Cestem Flavoured Tablets for Large Dogs

Composition

Each tablet contains:

Active substances:

Febantel 525 mg

Pyrantel (as embonate) 175 mg

Praziquantel 175 mg

Excipients:

Yellow brown, oval, divisible tablet, with liver flavouring.

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Pharmacological properties

ATC-vet code : QP52AA51

4.2 Pharmacodynamics

In this fixed combination pyrantel and febantel act against all relevant nematodes (ascarids, hookworms, and whipworms) in dogs. In particular the activity spectrum covers Toxocara canis, Toxascaris leonina, Uncinaria stenocephala, Ancylostoma caninum and Trichuris vulpis. This combination shows synergistic activity in the case of hookworms and febantel is effective against T. vulpis.

The spectrum of activity of praziquantel covers all important cestode species in dogs, in particular Taenia spp, Dipylidium caninum, Echinococcus granulosus and Echinococcus multilocularis. Praziquantel acts against all adult and immature forms of these parasites.

Praziquantel is very rapidly absorbed through the parasite’s surface and distributed throughout the parasite. Both in vitro and in vivo studies have shown that praziquantel causes severe damage to the parasite integument, resulting in the contraction and paralysis of the parasites. There is an almost instantaneous tetanic contraction of the parasite musculature and a rapid vacuolisation of the syncytial tegument. This rapid contraction has been explained by changes in divalent cation fluxes, especially calcium.

Pyrantel acts as a cholinergic agonist. Its mode of action is to stimulate nicotinic cholinergic receptors of the parasite, induce spastic paralysis of the nematodes and thereby allow removal from the gastro- intestinal (GI) system by peristalsis.

Within the mammalian system febantel undergoes ring closure forming fenbendazole and oxfendazole. It is these chemical entities which exert the anthelmintic effect by inhibition of tubulin polymerisation. Formation of microtubules is thereby prevented, resulting in disruption of structures vital to the normal functioning of the helminth. Glucose uptake, in particular is affected, leading to a depletion in cell ATP. The parasite dies upon exhaustion of its energy reserves, which occurs 2-3 days later.

4.3 Pharmacokinetics

After oral administration to dogs, praziquantel is extensively and quickly absorbed from the gastro-intestinal tract. Maximum plasma concentration of 752 µg/L is obtained in less than 2 hours. It is rapidly and extensively metabolised in the liver into hydroxylated derivatives of the parent compound, then rapidly eliminated, mainly in urine.

After oral administration to dogs, febantel is moderately absorbed from the gastro- intestinal tract. Febantel is rapidly metabolised in the liver into fenbendazole and its hydroxy and oxidative derivatives like oxfendazole. Maximum plasma concentration of fenbendazole (173 µg/L) is obtained after about 5 hours. Maximum plasma concentration of oxfendazole (147 µg/L) is obtained after about 7 hours. The excretion occurs mainly in the faeces.

After oral administration to dogs, pyrantel embonate is poorly absorbed. Maximum plasma concentration of 79 µg/L is obtained after about 2 hours. It is rapidly and extensively metabolised in the liver, then rapidly excreted, mainly in the faeces (the unchanged form) and in urine (the metabolites).

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Target species

Dogs ( weighing at least 17.5 kg)

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Indications

Treatment of mixed infections by adult cestodes and nematodes of the following species:

Nematodes:

Ascarids: Toxocara canis, Toxascaris leonina (adult and late immature forms).

Hookworms: Uncinaria stenocephala, Ancylostoma caninum (adults).

Whipworms: Trichuris vulpis (adults).

Cestodes:

Tapeworms: Echinococcus spp., Taenia spp., Dipylidium caninum (adult and immature forms).

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Dosage

For dogs and large breed puppies over 17.5 kg. Oral use.

15 mg febantel/kg bodyweight , 5 mg pyrantel (as embonate)/kg bodyweight and 5 mg praziquantel/kg bodyweight. This is equivalent to 1 tablet per 35 kg bodyweight, in one administration.

Dosages are as follows:

The smaller tablet size should be used to achieve accurate dosing in dogs weighing less than 17.5 kg.

The tablets can be given to the dog with or without food. No starvation is needed before or after treatment.

To ensure a correct dosage, body weight should be determined as accurately as possible.

The dosing program should be established by the veterinary surgeon.

As a general rule, puppies should be treated at 2 weeks of age and every 2 weeks until 12 weeks of age. Thereafter they should be treated at 3 month intervals. It is advisable to treat the bitch at the same time as the puppies.

For the control of Toxocara canis, nursing bitches should be dosed 2 weeks after giving birth and every two weeks until weaning.

For routine worm control adult dogs should be treated every 3 months.

In case of confirmed single infestation by cestode or by nematode, a monovalent product containing a cestocide or a nematocide alone should be preferred.

For routine treatment a single dose is recommended.

In the event of heavy roundworm infestation a repeat dose should be given after 14 days.

If an infestation caused by Echinococcus (E.granulosus) is detected in dogs, a repetition of the treatment is recommended for safety purpose.

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Contraindications

Do not use in cases of hypersensitivity to the active substances or to any of the excipients.

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Adverse reactions

Dogs:

Very rare (<1 animal / 10,000 animals treated, including isolated reports): Vomiting, Diarrhoea, Lethargy1

1 associated with vomiting and/or diarrhoea

Reporting adverse events is important. It allows continuous safety monitoring of a veterinary medicinal product. Reports should be sent, preferably via a veterinarian, to either the marketing authorisation holder or the national competent authority via the national reporting system. See the package leaflet for respective contact details.

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Warnings

Special precautions for safe use in the target species:

Not applicable.

Special precautions to be taken by the person administering the veterinary medicinal product to animals

Wash hands after administration to the animal.

In case of accidental ingestion, seek medical advice immediately and show the package leaflet or the label to the physician.

People with known hypersensitivity to any of the ingredients should avoid contact with the veterinary medicinal product.

Special precautions for the protection of the environment:

Not applicable.

Other precautions:

Since it contains praziquantel, the product is effective against Echinococcus spp. which do not occur in all EU member states but are becoming more common in some. Echinococcosis represents a hazard for humans. As Echinococcosis is a notifiable disease to the World Organisation for Animal Health (WOAH), specific guidelines on the treatment and follow-up, and on the safeguard of persons, need to be obtained from the relevant competent authority.

3.11 Special restrictions for use and special conditions for use, including restrictions on the use of antimicrobial and antiparasitic veterinary medicinal products in order to limit the risk of development of resistance

Not applicable

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Use during pregnancy, lactation or lay

Pregnancy:

Do not use in pregnant bitches during the first 4 weeks of pregnancy.

Lactation:

The product may be used during lactation (see Section 3.9 below).

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Interactions

Do not use simultaneously with piperazine, as the anthelmintic effects of pyrantel and piperazine may be antagonized.

Plasma concentrations of praziquantel may be decreased by concomitant administration with drugs that increase the activity of cytochrome P-450 enzymes (e.g. dexamethasone, phenobarbital).

Concurrent use with other cholinergic compounds can lead to toxicity.

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Overdose

In safety studies, single doses of 5 times (4 times in very young puppies) the recommended dose or greater gave rise to occasional vomiting.

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Special warnings

Parasite resistance to any particular class of anthelmintic may develop following frequent, repeated use of an anthelmintic of that class.

Fleas serve as intermediate hosts for one common type of tapeworm – Dipylidium caninum. Tapeworm infection may reoccur unless control of intermediate hosts such as fleas, mice etc is undertaken.

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Withdrawal period

Not applicable.

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Incompatibilities

None known.

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Immediate packaging

Nature of immediate packaging:

Polyamide-aluminium-PVC / aluminium blister packs.

Pack sizes:

Box containing 1 blister of 2 tablets

Box containing 2 blisters of 2 tablets

Box containing 2 blisters of 4 tablets

Box containing 12 blisters of 4 tablets

Box containing 24 blisters of 2 tablets

Not all pack sizes may be marketed.

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Storage

This veterinary medicinal product does not require any special storage conditions. Return any halved tablet to the opened blister pack .

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Shelf life

Shelf-life of the veterinary medicinal product as packaged for sale: 3 years. Shelf-life after first opening the immediate packaging: 7 days

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Disposal of unused product

Medicines should not be disposed of via wastewater.

Use take-back schemes for the disposal of any unused veterinary medicinal product or waste materials derived thereof in accordance with local requirements and with any national collection systems applicable to the veterinary medicinal product concerned.

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Additional information

7 MARKETING AUTHORISATION NUMBER

Vm 14966/5053

8 DATE OF FIRST AUTHORISATION

19 June 2009

9 DATE OF THE LAST REVISION OF THE SUMMARY OF THE PRODUCT CHARACTERISTICS

October 2025

10 CLASSIFICATION OF VETERINARY MEDICINAL PRODUCT

Veterinary medicinal product subject to prescription.

Find more product information by searching for the ‘Product Information Database’ on www.gov.uk.

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Registration holder

Ceva Sante Animale

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