Cardiovascular effects of pimobendan in healthy mature horses

Pharmacokinetics of pimobendan following oral administration to New Zealand White rabbits (Oryctolagus cuniculus)

OBJECTIVE

To determine the pharmacokinetics and potential adverse effects of pimobendan after oral administration in New Zealand White rabbits (Ocytolagus cuniculi).

ANIMALS

10 adult sexually intact (5 males and 5 females) rabbits.

PROCEDURES

2 pilot studies were performed with a pimobendan suspension or oral tablets. Eight rabbits received 7.5 mg of pimobendan (mean 2.08 mg/kg) suspended in a critical care feeding formula. Plasma concentrations of pimobendan and O-demethylpimobendan (ODMP) were measured, and pharmacokinetic parameters were calculated for pimobendan by noncompartmental analysis. Body weight, food and water consumption, mentation, urine, and fecal output were monitored.

RESULTS

Mean ± SD maximum concentration following pimobendan administration was 15.7 ± 7.54 ng/mL and was detected at 2.79 ± 1.25 hours. The half-life was 3.54 ± 1.32 hours. Plasma concentrations of pimobendan were detectable for up to 24 hours. The active metabolite, ODMP, was detected in rabbits for 24 to 36 hours. An adverse event occurred following administration of pimobendan in tablet form in 1 pilot study, resulting in death secondary to aspiration. No other adverse events occurred.

CLINICAL RELEVANCE

Plasma concentrations of pimobendan were lower than previously reported for dogs and cats, despite administration of higher doses, and had longer time to maximum concentration and half-life. Based on this study, 2 mg/kg of pimobendan in a critical care feeding formulation should maintain above a target plasma concentration for 12 to 24 hours. However, further studies evaluating multiple-dose administration as well as pharmacodynamic studies and clinical trials in rabbits with congestive heart failure are needed to determine accurate dose and frequency recommendations.

Cardiac Therapeutics in Horses

Many cardiac therapeutics lack significant evidence of benefit in the horse, and in many cases their use is based on extrapolation of evidence from other species. In recent years there has been a push to develop a better understanding of both the pharmacodynamics and pharmacokinetics of these drugs. Recent data have described the use of antiarrhythmic agents including sotalol, flecainide, and amiodarone. Data about the use of ACE inhibitors in the management of congestive heart failure are encouraging and support their use in certain cases, wheras evidence for other medicines, such as pimobendan, remain speculative.

Equine Acquired Valvular Disease

Degenerative myxomatous disease is common and is associated with aging. Poor prognostic indicators for equine aortic regurgitation specifically include ventricular ectopy, increased pulse pressure, and hyperkinetic pulses. Valvular prolapse is a functional abnormality diagnosed echocardiographically, about which knowledge is limited. A better understanding of its role in valvular regurgitation is needed. Infective endocarditis presents with fever and other systemic signs accompanying valvular regurgitation. The prognosis is poor, warranting aggressive therapy. Other forms of valvular disease occur rarely, but often presenting with severe regurgitation. Management of horses with valvular disease is focused on assessment of severity and regular clinical, echocardiographic, and electrocardiographic monitoring.

Pericardial effusion and congestive heart failure in a horse with multicentric lymphoma

A 20-year-old Warmblood mare was evaluated for acute-onset tachycardia and a one-week history of lethargy and ventral oedema. Haematology revealed leucocytosis with neutrophilia. Ultrasonographic examination revealed pericardial effusion and cardiac tamponade consistent with right-sided congestive heart failure. Abdominal ultrasonography demonstrated loss of definition of the right kidney and a structure adjacent to the kidney suggestive of a renal neoplasm. A tentative antemortem diagnosis of multicentric neoplasia, most likely lymphoma, was made. The horse was subjected to euthanasia due to a grave prognosis. Postmortem examination and histological evaluation were consistent with lymphoma, including infiltration of the cardiac muscle with neoplastic cells. Although lymphoma has been reported to affect the heart, congestive heart failure due to cardiac and pericardial neoplastic infiltration has not been previously reported as the presenting complaint. This case report describes the diagnostic approach to pericardial effusion and congestive heart failure in a mare with lymphoma.

Cardiac and Respiratory Disease in Aged Horses

Respiratory and cardiac diseases are common in older horses. Advancing age is a specific risk factor for cardiac murmurs and these are more likely in males and small horses. Airway inflammation is the most common respiratory diagnosis. Recurrent airway obstruction can lead to irreversible structural change and bronchiectasis; with chronic hypoxia, right heart dysfunction and failure can develop. Valvular heart disease most often affects the aortic and/or the mitral valve. Management of comorbidity is an essential element of the therapeutic approach to cardiac and respiratory disease in older equids.