Dexdomitor: Product Information (Page 5 of 7)
POST APPROVAL EXPERIENCE
The following adverse events were obtained from post-approval adverse drug events reported for DEXDOMITOR sterile injectable solution from 2007-2009. Not all adverse reactions are reported. Some adverse reactions occurred when DEXDOMITOR was used alone for sedation; most occurred when DEXDOMITOR was used in the presence of anesthetics and/or other preanesthetics. It is not always possible to reliably estimate the frequency of an adverse event or to establish a causal relationship to the drug, especially when multiple drugs are administered. The following reported adverse events are listed in decreasing order of frequency:
Dogs: ineffective for sedation, death, bradycardia, cardiac arrest, apnea, convulsions, vomiting, prolonged sedation, elevated temperature, and delayed sedation.
Cats: ineffective for sedation, death, cardiac arrest, vomiting, apnea, prolonged sedation, hypersalivation, hypothermia, bradycardia, cyanotic mucous membranes, sedation too brief, and dyspnea.
INFORMATION FOR OWNERS
Owners should notify their veterinarian immediately if their cat experiences difficulty breathing due to the rare possibility of delayed onset of pulmonary edema which has been associated with administration of alpha2 -adrenergic agonists in cats.
CLINICAL PHARMACOLOGY
Dexmedetomidine is a potent non-narcotic alpha2 -adrenoceptor agonist which produces sedation and analgesia. These effects are dose dependent in depth and duration. Blood pressure is initially increased due to peripheral vasoconstriction, subsequently dropping to normal or slightly below normal levels. Vasoconstriction may cause mucous membranes to appear pale or mildly cyanotic. This initial vasopressor response is accompanied by a compensatory marked decrease in heart rate mediated by a vagal baroreceptor. The peripheral pulse may feel weak and a transient change in the conductivity of the cardiac muscle may occur, as evidenced by first and second degree atrioventricular blocks. Other arrhythmias may occur. Dexmedetomidine also decreases the respiratory rate and decreases body temperature. The magnitude and duration of the decrease in body temperature is dose dependent. Dexmedetomidine causes depression of gastrointestinal motility due to decrease in smooth muscle activity, increases in blood glucose levels due to inhibition of insulin release, and increases in production of urine. Spontaneous muscle contractions (twitching) can be expected in some dogs sedated with dexmedetomidine. Vomiting in cats has been associated with alpha2 -adrenergic agonist central stimulation of the brain4.
EFFECTIVENESS
Canine sedation/analgesia field study
Dexmedetomidine was evaluated in a masked, controlled, multi-site field study, using parallel treatment groups. Effectiveness was evaluated in 200 (of 213) healthy client-owned dogs, ranging in age between 16 weeks and 16 years of age, and in size between 4.8 lbs and 141 lbs (2.2 kg and 64 kg). Dogs admitted to veterinary clinics for various procedures requiring sedation and/or analgesia received either dexmedetomidine or medetomidine once, by IV or IM injection. Procedures included dental care, radiography, minor skin tumor removal, and treatment of otitis.
Sedation and analgesia occurred within 5 minutes after IV dexmedetomidine, and within 15 minutes after IM dexmedetomidine, with peak effects approximately at 15 or 30 minutes, respectively. Effects waned by approximately two hours after IV administration, and by three hours using the IM route. Dexmedetomidine and medetomidine showed comparable clinical effects.
Cardiac rhythms were evaluated by auscultation. Bradycardia occurred within 5 to 15 minutes after IV dexmedetomidine or medetomidine, and within 15 to 30 minutes after either drug given IM. Sixty-four dexmedetomidine-treated dogs and 50 medetomidine-treated dogs were observed with bradycardia.
Adverse reactions during the field study included ausculted unidentified arrhythmias, apnea, hypothermia, and ineffectiveness (see ADVERSE REACTIONS).
Eleven dogs received concomitant medication during the field study, including amoxicillin, cephalexin, triamcinolone, methyl-prednisolone acetate, neomycin, nystatin, thiostrepton, acepromazine, atropine, and atipamezole.
The results of this field study demonstrate that dexmedetomidine produces satisfactory levels of sedation and analgesia for clinical examinations and procedures, minor surgical procedures, and minor dental procedures.
Canine preanesthesia field study
The use of dexmedetomidine as a preanesthetic was evaluated in a controlled, multi-site field study, using parallel treatment groups. Effectiveness was evaluated in 192 healthy, client-owned dogs, between 5 months and 15 years of age, weighing 4 to 196 lbs (2 kg to 89 kg). Dogs received IM dexmedetomidine or saline as a preanesthetic to general anesthesia. All dogs were induced by an injectable anesthetic; half of the dogs were maintained with an inhalation anesthetic. Procedures included orchiectomy, ovariohysterectomy, skin surgery, radiography, physical examination, dental procedures, ear cleaning, anal sac treatment, and grooming.
Compared to saline controls, dexmedetomidine IM reduced induction drug requirements by 30-36% (at 125 mcg/m2) and by 38-61% (at 375 mcg/m2). Inhalation anesthetic requirements were 40-60% less for dexmedetomidine-preanesthetized dogs. The number of dogs with clinical signs of pain was less for at least 30 minutes after the procedure in dogs treated with 375 mcg/m2 dexmedetomidine, compared to saline controls.
Recovery times were dose dependent, averaging 15-32 minutes to extubation and 71-131 minutes to standing recovery (longer times correspond to higher dexmedetomidine dose). Recovery times also depended on the induction anesthetic. Recovery times following barbiturate induction were longer (30 minutes to extubation and 118 minutes to standing), compared to dogs induced with propofol (23 minutes to extubation and 84 minutes to standing).
Cardiac arrhythmias were monitored by ECG. Dexmedetomidine-treated dogs were more frequently observed with at least one incidence of arrhythmia compared to saline controls. The most commonly observed arrhythmias were bradycardia, 1st and 2nd degree AV block, and sinus arrest. Other less frequently observed arrhythmias included ventricular premature complexes (VPCs), supraventricular premature complexes, 3rd degree AV block, and sinus pause.
Adverse events included bradycardia, tachycardia, VPCs, vomiting, diarrhea, urinary incontinence, and self trauma (see ADVERSE REACTIONS).
The results of the preanesthesia field study demonstrate that dexmedetomidine provided anesthetic dose-sparing, sedation, and analgesia during procedures conducted under general anesthesia.
Feline sedation/analgesia field study
DEXDOMITOR was evaluated in a masked, controlled, multiple site field study, using parallel treatment groups. Effectiveness was evaluated in 242 client-owned cats, ranging in age between 6 months and 17 years, and in size between 2.3 and 9.6 kg (5 and 21 lbs). Cats admitted to veterinary clinics for various procedures requiring restraint, sedation, and/or analgesia were randomized to treatment group and given dexmedetomidine (122 cats) or xylazine (120 cats) once by IM injection. Procedures performed using dexmedetomidine included dental care, radiography, minor superficial surgery, otitis treatment, blood or urine sample collection, tattooing, microchip placement, and grooming.
Sedation and analgesia occurred within 5 to 15 minutes and peak effects were observed 30 minutes after dexmedetomidine. The procedure was easily performed in 91% of cats beginning 30 minutes after dexmedetomidine. Sedative and analgesic effects waned by three hours after dexmedetomidine.
Signs of sedation were deeper for cats receiving dexmedetomidine compared to those receiving xylazine. No clinically relevant differences were observed between dexmedetomidine and xylazine with respect to analgesia or physiological variables. Heart rate, respiratory rate, and rectal temperature decreased. Bradycardia was observed within 5 to 15 minutes and heart rates of ≤70 beats/minute were seen in 18% of cats. The most commonly observed arrhythmias assessed with ECG were atrioventricular dissociation and escape rhythms, followed by a few incidences of premature complexes and one incidence of atrioventricular block. Oxygen saturation, mucous membrane color, capillary refill time, pulse character, respiratory depth and pattern, and response of the animal to injection were clinically satisfactory. All cats recovered from changes induced by dexmedetomidine.
Ninety-seven adverse events were reported after dexmedetomidine. The most frequently reported adverse reactions included vomiting (70), urinary incontinence (6), hypersalivation (4), involuntary defecation (4), hypothermia (2), and diarrhea (2) (see ADVERSE REACTIONS).
The results of this field study demonstrate that dexmedetomidine produces satisfactory levels of sedation and analgesia for clinical examinations and procedures, minor surgical procedures, and minor dental procedures.
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