Milbeworm 16 mg/40 mg Film-coated Tablets for Cats

Composition

Each tablet contains:

Active substances:

Milbemycin oxime 16 mg

Praziquantel 40 mg

Excipients:

For the full list of excipients, see section 6.1.

6.1 List of excipients

Core:

Microcrystalline cellulose

Croscarmellose sodium

Magnesium stearate

Povidone

Silica hydrophobic colloidal

Coat:

Natural Poultry liver flavour

Hypromellose

Microcrystalline cellulose

Macrogol stearate

Allura Red AC (E129)

Titanium Dioxide (E171)

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Pharmaceutical form

Film coated tablet.

Oval shaped, red to pink, meat flavoured tablets with a score on both sides. The tablets can be divided into halves.

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Pharmacological properties

Pharmacotherapeutic group: Antiparasitic products, insecticides and repellents - endectocides; milbemycin, combinations.

ATCvet code: QP54AB51

5.1 Pharmacodynamic properties

Milbemycin oxime belongs to the group of macrocyclic lactones, isolated from the fermentation of Streptomyces hygroscopicus var. aureolacrimosus. It is active against mites, against larval and adult stages of nematodes as well as against larvae of Dirofilaria immitis. The activity of milbemycin is related to its action on invertebrate neurotransmission: Milbemycin oxime, like avermectins and other milbemycins, increases nematode and insect membrane permeability to chloride ions via glutamate-gated chloride ion channels (related to vertebrate GABAA and glycine receptors). This leads to hyperpolarisation of the neuromuscular membrane and flaccid paralysis and death of the parasite.

Praziquantel is an acylated pyrazino-isoquinoline derivative. Praziquantel is active against cestodes and trematodes. It modifies the permeability for calcium (influx of Ca2+) in the membranes of the parasite inducing an imbalance in the membrane structures, leading to membrane depolarisation and almost instantaneous contraction of the musculature (tetany), rapid vacuolization of the syncytial tegument and subsequent tegumental disintegration (blebbing), resulting in easier expulsion from the gastrointestinal tract or death of the parasite.

5.2 Pharmacokinetic particulars

In the cat, praziquantel reaches peak plasma concentrations within 1-4 hours after oral administration.

The half life of elimination is around 3 hours.

In the dog, there is rapid hepatic biotransformation, principally to monohydroxylated derivatives.

The principal route of elimination in the dog is renal.

After oral administration in the cat, milbemycin oxime reaches peak plasma concentrations within 2-4 hours. The half life of elimination is around 32 to 48 hours. In the rat, metabolism appears to be complete although slow, since unchanged milbemycin oxime has not been found in urine or feces. Main metabolites in the rat are monohydroxylated derivatives, attributable to hepatic biotransformation. In addition to relatively high liver concentrations, there is some concentration in fat, reflecting its lipophilicity.

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Target species

Cats

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Indications

In cats: treatment of mixed infections by immature and adult cestodes (tapeworms) and adult nematodes (roundworms) of the following species:

Cestodes:

Echinococcus multilocularis, Dipylidium caninum, Taenia spp.,

Nematodes:

Ancylostoma tubaeforme, Toxocara cati

Prevention of heartworm disease (Dirofilaria immitis), if concomitant treatment against cestodes is indicated.

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Dosage

Oral route.

As per good veterinary practice, animals should be weighed to ensure accurate dosing.

Minimum recommended dose rate: 2 mg of milbemycin oxime and 5 mg of praziquantel per kg are given once orally as a single dose.

The product should be administered with or after some food.

The product is a small size tablet.

To aid with administration, the product has been coated with a meat flavour. The tablets can be divided into halves.

Depending on the bodyweight of the cat, the practical dosing is as follows:

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 monthly prevention of heartworm disease.

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Contraindications

Do not use in cats weighing less than 2 kg

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

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Adverse reactions

In very rare occasions, especially in young cats, hypersensitivity reactions, systemic signs (such as lethargy), neurological signs (such as ataxia and muscle tremors) and/or gastrointestinal signs (such as emesis and diarrhoea) may be observed after administration of the veterinary medicinal product.

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Warnings

Special precautions for use in animals

No studies have been performed with severely debilitated cats 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.

Studies have shown that 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 the absence of data on cats with microfilaraemia, its use should be according to a benefit risk assessment by the attending veterinarian.

As per good veterinary practice, animals should be weighed to ensure accurate dosing.

Ensure cats and kittens weighing between 0.5 kg and ≤2 kg receive the appropriate tablet strength (4 mg MBO/10 mg praziquantel) and the appropriate dose (1/2 or 1 tablet) for the corresponding weight band (1/2 tablet for cats weighing 0.5 to 1 kg ; 1 tablet for cats weighing >1 to 2 kg – 1 tablet).

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.

Other precautions

Echinococcosis represents a hazard for humans. As Echinococcosis is a notifiable disease to the World Organisation for Animal Health (OIE), specific guidelines on the treatment and follow-up, and on the safeguard of persons, need to be obtained from the relevant competent authority (e. g. experts or institutes of parasitology) If the cat has visited areas where Echinococcus spp. are prevalent, a veterinarian should be consulted.

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Use during pregnancy, lactation or lay

In a study, this combination of active substances was demonstrated to be well tolerated in breeding queens, 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. Also no such studies have been performed with reproducing animals.

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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.

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Overdose

In a study conducted with the product administered at 1X, 3X and 5X the therapeutic dose, and for a duration which exceed the therapeutic indication, i.e. 3 times at 15 day-intervals, signs uncommonly reported at the recommended dose (see section 4.6) have been observed at 5-fold the therapeutic dose after the second and third treatments. These signs disappeared spontaneously within a day.

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Special warnings

It is recommended to treat all the animals living in the same household concomitantly.

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

In order to develop an effective worm control programme local epidemiological information and the living conditions of the cat should be taken into account and therefore it is recommended to seek professional advice.

When D. caninum infection is present, concomitant treatment against intermediate hosts, such as fleas and lice, should be considered to prevent re-infection.

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Withdrawal period

Not applicable.

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Incompatibilities

Not applicable.

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Immediate packaging

Aluminium/ Aluminium blister pack (Oriented polyamide/Aluminium/ Polyvinyl chloride sealed to Aluminium film).

Available pack sizes:

1 box of 2 tablets containing 1 blister of 2 tablets (divisible per tablet)

1 box of 4 tablets containing 2 blisters of 2 tablets (divisible per tablet)

1 box of 24 tablets containing 12 blisters of 2 tablets (divisible per tablet)

1 box of 48 tablets containing 24 blisters of 2 tablets (divisible per tablet)

Not all pack sizes may be marketed.

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Storage

This veterinary medicinal product does not require any special temperature storage conditions.

Half tablets should be stored in the original blister and be used for the next administration.

Keep the blister in the outer carton.

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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: 6 months.

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Disposal of unused product

Any unused veterinary medicinal product or waste materials derived from such veterinary medicinal product should be disposed of in accordance with local requirements.

The product should not enter water courses as this may be dangerous for fish and other aquatic organisms.

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Additional information

Vm 17902/4081

9 DATE OF FIRST AUTHORISATION

26 February 2015

10 DATE OF REVISION OF THE TEXT

December 2021

Approved 10 December 2021

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Registration holder

Alfamed

13ème Rue - L.I.D.

06517 Carros Cedex

France

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