Boehringer Ingelheim
Vetmedin vet 1.25 mg for dogs 100 chewable tablets

For the treatment of canine congestive heart failure

Prescription required* (Exceptions apply)

Vetmedin Vet 1.25 mg chewable tablets for dogs

2. QUALITATIVE AND QUANTITATIVE COMPOSITION OF Vetmedin

One chewable tablet contains:

Active substance:
pimobendan 1.25 mg

Excipients:
For the full list of excipients, see section 6.1.

3. PHARMACEUTICAL FORM OF Vetmedin

Chewable tablet.
Oblong, scored, mottled brown tablets with fine white spots, embossed with Boehringer Ingelheim logo and P01.
The tablet can be divided into equal parts.

4. CLINICAL PARTICULARS OF Vetmedin

4.1 Target species

Dog

4.2 Indications for use, specifying the target species

For the treatment of canine congestive heart failure originating from dilated cardiomyopathy or valvular insufficiency (mitral and/or tricuspid valve regurgitation).
(See also section 4.9).
For the treatment of dilated cardiomyopathy in the preclinical stage (asymptomatic with an increase in left ventricular end-systolic and end-diastolic diameter) in Doberman Pinschers following echocardiographic diagnosis of cardiac disease (see section 4.4 and 4.5).

4.3 Contraindications

Do not use pimobendan in hypertrophic cardiomyopathies or in diseases in which an improvement in cardiac output cannot be achieved for functional or anatomical reasons (e.g. aortic stenosis).
Since pimobendan is metabolised mainly via the liver, it should not be used in dogs with severe impairment of liver function (see also 4.7).

4.4 Special warnings for each target species

The product has not been tested in cases of asymptomatic DCM in Dobermans with atrial fibrillation or sustained ventricular tachycardia.

4.5 Special precautions for use

Special precautions for use in animals
The blood glucose should be tested regularly during treatment in dogs with existing diabetes mellitus.
For use in the “preclinical stage” of dilated cardiomyopathy (asymptomatic with an increase in left ventricular end-systolic and end-diastolic diameter), a diagnosis should be made by means of a comprehensive cardiac examination (incl. echocardiographic examination and possibly Holter monitoring).
Monitoring of cardiac function and morphology is recommended in animals treated with pimobendan.
(See also section 4.6).
The chewable tablets are flavoured. In order to avoid any accidental ingestion, store tablets out of reach of the animals.

Special precautions to be taken by the person administering the veterinary medicinal product to animals
In case of accidental ingestion, seek medical advice immediately and show the package leaflet or the label to the physician.
Wash hands after use.
Advice to doctors: accidental ingestion, especially by a child, may lead to the occurrence of tachycardia, orthostatic hypotension, flushing of the face and headaches.
Close bottle tightly with cap directly after removal of the required number of tablets.

4.6 Adverse reactions (frequency and seriousness)

In rare cases a slight positively chronotropic effect (rise in heart rate) and vomiting can occur. However, these effects are dose-dependent and can be avoided by reducing the dose.
In rare cases transient diarrhoea, anorexia or lethargy have been observed.
Although a relationship with pimobendan has not been clearly established, in very rare cases, signs of effects on primary haemostasis (petechiae on mucous membranes, subcutaneous haemorrhages) may be observed during treatment. These signs disappear when the treatment is withdrawn. In rare cases, an increase in mitral valve regurgitation has been observed during chronic pimobendan treatment in dogs with mitral valve disease.

The frequency of adverse reactions is defined using the following convention:
- very common (more than 1 in 10 animals displaying adverse reactions during the course of one treatment)
- common (more than 1 but less than 10 animals in 100 animals)
- uncommon (more than 1 but less than 10 animals in 1,000 animals)
- rare (more than 1 but less than 10 animals in 10,000 animals)
- very rare (less than 1 animal in 10,000 animals, including isolated reports).

4.7 Use during pregnancy, lactation or lay

Laboratory studies in rats and rabbits have not produced any evidence of teratogenic or foetotoxic effects. However, these studies have shown evidence of maternotoxic and embryotoxic effects at high doses, and have also shown that pimobendan is excreted into milk. The safety of the product has not been assessed in pregnant or nursing bitches. Use only according to the benefit/risk assessment by the responsible veterinarian.

4.8 Interaction with other medicinal products and other forms of interaction

In pharmacological studies no interaction between the cardiac glycoside strophanthin and pimobendan was observed. The pimobendan-induced increase in cardiac contractility is attenuated by the calcium antagonists verapamil and diltiazem and by the β-antagonist propranolol.

4.9 Amounts to be administered and administration route

Do not exceed the recommended dosage.
Determine the bodyweight accurately before treatment to ensure correct dosage.
The dose should be orally administered and within the dose range of 0.2 mg to 0.6 mg pimobendan/kg bodyweight, divided into two daily doses. The preferable daily dose is 0.5 mg/kg bodyweight, divided into two daily doses (0.25 mg/kg bodyweight each). Each dose should be given approximately 1 hour before feeding. 

This corresponds to:
One 1.25 mg chewable tablet in the morning and one 1.25 mg chewable tablet in the evening for a body weight of 5 kg.

Chewable tablets can be halved at the score line provided, for dosage accuracy, according to the bodyweight.

The product may be combined with a diuretic, e.g. furosemide.

4.10 Overdose (symptoms, emergency procedures, antidotes), if necessary

In the case of overdose, a positive chronotropic effect, vomiting, apathy, ataxia, heart murmurs or hypotension may occur. In this situation, the dosage should be reduced and appropriate symptomatic treatment should be initiated.
In prolonged exposure (6 months) of healthy beagle dogs at 3 and 5 times the recommended dose, mitral valve thickening and left ventricular hypertrophy were observed in some dogs. These changes are of pharmacodynamic origin.

4.11 Withdrawal period(s)

Not applicable.

5. PHARMACOLOGICAL PROPERTIES OF Vetmedin

Pharmacotherapeutic group: Cardiac stimulants excl. cardiac glycosides, phosphodiesterase inhibitors
ATCvet Code: QC01CE90

5.1 Pharmacodynamic properties

When used in cases of symptomatic valvular insufficiency in conjunction with furosemide the product has been shown to improve the quality of life and extend life expectancy in treated dogs.
When used in a limited number of cases of symptomatic dilated cardiomyopathy in conjunction with furosemide, enalapril and digoxin, the product has been shown to improve the quality of life and to extend life expectancy in treated dogs.
In a randomized and placebo controlled study including Doberman Pinschers with preclinical dilated cardiomyopathy (asymptomatic with an increase in left ventricular end-systolic and end-diastolic diameter following echocardiographic diagnosis), the time to onset of congestive heart failure or sudden death was extended and survival time was prolonged among dogs administered pimobendan.
Additionally, there was a reduction in the heart size of dogs treated with pimobendan in the preclinical stage of dilated cardiomyopathy. Efficacy evaluation is based on data from 19 (of 39) and 25 (of 37) dogs that reached the primary efficacy endpoint in the pimobendan and the placebo group, respectively.

Pimobendan, a benzimadazole-pyridazinone derivative has a positive inotropic action and possesses pronounced vasodilator properties.

The positive inotropic effect of pimobendan is mediated by two mechanisms of action: increase in calcium sensitivity of cardiac myofilaments and inhibition of phosphodiesterase III. Thus the positive inotropism is triggered neither by an action similar to that of the cardiac glycosides nor sympathomimetics.
The vasodilator effect arises from inhibition of phosphodiesterase III.

5.2 Pharmacokinetic particulars

Absorption:
After oral administration of the product the absolute bioavailability is 60  63%. Since simultaneous or previous food intake reduces the bioavailability, pimobendan should be administered about 1 hour before feeding.

Distribution:
The volume of distribution is 2.6 l/kg, indicating that pimobendan is distributed readily into the tissues. The mean plasma protein binding is 93%.

Metabolism:
The compound is demethylated by oxidation to the major active metabolite (UD-CG212). Further metabolic steps are phase II conjugates of UD-CG212, such as glucuronides and sulphates.

Elimination:
The plasma elimination half-life of pimobendan is 0.4 ± 0.1 hours, which corresponds to the high clearance of 90 ± 19 ml/min/kg and the short mean residence time of 0.5 ± 0.1 hours.
The most significant active metabolite is eliminated with a plasma elimination half-life of 2.0 ± 0.3 hours. Almost the entire dose is eliminated in the faeces.

6. PHARMACEUTICAL PARTICULARS OF Vetmedin

6.1 List of excipients

Povidone
Lactose monohydrate
Maize starch
Croscarmellose sodium
Citric acid, anhydrous
Artificial powdered beef flavour
Silica, colloidal anhydrous
Magnesium stearate

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

Shelf life of the veterinary medicinal product as packaged for sale: 3 years
Shelf life after first opening the bottle: 100 days
Use any divided tablet at the next administration time.

6.4 Special precautions for storage

Do not store above 25°C.
Keep the bottle tightly closed in order to protect from moisture.

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