advantage multi 18 (Canada)

Company: Elanco

(imidacloprid and moxidectin topical solution)

Topical parasiticide for cats and kittens 8 weeks of age and older, weighing 4.1 to 8.2 kg.

DIN 02263513

VETERINARY USE ONLY

Description

Each 0.8 mL tube contains 80 mg imidacloprid and 8 mg moxidectin as a colorless to yellow solution. Imidacloprid is a chloronicotinyl nitroguanidine insecticide. The chemical composition of imidacloprid is 1-{(6-Chloro-3-pyridinyl)methyl}-N-nitro-2-imidazolidinimine. Moxidectin is a semisynthetic macrocyclic lactone endectocide derived from the actinomycete Streptomycetes cyaneogriseus noncyanogenus.

advantage multi 18 Indications

advantage multi 18 is indicated in cats and kittens, 8 weeks of age and older, for the prevention of cardiovascular dirofilariasis (heartworm disease) caused by Dirofilaria immitis, and for the treatment and control of parasitic infestations caused by the adult stage of the common flea, (Ctenocephalides felis) and due to ear mites (Otodectes cynotis). advantage multi 18 is also indicated for the treatment and control of parasitic infections caused by the developing L₄, the sexually immature adult and the adult stages of hookworms (Ancylostoma tubaeforme) and ascarids (Toxocara cati).

DOSAGE:

Apply the entire contents of one tube to the skin of cats and kittens 8 weeks of age and older, weighing between 4.1 to 8.2 kg, once a month. This will deliver at least the recommended minimum dose of 9.7 mg of imidacloprid and 0.9 mg of moxidectin per kg of body weight.

ADMINISTRATION:

1. Remove one unit dose tube from the package.

2. Administer the entire contents of a unit dose applicator tube of advantage multi 18 topically. Cats over 8.2 kg should be treated with the appropriate combination of advantage multi tubes.

3. While holding the tube in an upright position, pull the cap off the tube.

4. Turn the cap over and place the other end of cap onto the tip of the tube.

5. Twist the cap to break the seal and then remove cap from the tube.

Treatment And Control Of Ear Mite Infestations:

For the treatment and control of ear mite infestations, administer a single dose of advantage multi 18. Administer a second monthly dose if the cat remains mite positive at 4 weeks or in the case of re-infestation. Monthly use of advantage multi 18 will treat any subsequent ear mite infestations.

Heartworm Disease Prevention:

Cats in areas endemic for heartworm, or those which have travelled to endemic areas, may be infected with adult heartworms. For prevention of heartworm disease, advantage multi 18 must be administered at one-month intervals during the time of the year when mosquitoes are present. Administration of advantage multi 18 should start one month after the first expected exposure to mosquitoes and should continue at monthly intervals until one month after the last exposure to mosquitoes. When replacing another heartworm preventative product in a heartworm prevention program, the first treatment with advantage multi 18 must be given within one month of the last dose of the former medication.

advantage multi 18 may be safely administered to heartworm infected cats. However, cats six months of age or older in heartworm endemic areas may be tested to determine the presence of existing heartworm infections before beginning medication with advantage multi 18.

Treatment and Control of Intestinal Nematode Infections:

advantage multi 18 will remove the adult, the sexually immature adult and the developing L₄ stages of intestinal hookworms (Ancylostoma tubaeforme) and ascarids (Toxocara cati). Monthly treatment with advantage multi 18 will control the development of these intestinal nematode infections.

Contraindications

Do not administer orally. See the Animal Safety section.

CAUTIONS:

Use with caution in sick, debilitated, or underweight animals.

The safe use of advantage multi 18 in cats used for breeding purposes, during pregnancy, or lactation has not been evaluated.

Brief contact of the animal with water on one or two occasions between monthly treatments is unlikely to significantly reduce the efficacy of the product. However, frequent shampooing or immersion of the animal in water after treatment may reduce the efficacy of the product.

Warnings

Keep this product, and all drugs, out of the reach of children.

May be irritating to skin and eyes. If contact with eyes occurs, flush eyes copiously with water. If eye irritation persists, contact a physician. Wash hands after use. If contact with skin occurs, wash skin immediately with soap and water. If ingested, contact a physician immediately.

Adverse Reactions

Use of the product may result in transient pruritus in cats. Rarely, greasy fur, erythema and vomiting can occur. These signs disappear without further treatment. The product may, in rare cases, cause local hypersensitivity reactions. If the animal licks the application site after treatment, transient, self-limiting neurological signs such as ataxia, generalised tremors, ocular signs (dilated pupils, little pupillary reflex, nystagmus), abnormal respiration, salivation and vomiting may occur infrequently.

The product tastes bitter. Salivation may occasionally occur if the animal licks the application site immediately after treatment. This is not a sign of intoxication and disappears within some minutes without treatment. Correct application will minimise licking of the application site.

The product may in very rare cases cause at the application site a sensation resulting in transient behavioural changes such as lethargy, agitation, and inappetence.

In case of accidental oral uptake, symptomatic treatment should be performed by a Veterinarian. There is no known specific antidote. The use of activated charcoal may be beneficial.

To report suspected adverse drug events or for technical assistance, contact Elanco Canada Limited at 1-800-265-5475.

Post-market experience:

Although all adverse reactions are not reported, the following adverse reaction information is based on voluntary post-approval drug experience reporting. It is generally recognized that this method of reporting results in significant under-reporting of adverse drug reactions. It should be noted that suspected adverse drug reactions listed here reflect reporting and not causality. The categories of adverse reactions are listed in decreasing order of frequency by body system:

Application site disorders: erythema, alopecia, scab, irritation, pruritus

Digestive tract disorders: hypersalivation, vomiting, diarrhea

Systemic disorders: lethargy, inappetence, hyperthermia, hypothermia, shaking, pale mucous membranes, malaise

Behavioural disorders: agitation, vocalization, disorientation

Neurological disorders: ataxia, tremor, twitching, mydriasis, paresis, nystagmus, hyperesthesia

Skin and appendage disorders: pruritus, erythema, alopecia, dermatitis, lesion, pyoderma

SAFETY STUDIES IN CATS AND KITTENS:

In a clinical field safety study, advantage multi 18 was used safely in cats concomitantly receiving other classes of veterinary pharmaceuticals including anticonvulsants, antimicrobials, and progestins. In cats treated with advantage multi 18, owner observations classified as non-normal included: behavioral changes (including fright, irritability, isolation, nervousness and/or restlessness), coughing, head shaking, salivation, vocalization, scratching, and somnolence. No other reactions were reported.

Tolerance in Kittens:

In a formal tolerance study, advantage multi 18 was applied topically at 1, 3 and 5 times the recommended dosage in 8-9 week-old kittens, once every two weeks for 12 weeks, for a total of 6 consecutive treatments. A control group of kittens received dermal application of mineral oil at 5 times the recommended volume of advantage multi 18.

The most common clinical signs occurring in kittens during the pre-treatment period (Day - 14 to Day - 1) included soft/loose stools and/or diarrhea, vomition, and occasional mydriasis and eye discharge. The most common clinical signs occurring in kittens on the first three treatment days (Days 0, 14 and 28) included rough hair coat appearance at application site (all kittens, including controls), soft/loose stools and/or diarrhea, and occasional pruritus, mydriasis, depression, eye discharge and salivation; similar observations were made during each following 13-day post-treatment period. The most common clinical signs occurring in kittens on the last three treatment days (Days 42, 56 and 70) included rough hair coat appearance at application site (all kittens, including controls), and occasional soft/loose stools; similar observations were made during each 13-day post-treatment period. Clinical signs were distributed in the various treatment groups, including controls, without any pattern indicative of treatment relationship.

Due to the apparent ingestion of the drug shortly after the second dosing on day 14, one kitten treated at 5 times the recommended dosage reacted violently. Major clinical signs of moxidectin toxicosis including mydriasis, salivation, depression, unsteadiness and respiratory distress (slow or rapid, difficult breathing) were observed on several occasions, i.e. at 1, 2, 3, 4, 6, 8 and 12 hours after treatment administration. In addition, anorexia, vomiting and generalized tremors were observed on Day 15. Finally, additional signs of dehydration and nystagmus were observed on Day 16, at which time the animal was euthanised.

Collectively, the results of this study indicate that the topical administration of advantage multi 18 to 8-9 week-old kittens, at 1 x, 3 x or 5 x the recommended dosage, applied at 2-week intervals over a 12-week period does not pose serious safety concerns to kittens; however, oral administration must be avoided.

Tolerance in juvenile cats:

The topical administration of advantage multi 18 at 10 x the proposed dosage to 4-5 months old juvenile cats did not result in any significant local or systemic toxic changes in the parameters examined, i.e. clinical observations, dermal irritation at application site, physical examination, body weight, food consumption, haematology and clinical biochemistry.

Effect of inadvertent oral administration:

In a safety study designed to investigate the potential misuse of advantage multi 18 by oral administration, 24 adult cats, 11 to 16 months of aged, were randomly allocated to two groups of 12 cats, each consisting of equal numbers of each sex. The test article at 1 x (Group A) the unit dosage or control article (Group B, water), were administered by oesophageal feeding tube on study Days 0 (study duration = 14 days). No reactions of any kind were observed in the control cats. Three of 12 cats administered the drug had excess salivation within 1 hour after treatment; four vomited within 1-24 hours after treatment; one cat vomited twice, 5 and 7 days after treatment.

Safety in heartworm infected cats:

A controlled, laboratory study was conducted to evaluate the safety of advantage multi 18 administered topically at 1 x or 5 x the recommended dosage, to cats artificially infected with Dirofilaria immitis. Abnormal clinical signs noted during the post-treatment observation period included: salivation within 2 hours of treatment administration in 1 of 12 cats in the 1X group and in 7 of 12 cats in the 5 x group; skin irritation in 2 of 12 cats in the 5X group (from 0 to 12 hours after the second dose in one cat and for 25 days after the second dose in another). The data generated in this trial indicate that the administration of advantage multi 18 as per label recommendations should not pose serious safety concerns in heartworm-positive cats.

Clinical safety under field conditions of administration:

A controlled, double-blind, multi-centered, field study was conducted in four veterinary clinics/hospitals, in client-owned cats randomly assigned to two treatment groups: animals in Group 1 (principals) were treated with advantage multi 18, and animals in Group 2 (positive controls) were treated with a topical parasiticide approved for sale in Canada.

Treatments were administered once monthly, for three consecutive months, by pet owners according to instructions provided by the attending veterinarian.

Scoring of post-treatment clinical observations was defined as:

(1) Animal normal, no observation;

(2) Definitely no relationship between observation and treatment;

(3) Probably no relationship between observation and treatment;

(4) Probable relationship between observation and treatment;

(5) Definite relationship between observation and treatment.

Animals were found normal (score of 1) in 96.9% of the cases. No observations with scores of 4 and 5 were noted. Forty-two post-treatment observations with scores of 2 or 3 can be summarized as follows:

- Post-treatment behavioral changes including fright, irritability, isolation, nervousness and/or restlessness, were the most frequently reported observations: 15 incidences in 7 principals; the modified behavior was transient in duration.

- Cats may react rather vigorously following oral administration of advantage multi 18. In this study, owners described 13 post-treatment responses in 9 cats (11 incidences in 8 principals and 2 incidences in 1 control cat) that were consistent with oral exposure to an unpalatable substances; the observed signs included coughing, head shaking, bursts of hyperactivity (pacing, running, spinning), salivation and vocalization. All signs were transient in duration and resolved without intervention.

- In 9 observations involving 5 principals, owners described post-treatment attempts by cats to scratch or rub the application site. Most attempts (7 of 9) occurred within 30-60 minutes post-treatment and all were transient in duration. Neither owners nor attending veterinarians observed visible lesions at the application site of any cat participating in the study.

- Five incidences of post-treatment somnolence were described in 3 geriatric principals (13 to 15 years of age at the time of treatment). These cats experienced an extended period of sleep that began approximately 60-90 minutes after the first treatment and persisted for the next 30-40 hours, after which they returned to normal. Clinical signs of somnolence/lethargy did not recur in conjunction with the 2^nd and 3^rd treatments.

Storage

Store at temperatures between 4° and 30°C, avoiding excess heat or cold.

How Supplied

Elanco Canada Limited, 1919 Minnesota Court, Suite 401, Mississauga, Ontario L5N 0C9

advantage multi, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.

© 2022 Elanco or its affiliates.

30May2022

CPN: 1231198.1