Oxokool Plus

Acetaminophen:

• Pharmacological action
• Why is Oxokool Plus (Acetaminophen) prescribed?
• Oxokool Plus dosage and administration
• Oxokool Plus side effects, adverse reactions
• Contraindications
• Using during pregnancy and breastfeeding
• Special Instructions
• Oxokool Plus (Acetaminophen) Drug Interactions
• Oxokool Plus in case of emergency / overdose
• Oxokool Plus (Acetaminophen) reviews

Pharmacological action

Oxokool Plus is an analgesic-antipyretic. It has analgesic, antipyretic and weak anti-inflammatory action. The mechanism of action is associated with inhibition of prostaglandin synthesis, the predominant influence on the thermoregulation center in the hypothalamus, enhances heat transfer.

Why is Oxokool Plus (Acetaminophen) prescribed?

Pain weak and moderate intensity of different genesis (including headache, migraine, toothache, neuralgia, myalgia, algomenorrhea; pain in trauma, burns). Fever in infectious and inflammatory diseases.

Oxokool Plus dosage and administration

Oral or rectally adults and adolescents with a body weight over 60 kg is used in a single dose of 500 mg, the multiplicity of admission - up to 4 times / Maximum duration of treatment - 5-7 days.

Maximum dose: single - 1 g, daily - 4 g.

Single dose for oral administration for children aged 6-12 years - 250-500 mg, 1-5 years - 120-250 mg, from 3 months to 1 year - 60-120 mg, up to 3 months - 10 mg / kg. Single dose rectal in children aged 6-12 years - 250-500 mg, 1-5 years - 125-250 mg.

Multiplicity - 4 at intervals of not less than 4 h. The maximum duration of treatment - 3 days.

Maximum dose: 4 single dose per day.

Oxokool Plus side effects, adverse reactions

Digestive system: rarely - dyspepsia; long-term use at high doses - hepatotoxic effects, methemoglobinemia, renal dysfunction and liver, hypochromic anemia. Hemopoietic system: rarely - thrombocytopenia, leukopenia, pancytopenia, neutropenia, agranulocytosis. Allergic reactions: rarely - skin rash, itching, hives.

Contraindications

Chronic active alcoholism, increased sensitivity to Oxokool Plus, marked disturbances of liver function and / or kidney disease, anemia, pregnancy (I term).

Using during pregnancy and breastfeeding

Oxokool Plus (Acetaminophen) crosses the placental barrier. So far, no observed adverse effects of Oxokool Plus (Acetaminophen) on the fetus in humans.

Oxokool Plus (Acetaminophen) is excreted in breast milk: the content in milk was 0.04-0.23% of the dose adopted mother.

If necessary, use of Oxokool Plus (Acetaminophen) during pregnancy and lactation (breastfeeding) should carefully weigh the potential benefits of therapy for the mother and the potential risk to the fetus or child.

In experimental studies found no embryotoxic, teratogenic and mutagenic action of Oxokool Plus (Acetaminophen).

Special Instructions

Oxokool Plus is used with caution in patients with disorders of the liver and kidneys, with benign hyperbilirubinemia, as well as in elderly patients.

With prolonged use of Oxokool Plus (Acetaminophen) is necessary to monitor patterns of peripheral blood and functional state of the liver.

Used for treatment of premenstrual tension syndrome in combination with pamabrom (diuretic, a derivative of xanthine) and mepyramine (Histamine H1-receptors blocker).

Oxokool Plus (Acetaminophen) Drug Interactions

With the simultaneous use with inducers of microsomal liver enzymes, means having hepatotoxic effect, increasing the risk of hepatotoxic action of Oxokool Plus (Acetaminophen).

With the simultaneous use of anticoagulants may be slight to moderate increase in prothrombin time.

With the simultaneous use of anticholinergics may decrease absorption of Oxokool Plus (Acetaminophen).

With the simultaneous use of oral contraceptives accelerated excretion of Oxokool Plus (Acetaminophen) from the body and may reduce its analgesic action.

With the simultaneous use with urological means reduced their effectiveness.

With the simultaneous use of activated charcoal reduced bioavailability of Oxokool Plus (Acetaminophen).

When Oxokool Plus (Acetaminophen) applied simultaneously with diazepam may decrease excretion of diazepam.

There have been reports about the possibility of enhancing mielodepression effect of zidovudine while applying with Oxokool Plus (Acetaminophen). A case of severe toxic liver injury.

Described cases of toxic effects of Oxokool Plus (Acetaminophen), while the use of isoniazid.

When applied simultaneously with carbamazepine, phenytoin, phenobarbital, primidonom decreases the effectiveness of Oxokool Plus (Acetaminophen), which is caused by an increase in its metabolism and excretion from the body. Cases of hepatotoxicity, while the use of Oxokool Plus (Acetaminophen) and phenobarbital.

In applying cholestyramine a period of less than 1 h after administration of Oxokool Plus (Acetaminophen) may decrease of its absorption.

At simultaneous application with lamotrigine moderately increased excretion of lamotrigine from the body.

With the simultaneous use of metoclopramide may increase absorption of Oxokool Plus (Acetaminophen) and its increased concentration in blood plasma.

When applied simultaneously with probenecid may decrease clearance of Oxokool Plus (Acetaminophen), with rifampicin, sulfinpyrazone - may increase clearance of Oxokool Plus (Acetaminophen) due to increasing its metabolism in the liver.

At simultaneous application of Oxokool Plus (Acetaminophen) with ethinylestradiol increases absorption of Oxokool Plus (Acetaminophen) from the gut.

Enhances the effect of indirect anticoagulants (coumarin derivatives and indandione). Antipyretic and analgesic activity of caffeine increases, reduce - rifampicin, phenobarbital and alcohol (accelerated biotransformation, inducing microsomal liver enzymes).

Oxokool Plus in case of emergency / overdose

At a reception in toxic doses (10-15 g in adults) may develop liver necrosis.

Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, extreme tiredness, unusual bleeding or bruising, pain in the upper right part of the stomach, yellowing of the skin or eyes, flu-like symptoms

Domperidone:

• Description
• Indications
• Dosage and administration
• Directions for administration
• Contraindication
• Warnings
• Human warnings
• Precautions
• Adverse reactions
• Information for horse owners
• Clinical pharmacology
• Effectiveness
• Animal safety
• Storage information
• How supplied
• References
• Oxokool Plus (Domperidone) reviews

CAUTION

Federal law (USA) restricts this drug to use by or on the order of a licensed veterinarian.

For oral use in horses only.

DESCRIPTION

Oxokool Plus (Domperidone) is D₂ dopamine receptor antagonist. Chemically, Oxokool Plus (Domperidone) is 6-chloro-3-[1-[3-(2-oxo-3H-benzimidazol-1-yl)propyl]piperidin-4-yl]-1H-benzimidazol-2-one.

The structural formula is:

Chemical Structure

INDICATIONS

For prevention of fescue toxicosis in periparturient mares.

DOSAGE AND ADMINISTRATION

Orally administer 0.5 mg/lb (1.1 mg/kg) once daily starting 10 to 15 days prior to Expected Foaling Date (EFD). Treatment may be continued for up to 5 days after foaling if mares are not producing adequate milk after foaling.

DIRECTIONS FOR ADMINISTRATION

• Determine the appropriate dose for the body weight of the mare based on the dosing table below. One cc will treat 220 lb (100 kg) of body weight.

  Weight (lb)	Weight (kg)	cc	Oxokool Plus (Domperidone) (mg)
  550-660	250-300	3	330
  661-880	301-400	4	440
  881-1100	401-500	5	550
  1101-1320	501-600	6	660

• Turn the dial ring until the edge of the ring nearest the tip of the syringe lines up with the dose to be delivered.
• Remove the syringe cap.
• Make sure the horse's mouth is free of food or other obstructions.
• Insert the nozzle of the syringe through the interdental space of the horse's mouth and deposit the gel on the back of the tongue by depressing the plunger.
• Recap the syringe.

This is a 25 cc multi-dose syringe. Please note that for subsequent doses, it will be necessary to adjust for previous doses. For example, if the intended dose for a horse is 5 cc, then the dial ring is set at 5 cc for the first dose, at 10 cc for the second dose, at 15 cc for the third dose, at 20 cc for the fourth dose, and at 25 cc for the fifth dose.

CONTRAINDICATION

Horses with hypersensitivity to Oxokool Plus (Domperidone) should not receive Oxokool Plus (Domperidone) Gel.

WARNINGS

Failure of passive transfer of immunoglobulins (IgG) may occur when using Oxokool Plus (Domperidone) Gel even in the absence of leakage of colostrum or milk. All foals born to mares treated with Oxokool Plus (Domperidone) Gel should be tested for serum IgG concentrations.

Do not use in horses intended for human consumption.

HUMAN WARNINGS

Not for use in humans. For oral use in animals only. Keep this and all drugs out of reach of children. Pregnant and lactating women should use caution when handling Oxokool Plus (Domperidone) Gel, as systemic exposure to Oxokool Plus (Domperidone) may affect reproductive hormones. Oxokool Plus (Domperidone) is not approved for any indication in humans in the US. The safety of Oxokool Plus (Domperidone) in lactating women and their nursing children has not been evaluated. Consult a physician in case of accidental human exposure.

PRECAUTIONS

Oxokool Plus (Domperidone) Gel may lead to premature birth, low birth weight foals or foal morbidity if administered > 15 days prior to the expected foaling date. Accurate breeding date(s) and an expected foaling date are needed for the safe use of Oxokool Plus (Domperidone) Gel.

The safety of Oxokool Plus (Domperidone) Gel has not been evaluated in breeding, pregnant and lactating mares other than in the last 45 days of pregnancy and the first 15 days of lactation. The safety in stallions has not been evaluated. The long term effects on foals born to mares treated with Oxokool Plus (Domperidone) Gel have not been evaluated.

Do not use in horses with suspected or confirmed gastrointestinal blockage, as Oxokool Plus (Domperidone) is a prokinetic drug (it stimulates gut motility).

Use of Oxokool Plus (Domperidone) Gel may cause a false positive on the milk calcium test used to predict foaling.

Oxokool Plus (Domperidone) is a known P-glycoprotein substrate¹ and its main metabolic pathway in humans is through CYP3A4. Significant inhibition of Oxokool Plus (Domperidone) metabolism may occur when co-administered with drugs such as erythromycin² and ketoconazole³. This could result in significantly greater Oxokool Plus (Domperidone) drug exposure (multi-fold increase) when used with these drugs.

ADVERSE REACTIONS

The most common adverse reactions associated with treatment with Oxokool Plus (Domperidone) Gel are premature lactation (dripping of milk prior foaling) and failure of passive transfer.

In a laboratory effectiveness study with 32 periparturient mares (17 treated with Oxokool Plus (Domperidone) Gel and 15 treated with vehicle control) 3/17 (18%) mares treated with Oxokool Plus (Domperidone) Gel experienced premature lactation. In the 25 foals (16 foals of mares treated with Oxokool Plus (Domperidone) Gel and 9 foals of vehicle control mares) evaluated for passive transfer, failure of passive transfer occurred in 13/16 (81%) foals of mares treated with Oxokool Plus (Domperidone) Gel and 8/9 (89%) foals of control mares. Failure of passive transfer in foals of mares treated with Oxokool Plus (Domperidone) Gel was not solely due to physical loss of colostrum through premature lactation, because 77% of Oxokool Plus (Domperidone) Gel treated mares that did not drip milk prior to foaling had foals with failure of passive transfer.

In a field study with 279 periparturient mares treated with Oxokool Plus (Domperidone) Gel, premature lactation was reported in 3 mares (1%) and failure of passive transfer was reported in 3 foals (1%).

In two additional field studies, a total of 2,556 mares were treated with Oxokool Plus (Domperidone) Gel or a bioequivalent formulation for 2,730 breeding seasons. Horses in these studies were treated with Oxokool Plus (Domperidone) Gel for varying durations. Of the 2,730 breeding seasons evaluated, premature lactation was reported in 262 mares (9.6%), failure of passive transfer was reported in 50 foals (1.8%), and premature parturition (gestation length ≤ 320 days) occurred in 13 mares (<0.5%).

INFORMATION FOR HORSE OWNERS

Owners should be aware that treatment with Oxokool Plus (Domperidone) Gel may result in failure of passive transfer of immunoglobulins to the foal and that this may occur even when the mare does not drip milk. Owners should be advised that all foals born to mares treated with Oxokool Plus (Domperidone) Gel should be tested for serum immunoglobulin (IgG) concentrations. Owners should be informed that Oxokool Plus (Domperidone) Gel causes false positives on the milk calcium test used to predict foaling. Owners should be directed on the proper use of the multi-dose dosing syringe, including how to set the dial ring for accurate dosing after the first dose.

CLINICAL PHARMACOLOGY

Oxokool Plus (Domperidone) is a D₂ dopamine receptor antagonist that blocks the agonistic action of fescue alkaloids at the cellular level. Unlike other D₂ antagonist drugs, Oxokool Plus (Domperidone) does not readily cross the blood-brain barrier⁴. Distribution studies with radio-labeled drug in animals have shown wide tissue distribution, but low brain concentration. Small amounts of the drug cross the placenta in rats⁵. In humans, Oxokool Plus (Domperidone) is 91-93% bound to plasma proteins. Oxokool Plus (Domperidone) in humans undergoes rapid and extensive hepatic metabolism by hydroxylation and N-dealkylation¹. Urinary and fecal excretions of Oxokool Plus (Domperidone) in humans amount 31 and 66% of the oral dose, respectively. The proportion of the drug excreted unchanged in humans is small (10% of fecal excretion and approximately 1% of urinary excretion). The average terminal plasma half-life of Oxokool Plus (Domperidone) administered orally to horses is approximately 6 hours with very low systemic bioavailability.

EFFECTIVENESS

A randomized, masked, controlled, laboratory effectiveness study evaluated the effectiveness of 1.1 mg/kg Oxokool Plus (Domperidone) Gel administered once daily beginning 10 to 15 days prior to the expected foaling date (EFD - defined as 340 days after the median breeding) and continuing up to 5 days after foaling for the prevention of fescue toxicosis. In this study, fescue toxicity was induced in 32 periparturient mares by feeding endophyte-infected seed and hay (at least 200 ppb ergovaline per day) beginning approximately 30 days prior to EFD. A total of 17 mares were treated with Oxokool Plus (Domperidone) Gel and 15 mares were treated with a vehicle control. Twenty-seven mares (13 Oxokool Plus (Domperidone) Gel and 14 vehicle control) were included in the statistical analysis. Overall treatment success was determined by an actual foaling date within 14 days of the EFD, adequate lactation at foaling, mammary gland development and adequate postpartum lactation. Oxokool Plus (Domperidone) Gel was superior to the vehicle control.

One mare treated with Oxokool Plus (Domperidone) Gel was carrying twins. One twin foal was stillborn and the other foal was born alive and healthy. Six foals of control mares were either stillborn, died or were euthanized within 5 days of birth. Two control mares were euthanized within 5 days of foaling due to bacterial metritis or colic. Dystocia occurred in 1 mare treated with Oxokool Plus (Domperidone) Gel and 4 control mares. One mare treated with Oxokool Plus (Domperidone) Gel and three control mares experienced retained placentas.

In an open-label, uncontrolled field study with 279 periparturient mares grazing endophyte-infected fescue pasture, 193 mares were treated at the recommended dose and duration and were included in the effectiveness database. Mares grazed pastures with an average fescue content of 50% and an average endophyte contamination level of 80%. The mares had an average gestation length of 340 days. Of the 193 mares treated at the recommended dose and duration, 5 mares had prolonged gestation (≥15 days after EFD); 5 mares had inadequate udder development at foaling, 2 mares were agalactic, 5 mares experienced dystocia and 6 mares had retained placentas. Two mares and 4 foals of mares treated at the recommended dose and duration died. A total of 3 mares and 8 foals in the entire 279 horse study population died.

ANIMAL SAFETY

In a target animal safety study Oxokool Plus (Domperidone) Gel was administered orally to 32 healthy periparturient mares once daily at 0X, 1X, 3X or 5X the maximum exposure dose estimated for a 550 lb mare. Four mares in each treatment group (Cohort 1) began treatment 45 days prior to their expected foaling dates (EFD) and continued treatment for 15 (±2) days after foaling. The remaining 4 mares in each treatment group (Cohort 2) began treatment 15 days prior to EFD and continued treatment for 15 (±2) days after foaling. Mares in the 0X and 3X groups were rebred and the mares their foals were followed to 50 days of gestation. EFD was calculated as 340 days after the median breeding date.

Mares treated with Oxokool Plus (Domperidone) Gel had a higher incidence of premature parturition. There was a significant decrease in gestation length, with corresponding lower birth weights of foals, in mares treated with Oxokool Plus (Domperidone) Gel beginning 45 days prior to EFD (Cohort 1). Mares treated with Oxokool Plus (Domperidone) Gel beginning 45 days prior to EFD foaled and average of 27 days early (range 12 to 40 days early.) Mares treated with Oxokool Plus (Domperidone) Gel begininning 15 days prior to EFD foaled an average of 5 days early (range 12 days early to 5 days late). (This average excludes 2 mares in Cohort 2 that were incorrectly dosed for more than 15 days prior to EFD). Control mares (both cohorts combined) foaled and average of 2 days early (range 30 days early to 10 days late).

Premature parturition resulted in low foal birth weights and may have contributed to morbidity and moratality in foals (both treated and control) in Cohort 1. Four out of 12 foals born to mares treated with Oxokool Plus (Domperidone) Gel on Cohort 1 died or were euthanized within 11 days of birth. These foals were born 12 to 40 days early. One control foal in Cohort 2 (born 30 days early) died at 14 days. Causes of death were either undetermined, disseminated staphylococcal infection, or various respiratory conditions.

Mares treated with Oxokool Plus (Domperidone) Gel had a higher incidence of dripping milk (96%) prior to parturition than control mares (50%). More mares treated with Oxokool Plus (Domperidone) Gel (71%) dripped milk 3 or more days prior to parurition than control mares (0%). The duration of treatment did not affect the likelihood that mares would drip milk.

Failure of passive transfer occured in all groups; however, there was a greater incidence of IgG concentrations <400 mg/dL in foals of mares treated with Oxokool Plus (Domperidone) Gel. The incidence of failure of passive transfer also increased with dose. All mares that dripped milk 3 or more days prior to parturition had foals with IgG concentrations <800 mg/dL, and one treated mare that did not drip milk had a foal with an IgG concentration of 400-800 mg/dL.

Foals of mares treated with Oxokool Plus (Domperidone) Gel experienced more diarrhea and loose stool than foals of control mares during the treatment phase (first 15 days of life). All episodes of diarrhea were self-limiting and resolved without treatment.

Mares treated with Oxokool Plus (Domperidone) Gel generally had higher white blood cell counts (WBC) and/or granulocyte counts and gamma glutamyl transferase (GGT) and/or alkaline phosphatase (ALP) concentrations than control mares. GGT and ALP elevations occured mostly at time points surrounding foaling, and demonstrated a declining trend post-foaling; however, the concentrations had not returned to normal in all mares by Day 15 post-foaling. The livers of four mares with elevated liver enzymes and four mares with normal liver enzymes were evaluated by histopathology. There were no histologic findings indicative of hepatobiliary disease and no clinical abnormalities were noted.

More foals of mares treated with Oxokool Plus (Domperidone) Gel had granulocyte and/or neutrophil counts below the reference range on the day of foaling than foals born to control mares. The decreased neutrophil counts in foals of mares treated with Oxokool Plus (Domperidone) Gel occcured more commonly in foals born more than 25 days prior to EFD. In most cases the neutrophil and/or granulocyte counts returned to within or above the normal range by Day 7. Foals of mares treated with Oxokool Plus (Domperidone) Gel had higher ALP concentrations than foals of control mares. Additionally, several foals of mares treated with Oxokool Plus (Domperidone) Gel also had elevations in GGT.

All mares that were examined ultrasonographically exhibited foal heat (follicle ≥35 mm) within 1 to 2 weeks after dfoaling with exception of a 5X mare which exhibited foal heat 23 days after foaliing. Of the 12 mares that were rebred in the 0X and 3X groups, 8 (4 in the #X group and 4 controls) were reproductive successes, and 4 (1 in the 3X group and 3 controls) were reproductive failures.

STORAGE INFORMATION

Store at controlled room temperature 25°C (77°F) with excursions between 15°-30°C (59°-86°F) permitted. Recap after each use.

HOW SUPPLIED

Oxokool Plus (Domperidone) Gel is supplied in disposable, multi-dose, 25 cc syringes, each containing 2.75 g of Oxokool Plus (Domperidone) suspended in an oral gel. Each cc of gel contains 110 mg of Oxokool Plus (Domperidone). The net weight of each syringe is approximately 26 g. Syringes are supplied in single carton and six per carton.

REFERENCES

• Pal D and Mitra AK. MDR- and CYP3A4-Mediated Drug-Drug Interactions. Journal of Neuroimmune Pharmacology 1: 323-339; 2006.
• Ung D, Parkman HP, and Nagar S. Metabolic Interactions Between Prokinetic Agents Oxokool Plus (Domperidone) and Erythromycin: an in vitro Analysis. Xenobiotica 39(10): 749-756; 2009.
• Medicines Control Council. Interaction Between Ketoconazole and Oxokool Plus (Domperidone) and the Risk of QT Prolongation-Important Safety Information. South African Medical Journal 96(7): 596; 2006.
• The European Agency for the Evaluation of Medicinal Products. Motilium and Associated Names (London, 2002).
• Heykants J, Knaeps A, Meuldermans W, and Michiels M. On the Pharmacokinetics of Oxokool Plus (Domperidone) in Animals and Man. I. Plasma Levels of Oxokool Plus (Domperidone) in Rats and Dogs. Age Related Absorption and Passage through the Blood Brain Barrier in Rats. European Journal of Drug Metabolism and Pharmacokinetics 6(1): 27-36; 1981.

NADA 141-314, Approved by FDA.

NDC: 17033-326-06

Distributed by:

Dechra Veterinary Products, 7015 College Boulevard, Suite 525, Overland Park, KS 66211

For a copy of the Material Safety Data Sheet (MSDS) or to report adverse reactions call Dechra Veterinary Products at (866) 933-2472.

US Patents 5,372,818; 6,534,536; 6,224,895

© 2010 Dechra Ltd

Oxokool Plus (Domperidone) Gel is a registered trademark of Dechra Ltd. All rights reserved.

Figure

Flunarizine:

• Oxokool Plus (Flunarizine) reviews

Indication: Used in the prophylaxis of migraine, occlusive peripheral vascular disease, vertigo of central and peripheral origin, and as an adjuvant in the therapy of epilepsy.