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Home , Acepromazine, Atipamezole

DECONTAMINATION INFORMATION

• Bathing Patient should be bathed in a mild liquid dishwashing detergent. Baths may need to be repeated. Afterwards, the animal should be rinsed well with warm water and towel dried to prevent chilling.

• Dilution Dilution with milk or water is recommended in cases of corrosive ingestion. A suggested dose is 1-3 ml/lb.

• Emesis Emesis is most productive if performed within 2-3 hours post-ingestion. Feeding the animal a small moist meal before inducing can increase chances of an adequate emesis. Emetics generally empty 40-60% of the stomach contents and are assumed to be more beneficial than gastric lavage.

Dogs, cats, ferrets, and potbelly pigs are examples of house pets that can vomit. Emetics should not be used in rodents, rabbits, birds, horses, and ruminants.

Induction of emesis is contraindicated with ingestion of alkalis, acids, corrosive agents, or hydrocarbons. Pre-existing condition of the animal also determines the indication for using an emetic. Emesis should not be attempted if the animal has already vomited or is exhibiting clinical signs.

3% hydrogen peroxide is a useful emetic for and potbellied pigs. It generally is unhelpful in cats, and the use may lead to marked gastritis. The dosage is 1 teaspoon/5 lbs body weight, not to exceed 3 tablespoons. Vomiting usually occurs within minutes and the dose can be repeated once if not initially successful.

Apomorphine can be used in dogs to induce vomiting. The eye should be rinsed well after conjunctival usage.

Alpha - 2 agonists ( at 0.01 mg/kg or at 0.4 mg/kg) can be used to induce vomiting in cats.

• Activated Charcoal (ToxiBan®) Activated charcoal adsorbs a toxicant and facilitates its excretion via the feces.The recommended dose of activated charcoal for all species of animals is 1-3 gms/kg body weight. Repeated doses of activated charcoal every 6-8 hours at half the original dose may be indicated when enterohepatic recirculation is known to occur. Watch for hypernatremia. Ensuring free access to water may help to limit risk of this condition.

Activated charcoal is given orally with a large syringe or via a stomach tube. In symptomatic or uncooperative animals, anesthesia may be needed. A cuffed endotracheal tube should be used in the sedated or clinically depressed animal to prevent aspiration. Activated charcoal should not be given to animals that have ingested caustic materials. Other chemicals not effectively adsorbed by activated charcoal include ethanol, methanol, fluoride, petroleum distillates, most heavy metals, iodides, nitrates, nitrites, sodium chloride, chlorate, and xylitol.

• Cathartics Enhance elimination of the activated charcoal. Without cathartics, the toxicant bound by charcoal can eventually be released and reabsorbed. Cathartics are not to be used if the animal has or is dehydrated. There are saline, osmotic and bulk cathartics.

• Enemas Enemas are helpful when elimination of toxicants from the lower gastrointestinal tract is desired.

• Gastric Lavage Gastric lavage should not be performed in cases of caustic or petroleum distillate ingestion. General anesthesia must be used when performing gastric lavage. Lavage should be used for potentially lethal exposures in situations where emesis cannot be induced such as in a comatose patient. www.aspcapro.org/poison © 2016 ASPCA® DRUGS USED IN TOXICOLOGY TM LLOYD, Inc. of Iowa DOSE USE COMMENTS Acepromazine Dogs and cats: Treatment of CNS Can alternatively use 0.05-1.0 mg/kg IM or IV excitation associated with 3.3 mg/kg PO, and 1.1-6.6 mg/kg IM, 0.55-4.4 amphetamine toxicosis. mg/kg IV SID-QID (titrate dose to effect). Atropine Dogs and cats: To control muscarinic Consider giving a test dose 0.1-0.2 mg/kg; give ¼ of the signs associated with of 0.01-0.02 mg/kg first. initial dose IV and the rest IM organophosphate (OP) A response to this dose is or SQ or carbamate toxicity. unlikely to be seen with true OP/carbamate toxicity. Dogs: 1.1 mg/kg PO q 8 hr if needed Serotonin syndrome May be given rectally if patient (Periactin®) Cats: 2-4 mg PO q 8-12 hr if needed is vomiting. Diazepam Dogs: 0.2-2.2 mg/kg IV Control of seizures Always give slowly IV to effect. (Valium®) Cats: 0.05-1 mg/kg IV Do not give in cases of ephedra or pseudoephedrine toxicity. Ethanol Dogs and cats: Ethylene glycol CRI preferred to avoid Using 7% ethanol load at 600 (antifreeze) toxicity high blood ethanol levels. mg/kg slow IV (or 8.6 ml/kg), then Do not give along with 4-MP maintain at 100 mg/kg/h (or 1.43 ml/kg/hr) CRI IV Dogs and cats: Benzodiazepine antagonist Dose can be repeated if severe (Romazicon®) 0.01 mg/kg IV depression returns Fomepizole Dogs: Load at 20 mg/kg, slow IV Ethylene glycol May continue treatment at 5 mg/ (4-MP, Antizol-Vet® ) infusion over 5-10 minutes, 15 (antifreeze) toxicity kg IV every 12 hours if EG is still mg/kg slow IV at 12 hours and present in the ’s system (per again at 24 hours, 5 mg/kg IV at EG test results). 36 hours Effective within 3 hr of Cats: 125 mg/kg IV then 31.25 exposure in cats. Do not give mg/kg q 12, 24, 36 hrs along with ethanol. Methocarbamol Dogs and cats: 55-220 mg/kg Muscle associated Tablets can be crushed into (Robaxin®) slow IV to effect; use caution with tremorgenic mycotoxin saline and given rectally when exceeding 330 mg/kg/ and metaldehyde Monitor for CNS and day ingestions, permethrin respiratory depression with toxicity in cats. doses > 330 mg/kg/d. Dogs and cats: 0.002-0.04mg/ Opioid antagonist Can be repeated as needed, but ® (Narcan ) kg IV, IM or SQ 24 HOURhigh doses EMERGENCY have caused seizures. ANIMAL POISON CONTROL CENTER Pralidoxime Dogs and cats: To control nicotinic signs Not recommended DRUGS USED IN TOXICOLOGY chloride 20 mg/kg IM. Discontinue associated with OP toxicity.888-426-4435for carbamate toxicity. (2-PAM, Protopam®) if no effect after 3 doses. www.aspcapro.org/poison Propanolol Dogs:DOSE 0.02 -0.06 mg/kg slow IV, TreatmentUSE of , UsefulCOMMENTS in toxicoses involving DRUGSAcepromazine USED IN0.2-1.0Dogs TOXICOLOGY and mg/kg Cats: PO TID Treatmenttachyarrhythmias, of CNS and Cancaffeine, alternativ theobromine,ely use excitation due to chlorpromzine 3.3 mg/kgTM PO, Cats:Administer 0.04 inmg/kg increments slow IV, ofor 2.5- hypertension. ephedra, pseudoephredrine, serotoninergic medications, 1.1-6.6 mg/kgLLOYD, Inc. IM, of Iowa 0.55-4.4 5.00.025-0.05 mg total mg/kg,PO BID-TID assess , amphetamine, pseudoephedrine, and mg/kg IV SID-QID (tritrate response before repeating. cardiac glycosides, and thyroid DOSE amphetamines.USE doseCOMMENTS to effect). hormones. Dogs and cats: Treatment of CNS Can alternatively use AtipamezoleAcepromazine Dogs and Cats: 50 mcg/ Used as an alpha-2 Can use 0.1-0.2 kg0.05-1.0 IV or IM mg/kg IM or IV antagonistexcitation associatedto reverse toxic with chlorpromazinemg/kg IV; if atipamezole 3.3 mg/kg is PO, not 0.1-0.2 mg/kg; give ¼ of the effectspseudoephedrinesigns associated of , withclonidine,and 1.1-6.6ofavailable. 0.01-0.02 mg/kg mg/kg IM, 0.55-4.4 first. initial dose IV and the rest IM andamphetamineorganophosphate other alpha-2 toxicosis. agonists.(OP) mg/kgA response IV SID-QID to this (titratedose is dose or SQ or carbamate toxicity. unlikely to be seen with true Atropine Dogs and Cats: To control muscarinic Consider giving a test dose of 0.1-0.2 mg/kg; give ¼ of the signs associated with OP/carbamate0.01-0.02 mg/kg toxicity. first. A initial dose IV and the rest IM Cyproheptadine Dogs: 1.1 mg/kg PO q 8 hr if needed organophosphateSerotonin syndrome (OP) Mayresponse be given to thisrectally dose if ispatient or SQ or carbamate toxicity. unlikely to be seen with true ® Cats: 2-4 mg PO q 8-12 hr if needed is vomiting. (Periactin ) OP/carbamate toxicity. CyproheptadineDiazepam DogsDogs:: 0.2-2.21.1 mg/kg mg/kg PO q IV 8 hr if needed SerotoninControl of syndromeseizures AlwaysMay be give given slowly rectally IV toif patienteffect. ® (Periactin(Valium ) ®) Cats: 2-4 0.05-1 mg PO mg/kg q 8-12 IV hr if needed Dois vomiting. not give inLimit cases 2-3 doses. of ephedra or pseudoephedrine Diazepam Dogs: 0.2-2.2 mg/kg IV Control of seizures toxicity.Always give slowly IV to effect. ® Do not give in cases of (Valium ) Cats: 0.05-1 mg/kg IV Ethanol Dogs and cats: Ethylene glycol CRIephedra, preferred amphetamine, to avoid or Using 7% ethanol load at 600 (antifreeze) toxicity pseudoephedrinehigh blood ethanol toxicitylevels. mg/kg slow IV (or 8.6 ml/kg), then Do not give along with 4-MP Ethanol Dogs and Cats: Ethylene glycol CRI preferred to avoid high Usingmaintain 7% at ethanol 100 mg/kg/h load at (or 600 1.43 (antifreeze) toxicity blood ethanol levels. mg/kgml/kg/hr) slow CRI IV IV (or 8.6 ml/kg), Do not give along with 4-MP then maintain at 100 mg/kg/hr Flumazenil (orDogs 1.43 and ml/kg/hr) cats: CRI IV Benzodiazepine antagonist Dose can be repeated if severe (Romazicon®) 0.01 mg/kg IV depression returns Flumazenil Dogs and Cats: Benzodiazepine antagonist Dose can be repeated if ® 0.01 mg/kg IV severe (RomaziconFomepizole) Dogs: Load at 20 mg/kg, slow IV Ethylene glycol May continuedepression treatment returns. at 5 mg/ ® infusion over 5-10 minutes, 15 (antifreeze) toxicity kg IV every 12 hours if EG is still (4-MP, Antizol-Vet ) Dogs: Load at 20 mg/kg, slow May continue treatment at 5 mg/ Fomepizole mg/kg slow IV at 12 hours and Ethylene glycol present in the dog’s system (per IV infusion over 5-10 minutes, (antifreeze) toxicity kg IV every 12 hours if EG is still (4-MP) 15again mg/kg at 24 slow hours, IV at5 mg/kg12 hours IV at presentEG test results).in the dog's system (per 36and hours again at 24 hours. 5 mg/kg EGEffective test results). within 3 hr of Cats:IV at 36 125 hours. mg/kg IV then 31.25 Effectiveexposure within in cats. 3 hr Doof exposure not give mg/kgCats: 125 q 12, mg/kg 24, 36 IV hrs then 31.25 inalong cats. with Do notethanol. give along with mg/kg q 12, 24, 36 hours. ethanol. Dogs and cats: 55-220 mg/kg Muscle tremors associated Tablets can be crushed into Methocarbamol Recommend 20% solution. (no Remove lipid soluble agents Check for hyperlipemia before Lipids ® slow IV to effect; use caution with tremorgenic mycotoxin saline and given rectally (Robaxin ) brand preference) Initial bolus at from body, likely acting as repeating the dose. Do not 1.5when ml/kg exceeding then 0.25 330 ml/kg/minmg/kg/ sink.and metaldehyde Monitorrepeat intralipid for CNS dose and until forday 30-60 minutes. ingestions, permethrin respiratoryserum has become depression clearer. with toxicityMay be inless cats. effective in dosesDo not > give 330 more mg/kg/d. than 3 doses 20% emulsion ABCB1 deficient animals. if no significant response is Naloxone Dogs and cats: 0.002-0.04mg/ Opioid antagonist Canseen be after repeated giving as 3needed, doses. but ® kg IV, IM or SQ high doses have caused seizures. Methocarbamol(Narcan ) Dogs and Cats: 55-220 mg/kg Muscle tremors associated Tablets can be crushed into with tremorgenic mycotoxin saline and given rectally. (Robaxin®) Dogsslow IVand to effect;cats: use caution To control nicotinic signs Not recommended Pralidoxime when exceeding 330 mg/kg/day and metaldehyde Monitor for CNS and respiratory chloride 20 mg/kg IM. Discontinue ingestions,associated permethrinwith OP toxicity. fordepression carbamate with toxicity. doses > 330 ® toxicity in cats. (2-PAM, Protopam ) if no effect after 3 doses. mg/kg/d. Naloxone Dogs and Cats: Opioid antagonist Can be repeated as needed, but high doses have caused (NarcanPropanolol ® ) 0.002-0.04Dogs: 0.02 -0.06mg/kg mg/kg IV, IM slow or SQ IV, Treatment of tachycardias, Useful in toxicoses involving 0.2-1.0 mg/kg PO TID tachyarrhythmias, and seizures., theobromine, Dogs and Cats: Pralidoxime Cats: 0.04 mg/kg slow IV, or 2.5- hypertension.To control nicotinic Notephedra, recommended pseudoephredrine, for 20 mg/kg IM. Discontinue if chloride 5.0 mg total PO BID-TID signs associated with carbamatecocaine, amphetamine, toxicity. no effect after 3 doses. OP toxicity. (2-PAM, Protopam®) cardiac glycosides, and thyroid hormones. Propanolol Dogs: 0.02 -0.06 mg/kg slow IV, Treatment of tachycardias, Useful in toxicoses involving Yohimbine 0.2-1.0Dogs: 0.1-0.2 mg/kg mg/kgPO TID IV; repeat Usedtachyarrhythmias, as an alpha-2 and caffeine,Can use theobromine,atipamezole 50 ephedra, mcg/ Cats:as needed 0.04 mg/kg slow IV, antagonisthypertension. to reverse toxic pseudoephredrine,kg IM if yohimbine cocaine,is not or 2.5-5.0 mg total PO effects of amitraz, , amphetamine,available. cardiac BID-TID and other alpha-2 agonists. glycosides, and thyroid hormones. Yohimbine Dogs: 0.1-0.2 mg/kg IV; repeat Used as an alpha-2 Can use atipamezole 50 mcg/ as needed antagonist to reverse toxic kg IM if yohimbine is not effects of amitraz, clonidine, available. and other alpha-2 agonists.