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Contra-indications, warnings, etc
Before using any combinations consult the contraindications and warnings that appear on the other products' data sheets.
Contra-indications: Medetomidine should not be used in conjunction with sympathomimetic amines. Care should be taken with the use of medetomidine in animals with cardiovascular disease or in poor general health. Medetomidine should not be used with thiopentone or propofol in animals with cardiac or respiratory disease.
The use of Domitor in pregnancy has not been monitored in sufficient animals and therefore is not recommended.
Warnings: The concomitant use of other CNS depressants should be expected to potentiate the effect of either product, and appropriate dose adjustment should be made. Medetomidine, ketamine and thiopentone are metabolised in the liver and excreted mainly via the kidneys. Pre-existing liver or kidney pathology should be carefully evaluated prior to using these products.
Side-effects: Due to the mode of action of medetomidine, heart rate and body temperature decrease. Treated animals should be kept in a warm and even temperature during the procedure and for 12 hours after sedation. Blood pressure will initially increase and then return to normal or slightly below. Some dogs and most cats will vomit 5-10 minutes post-injection. Some cats may also vomit at recovery. In some dogs and cats very slow respiratory rates may be seen.
Overdosage: In cases of overdosage, or should the effects of medetomidine become life-threatening, the appropriate dose of atipamezole is recommended provided that reversal of sedation and analgesia is not dangerous to the patient (e.g. Antisedan does not reverse the effects of ketamine).
PREMEDICATION
Medetomidine has marked anaesthetic-sparing effects. It is essential to appropriately reduce the dose of anaesthetic induction and maintenance agents in animals that have been given Domitor.
Domitor with ketamine in cats: Medetomidine and ketamine are metabolised in the liver and excreted mainly via the kidneys, thus any pre-existing hepatic or renal pathology must be carefully evaluated before considering this method of anaesthesia. Vomiting prior to onset of anaesthesia occurs in approximately 10% of cases. Laryngeal and pharyngeal reflexes are retained during anaesthesia. The combination has been reported to elicit a pain response in some cats when administered IM. Heart rates will generally fall to approximately 50% of pre-anaesthetic levels and in some cats very slow respiratory rates are observed (4-6 breaths per minute). Where procedures are prolonged it may be helpful to apply an eye preparation at regular intervals to lubricate the cornea. During and after anaesthesia, treated animals should be kept in a warm and even temperature. Medetomidine must not be mixed with other ketamine products, with the exception of Vetalar and Ketaset injection.
Domitor as a premedicant before thiopentone in dogs, anaesthesia being maintained with halothane (with or without nitrous oxide):
This regime should not be used in animals with cardiovascular or respiratory disease. Medetomidine and thiopentone are metabolised in the liver and excreted via the kidneys; any pre-existing hepatic or renal pathology must be carefully evaluated before considering this method of anaesthesia.
As medetomidine has marked anaesthetic-sparing effects, it should be ensured that the dose of thiopentone and halothane is reduced accordingly and should be administered with care to minimise the possibility of inadvertent overdosage.
Respiratory rates may fall by up to 30% of pre-dose values following administration of medetomidine. Heart rates will fall following the administration of medetomidine and they will not return to presedation levels following induction. Occasionally there will be a transient rise in heart rate associated with induction followed by bradycardia.
During and after anaesthesia, treated animals should be kept in a warm and even temperature.
Domitor as a premedicant before propofol in dogs:
This regime should not be used in animals with cardiovascular or respiratory disease. Medetomidine and propofol are metabolised in the liver and excreted via the kidneys; any pre-existing hepatic or renal pathology must be carefully evaluated before considering this method of anaesthesia.
Medetomidine has marked anaesthetic sparing effects. Therefore, it should be ensured that the dose of propofol is reduced accordingly and should be administered with care to minimise the possibility of inadvertent overdosage.
Transient apnoea and movement of the forelegs may occur during induction of anaesthesia and in some cases, at higher dosages, a decline in arterial oxygen tensions may occur. When using the regime dogs should be intubated and oxygen administered during anaesthesia.
During and after anaesthesia, treated animals should be kept in a warm and even temperature.
OPERATOR WARNINGS
In the case of accidental oral intake or self-injection, seek medical advice immediately and show the package leaflet to the doctor but DO NOT DRIVE as sedation and changes in blood pressure may occur. Avoid skin, eye or mucosal contact. Immediately after exposure, wash the exposed skin with large amounts of fresh water. Remove contaminated clothes that are in direct contact with skin. In the case of accidental contact of the product with eyes, rinse with large amounts of fresh water. If symptoms occur, seek the advice of a doctor. If pregnant women handle the product, special caution should be observed not to self-inject as uterine contractions and decreased foetal blood pressure may occur after accidental systemic exposure.
Advice to Doctors: Medetomidine hydrochloride is an alpha2-adrenoreceptor agonist. Symptoms after absorption may involve clinical effects including dose dependent sedation, respiratory depression, bradycardia, hypotension, a dry mouth, and hyperglycaemia. Ventricular arrhythmias have also been reported. Respiratory and haemodynamic symptoms should be treated symptomatically.