Target species
Dogs and cats.
Indications for use, specifying the target species
General anaesthesia.
Contraindications
Do not use in cases of hypersensitivity to the active substances, or to any of the excipients.
Do not use the product in animals with severe cardiac or respiratory disease, or in animals with renal, pancreatic or hepatic insufficiency.
Do not use the product in the event of severe hypertension.
Do not use in rabbits.
Do not use in patients with head trauma or intracranial tumours.
Do not use for caesarean section.
Do not use in pregnant bitches and queens.
Special warnings for each target species
In dogs, since zolazepam is eliminated more quickly than tiletamine, there is a shorter duration of tranquilisation than there is of anaesthesia.
Special precautions for use
i) Special precautions for use in animals
Animals should be fasted for 12 hours prior to anaesthesia.
Remove anti-parasite collar 24 hours before anaesthesia.
If necessary, hypersalivation can be controlled with the administration of anticholinergic agents, such as atropine, before the anaesthesia according to a benefit/risk assessment by the responsible veterinarian.
Please refer to section “Interaction with other medicinal products and other forms of interaction” in case of the use of pre-anaesthetic agents.
Keep anaesthetised animals away from excessive noise and visual stimuli.
Apneustic breathing may be observed more commonly in cats after intravenous injection than after intramuscular injection. Especially for high dosages, such abnormal breathing patterns last for up to 15 minutes and then breathing returns to normal. In case of prolonged apnea respiratory assistance should be provided.
Close observation of dogs during the first 5-10 minutes after induction is recommended especially in animals with cardiopulmonary disease.
The product may cause hypothermia, in susceptible animals (small body surface area, low ambient temperature) supplemental heat should be applied if needed.
In dogs and cats the eyes remain open after receiving the product and should be protected from injury and excessive drying of the cornea.
Dosage may need to be reduced in geriatric, debilitated, or animals with renal dysfunction.
Reflexes (e.g. palpebral, pedal, laryngeal) are not abolished during anaesthesia and therefore use of this product alone may not be adequate if surgery is performed on these areas.
Redosing may prolong and worsen recovery.
In the event of reinjections, side effects (hyper-reflexia, neurological problems) can be produced due to tiletamine. It is recommended that the recovery phase occurs in a calm environment.
The product contains benzyl alcohol, which has been documented to cause adverse reactions in neonates. Therefore, the use of the veterinary medicinal product is not recommended in very young animals.
ii) Special precautions to be taken by the person administering the veterinary medicinal product to animals
In cases of accidental self-injection seek medical advice immediately and show the package leaflet or the label to the physician. Do not drive due to risk of sedation.
Wash splashes from skin and eyes immediately. In case of eye irritation, seek medical advice.
Wash hands after use.
This product may cross the placenta and be harmful to the foetus, therefore women who are pregnant, or are suspected to be pregnant, should not use the product.
Benzyl alcohol may cause hypersensitivity (allergic) reactions. People with known hypersensitivity to benzyl alcohol should avoid contact with the product.
Adverse reactions (frequency and seriousness)
Pain upon injection has been reported very rarely. This is most prevalent in cats.
•The following signs have been reported very rarely, mainly during the awakening phase in the dog, and during surgery and the awakening phase in the cat; - Neurological signs – prostration, convulsions, coma.
•Cardio-respiratory signs – dyspnoea, tachypnoea, bradypnoea, tachycardia, cyanosis, have been noted at doses of 20 mg/kg and above.
•Certain systemic signs – hypothermia, hyperthermia, pupillary disorder, hypersalivation, hypersensitivity to external stimuli, agitation, vocalisation.
Prolonged anaesthesia and difficulties when awakening (with myoclonus, restlessness, ataxia, paresis, etc.) have been observed in the recovery phase. All reactions are reversible and disappear once the active substance is eliminated from the body.
The frequency of adverse reactions is defined using the following convention:
very common (more than 1 in 10 animals treated displaying adverse reaction(s))
common (more than 1 but less than 10 animals in 100 animals treated)
uncommon (more than 1 but less than 10 animals in 1,000 animals treated)
rare (more than 1 but less than 10 animals in 10,000 animals treated)
very rare (less than 1 animal in 10,000 animals treated, including isolated reports)
Use during pregnancy, lactation or lay
Laboratory studies in laboratory animals have not produced any evidence of teratogenic effects.
The product crosses the placenta and may cause respiratory depression in newborns that can be fatal for puppies and kittens. The safety of the veterinary medicinal product has not been established during pregnancy or lactation. Do not use during pregnancy. During lactation, use only according to the benefit-risk assessment by the responsible veterinarian.
Interaction with other medicinal products and other forms of interaction
The benefit-risk assessment for using the product with other pre-anaesthetic or anaesthetic agents must take into consideration the dosages of the agents used, the nature of the intervention and the ASA (American Society of Anaesthesiologists) class to which the animal belongs. The required dosage of tiletamine-zolazepam is likely to change depending on which agents are concurrently used.
The dosage of tiletamine – zolazepam may need to be reduced when used concomitantly with pre-anaesthetic and other anaesthetic agents. Premedication with phenothiazine tranquilisers (e.g. acepromazine) can cause increased cardio-respiratory depression and an increased hypothermic effect that occurs in the last phase of anaesthesia.
Do not use medications containing chloramphenicol during the pre- or intra-operative period, as this slows down elimination of the anaesthetics.
Amounts to be administered and administration route
Intramuscular or intravenous use.
Dosage:
The content of the lyophilisate vial is to be diluted in 5 ml of the attached solvent.
The dosage is expressed in mg of the product, on the understanding that the reconstituted product is at a concentration of 100 mg per ml and contains 50 mg of tiletamine per ml and 50 mg of zolazepam per ml.
When the product is administered intramuscularly (unable to stand in 3 to 6 minutes) or intravenously (unable to stand in less than one minute), the recommended therapeutic dosages are the following:
IN DOGS | Intramuscular route | Intravenous route |
Testing and procedures causing little pain | 7 to 10 mg/kg bw | 5 mg/kg bw |
Minor surgical procedures, anaesthesia of short duration | 10 to 15 mg/kg bw | 7.5 mg/kg bw |
Painful interventions | 15 - 25 mg/kg bw | 10 mg/kg bw |
IN CATS | Intramuscular route | Intravenous route |
Tests and procedures causing little pain | 10 mg/kg bw | 5 mg/kg bw |
Orthopaedic operation | 15 mg/kg bw | 7.5 mg/kg bw |
Intravenous injections to be repeated, if needed, at between 1/3 and 1/2 of the initial dose but the total dosage should not exceed 26.4 mg/kg.
Dosage is based on species and on type of intervention; to be adjusted at the discretion of the practitioner based on the status of the subject (age, obesity, severe organic deficiencies, state of shock, debilitating diseases).
Please refer also to sections “Adverse reactions” and/or “Overdose” since adverse reaction might occur at therapeutic doses.
Duration of anaesthesia: 20 to 60 minutes depending on dose.
The product should not be used as sole anaesthetic agent for painful operations. For these operations the product should be combined with an appropriate analgesic.
Pre-surgical preparation:
As for all anaesthetics animals should be fasted for at least 12 hours before anaesthesia.
In dogs and cats, the use of atropine subcutaneously, 15 minutes before injection, may be considered.
Recovery period:
Analgesia lasts longer than surgical anaesthesia. Return to normal is progressive and can last 2 to 6 hours in a calm environment (avoid excessive noise and light). Recovery may be delayed due to an overdose in obese, old or debilitated animals.
Overdose (symptoms, emergency procedures, antidotes), if necessary
100 mg per kg constitutes a lethal dose for cats and dogs when administered intramuscularly, i.e., 5 to 10 times the anaesthetic dose. In the event of an overdose and in obese or old animals, recovery may be slower.
Overdosed animals must be monitored carefully. The signs of overdosage are mainly cardio-respiratory depression that can appear from 20 mg/kg depending on the animal’s health, the level of central nervous system depression, and whether hypothermia is present. An earlier warning sign of overdosage is the loss of cranial and spinal reflexes. Prolongation of anaesthesia can be produced.
There is no specific antidote and treatment is symptomatic. Doxapram may have antagonistic activity against the tiletamine-zolazepam, increasing both heart and respiratory rates and reducing the arousal time.