“Over-The-Counter” Drug Toxicities in Companion Animals

Use of orally administered dexmedetomidine to induce emesis in cats

CASE SERIES SUMMARY

This case series describes the use of orally administered dexmedetomidine at a dose of 20 µg/kg to induce emesis in six cats. Emesis was successfully induced in 5/6 cats, with each of the cats vomiting once. The reasons for inducing vomiting included known or suspected ingestion of lilies, onions, acetaminophen (paracetamol) or acetylsalicylic acid. Four of the five cats in which emesis induction was successful did not develop any clinical signs of toxicity associated with the toxin ingested; the fifth cat developed clinicopathological changes consistent with acetaminophen toxicity. All six cats exhibited moderate to profound sedation, as expected, but no other adverse effects were documented.

RELEVANCE AND NOVEL INFORMATION

Induction of emesis in cats is notoriously difficult. This case series describes a novel route of administration of dexmedetomidine, a commonly available medication, with a high success rate observed for inducing emesis in this group of cats.

A retrospective evaluation of confirmed and suspected poisonings in 166 cats between 2016 and 2020

Background and Aim

Poisonings commonly bring cats and dogs to veterinary emergency facilities. This retrospective study aimed to analyze clinical signs, confirmed or suspected toxicants, treatments, and outcomes of feline poisoning cases presented over 5 years to the emergency service of a small animal referral center.

Materials and Methods

Medical records of 166 cats were evaluated for a history of confirmed or presumed poisoning, suspected toxicant, clinical signs, treatment, and outcome. Poisoning probability was determined using patient history, clinical findings, observation, toxicologic examination, and, in some cases, gastric contents.

Results

Most cats were hospitalized (94.0%) due to poisoning with mostly unknown toxicants (48.2%), rodenticides (21.1%), and various toxic plants (12.0%), followed by antiparasitics (6.0%), chemicals (6.0%), drugs (4.2%), tetrahydrocannabinol (1.2%), or inhaled smoke (1.2%). Patients presented predominantly with neurologic deficits (68.7%), reduced general condition (60.2%), and hypothermia (43.4%). The survival rate was 88.6%. Most cats (93.2%) showed no apparent complications at the time of discharge from the hospital. Toxicant-related complications (48.2%) included thermodysregulation (22.9%), central nervous system signs (18.7%), respiratory issues (7.2%), nephrotoxicity (6.0%), gastrointestinal complications (4.8%), evidence of hepatic failure (4.8%), and hemorrhage (1.8%).

Conclusion

In this study, the causative toxicant remained unidentified in many cases. Known poisonings were mostly caused by rodenticides. Neurological signs were the most common clinical presentation. Survival rates were high and comparable with those reported by others.

Promoting veterinary medication safety - Exploring the competencies of community pharmacy professionals in veterinary pharmacotherapy

The science of veterinary medicine is currently lacking studies on medication safety, although its importance in protecting animals from medication errors is central. Pharmacy professionals have an important role in ensuring medication safety of both prescription and over-the-counter medications of animals. However, this requires adequate competencies of pharmacy professionals in veterinary pharmacotherapy. The present study aimed to explore the competencies of pharmaceutical staff in community pharmacies in veterinary pharmacotherapy, which factors influence these competencies and what kind of information sources they typically use on veterinary pharmacotherapy. The study was conducted as a cross-sectional online survey targeted to pharmacy professionals in the Finnish community pharmacies, providing 596 responses. Less than half of the respondents (41%, n = 246) are considered to possess good competencies in veterinary pharmacotherapy. A third of the respondents (35%, n = 211) would dispense an anti-inflammatory drug for an animal off-label, whereas 24% (n = 145) would not interview the pet owner to discover the need for internal parasite medication before dispensing the drug. A small proportion (<1%, n = 5) would have dispensed a broad-spectrum internal parasite medication. Approximately a quarter of the respondents (27%, n = 159) stated that they acquired information on pharmacotherapy only from the material produced by the manufacturers of veterinary drugs. The competencies of pharmacy professionals in veterinary pharmacotherapy need to be strengthened in many areas to better promote veterinary medication safety. It should also be ensured that pharmacy professionals can access and use independent, high-quality information on veterinary pharmacotherapy.

Outcomes of 434 dogs with non-steroidal anti-inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange

BACKGROUND

Traditional management of non-steroidal anti-inflammatory drug (NSAID) intoxication includes gastrointestinal decontamination, intravenous administration of fluids (IVF), and gastroprotection. Intravenous administration of lipid emulsion (ILE) and therapeutic plasma exchange (TPE) are popular novel therapeutic strategies.

HYPOTHESIS

Compare outcomes of dogs treated with IVF, ILE, and TPE for NSAID intoxications and evaluate outcome predictors for drug subgroups.

ANIMALS

Four hundred thirty-four dogs with NSAID intoxications (2015-2020).

METHODS

Multicenter retrospective study of ibuprofen, carprofen, and naproxen intoxication. An ordinal outcome was defined as mild gastrointestinal, moderate kidney, or signs of severe central nervous system disease.

RESULTS

Signs of neurological disease were overrepresented and acute kidney injury underrepresented in the TPE group among dogs exposed to kidney- or CNS-toxic doses (P = .05), though all TPE dogs with signs of neurological disease had evidence of neurotoxicity at presentation. Dogs treated with IVF had a higher maximal creatinine concentration (median, 1.1 mg/dL; range, 0.4-8.44 mg/dL) compared with IVF + ILE (median, 0.9 mg/dL; range, 0.4-6.2 mg/dL; P = .01). Increased maximum time to presentation (P < .001), higher baseline creatinine (P < .001) and PCV (P = .007), and absence of induced emesis (P < .001) were associated with greater clinical severity. Ibuprofen toxicosis was associated with more severe clinical signs compared with carprofen (P = .03). Overall survival rate was 99%.

CONCLUSIONS AND CLINICAL IMPORTANCE

NSAID toxicosis generally carries an excellent prognosis in dogs. Despite similar outcomes of lower incidence of AKI in the TPE group, and slightly lower maximal creatinine concentration in dogs treated with ILE vs IVF alone, ILE and TPE should be considered in the management of severe NSAID toxicosis.

Exotic pets in Ireland: 1. Prevalence of ownership and access to veterinary services

Background

There has been increasing concern expressed about the welfare of exotic pets worldwide. For the purposes of this article, an exotic pet is considered to be a non-domesticated species, where there are knowledge gaps on good practice (minimum standards of care), veterinary diagnostics and treatments. The categories of exotic pets included in this study were: small mammals (< 20 kg), large mammals (> 20 kg), birds, reptiles, amphibians, fish and invertebrates. Dogs, cats, rabbits, hamsters, gerbils, guinea pigs, mice, rats, and ferrets were excluded from the study. An online survey of pet owning staff at University College Dublin was conducted between July and August 2020 to provide the first empirical data for Ireland. In this pilot study (the first in this thematic series) we aim to characterise exotic pet ownership, the challenges and benefits of keeping exotic pets, and access to veterinary services from the pet owner’s perspective.

Results

Using an online survey this pilot study gathered evidence from 83 domestic and 32 exotic pet owners within the staff (n = ~ 3600 FTE) at University College Dublin, the largest third level institution in Ireland. The prevalence of exotic pet ownership was determined to be 34.4 % of households with more than 10 % of pet owning households owning only exotic pets. Fish (n = 15), reptiles (n = 13) and birds (n = 8) were the most common types of exotic pets. Thirty-four per cent of exotic pet owners never sought veterinary services, the most common reasons were due to lack of local veterinary specialists (n = 10) and good owner knowledge (n = 8). However identifying appropriate guidance on the animals’ needs was a common challenge for exotic pet owners (n = 13). A reasonable monthly cost of caring for an exotic ranged from €20–180, depending on the species.

Conclusions

This pilot study contains important implications for veterinary education to support the veterinary community with providing services to the exotic pet owning community. Policy issues with exotic pet ownership also need to be considered and further research into the proposed strategies to support the health and welfare of exotic pets should be carried out such as the introduction of white lists and guidelines on responsible pet ownership.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13620-021-00190-6.

Companion animal exposures to potentially poisonous substances reported to a national poison control center in the United States in 2005 through 2014

OBJECTIVE

To evaluate data concerning suspected companion animal exposures to possibly hazardous substances reported during telephone calls to the US Animal Poison Control Center (APCC) for characterization of dog and cat exposures to potentially toxic substances in the United States.

SAMPLE

Household-level poisonings events involving dogs and cats in the United States that were reported to the APCC in 2005 through 2014.

PROCEDURES

Substances involved in reported poisonings of dogs and cats were classified into 20 general categories, and descriptive statistical analysis was used to examine the most common categories. Case fatality ratios were estimated for all exposure categories for which a final outcome status of the affected animal was documented.

RESULTS

Over the 10-year study period, 241,261 household-level poisoning events were reported to the APCC from across the United States, of which 86.0% and 14.0% involved dogs and cats, respectively. The most common agent categories reported for dogs included human medicines, foods, and pesticides. The most common agent categories reported for cats included human medicines, plants, and veterinary medicines. Chocolate and Lilium plants were the most commonly reported exposures of dogs and cats, respectively. Fluorouracil (65.2%) and bifenthrin (66.7%) were found to have the highest case fatality ratio for dogs and cats, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

The APCC call data can be used to identify the most common toxicological exposures of dogs and cats, understand the epidemiological aspects of these poisonings, and inform education programs for owners and veterinarians. Data from the APCC may be suitable for surveillance of toxicological exposures of companion animals in the United States.

Plants and mushrooms associated with animal poisoning incidents in South Africa

Background

There is extensive literature on animal poisoning from plants and mushrooms worldwide; however, there is limited account of poisoning from South Africa.

Methods

This study sought to describe and provide an overview of animal poison exposures in South Africa. Poisoning episodes reported to the Poisons Information Helpline of the Western Cape, jointly run by the Poisons Information Centres at the Red Cross War Memorial Children’s Hospital and Tygerberg Hospital over a period of approximately 2.5 years, from June 2015 to November 2017, were analysed to identify exposure patterns, severity and clinical outcomes.

Results

Alien plant species accounted for most cases (n=10) of reported poison exposures. Among the 26 recorded animal poisoning episodes, the dog was the most commonly implicated species (n=24), whereas just two enquiries were related to other animals (one rabbit and one cow). There were 20 plant cases and 6 mushroom cases (all dogs). There was only one fatal case involving cycad in a dog.

Conclusion

Features of animal poisoning in South Africa were similar to those in other countries. The reported cases of animals exposed to poisonous plants and mushrooms could represent only a fraction of the actual exposures. Since most reported cases involved taxa that could not be identified to species level, more attention should be paid in case reporting and in animal poisoning prevention, engaging the public to enable people to recognise potentially hazardous plants and reduce the risk of poisoning in animals.

Treatment of ibuprofen intoxication in a dog via therapeutic plasma exchange

OBJECTIVE

To describe the treatment of ibuprofen intoxication with therapeutic plasma exchange in a dog (TPE).

SUMMARY

A 13-year-old male neutered mixed breed dog presented after ingesting approximately 200 mg/kg of ibuprofen. Treatment consisted of supportive medical therapy with IV fluids, gastrointestinal protectants, antiemetics and prostaglandin analogs, and TPE. A cycle of TPE was performed over 180 minutes, achieving 1.5 plasma volume exchanges. During therapy, heparinized blood and effluent samples were collected. Ibuprofen concentrations were determined in the samples by high-pressure liquid chromatography. Post TPE, the dog was continued on supportive medical therapy and was discharged 96 hours after the overdose.

NEW OR UNIQUE INFORMATION

This report describes the use of TPE as an adjunct for ibuprofen intoxication. An 85% reduction in plasma ibuprofen concentration occurred and recovery from a potentially lethal ingestion of ibuprofen was achieved with TPE and supportive care. TPE should be considered when presented with acute ibuprofen intoxication due to the rapid and efficacious nature of therapy.

Pharmaceuticals and the Environment (PiE): Evolution and impact of the published literature revealed by bibliometric analysis

The evolution and impact of the published literature surrounding the transdisciplinary, multifaceted topic of pharmaceuticals as contaminants in the environment is examined for the first time in an historical context. The preponderance of literature cited in this examination represents the earlier works. As an historical chronology, the focus is on the emergence of key, specific aspects of the overall topic (often termed PiE) in the published literature and on the most highly cited works. This examination is not a conventional, technical review of the literature; as such, little attention was devoted to the more recent literature. The many dimensions involved with PiE span over 70years of published literature. Some articles began to appear in published works in the 1940s and earlier, while others only began to receive attention in the 1990s and later. Decades of early research on what at the time seemed to be disconnected topics eventually coalesced in the mid-to-late 1990s around a number of interconnected concerns and issues that now comprise PiE. Major objectives are to provide a new perspective to the topic, to facilitate more efficient and effective review of the literature by others, and to recognize the more significant, seminal contributions to the advancement of PiE as a field of research. Some of the most highly cited articles in all of environmental science now involve PiE. As of April 2015, a core group of 385 PiE articles had each received at least 200 citations; one had received 5424 citations. But hundreds of additional articles also played important roles in the evolution and advancement of the field.

Poisoning of dogs and cats by drugs intended for human use

One of the main causes of poisoning of small animals is exposure to drugs intended for human use. Poisoning may result from misuse by pet owners, off-label use of medicines or, more frequently, accidental ingestion of drugs that are improperly stored. This review focuses on classes of drugs intended for human use that are most commonly involved in the poisoning of small animals and provides an overview of poisoning episodes reported in the literature. To perform this review a comprehensive search of public databases (PubMed, Web of Science, Scopus, Google Scholar) using key search terms was conducted. Additionally, relevant textbooks and reference lists of articles pertaining to the topic were reviewed to locate additional related articles. Most published information on small animal poisoning by drugs intended for human use was from animal and human poison control centres or from single case reports. The dog was the species most frequently poisoned. The major drugs involved included analgesics (nonsteroidal anti-inflammatory drugs), antihistamines (H1-antihistamines), cardiovascular drugs (calcium channel blockers), central nervous system drugs (selective serotonin reuptake inhibitors, baclofen, benzodiazepines and zolpidem), gastrointestinal drugs (loperamide), nutritional supplements (vitamin D and iron salts) and respiratory drugs (β2-adrenergic receptor agonists).

Sensibilidade espécie-específica aos anti-inflamatórios não esteroidais: humanos X animais de companhia

Este estudo forneceu subsídios para o melhor entendimento das intoxicações pelos anti-inflamatórios não esteroidais (AINES) em humanos e animais de companhia. Os principais focos foram a diferença espécie-específica e os serviços prestados por Centros de Informação Toxicológica. Para tanto, foram utilizados dados referentes às intoxicações por AINES em pessoas, cães e gatos reportadas ao CIT/RS entre 2005 e 2009. Além disso, foram abordados, comparativamente, os dados do American Association of Poison Centers (AAPCC) entre 2004 e 2008, bem como as referências na literatura acerca da sensibilidade espécie-específica. Constatou-se que a maioria das intoxicações por AINES, independentemente da espécie, abrangeu o cetoprofeno, o ibuprofeno e o diclofenaco, sendo 54% destes intencionais em humanos, destacando-se o diclofenaco. Em se tratando de animais de companhia, 73% das intoxicações em cães ocorreram pelo diclofenaco, e 60% dos acidentes em gatos foram ocasionados pelo ibuprofeno. Chama-se a atenção para a importância dos Centros de Informação Toxicológica como forma de assistência e prevenção desses acidentes, bem como para a venda indiscriminada desses fármacos, aliados à medicação extraprescrição - que leva, na maioria das vezes, cães e gatos ao óbito.

Characterization of Animal Exposure Calls Captured by the National Poison Data System, 2000-2010

OBJECTIVE

Our objective was to characterize the data captured in all animal exposure calls reported to the National Poison Data System (NPDS), a national poison center reporting database, from 1 January 2000 through 31 December 2010 and identify Poison Center usage and needs in animal exposure calls.

DESIGN

We calculated descriptive statistics characterizing animal type, exposure substance, medical outcome, year and month of call, caller location, and specific state for all animal exposure call data in NPDS from 1 January 2000 to 31 December 2010. SAS version 9.2 was used for the analysis.

RESULTS

There were 1,371,095 animal exposure calls out of 28,925,496 (4.7%) total human and animal exposure calls in NPDS during the study period. The majority involved companion animal exposures with 88.0% canine exposures and 10.4% feline exposures. Pesticides were the most common exposure substance (n=360,375; 26.3%), followed by prescription drugs (n=261,543; 18.6%). The most common outcome reported was 'Not followed, judged as nontoxic exposure or minimal clinical effects possible' (n=803,491; 58.6%), followed by 'Not followed, judged potentially toxic exposure' (n=263,153; 19.2%). There were 5,388 deaths reported. Pesticide exposures were responsible for the greatest number of deaths (n=1,643; 30.4%).

CONCLUSIONS AND CLINICAL RELEVANCE

Approximately 1 in 20 calls to PCs are regarding potentially toxic exposures to animals, suggesting a need for veterinary expertise and resources at PCs. Pesticides are one of the greatest toxic exposure threats to animals, both in numbers of exposures and severity of clinical outcomes, and is an important area for education, prevention, and treatment.

Learning lessons from drugs that have recently entered the market

Which projects in the drug discovery field are most likely to be successful? In this article, I provide guidelines for answering this question by examining recent drug market entrants in detail, in particular their route of administration, trial design, novelty, therapeutic target and toxicities. I identify targets, trials and organizations as the key issues that are currently leading to the poor productivity in the pharmaceutical industry. Here, I outline some solutions and reasons for optimism, and suggest that the key determinants for success in drug discovery can be defined by studying recently launched drugs.