Milpro film-coated tablets for Dogs and Puppies Species: Dogs Therapeutic indication: Pharmaceuticals: Endoparasiticides: Anthelmintics for dogs, Tapeworm products Active ingredient: Milbemycin Oxime, Praziquantel Product:Milpro Film-coated tablets for Dogs and Puppies Product index: Milpro for Dogs and Puppies Qualitative and quantitative composition Milpro for Small Dogs and Puppies: Each tablet contains as active ingredients - Milbemycin oxime 2.5mg and Praziquantel 25mg Milpro for Dogs: Each tablet contains as active ingredients - Milbemycin oxime 12.5mg and Praziquantel 125mg Pharmaceutical form Film-coated tablet. Round shaped, beige to pale brown meat flavoured tablets. Milpro film-coated tablets for Small dogs and puppies are scored on both sides and can be halved. Clinical particulars Target species DOGS Indications for use In dogs: treatment of mixed infections by adult cestodes (tapeworms) and nematodes (roundworms) of the following species: Cestodes: Dipylidium caninum, Taenia spp., Echinococcus spp., Mesocestoides spp. Nematodes: Ancylostoma caninum, Toxocara canis, Toxascaris leonina, Trichuris vulpis, Thelazia callipaeda (see specific treatment schedules under section 4.9 “Amounts to be administered and administration route”), Crenosoma vulpis (Reduction of the level of infection), Angiostrongylus vasorum (Reduction of the level of infection by immature adult (L5) and adult parasite stages; see specific treatment and disease prevention schedules under section “ Amounts to be administered and administration route”). The product can also be used in the prevention of heartworm disease (Dirofilaria immitis), if concomitant treatment against cestodes is indicated. Contra-indications Milpro 2.5mg/25mg for small dogs and puppies - Do not use in puppies of less than 2 weeks of age and/or weighing less than 0.5 kg. Milpro 12.5mg/125mg for dogs - Do not use in dogs weighing less than 5 kg Do not use in cases of hypersensitivity to the active substances or to any of the excipients. See also point "Special precautions for use" Special warnings for each target species In order to develop an effective worm control programme local epidemiological information and the living conditions of the dog should be taken into account and therefore it is recommended to seek professional advice. Parasite resistance to any particular class of anthelmintic may develop following frequent, repeated use of an anthelmintic of that class Special precautions for use Special precautions for use in animals Studies with milbemycin oxime indicate that the margin of safety in certain dogs of Collie or related breeds is less than in other breeds. In these dogs, the recommended dose should be strictly observed. The tolerance of the product in young puppies from these breeds has not been investigated. Clinical signs in Collies are similar to those seen in the general dog population when overdosed (see also section 4.10). As per good veterinary practice, animals should be weighed to ensure accurate dosing. Treatment of dogs with a high number of circulating microfilariae can sometimes lead to the appearance of hypersensitivity reactions, such as pale mucous membranes, vomiting, trembling, laboured breathing or excessive salivation. These reactions are associated with the release of proteins from dead or dying microfilariae and are not a direct toxic effect of the product. The use in dogs suffering from microfilaremia is thus not recommended. In heartworm risk-areas, or in the case it is known that a dog has been travelling to and from heartworm risk regions, before using the product, a veterinary consultation is advised to exclude the presence of any concurrent infestation of Dirofilaria immitis. In the case of a positive diagnosis, adulticidal therapy is indicated before administering the product. Echinococcosis represents a hazard for humans. In case of Echinococcosis, specific guidelines on the treatment and follow up and on the safeguard of persons have to be followed. Experts or institutes of parasitology should be consulted. If the dog has visited areas where Echinococcus spp. is prevalent a veterinarian should be consulted. No studies have been performed with severely debilitated dogs or individuals with seriously compromised kidney or liver function. The product is not recommended for such animals or only according to a benefit/risk assessment by the responsible veterinarian. In dogs less than 4 weeks old, tapeworm infection is unusual. Treatment of animals less than 4 weeks old with a combination product may therefore not be necessary. Special precautions to be taken by the person administering the veterinary medicinal product to animals Wash hands after use. In the event of accidental ingestion of the tablets, particularly by a child, seek medical advice immediately and show the package leaflet or the label to the doctor Adverse reactions In very rare occasions, systemic signs (such as lethargy), neurological signs (such as muscle tremors and ataxia) and/or gastrointestinal signs (such as emesis, diarrhoea, anorexia and drooling) may be observed in dogs after administration of the veterinary medicinal product. Use during pregnancy, lactation or lay In a study, this combination of active substances was demonstrated to be well tolerated in breeding bitches, including during pregnancy and lactation. As a specific study with this product has not been performed, use during pregnancy and lactation only according to a benefit/risk assessment by the responsible veterinarian. Interactions The concurrent use of the combination praziquantel/milbemycin oxime with selamectin is well tolerated. No interactions were observed when the recommended dose of the macrocyclic lactone selamectin was administered during treatment with the combination at the recommended dose. In the absence of further studies, caution should be taken in the case of concurrent use of the product and other macrocyclic lactones. Also no such studies have been performed with reproducing animals. Amounts to be administered and administration route Oral use. Minimum recommended dose rate: 0.5 mg of milbemycin oxime and 5 mg of praziquantel per kg are given once orally. The product should be administered with or after some food. The tablets are meat flavoured and easy to administer (usually dogs and puppies will accept them voluntarily even without any food). Depending on the bodyweight of the dog, the practical dosing is as follows: Weight Milpro 2.5mg/25mg tablets for small dogs and puppies 0.5 - 1 kg ½ tablets >1 - 5 kg 1 tablet >5 - 10 kg 2 tablets Weight Milpro 12.5mg/125mg tablets for dogs 5 - 25 kg 1 tablet >25 - 50 kg 2 tablets >50 - 75 kg 3 tablets In cases when heartworm disease prevention is used and at the same time treatment against tapeworm is required, the product can replace the monovalent product for the prevention of heartworm disease. For treatment of Angiostrongylus vasorum infections, milbemycin oxime should be given four times at weekly intervals. It is recommended, where concomitant treatment against cestodes is indicated, to treat once with the product and continue with the monovalent product containing milbemycin oxime alone, for the remaining three weekly treatments. In endemic areas administration of the product every four weeks will prevent angiostrongylosis by reducing immature adult (L5) and adult parasite burden, where concomitant treatment against cestodes is indicated. For the treatment of Thelazia callipaeda, milbemycin oxime should be given in 2 treatments, seven days apart. Where concomitant treatment against cestodes is indicated, the product can replace the monovalent product containing milbemycin oxime alone. Overdose No other signs than those observed at the recommended dose have been observed. See above under adverse reactions Withdrawal periods Not applicable