biotransformation, principally to
monohydroxylated (also some di- and tri-hydroxylated) derivatives, which are mostly
glucuronide and/or sulfate conjugated before excretion. Plasma binding is about
80%. Excretion is fast and complete (about 90% in 2 days); the principal route of
elimination is renal.
After oral administration of milbemycin oxime in dogs, after a small amount of food,
peak plasma levels occur at about 0.75-3.5 hours, and decline with a half-life of the
unmetabolised milbemycin oxime of 1-4 days. Bioavailability is about 80%.
In the rat, metabolism appears to be complete although slow, since unchanged
milbemycin oxime has not been found in urine or faeces. Main metabolites in the rat
are monohydroxylated derivatives, attributable to hepatic biotransformation. In
addition to relatively high liver concentrations, there is some concentration in fat,
reflecting its lipophilicity.

PHARMACEUTICAL PARTICULARS
List of excipients
Cellulose, microcrystalline
Lactose monohydrate
Povidone
Croscarmellose sodium
Silica, colloidal anhydrous
Meat Flavour
Yeast powder
Magnesium stearate

Incompatibilities
Not applicable.

Shelf life
Shelf life of the veterinary medicinal product as packaged for sale: 2 years
Shelf life for halved tablets after first opening the immediate packaging: 6 months.

Special precautions for storage
Store in the original package in order to protect from moisture. This veterinary
medicinal product does not require any special temperature storage conditions.
Halved tablets should be stored below 25°C in the original blister and be used for the
next administration.
Keep the blister in the outer carton.

Nature and composition of immediate packaging
Blister packs consisting of cold formed OPA/Al/PVC foil and aluminium foil.
Box with 1 blister of 2 tablets.
Box with 1 blister of 4 tablets.
Box with 12 blisters, each blister contains 4 tablets.
Not all pack sizes may be marketed.

Special precautions for the disposal of unused veterinary medicinal
product or waste materials derived from the use of such products
Any unused veterinary medicinal product or waste materials derived from such
veterinary medicinal product should be disposed of in accordance with local
requirements.
The product should not enter water courses as this may be dangerous for fish and
other aquatic organisms.