Advocate spot-on solution for cats and ferrets Species: Cats, Ferrets Therapeutic indication: Pharmaceuticals: Ectoparasiticides: For cats, Pharmaceuticals: Endectocides: For companion animals, Pharmaceuticals: Endoparasiticides: Anthelmintics for cats Active ingredients: Imidacloprid, Moxidectin Product:Advocate spot-on solution for cats and ferrets Product Index: Advocate spot-on solution for cats and ferrets Incorporating: Advocate 40 mg + 4 mg spot-on solution for small cats and ferrets Advocate 80 mg + 8 mg spot-on solution for large cats Clinical particulars Target species Cats, ferrets Indications for use, specifying the target species For cats suffering from, or at risk from, mixed parasitic infections: ∙ the treatment and prevention of flea infestation (Ctenocephalides felis), ∙ the treatment of ear mite infestation (Otodectes cynotis), ∙ the treatment of notoedric mange (Notoedres cati), ∙ the treatment of the lungworm Eucoleus aerophilus (syn. Capillaria aerophila) (adults), ∙ the prevention of lungworm disease (L3/L4 larvae of Aelurostrongylus abstrusus), ∙ the treatment of the lungworm Aelurostrongylus abstrusus (adults), ∙ the treatment of the eye worm Thelazia callipaeda (adults), ∙ the prevention of heartworm disease (L3 and L4 larvae of Dirofilaria immitis), ∙ the treatment of infections with gastrointestinal nematodes (L4 larvae, immature adults and adults of Toxocara catiand Ancylostoma tubaeforme). The product can be used as part of a treatment strategy for flea allergy dermatitis (FAD). For ferrets suffering from, or at risk from, mixed parasitic infections: ∙ the treatment and prevention of flea infestation (Ctenocephalides felis), ∙ the prevention of heartworm disease (L3 and L4 larvae of Dirofilaria immitis). Contraindications Do not use in kittens under 9 weeks of age. Do not use in cases of hypersensitivity to the active substances or to any of the excipients. For ferrets: Do not use Advocate for large cats (0.8 ml) or Advocate for dogs (any size). For dogs, the corresponding “Advocate for dog” product, which contains 100 mg/ml imidacloprid and 25 mg/ml moxidectin, must be used. Do not use on canaries. Special warnings for each target species Please refer to section, 'Special precautions for use'. The product’s efficacy has not been tested in ferrets weighing over 2 kg and therefore the duration of effect might be shorter in these animals. 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. Parasite resistance to any particular class of anthelmintic may develop following frequent, repeated use of an anthelmintic of that class. Therefore, the use of this product should be based on the assessment of each individual case and on local epidemiological information about the current susceptibility of the target species in order to limit the possibility of a future selection for resistance. The use of the product should be based on the confirmed diagnosis of mixed infection (or risk of infection, where prevention applies) at the same time (see also sections, indications for use' and 'Amount to be administered'. Special precautions for use Special precautions for use in animals The treatment of cats weighing less than 1 kg and ferrets weighing less than 0.8 kg should be based on a benefit-risk assessment. There is limited experience on the use of the product in sick and debilitated animals, thus the product should only be used based on a benefit-risk assessment for these animals. Do not apply in the mouth, in the eyes or the ears of the animal. Care should be taken that the product is not ingested by animals and does not come into contact with the eyes or mouth of the recipient and/or other animals. Consider carefully the correct application method described in section 4.9, especially that the product should be applied to the site specified in order to minimise the risk for the animal to lick the product. Do not allow recently treated animals to groom each other. Do not allow treated animals to come into contact with untreated animals until the application site is dry. It is recommended that cats and ferrets living in, or travelling to areas endemic for heartworm are treated monthly with the product to protect them from heartworm disease. Whilst the accuracy of diagnosis of heartworm infection is limited, it is recommended that attempts be made to check the heartworm status of any cat and ferret aged over 6 months, before beginning prophylactic treatment, as use of the product on cats or ferrets which have adult heartworms may cause serious adverse effects, including death. If adult heartworm infection is diagnosed, the infection should be treated in accordance with current scientific knowledge. In certain individual cats Notoedres cati infestation may be severe. In these severe cases concomitant supportive treatment is necessary as treatment with the product alone may not be sufficient to prevent death of the animal. Imidacloprid is toxic for birds, especially canaries. Special precautions to be taken by the person administering the veterinary medicinal product to animals Avoid contact with skin, eyes or mouth. Do not eat, drink or smoke during application. Wash hands thoroughly after use. After application do not stroke or groom animals until the application site is dry. In case of accidental spillage onto skin, wash off immediately with soap and water. People with known hypersensitivity to benzyl alcohol, imidacloprid or moxidectin should administer the product with caution. In very rare cases the product may cause skin sensitisation or transient skin reactions (for example numbness, irritation or burning/tingling sensation). In very rare cases the product may cause respiratory irritation in sensitive individuals. If the product accidentally gets into eyes, they should be thoroughly flushed with water. If skin or eye symptoms persist, or the product is accidentally swallowed, seek medical advice immediately and show the package leaflet or the label to the physician. The solvent in Advocate may stain or damage certain materials including leather, fabrics, plastics and finished surfaces. Allow the application site to dry before permitting contact with such materials. Adverse reactions (frequency and seriousness) Use of the product may result in transient pruritus in cats. On rare occasions 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, neurological signs (most of which are transient) may be observed in very rare cases (see section 'Overdose'). 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. The frequency of adverse reactions is defined using the following convention: - very common (more than 1 in 10 animals treated displaying adverse reaction(s)) - common (more than 1 but less than 10 animals in 100 animals treated) - uncommon (more than 1 but less than 10 animals in 1,000 animals treated) - rare (more than 1 but less than 10 animals in 10,000 animals treated) - very rare (less than 1 animal in 10,000 animals treated, including isolated reports). Use during pregnancy, lactation or lay The safety of the veterinary medicinal product has not been established during pregnancy and lactation in the target species. Therefore, the use of the product is not recommended in animals intended for breeding or during pregnancy and lactation. Interaction with other medicinal products and other forms of interaction During treatment with Advocate no other antiparasitic macrocyclic lactone should be administered. No interactions between Advocate and routinely used veterinary medicinal products or medical or surgical procedures have been observed. Amounts to be administered and administration route Dosage schedule for cats: The recommended minimum doses are 10 mg/kg bodyweight imidacloprid and 1.0 mg/kg bodyweight moxidectin, equivalent to 0.1 ml/kg bodyweight Advocate for cats. The treatment schedule should be based on individual veterinary diagnosis and on the local epidemiological situation. Weight of cat (kg) Pipette size to be used Volume (ml) Imidacloprid (mg/kg bw) Moxidectin (mg/kg bw) 4 kg or less Advocate for small cats 0.4 minimum of 10 minimum of 1 > 4–8 kg Advocate for large cats 0.8 10 - 20 1 - 2 > 8 kg the appropriate combination of pipettes Flea treatment and prevention (Ctenocephalides felis) One treatment prevents future flea infestation for 4 weeks. Existing pupae in the environment may emerge for 6 weeks or longer after treatment is initiated, depending upon climatic conditions. Therefore, it may be necessary to combine Advocate treatment with environmental treatments aimed at breaking the flea life cycle in the surroundings. This can result in a more rapid reduction in the household flea population. The product should be administered at monthly intervals when used as part of a treatment strategy for flea allergy dermatitis. Treatment of ear mite infestation (Otodectes cynotis) A single dose of the product should be administered. A further veterinary examination 30 days after treatment is recommended as some animals may require a second treatment. Do not apply directly to the ear canal. Treatment of notoedric mange (Notoedres cati) A single dose of the product should be administered. Treatment of the lungworm Eucoleus aerophilus (syn. Capillaria aerophila) (adults) A single dose of the product should be administered. Prevention of Aelurostrongylus abstrusus The product should be administered monthly. Treatment of Aelurostrongylus abstrusus Advocate should be administered monthly for three consecutive months. Treatment of the eye worm Thelazia callipaeda (adults) A single dose of the product should be administered. Heartworm prevention (Dirofilaria immitis) Cats in areas endemic for heartworm, or those which have travelled to endemic areas, may be infected with adult heartworms. Therefore prior to treatment with Advocate, the advice provided in section, 'Special precautions for use' should be considered. For prevention of heartworm disease, the product must be applied at regular monthly intervals during the time of the year when mosquitoes (the intermediate hosts which carry and transmit heartworm larvae) are present. The product may be administered throughout the year. The first dose may be given after first possible exposure to mosquitoes, but not more than one month after this exposure. Treatment should continue at regular monthly intervals until 1 month after the last exposure to mosquitoes. To establish a treatment routine, it is recommended that the same day or date be used each month. When replacing another heartworm preventative product in a heartworm prevention programme, the first treatment with Advocate must be given within 1 month of the last dose of the former medication. In non-endemic areas there should be no risk of cats having heartworm. Therefore, they can be treated without special precautions. Roundworm and hookworm treatment (Toxocara cati and Ancylostoma tubaeforme) In areas endemic for heartworm, monthly treatment may significantly reduce the risk of re-infection caused by the respective roundworms and hookworms. In areas non-endemic for heartworm, the product can be used as part of a seasonal prevention programme against fleas and gastrointestinal nematodes. Dosage schedule for ferrets: One pipette of Advocate spot-on solution for Small Cats (0.4 ml) should be administered per animal. Do not exceed the recommended dose. The treatment schedule should be based on the local epidemiological situation. Flea treatment and prevention (Ctenocephalides felis) One treatment prevents future flea infestation for 3 weeks. Under heavy flea pressure it may be necessary to repeat administration after 2 weeks. Heartworm prevention (Dirofilaria immitis) Ferrets in areas endemic for heartworm, or those which have travelled to endemic areas, may be infected with adult heartworms. Therefore prior to treatment with Advocate, the advice provided in section, 'Special precautions for use' should be considered. For prevention of heartworm disease, the product must be applied at regular monthly intervals during the time of the year when mosquitoes (the intermediate hosts which carry and transmit heartworm larvae) are present. The product may be administered throughout the year. The first dose may be given after first possible exposure to mosquitoes, but not more than one month after this exposure. Treatment should continue at regular monthly intervals until 1 month after the last exposure to mosquitoes. In non-endemic areas there should be no risk of ferrets having heartworm. Therefore, they can be treated without special precautions. Method of administration For external use only. Remove one pipette from the package. Then hold the pipette in an upright position, and twist and pull off the cap. Reverse the cap and use it to twist and remove the seal from the pipette, as shown. Part the fur on the animal's neck at the base of the skull until the skin is visible. Place the tip of the pipette on the skin and squeeze the pipette firmly several times to empty its contents directly onto the skin. Application at the base of the skull will minimise the opportunity for the animal to lick the product. Apply only to undamaged skin. Overdose (symptoms, emergency procedures, antidotes), if necessary Up to 10 times the recommended dose was tolerated in cats with no evidence of adverse effects or undesirable clinical signs. The product was administered to kittens at up to 5 times the recommended dose, every 2 weeks for 6 treatments, and there were no serious safety concerns. Transient mydriasis, salivation, vomiting and transient rapid respiration were observed. After accidental oral ingestion or overdose, neurological signs (most of which are transient) such as ataxia, generalised tremors, ocular signs (dilated pupils, little pupillary reflex, nystagmus), abnormal respiration, salivation and vomiting may occur in very rare cases. The product was administered to ferrets at 5 times the recommended dose, every 2 weeks for 4 treatments, and there was no evidence of adverse effects or undesirable clinical signs. In case of accidental oral uptake, symptomatic treatment should be administered. There is no known specific antidote. The use of activated charcoal may be beneficial. Withdrawal period(s) Not applicable.