Flea Allergy Dermatitis in Cats

Flea Allergy Dermatitis in Cats

Dr. Rosanna Marsalla

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Overview of Flea Allergy Dermatitis in Cats

Flea allergy dermatitis is the most common allergy in cats and is caused by flea bites, specifically the saliva of the flea. It is a very itchy disease and predisposes to the development of secondary skin infections.

Below is an overview of Flea Allergy Dermatitis in Cats followed by in-depth information on the diagnosis and treatment of this condition.

Oddly enough, most animals with flea allergy have very few fleas – because they are so itchy, they groom themselves excessively, eliminating any evidence of fleas. However, a couple of flea bites every two weeks are sufficient to make a flea allergic cat itchy all the time. Any animal can become allergic to fleas, although some cats are more attractive to fleas than others.

Fleas are bloodsucking insects with a life span of 6 to 12 months. This life span is influenced by environmental conditions and can vary from two to three weeks up to a year. Optimal conditions include humidity of 75 to 85 percent and temperature of 65 to 80 degrees Fahrenheit. Humidity is more important than the temperature. The adult flea spends most of its life on the host, while the immature stages (eggs) are found in the environment.

What to Watch For

Diagnosis of Flea Allergy Dermatitis in Cats

Flea allergy dermatitis is a common cause of itchiness and scratching in cats, but other medical problems can lead to similar symptoms. Other disorders that must be excluded are:

  • Food allergy
  • Atopy
  • Trauma or other cause of local skin irritation
  • Sarcoptic mange
  • Cheyletiellosis (a mite infestation)
  • Otitis externa (ear infection)
  • Primary keratinization defects

    Some pets may have more than one medical problem. For example, scratching or biting due to flea irritation can cause a “hot spot” (acute moist dermatitis”) and secondary bacterial skin infection (pyoderma) can follow.

    Diagnosis of flea allergy is made based on history, clinical signs and a positive response to flea control.

    Treatment of Flea Allergy Dermatitis in Cats

    Treatment of flea allergy dermatitis involves three phases:

  • Prevention of flea bites. The most important part of treatment is preventing flea bites with aggressive flea control on your cat and in the environment.
  • Treatment of secondary skin infections. Antibiotics and antifungal drugs may be necessary to treat secondary skin infections triggered by the flea allergy.
  • Breaking the itch cycle. If your cat is intensely itchy, a short course of steroids may be necessary to break the itch cycle and make your cat more comfortable.

    Preventative Care

    Use an effective safe flea control product on your cat on a regular basis beginning one month before the flea season starts and continuing up until one month after the flea season ends.

    Use frequent vacuuming and carpet cleaning strategies to remove eggs and larvae from the cat’s indoor environment. Use a professional cleaning or exterminating service in difficult cases.

    See your veterinarian promptly if your cat develops acute skin lesions (acute moist dermatitis) as a result of biting or scratching at fleas. Frequent grooming of your cat with a “flea comb” may be helpful to remove fleas.

    In-depth Information on Flea Allergy Dermatitis in Cats

    Veterinary care should include diagnostic tests and subsequent treatment recommendations.

    Diagnosis In-depth

    Diagnostic tests often are performed to confirm a diagnosis of flea allergy dermatitis and exclude other diseases that may cause similar symptoms. Tests may include:

  • A complete medical history including questions about itchiness, areas of involvement, prior history of skin problems, diet, response to therapy, and any concurrent medical conditions
  • A thorough physical examination, including examination of the skin
  • Fecal flotation tests to determine the presence of concurrent gastrointestinal parasites or identify tapeworms, which are transmitted via fleas
  • Skin scrapings examined under the microscope to detect mange mites (sarcoptes, cheyletiella, demodex). The sarcoptic mange mite can be very difficult to find and several skin scrapings may have to be collected.

    Your veterinarian may recommend additional diagnostic tests to exclude or diagnose other conditions. These tests insure optimal medical care and are selected on a case-by-case basis. Examples include:

  • A complete blood count (CBC or hemogram) to identify infection or inflammation and anemia, which can be seen in severe flea infestations. Occasionally, a high percentage of circulating eosinophils may be seen in the blood smear. This type of white blood cell may be found in increased numbers in some animals with parasitic infections.
  • Serum chemistry tests to evaluate the overall health of the cat and to evaluate the function of vital organs such as the liver and kidneys
  • Allergy tests such as the radioallergosorbent test (RAST) or the enzyme-linked immunosorbent assay (ELISA), although the accuracy and usefulness of these tests is variable
  • Intradermal allergy testing (skin testing) to identify the responsible allergens in allergic animals. Most flea allergic cats will react to the flea antigen used in this test.
  • Microscopic examination of material collected from the external ear to check for mites or infectious organisms like bacteria or yeast

    Treatment In-depth

    The type of treatment for fleas on your cat will depend on several factors:

  • The severity of the infestation
  • Whether you have only a cat or cats, or both cats and dogs
  • Whether your pets spend all of their time indoors or some time indoors and some time outdoors
  • The time of the year the problem occurs
  • Area of exposure to fleas as the pet’s yard or public park
  • Whether or not the animal is allergic to fleas

    Recommendations for dealing with cat fleas Include:

    Prescription flea control products are most potent and include:

  • Capstar® (nitenpyram), an oral product that results in flea death within four hours after administration
  • Program® (lufenuron), a product that can be administered orally or by injection, and that inhibits the development of the flea
  • Frontline® (fipronil) and Advantage® (imidacloprid), topical products placed directly on the skin that prevent and kill fleas
  • Revolution® (selamectin), a topical product that prevents fleas, heartworms and some intestinal parasites

    If your pet already has fleas, they must be killed first with products such as Capstar® (nitenpyram), Frontline Plus® (fipronil) or Advantage® (imidacloprid).

    Recommendations for flea control will vary depending upon local and regional variations in climate. New flea control products are constantly being developed. Consult your veterinarian about the newest and most effective product for your particular area and circumstances.

    Follow-up Care for Cats with Flea Allergy Dermatitis

    Optimal treatment for your cat requires a combination of home and professional veterinary care. Follow-up is important especially for flea allergic cats. Administer as directed any medications prescribed by your veterinarian.

    Mark dates on your calendar that treatments and follow-up evaluations are due. Follow the preventative measures recommended by your veterinarian as appropriate for the season of the year and your geographic location.

    Contact your veterinarian if you are having difficulty administering prescribed medications or if the results are not as expected.

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    Flea Medications and Dog Seizures

    Flea medications are used in treating dogs suffering from flea infestation. However, not all dogs find flea medications effective. As a matter of fact, there are some dogs that are quite sensitive to flea medications. There are some flea medications that contain ingredients that can be causative factors for dog seizures. Before using any flea medications and to help in preventing dog seizures, discuss with your dog’s veterinarian and even with your dog’s groomer about other alternative flea prevention medications and other flea treatment options that are safer for your dog’s overall health.

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    What’s In Flea Medications that Cause Dog Seizures

    Flea Medications and Dog Seizures

    It has been proven that one of the most common causative factors for dog seizures related to flea medications is IVERMECTIN. Ivermectin is the primary chemical culprit found in flea medications or in other flea control products that can really bring about seizures in dogs. To prevent seizures from affecting your dog from Ivermectin, look for flea control products or flea medications that do not contain any Ivermectin.

    Warning in Using Flea Control Products

    Dogs that are already prone to dog seizures even without using flea products that contain Ivermectin will be best for owners not to use flea control products. Dogs that are already prone to dog seizures because of hypoglycemia can suffer from dog seizures with other chemicals found in flea control products aside from Ivermectin. There are also certain dog breeds that are more prone to dog seizures caused by Ivermectin. Collies, when compared to other dog breeds are quite sensitive to Ivermectin.

    How to Prevent Dog Seizures

    It will be best for dog owners to discuss with the veterinarian on specific flea prevention products that are safe to use in dogs. Veterinarians will most likely opt for the usage of all natural flea repellent products. And to further prevent dog seizures and keep your dogs safe, as much as possible, do not get your dog exposed to lawn chemicals and other household cleaning products that are containing numerous chemicals. Limiting dogs’ exposure to harmful chemicals will not only prevent dog seizures, but it can also help in maintaining overall health of your dogs.

    Other Chemicals That Can Cause Dog Seizures

    Aside from Ivermectin that can cause dog seizures, there are still other chemicals found in flea prevention products that can cause dog seizures. These chemicals include Pyriproxyfen, Midacloprid, Methoprene, Fipronil, and Premethrin. These chemicals are not only dangerours to dogs, these chemicals are also dangerous to human beings.


    Treatment of Behavior Problems in Cats

    Gary M. Landsberg

    , BSc, DVM, MRCVS, DACVB, DECAWBM, North Toronto Veterinary Behaviour Specialty Clinic

    The treatment of behavior problems depends on the disorder and its outlook. In general, the program begins with prevention and avoidance of problems, while you and your veterinarian develop strategies to modify the cat’s behavior. Prevention is especially important in cases of aggression to ensure safety for owners and pets. Avoiding problematic behaviors is also important because repetition of an abnormal behavior can make the problem worse if the cat successfully accomplishes its intended goal (eg, escape or retreat from the stimulus). Additionally, each exposure to an unpleasant outcome can worsen anxiety.

    Improvement is generally a slow and gradual process. Treatment for abnormal behaviors takes time and commitment from pet owners. Quick fixes or «magic pills» do not exist for behavior problems. Modifying the pet’s behavior is accomplished by behavior modification techniques aimed at achieving and rewarding improved behavior. Changes to the cat’s home environment may be required so that the cat can be kept away from anything that stimulates the abnormal behavior or from the areas in which the problem occurs. Products that improve safety, reduce anxiety, or quicken improvements may also be used. Drugs and natural products may also be indicated for some pets and some problems.

    The techniques used most commonly to modify cat behavior include habituation, extinction, desensitization, counterconditioning, response substitution, and shaping. A behavior modification technique called flooding is not used very often because it is more likely to make animals worse. While it is claimed that punishment is frequently used with varying degrees of success, few people use punishment correctly. For punishment (such as yelling at the cat) to be successful, it must occur just as the behavior starts, be consistently delivered, and be strong enough to stop the unwanted behavior. Most punishments are not given at the right time or are not the appropriate type for the situation. In fact, studies have shown that punishment and confrontational training techniques are more likely to lead to fear, avoidance, and increased aggression.

    Behavior Modification Techniques

    Most of the techniques involved in behavior modification are not hard to learn and can be successfully employed with preventive techniques. They do, however, require an investment of time and effort. The following is a short review of the basic principles involved in these techniques.

    Habituation is a simple form of learning that involves no rewards. It is merely the ending of or decrease in a response to a stimulus that results from repeated or prolonged exposure to that stimulus. For example, horses placed in a pasture bordering a road may at first run away when traffic passes, but eventually learn to ignore it. A cat that habituates to one type of sound does not, as a consequence of this habituation, become habituated to other sounds. Habituation is not the same as failing to respond to stimulation as a result of fatigue, sensory adaptation, or injury. The effects of habituation are generally long lasting. However, if an animal is repeatedly exposed to a potentially harmful stimulus (such as a predator) without being harmed, habituation does not generally occur. Because of this, scientists believe that responses to dangerous stimuli may have an inherited resistance to habituation.

    Spontaneous recovery is associated with habituation. If there is a long period of time between when a cat has experienced an event to which it had habituated and re-exposure to the same event, the animal may again react. For example, a cat sitting by a window might startle at the sound of traffic passing the house. Eventually, the cat ignores the traffic as it learns there are no consequences to the sound. If there had been no traffic for a long time, the next passing car might cause the cat to startle again.

    Conditioning refers to associations between stimuli and behavior. For example, a hungry cat may drool when it sees food (the stimulus). If every time that the hungry cat sees the food it also hears a can opener, after several times, the sound of the can opener alone will cause the cat to start drooling. This is called conditioning. The can opener elicits the same response as the sight of food. After several times, the cat has learned to associate the sound of the can opener with the food.

    Reinforcement is any event that increases the chances that a certain behavior will be repeated. Reinforcements can be positive or negative. When positive reinforcement (a reward) is used in training, there is a positive relationship between the behavior and its consequences. The more the pet does a behavior, the more it gets positive reinforcement. This makes that behavior increase. A negative reinforcement (which is mistakenly thought of as punishment by many people) is something unpleasant that increases a behavior when it is removed. For example, some cats find being held in a lap unpleasant. When a cat squirms and escapes from your lap, it is rewarded with being freed from your hold. After several times, the release from restraint will increase the chance that your cat will try to escape again the next time.

    Second-order reinforcers are signals that can be used at a distance to let the cat know that a reward is coming. Commonly used second-order reinforcers are words, such as “good kitty,” clickers, and whistles. By carefully pairing these with a primary reward (such as food or petting), second-order reinforcers can generate the same response as the reward itself, as long as the pairing is repeated occasionally. For example, a clicker can be associated with a food treat as a reward for coming. By associating the clicker with the food, you can train the cat to come from farther away, and still reward the behavior by using the clicker. Positive training and “clicker” training have recently become very popular and work well with cats as well as dogs. However, it is possible to do an excellent job at positive training without using any second-order reinforcers. Clicker training requires frequent practice and excellent timing. In some situations involving problem behaviors, the incorrect use of a clicker may hinder, rather than help, a behavior modification program.

    The Premack Principale states that more desirable behaviors will reinforce less desirable behaviors. Using this principle, a cat can be trained to perform a behavior by rewarding it with something it wants to do.

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    Extinction is a response that stops when the reward is removed. An example of extinction is ignoring a cat that howls at night for attention. If the owners get up to feed the cat (or even in many cases to yell at it), the behavior continues. If they stop feeding the cat or giving it attention, the cat will eventually stop howling during the night because the reward is no longer there. However, occasional feeding in response to the howling will only reinforce the pattern. The more valuable the original reward, the longer the reward has been given, and the more uncertain the cat is that the reward has been truly removed, the greater the resistance to extinction.

    Because there is often an association between getting the reward and the intensity of the behavior, the intensity or frequency of the behavior you are trying to eliminate usually increases at the beginning of extinction. In other words, a behavior you are trying to extinguish often gets worse before it gets better. It is critical that you do not give in. Giving in will only make extinction more difficult. The cat has learned that, although your threshold has increased, the cat can override it by working harder.

    Overlearning is the repeated performance of an already learned behavior. It is frequently used in training for specific events. Overlearning accomplishes 3 things: it delays forgetting, it increases the resistance to extinction, and it increases the chances that the response will become a “knee-jerk”, or automatic response, when the circumstances are similar. This aspect can be useful in teaching a cat to overcome a fear or anxiety.

    Shaping is a learning technique that works well for cats that do not know what response is desired by the trainer. Shaping works through gradual approximations and allows the cat to be rewarded at first for any behavior that resembles the desired end result. For example, when teaching a cat to come, tossing a food treat in front of the cat when it first takes a step or two in your direction will increase the chance that the cat will come closer. Then the cat can be given a treat for taking several steps toward you, and finally, only when it comes all the way to you.

    Avoidance of a problem behavior is essential until you can seek qualified help, particularly in the case of cats that are biting or scratching. With treatment it may be possible to desensitize the cat to circumstances in which aggressive behavior occurs, but avoidance is the key to minimizing danger. Avoidance does not mean that the cat has control, or that you are giving in to the cat. Rather, it means that the cat is not being given the chance to reinforce the pattern by acting aggressively. Every time a cat becomes aggressive, it learns that this reaction may help it cope with the situation, thus reinforcing the problem.

    Desensitization is a way to gradually teach a cat to tolerate a situation by carefully exposing it to the situation in small steps. If a cat is afraid of another cat in the household, gradual, controlled exposure to the other pet can be arranged to desensitize the fearful cat. The second cat could be placed in a carrier and kept at the far side of the room for a minute or two. The cat in the carrier could gradually be moved closer and kept in the room longer, but only if the fearful cat remains calm and relaxed. For best results, desensitization is often paired with counterconditioning methods.

    Counterconditioning is a method for reducing unwanted behavior by teaching the cat to replace it with another more favorable behavior. In the example of the fearful cat, the cat will learn faster if it is first taught to sit and relax in exchange for a treat. The cat must be calm, and convey by its eyes, body posture, and facial expressions that it is not upset or agitated in any way. Once this routine is learned, the desensitization is added by placing the other cat (in a carrier at first) on the other side of the room for a few minutes. If at any time the cat starts to become anxious or act like it wants to leave, the other cat should be moved farther away until the nervous cat relaxes. Relaxing is the key and is the first step in changing the fearful cat’s behavior. There is no point in having the cat stay if it is clearly distressed. Counterconditioning and desensitization can take a lot of time and effort. The exercises must be frequently repeated so that the unwanted behavior decreases to an acceptable level. Moving too quickly provokes anxiety and works against any progress with the behavior modification program.

    Flooding is prolonged exposure to a stimulus until the cat eventually stops reacting. This is the opposite of the approach taken in desensitization. It is far more stressful than any of the other treatment strategies and if not used correctly will make things worse. This technique should be used only by a professional and only as a last resort.

    Punishment is also known as aversive conditioning. It is any unpleasant event that lowers the chance that a behavior will be repeated. Punishment is not the same as negative reinforcement (see above). To be most successful, punishment must occur as early as possible (within a few seconds of the start of the behavior), and it must be consistent and appropriate. Critical factors in punishment include timing, consistency, appropriate intensity, and the presence of a reward after the undesirable behavior ends. This is the most frequently ignored part of treatment for people whose pets have behavior problems. Owners often resort to physical punishment as the first choice, but punishment does not need to be physical. Furthermore, punishment is just as hard to use correctly as counterconditioning and desensitization. Punishment is never an “easy out” and has a high chance of failure. It can also lead to other negative consequences, such as increasing the chance of fear or aggression.

    Response substitution involves replacing an undesirable behavior with a desirable one. For example, a cat that is jumping out of hiding to attack a person’s ankle could be taught to chase and grab a toy instead.

    Use of Medication to Treat Behavior Problems

    Your veterinarian may, in some cases, prescribe medication to help treat a behavior problem of your cat. Drug treatment for almost any behavior change is most useful when combined with behavior modification.


    Guidelines for Veterinary Prescription Drugs

    Veterinary Prescription Drugs

    Veterinary prescription drugs are those drugs restricted by federal law to use by or on the order of a licensed veterinarian [Section 503(f) Food, Drug, and Cosmetic Act]. The law requires that the drug sponsor label such drugs with the statement: «Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian.»

    • Veterinary prescription drugs are labeled for use only by or on the order of a licensed veterinarian. Incidents involving the sale and use of prescription drugs without a prescription should be reported to the proper state authority and the U.S. Food and Drug Administration.
    • Veterinarians making treatment decisions must use sound clinical judgment and current medical information and must be in compliance with federal, state, and local laws and regulations.
    • Veterinary prescription drugs must be properly labeled before being dispensed.
    • Appropriate dispensing and treatment records must be maintained.
    • Veterinary prescription drugs should be dispensed only in quantities required for the treatment of the animal(s) for which the drugs are dispensed. Avoid unlimited refills of prescriptions or any other activity that might result in misuse of drugs.
    • Any drug used in a manner not in accordance with its labeling should be subjected to the same supervisory precautions that apply to veterinary prescription drugs.

    Veterinary Prescription Orders

    Veterinarians should assure compliance with relevant regulations (e.g. VCPR) of their State Board of Pharmacy and State Board of Veterinary Medicine, and applicable federal regulations including FDA’s Extralabel Drug Use Rules (21CFR 530) found at the Electronic Code of Federal Regulations (ecfr.gov).

    Labeling and Record Keeping

    Adequate written treatment records must be maintained by the veterinarian for at least two years (or as otherwise mandated by law), for all animals treated, to document that the drugs were supplied to clients in line with federal and state rules and policies, and AVMA’s Principles of Veterinary Medical Ethics. Such records must include the information set forth under Basic Information for Records, Prescriptions, and Labels.

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    Food animal owners should have a written treatment records system in place to decrease the risk of violative residues in meat, milk or eggs. All patient treatments should be recorded. Food animal owners must keep records when engaging in ELDU, and when milk and or meat withdrawal of a certain drug may differ from its label. Owner treatment records have been developed by several producer organizations and are available in conjunction with quality assurance programs.

    All veterinary prescription drugs must be properly labeled when dispensed. A complete label should include all the information set forth under the section on Basic Information for Records, Prescriptions, and Labels.

    Basic Information for Records (R) Prescriptions (P), and Labels (L)

    • Name, address, and telephone number of veterinarians (RPL)
    • Name (L), address, and telephone number of clients (RP)
    • Identification of animal(s) treated, species and numbers of animals treated, when possible (RPL)
    • Date of treatment, prescribing, or dispensing of drug (RPL)
    • Name, active ingredient, and quantity of the drug (or drug preparation) to be prescribed or dispensed (RPL)
    • Drug strength (if more than one strength available) (RPL)
    • Dosage and duration
    • Route of administration (RPL)
    • Number of refills (RPL)
    • Cautionary statements, as needed (RPL)
    • Expiration date if applicable
    • Slaughter withdrawal and/or milk withholding times, if applicable (RPL)
    • Signature or equivalent (P)

    The actual container must bear the veterinarian’s name, address, name of the drug (active ingredient), identification of the animal(s) to be treated, adequate directions for proper use, and cautions/precautions including milk and meat withdrawal times. This information may be on the label applied by the manufacturer, or on a label attached to the product by the veterinarian.

    If there is inadequate space on the label for any of the other required information, the veterinarian must provide the additional information on a separate sheet that accompanies the drug dispensed or prescribed.

    State law and other regulations such as the Pasteurized Milk Ordinance may require more information than is stated in these guidelines. Specific label and record keeping information is required when drugs are prescribed for extralabel use (see the next section on AMDUCA).

    When veterinary prescription drugs are dispensed to companion animal owners, the AVMA recommends that such drugs be placed in child-resistant containers. Such containers are mandated by law in certain states.

    Handling, Storage and Disposal

    In the clinic, veterinary prescription drugs should be stored separately from over-the-counter drugs, and be easily distinguishable by the professional and paraprofessional staff. Drugs should be stored under conditions recommended by the manufacturer. All drugs should be examined periodically to ensure cleanliness and current dating.

    Food animal clients should be advised that veterinary prescription drugs should be securely stored, with access limited to key personnel.

    Animal Medicinal Drug Use Clarification Act (AMDUCA)Compliance in Veterinary Medical Practice

    With passage of the AMDUCA by Congress in 1994, the extralabel use of approved animal or human drugs in animals became a codified, FDA-regulated activity. Veterinarians may utilize drugs in an extralabel manner in their regular course of practice when the health of an animal is threatened or death may result from failure to treat. Under AMDUCA regulations, extralabel use means the actual or intended use of a drug, by or on the order of a veterinarian, in a manner that is not in accordance with approved labeling. Any deviation from the label, by veterinarians or lay persons is an illegal use, unless the use meets all the requirements of FDA’s extralabel drug use rules. Deviations from the label include, but are not limited to:

    • Use in a speciesor production class not on the label
    • Use of a different route of administration, indication, frequency, dose, or duration

    Extralabel use is legal only when ordered by a veterinarian and within the context of of FDA’s VCPR found within 21 CFR 530.3 and state VCPR requirements.

    Veterinarians are strongly encouraged to familiarize themselves with the complete regulations.

    Guidelines for extralabel use in food producing animals:

    Veterinarians contemplating extralabel drug use should note there are additional requirements specific for food-producing animals.

    Extralabel drug use is only allowed if there is no approved animal drug that is labeled for such use, or that contains the same active ingredient in the required dosage form and concentration. Alternatively, an approved animal drug exists, but a veterinarian finds, within the context of a veterinarian/client/ patient relationship, that the approved drug is clinically ineffective for its intended use.

    Use of a human drug, or an animal drug that is only approved for use in nonfood-producing animals, has further restrictions. These drugs are not permitted if a drug that is labeled for use in a food-producing animal can be used in a labeled or extralabel manner.

    When using drugs in an extralabel fashion in food animals, FDA also requires extended withdrawal intervals be established using appropriate scientific information.

    It is important to note that AMDUCA does not permit extralabel use of drugs, including over-the-counter drugs and Veterinary Feed Directive drugs, in animal feed. AMDUCA also does not permit extralabel drug use for production purposes.

    The extralabel use of certain drugs is prohibited in food animals. This list found at 21 CFR 530.41 may be amended by the Food and Drug Administration. Thus, the following list is accurate as of the publication date of this document.

    Prohibited therapy in food animals: chloramphenicol, clenbuterol, diethylstilbestrol, dimetridazole, ipronidazole, other nitromidazoles, furazolidone, nitrofurazone, glycopeptides, fluoroquinolones.

    Prohibited therapy in lactating dairy cows: any sulfonamide except for approved uses of sulfadimethoxine, sulfabromethazine and sulfaethoxypyridazine.

    Prohibited therapy in female dairy cattle 20 months of age or older: phenylbutazone.

    Prohibited therapy in chickens, turkeys, and ducks: adamantane and neuraminidase inhibitor classes of drugs that are approved for treating or preventing influenza A.

    Prohibited cephalosporin (excluding cephapirin) use in cattle, swine, chickens and turkeys:

    Using cephalosporin drugs at unapproved dose levels, frequencies, durations or routes of administration is prohibited.

    Using cephalosporin drugs in cattle, swine, chickens or turkeys that are not approved for use in that species (e.g., cephaloporin drugs intended for humans or companion animals) or production class

    Using cephalosporin drugs for disease prevention

    Guidelines for extralabel use in nonfood-producing animals:

    AMDUCA also applies to medical decisions in nonfood producing animals. There is greater latitude for extralabel use in nonfood producing animals. However, the requirements stated above for «all animals» must still be followed. In addition, veterinarians should consider the following when treating nonfood-producing animals:

    • Veterinarians may use approved animal and human drugs for therapeutic purposes in an extralabel manner so long as there is no threat to public health.
    • An approved human drug may be used for treatment in an extralabel manner even when an identical, approved animal drug exists.
    • Extralabel use of a drug labeled for another animal species can be used only if there is no approved, appropriate drug that is labeled for use in the patient’s species or if an approved drug exists for the patient’s species but is found by the veterinarian to be clinically ineffective.
    • Extralabel use without a VCPR is illegal in all animals.

    Guidelines for compounding of approved new animal and approved human drugs in all animals:

    Compounding from FDA-approved drugs is considered extralabel drug use under FDA rules.

    Compounding is the customized manipulation of an approved drug(s) by either a veterinarian, or by a pharmacist upon the prescription of a veterinarian, to meet the needs of a particular patient. For example, mixing two injectable drugs is compounding. Preparing a paste or suspension from crushed tablets is another example of compounding. Likewise, adding flavoring to a drug is compounding.

    Compounding is not allowed unless there is no approved new animal or approved new human drug that, when used per label or in an extra label fashion, can appropriately treat the condition diagnosed.

    • Compounding must be done by or under the order of a veterinarian.
    • Compounded drugs must not be used for production or performance purposes.
    • A compounded human drug cannot be used in a food-producing animal if a legally compounded animal drug can instead be used.
    • Compounded drugs must be prepared from FDA-approved drugs
    • The volume of compounded drug must be commensurate with the anticipated need for use in individual patients.
    • ​State laws on compounding must also be followed.
    • A veterinarian must be cognizant of the need to maintain a safe food supply. Specifically, veterinarians must not allow entry of a treated animal into the food chain, if there is insufficient scientific evidence indicating a proper withdrawal interval after treatment.


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