Introduction

Company name: Pfizer Limited

Address: Ramsgate Road

Sandwich

Kent CT13 9NJ

Telephone: 0845 300 8034 (Out of hours: 01304 616161)

Fax: 01737 332521

Email: UKVetLine@pfizer.com

Website: www.only4vets.co.uk

Presentation

Vetalar (ketamine hydrochloride) is a colourless solution for injection containing 100 mg ketamine base per ml. It contains 0.1 mg/ml benzethonium chloride as a preservative.

Uses

Vetalar is a non-barbiturate, non-narcotic, dissociative anaesthetic.

Vetalar can be used alone in cats and sub-human primates for restraint or as the sole anaesthetic agent in diagnostic or minor and brief surgical procedures that do not require complete skeletal muscle relaxation.

For surgical procedures requiring muscle relaxation, Vetalar may be used in conjunction with xylazine in the cat, dog and horse, in conjunction with medetomidine in the cat and dog and in conjunction with detomidine or romifidine in the horse.

In the cat atipamezole may be used to speed recovery from Vetalar/medetomidine anaesthesia.

Cat - Vetalar

Indications

Handling of fractious animals, wound repair, lancing abscesses, radiography and other minor and brief surgical procedures where muscle relaxation is not required.

Dosage and administration

Vetalar may be used by intravenous or subcutaneous injection, but intramuscular injection is the preferred recommended route. The dose is 11–33 mg ketamine/kg bodyweight depending on the degree of restraint or surgical interference that is intended.

	Vetalar dosage (mls)
		Restraint	Minor surgery
Weight of cat (kgs)	11 mg/kg	22 mg/kg	33 mg/kg
1	0.11	0.22	0.33
2	0.22	0.44	0.66
3	0.33	0.66	0.99
4	0.44	0.88	1.32
5	0.55	1.10	1.65

Following intramuscular administration of recommended doses, cats become ataxic in about five minutes with anaesthesia usually lasting 30–45 minutes. Complete recovery usually occurs in 4–5 hours, but with higher doses recovery is more prolonged. The individual response to Vetalar is variable and depends upon the general condition and age of the subject.

Fasting prior to administration of Vetalar is not essential due to the maintenance of the pharyngeal-laryngeal reflexes. However, when preparing for elective surgery, it is advisable to withhold food for at least 6 hours prior to administration of Vetalar.

Cat - Xylazine/Vetalar

Indications

Spaying, castration, laparotomy, wound treatment, radiography, fracture repair, etc.

Dosage and administration

Administer xylazine at a dosage of 1.1 mg/kg by intramuscular injection. This injection is followed immediately by an intramuscular injection of 0.04 mg/kg atropine sulphate, and an intramuscular injection of Vetalar at a dosage of 22 mg ketamine per kg.

Weight of cat (kgs)	Dose of xylazine 2 mg/ml solution (mls)	Dose of Vetalar (mls
1	0.06	0.22
2	0.11	0.44
3	0.17	0.66
4	0.22	0.88
5	0.28	1.10

Due to low dose volumes, it is advisable to use an insulin type syringe to accurately measure dosages. Following this procedure the average time for onset of anaesthesia is 5 minutes. Surgical anaesthesia should be maintained for at least 30 minutes.

If the cat is not starved prior to anaesthesia, then there should be an interval of 20 minutes between the xylazine and Vetalar injections. Vomiting will normally occur within 3–18 minutes of the xylazine injection in cats with a full stomach.

Vomiting and aspiration are unlikely to be a problem in starved cats.

Cat - Medetomidine/Vetalar

Indications

Spaying, castration, laparotomy, wound treatment, radiography, fracture repair, etc.

Dosage and administration

By intramuscular injection, administer medetomidine at a dosage of 80 μg/kg and Vetalar at a dosage of 5.0 to 7.5 mg ketamine per kg.

Weight of cat (kgs)	Dose of medetomidine 1 mg/ml solution (mls)	Dose of Vetalar 5.0 mg/ kg (mls)	Dose of Vetalar 7.5 mg/kg (mls)
1	0.08	0.05	0.08
2	0.16	0.10	0.15
3	0.24	0.15	0.23
4	0.32	0.20	0.30
5	0.40	0.25	0.38
*For reversal of anaesthesia atipamezole may be administered at a dose volume of half the previously administered medetomidine.

Due to low dose volumes, it is advisable to use an insulin type syringe to accurately measure dosages. Vetalar and medetomidine (in the form of Domitor) may be administered in the same syringe, however, to minimise the risk of cross contamination, the vials of Vetalar and medetomidine should have separate needles inserted for withdrawal. The average onset of anaesthesia is 3–4 minutes. Duration of surgical anaesthesia will vary between 30–60 minutes and is related to the dose of Vetalar used.

To speed recovery from anaesthesia (in cats only), atipamezole 5 mg/ml solution may be administered at a dose of 200 μg/kg. Thus in the cat the dose volume of atipamezole 5 mg/ml solution required is half that of the previously administered medetomidine 1 mg/ml solution.

Dog - Xylazine/Vetalar

Indications

To induce and maintain surgical anaesthesia in the dog. Short seizure-like movements can occasionally occur during Vetalar/xylazine anaesthesia, therefore, this anaesthetic technique is not recommended for delicate surgical procedures, e.g. delicate orthopaedic or eye surgery.

Dosage and administration

Administer xylazine by intramuscular injection at a dosage of 2 mg/kg. Atropine at recommended dose rates should be given to control salivation. In dogs weighing over 25 kg the dose of xylazine should be reduced by one-third to 1.3 mg/kg.

After 10 minutes, administer Vetalar at a dosage of 10 mg ketamine per kg by intramuscular injection.

The dog should be kept quiet and unnecessary stimulation avoided during the induction period.

Weight of dog (kgs)	Dose of xylazine 2% solution (mls)	Dose of Vetalar (mls)
5	0.5	0.5
10	1.0	1.0
15	1.5	1.5
20	2.0	2.0
25	2.5	2.5
30	2.0*	3.0
35	2.3*	3.5
*The dosage of xylazine in dogs weighing over 25 kg is reduced from 2.0 mg/kg to 1.3 mg/kg.

Surgical anaesthesia is usually obtained within 10 minutes of the Vetalar injection and maintained for approximately 30 minutes. Anaesthesia may be prolonged by incremental intramuscular doses of Vetalar at half the original dose, i.e. 5 mg ketamine/kg bodyweight.

Dog - Medetomidine/Vetalar

Indications

To induce and maintain surgical anaesthesia. Short seizure-like movements can occasionally occur during Vetalar/medetomidine anaesthesia, therefore, this anaesthetic technique is not recommended for delicate surgical procedures e.g. delicate orthopaedic or eye surgery.

Dosage and administration

By intramuscular injection, administer medetomidine at a dosage of 40 μg/kg and Vetalar at a dosage of 5.0 to 7.5 mg ketamine per kg.

Weight of dog (kgs)	Dose of medetomidine 1 mg/ml solution (mls)	Dose of Vetalar 5.0 mg/kg (mls)	Dose of Vetalar 7.5 mg/kg (mls)
5	0.2	0.25	0.38
10	0.4	0.50	0.75
15	0.6	0.75	1.13
20	0.8	1.00	1.50
25	1.0	1.25	1.88
30	1.2	1.50	2.25
35	1.4	1.75	2.63

Vetalar and medetomidine (in the form of Domitor) may be administered in the same syringe, however, to minimise the risk of cross contamination, the vials of Vetalar and medetomidine should have separate needles inserted for withdrawal. The duration of surgical anaesthesia varies between 30–50 minutes and is related to the dose of Vetalar used. Atropine is not normally required when using a Vetalar/medetomidine combination. Atipamezole should not be used in dogs to speed up recovery.

Horse - Xylazine/Vetalar

Indications

Castration, wound repair, radiography, induction agent for halothane and oxygen anaesthesia.

Dosage and administration

Xylazine should be administered by slow intravenous injection at a dosage of 1.1 mg/kg. The horse should appear sedated by 2 minutes post xylazine injection. Vetalar should then be administered at a dosage of 2.2 mg ketamine per kg as an intravenous bolus.

It is a prime requisite that the horse should be quietly and carefully handled during the administration of the anaesthetic agents so as to ensure the minimum amount of upset during the induction period. Onset of anaesthesia is gradual, the horse taking approximately 1 minute to become recumbent. In large fit horses, recumbency may take longer. Anaesthesia will continue to deepen for a further 1–2 minutes and during this time the horse should be left quietly.

Weight of horse (kgs)	Dose of xylazine 2% solution (mls)	Dose of xylazine 10% Solution (mls)	Dose of Vetalar (mls)
100	5.5	1.1	2.2
200	11.0	2.2	4.4
300	16.5	3.3	6.6
400	22.0	4.4	8.8
500	27.5	5.5	11.0
600	33.0	6.6	13.2
*For prolongation of anaesthesia xylazine and Vetalar may be administered at half the original induction dose.

Horses will regain sternal recumbency approximately 30 minutes post ketamine administration. Duration of surgical anaesthesia is variable lasting 10–30 minutes but usually less than 20 minutes.

Owing to the abrupt nature of the recovery, the intended procedure should be completed, if possible, within approximately 15 minutes.

For longer periods of anaesthesia, intubation and maintenance by inhalational, halothane and oxygen, anaesthesia should be used.

Should maintenance of surgical anaesthesia be required and facilities for gaseous anaesthesia are not available, the following procedure may be followed:

Administer 0.55 mg/kg xylazine by intravenous injection followed immediately by 1.1 mg/kg ketamine (Vetalar) by intravenous injection. (These dose rates are ½ the original induction dosages). Anaesthesia should be maintained for approximately 10–15 minutes following top-up administration. More than one top-up dose can be given if anaesthesia needs to be prolonged for longer periods.

This method of prolonging anaesthesia is not recommended for routine maintenance of anaesthesia in which maintenance with gaseous anaesthesia would ordinarily be used.

Horse - Detomidine/Vetalar

Indications

For short duration general anaesthesia to carry out surgical procedures such as castration.

Dosage and administration

Administer detomidine at a dosage of 20 μg/kg by intravenous injection. Allow 5 minutes for the horse to become deeply sedated then administer Vetalar at a dosage of 2.2 mg ketamine per kg as an intravenous bolus.

Detomidine/Vetalar
Weight of horse (kgs)	Dose of 10 mg/ml detomidine solution (mls)	Dose of Vetalar (mls)	2 mg/kg dose of 5% thiopentone if required for supplementation of anaesthesia (mls)
100	0.20	2.2	4.0
200	0.40	4.4	8.0
300	0.60	6.6	12.0
400	0.80	8.8	16.0
500	1.00	11.0	20.0
600	1.20	13.2	24.0

Onset of anaesthesia is gradual, the horse taking approximately 1 minute to become recumbent. In large fit horses, recumbency may take up to 3 minutes.

Anaesthesia will continue to deepen for a further 1–2 minutes and during this time the horse should be left quietly. Horses regain sternal recumbency approximately 20 minutes post ketamine administration.

The duration of surgical anaesthesia is approximately 10–15 minutes and if for any reason it is necessary to prolong anaesthesia, thiopentone sodium can be administered intravenously in boluses of 1–2.0 mg/kg as required. Incremental doses totalling 5 mg/kg have been given. Total doses greater than this may reduce the quality of recovery.

Thiopentone can also be administered (as above regime) if sufficient depth of anaesthesia is not achieved. The horse should be allowed to stand in its own time.

The horse may be ataxic if it is encouraged to stand prematurely. To facilitate handling and the administration of the induction agents, some horses have received acepromazine ACP by intramuscular injection at a dose rate of 0.03 mg/kg at least 45 minutes before induction of anaesthesia (0.3 mls of 10% ACP solution per 100 kg bodyweight).

Horse - Romifidine/Vetalar

Indications

Castration, wound repair, radiography, induction agent for gaseous anaesthesia.

Dosage and administration

Administer romifidine intravenously at a dosage of 100 μg/kg. After 5 to 10 minutes, administer Vetalar at a dosage of 2.2 mg ketamine per kg as an intravenous bolus.

After induction, should deepening or maintenance of surgical anaesthesia be required and facilities for gaseous anaesthesia are not available either of the following two procedures may be followed:

1.Administer romifidine, 25 μg/kg (¼ original induction dose) intravenously followed immediately by Vetalar intravenously at a dosage of 1.1 mg ketamine/kg (½ original induction dose). This should be administered prior to commencement of surgical anaesthesia and/or when early signs of returning consciousness appear. Anaesthesia should be maintained for a further 10–15 minutes.

2.Administer thiopentone at a dosage of 2.5 mg/kg. This should be administered when signs of returning consciousness appear. Each repeat dose will provide approximately 10 minutes additional anaesthesia.

Romifidine/Vetalar
	Induction doses
Weight of horse (kgs)	Dose of romifidine 10 mg/ml solution (mls)	Dose of Vetalar (mls)
100	1.0	2.2
200	2.0	4.4
300	3.0	6.6
400	4.0	8.8
500	5.0	11.0
600	6.0	13.2
	Prolongation doses romifidine/Vetalar (if required)			Prolongation dose thiopentone 2.5 mg/kg (if required)
Weight of horse (kgs)	Dose of romifidine 10 mg/ml solution (mls)	Dose of Vetalar (mls)	Or	Dose of 5% thiopentone (mls)
100	0.25	1.1		5
200	0.50	2.2		10
300	0.75	3.3		15
400	1.00	4.4		20
500	1.25	5.5		25
600	1.50	6.6		30

Sub-human primates - Vetalar

Indications

Sedation for clinical examinations, blood sampling etc. Light surgical anaesthesia for minor procedures.

Dosage and administration

By intramuscular injection

Sedation

5–16 mg ketamine per kg bw (1 ml Vetalar per 20 kg bw, to 1 ml Vetalar per 6 kg bw).

Light anaesthesia

10–33 mg ketamine per kg bw (1 ml Vetalar per 10 kg bw, to 1 ml Vetalar per 3 kg bw).

The dosage of Vetalar in sub-human primates is inversely proportional to weight in many species i.e., as the animal's size increases the mg/kg dosage required decreases.

Temperament of the animal may also affect dosage.

Contra-indications, warnings, etc

General—If using Vetalar in conjunction with xylazine, medetomidine, detomidine, atipamezole or romifidine, reference should be made to the contra-indications and warnings specific to these products. For example, xylazine and detomidine should not be used in late stages of pregnancy. Medetomidine must not be used in pregnant dogs or cats.

Vetalar is contra-indicated in patients with pre-existent hepatic or renal pathology. Caution on the use of Vetalar is required when pulmonary disease is present or suspected.

With Vetalar anaesthesia, the eyes normally remain open with the pupils dilated. The eyes should be protected by covering with a damp gauze swab or by application of a bland ophthalmic ointment.

Care should be taken when using halothane/ketamine combinations since the half-life of ketamine is prolonged.

It is advisable that where general anaesthesia is induced, animals are previously starved for at least 12 hours.

A small proportion of animals have been reported to be unresponsive to ketamine as an anaesthetic agent at normal doses.

Overdosage

Respiratory depression may occur following administration of high doses of Vetalar. If, at any time, respiration seems excessively depressed and the animal becomes cyanotic resuscitative measures should be instituted promptly. Adequate pulmonary ventilation with either oxygen or room air is recommended as there is temporary cardiovascular stimulation. Cardiac stimulants should not be used.

Cats

Cats, after administration of Vetalar, should not be stimulated by sound or handling during the recovery period. They should be kept at normal room temperature.

Dogs

In some dogs, especially excitable dogs, insufficient anaesthesia as indicated by poor muscle relaxation and occasional short seizure-like movements may occur. Quiet handling before and after induction will help to minimise this effect.

Due to the risk of occasional short seizure-like movements, this anaesthetic technique is not recommended for use in delicate surgical procedures. Atipamezole should not be used to speed up recovery in dogs.

Horses

Vetalar must not be used as the sole anaesthetic agent in horses.

Excitable horses are sometimes poor subjects for anaesthesia. It is a prime requisite that the horse should be quietly and carefully handled during the administration of the anaesthetic agents so as to ensure the minimum amount of upset during the induction period.

If the horse fails to become sedated following the injection of either xylazine, detomidine or romifidine, then Vetalar should not be injected and the anaesthetic procedure should be abandoned.

Vetalar should not be used in horses intended for slaughter for human consumption.

Operator Warnings

This is a potent drug–particular care should be taken to avoid accidental self administration.

Wash off splashes from skin and eyes immediately.

In the event of accidental self administration–seek urgent medical attention and show this label.

Advice to doctor: Do not leave patient unattended. Maintain airways and give symptomatic and supportive treatment.

Pharmaceutical precautions

Protect from light. Vetalar must not be mixed with other products, with the exception of Domitor.

Following withdrawal of the first dose, use the product within 28 days. Unused product and containers should be disposed of in accordance with national requirements.

Legal category

POM-V

Packaging Quantities

10 ml and 20 ml rubber capped multi-dose vials.

Further information

Nil.

Marketing authorisation number

Vm 00057/4257.