Contraindications
Do not administer intravenously.
Do not administer intramuscularly
Do not administer to lambs weighing less than 15 kg.
Do not administer to primates.
Do not administer to pigs.
Do not administer to horses and donkeys.
Do not administer to goats.
Do not use in case of hypersensitivity to the active substance or to any of the excipients.
Special warnings for each target species
Sheep
The clinical trials did not demonstrate a bacteriological cure in sheep with acute mastitis caused by Staphylococcus aureus and Mycoplasma agalactiae.
Accurate weighing of lambs is important to avoid overdose.
Special precautions for use
Special precautions for use in animals
Use of the product should be based on susceptibility testing of the bacteria isolated from the animal. If this is not possible, therapy should be based on local (regional, farm level) epidemiological information about susceptibility of the target bacteria.
Use of the product deviating from the instructions given in the SPC may increase the prevalence of bacteria resistant to tilmicosin and may decrease the effectiveness of treatment with other macrolides, lincosamides and streptogramin B due to the potential for cross-resistance.
The feeding of waste milk containing residues of tilmicosin to calves should be avoided up to the end of the milk withdrawal period (except during the colostral phase), because it could select antimicrobial-resistant bacteria within the intestinal microbiota of the calf and increase the faecal shedding of these bacteria.
Official, national and regional antimicrobial policies should be taken into account when the product is used.
Do not administer to lambs weighing less than 15 kg since there is a risk of overdose toxicity.
Overdose (symptoms, emergency procedures, antidotes), if necessary:
In cattle subcutaneous injections of 10, 30 and 50 mg/kg body weight, repeated three times with a 72 hours interval, did not cause death. As expected, oedema developed at the site of injection. The only lesion observed at autopsy was a necrosis of the myocardium in the group treated with 50 mg/kg body weight.
Doses of 150 mg/kg body weight, administered subcutaneously with an interval of 72 hours caused death. Oedema at the site of injection was observed and at autopsy a light necrosis of the myocardium was the only lesion determined. Other symptoms observed were: difficulty in moving, reduced appetite and tachycardia.
In sheep single injections (approximately 30 mg/kg body weight) may cause a slight increase of the rate of respiration. Higher doses (150 mg/kg body weight) caused ataxia, lethargy and the inability to raise the head.
Deaths occurred after one single intravenous injection of 5 mg/kg body weight in cattle and 7.5 mg/kg in sheep body weight.
Special precautions to be taken by the person administering the veterinary medicinal product to animals
Operator Safety Warnings:
INJECTION OF TILMICOSIN IN HUMANS CAN BE FATAL – EXERCISE EXTREME CAUTION TO AVOID ACCIDENTAL SELF-INJECTION AND FOLLOW THE ADMINISTRATION INSTRUCTIONS AND THE GUIDANCE BELOW, PRECISELY:
∙ This product should only be administered by a veterinary surgeon.
∙ Never carry a syringe loaded with Tilmovet with the needle attached. The needle should be connected to the syringe only when filling the syringe or administering the injection. Keep the syringe and needle separate at all other times.
∙ Do not use automatic injection equipment.
∙ Ensure that animals are properly restrained, including those in the vicinity.
∙ Do not work alone when using Tilmovet.
∙ In case of self-injection SEEK IMMEDIATE MEDICAL ATTENTION and take the vial or the package leaflet with you. Apply a cold pack (not ice directly) to the injection site.
Additional operator safety warnings:
∙ Avoid contact with skin and eyes. Rinse any splashes from skin and eyes immediately with water.
∙ May cause sensitisation by skin contact. Wash hands after use.
NOTE TO THE PHYSICIAN:
INJECTION OF TILMICOSIN IN HUMANS HAS BEEN ASSOCIATED WITH FATALITIES.
The cardiovascular system is the target of toxicity, and this toxicity may be due to calcium channel blockade. Administration of intravenous calcium chloride should only be considered if there is positive confirmation of exposure to tilmicosin.
In dog studies, tilmicosin induced a negative inotropic effect with consequent tachycardia, and a reduction in systemic arterial blood pressure and arterial pulse pressure.
DO NOT GIVE ADRENALIN OR BETA-ADRENERGIC ANTAGONISTS SUCH AS PROPRANOLOL.
In pigs, tilmicosin-induced lethality is potentiated by adrenalin.
In dogs, treatment with intravenous calcium chloride showed a positive effect on the left ventricular inotropic state and some improvements in vascular blood pressure and tachycardia.
Pre-clinical data and an isolated clinical report suggest that calcium chloride infusion may help to reverse tilmicosin induced changes in blood pressure and heart rate in humans.
Administration of dobutamine should also be considered due to its positive inotropic effects although it does not influence tachycardia.
As tilmicosin persists in tissues for several days, the cardiovascular system should be closely monitored and supportive treatment provided.
Physicians treating patients exposed to this compound are advised to discuss clinical management with the National Poison Information Service.
Adverse reactions (frequency and seriousness)
Occasionally, a soft diffuse swelling may occur at the injection site but this disappears within five to eight days. In rare cases recumbency, incoordination and convulsions have been observed.
Deaths of cattle have been observed following a single intravenous dose of 5 mg/kg body weight, and following the subcutaneous injection of doses of 150 mg/kg body weight at 72 hour intervals. In pigs, intramuscular injection at 20 mg/kg body weight has caused deaths. Sheep have died following a single intravenous injection of 7.5 mg/kg body weight.
Use during pregnancy, lactation or lay
The safety of the veterinary medicinal product has not been established during pregnancy.
Use only according to the benefit/risk assessment by the responsible veterinarian.
Interaction with other medicinal products and other forms of interaction
Interactions between macrolides and ionophores could be observed in some species.
Tilmicosin may lessen the antibacterial activity of beta-lactam antibiotics.
Do not use simultaneously with bacteriostatic antimicrobial agents.