Do not use in animals with severe cardiovascular disease or respiratory diseases or impaired liver or kidney function, mechanical disturbances of the gastro-intestinal tract (torsio ventriculi, incarcerations, oesophagal obstructions), pregnancy, Diabetes mellitus, state of shock, emaciation or serious debilitation.
Do not use concomitantly with sympathomimetic amines.
Do not use in cases of known hypersensitivity to the active substance or to any other excipients.
Do not use in animals with ocular problems where an increase in intraocular pressure would be detrimental.
Medetomidine may not provide analgesia throughout the entire period of sedation, therefore consideration should be given to providing additional analgesia for painful procedures.
Special precautions for use in animals:A clinical examination should be carried out in all animals before the use of veterinary medicinal products for sedation and/or general anaesthesia. Higher doses of medetomidine should be avoided in large breed dogs. Care should be taken when combining medetomidine with other anaesthetics or sedatives because of its marked anaesthetic sparing effects. The dose of the anaesthetic should be reduced accordingly and titrated to response due to considerable variability in requirements between patients. Before using any combinations, the warnings and contra-indications in the product literature for the other products should be observed.
The animal should be placed in a calm and quiet surrounding to let the sedation gain its maximum effect. This takes about 10 – 15 minutes. One should not start any procedure or give other medicines before maximum sedation is reached. Treated animals should be kept warm and at a constant temperature, both during the procedure and recovery. The eyes should be protected by a suitable lubricant. Nervous, aggressive or excited animals should be given the possibility to calm down before initiation of treatment Sick and debilitated dogs and cats should only be premedicated with medetomidine before induction and maintenance of general anaesthesia based on a risk-benefit assessment. Care should be taken with use of medetomidine in animals with cardiovascular disease, or which are elderly or in general poor health. Liver and kidney function should be evaluated prior to use. As ketamine alone can elicit cramps, alpha-2 antagonists should be administered not before 30-40 min. after ketamine. Medetomidine may cause respiratory depression and under these circumstances, manual ventilation and oxygen may be administered.
The safety of the product has not been established during pregnancy and lactation. Therefore it should not be used during pregnancy and lactation.
In the case of overdose the main signs are prolonged anaesthesia or sedation. In some cases cardio-respiratory effects may occur. For treatment of these cardio-respiratory effects of an overdose it is recommended to administer an alpha-2 antagonist e.g. atipamezole or yohimbine, provided that reversal of sedation is not dangerous to the patient (atipamezole does not reverse the effects of ketamine which may cause seizures in dogs and elicit cramps in cats when used alone). Use atipamezole hydrochloride 5 mg/ml intramuscularly in the dog in the same volume as Medetor , in the cat use half the volume. The required dose of atipamezole hydrochloride corresponds in dogs to the 5-fold dose of the medetomidine hydrochloride dose in mg administered before and in cats to the 2.5-fold dose. Alpha-2 antagonists should be administered not before 30-40 min. after ketamine.
If it is imperative to reverse bradycardia but maintain sedation, atropine may be used.
The concomitant use of other CNS depressants should be expected to potentiate the effect of either active substance. Appropriate dose adjustments should be made. Medetomidine has marked anaesthetic sparing effects. See also section 4.5. The effects of medetomidine may be antagonized by administration of atipamezole or yohimbine.
Adverse reactions:Bradycardia with atrioventricular block (1th and 2nd degree) and occasionally extrasystolia. Vasoconstriction of coronary artery. Decreased cardiac output. Blood pressure will increase initially after administration and then return to normal, or slightly below normal. Some dogs and most cats will vomit within 5-10 minutes of injection. Cats may also vomit on recovery. Sensitivity to loud noises is observed in some individuals. Increased diuresis. Hypothermia. Respiratory depression, cyanosis, pain at injection site and muscle tremor may be seen. In individual cases reversible hyperglycaemia due to depression of insulin secretion. In circulatory and respiratory depression manual ventilation and an oxygen supplement may be indicated. Atropine may increase the cardiac rate. Dogs with a body weight of less than 10 kg may show the undesirable effects mentioned above more often.
As incompatibility studies have not been carried out, the product should not be mixed with other medicinal products in the same syringe.
Operator warnings:In the case of accidental oral intake or self-injection, seek medical advice immediately and show the package insert to the physician but DO NOT DRIVE as sedation and changes in blood pressure may occur. Avoid skin, eye or mucosal contact. Wash the exposed skin immediately after exposure with large amounts of water. Remove contaminated clothes that are in direct contact with skin. In the case of accidental contact of the product with eyes, rinse abundantly with fresh water. If symptoms occur, seek the advice of a physician. 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 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.