EASY TO QUARTER TABLETS FOR PRECISE DOSING

CARDIOLOGY NEPHROLOGY HYPERTENSION DOG CAT

Flexible dosage for precision treatment

FINE-TUNE MANAGEMENT

OF OEDEMA

Furosemide

A complete range of solutions

Libeo 10 mg chewable tablets for dogs: Furosemide 10 mg Libeo 40 mg chewable tablets for dogs: Furosemide 40 mg. INDICATIONS FOR USE: Treatment of ascites and oedema, particularly associated with cardiac insufficiency. CONTRAINDICATIONS: Do not use the product in dogs suffering from hypovolaemia, hypotension or dehydration. Do not use in cases of renal failure with anuria. Do not use in cases of electrolyte deficiency. Do not use in cases of known hypersensitivity to furosemide, sulfonamides or any of the excipients. ADVERSE REACTIONS (FREQUENCY AND SERIOUSNESS): Cross-reactivity to sulfonamides is possible. In rare cases, soft faeces may occur. These signs are transient and mild and do not necessitate the withdrawal of the treatment. Due to the diuretic action of furosemide, there may be hemoconcentration and impairment of the circulation. In cases of prolonged treatment electrolyte deficiency (including hypokalemia, hyponatremia) and dehydration may occur. USE DURING PREGNANCY or LACTATION: Laboratory studies have produced evidence of teratogenic effects. The safety of the product has not been established in pregnant and lactating bitches however, furosemide is excreted into milk. In pregnant and lactating animals, use only according to the benefit/risk assessment by the responsible veterinarian. Always read the SPC before use.

Cardalis contains benazepril and spironolactone POM-V UK, POM IE Nelio contains benazepril POM-V UK Prilactone contains spironolactone POM-V UKFor further information on contraindications, warnings and side-effects, read the product SPC or data sheet.

Use medicines responsibly (www.noah.co.uk/responsible)

For further information contactCeva Animal Health LtdUnit 3, Anglo Office Park, White Lion Road, Amersham, Bucks HP7 9FBTel: 01494 781510 www.ceva.co.uk

Cardiology range

Benazepril andspironolactone

Cardalis® Prilactone®

SpironolactoneBenazeprilNelio®

Easy-to-quarter tablet to fine-tune dosingLibeo® tablets can be broken into four with light pressure. This allows very precise dosage.

Available in packs of 120 tablets.

Weight (kg) 2 - 3.5 3.6 - 5 5.1 - 7.5 12.6 - 1510.1 - 12.57.6 - 10 15.1 - 20 20.1 - 30 30.1 - 40 40.1 - 50

Libeo® 10 mg

Libeo® 40 mg

2 tablet sizes10 mg and 40 mg

Dose rate of 1mg/kg/day

Tools and servicesCardalis App

(sleeping respiratory rate)

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Prila

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Benazepril (mg)

Benazepril (mg)

Furosemide (mg)*

Spironolactone (mg)

Cardalis

®

Libeo®

Nelio®

Cardiology Dosage CalculatorInstructions

Set Weight of Dog •Read appropriate dosage for each drug •

Solutions for Life

www.vetintermed.ceva.com

Cardiology Dosage CalculatorCardioacademy WebsiteMore than 15 hours of CPD. Now

includes webinars for nurses!Dosing Wheel

Cardalis Loyalty Programme for Pet Owners

In Practice Cardiology Training (please ask your territory manager for details)

Pet Owner Information Brochures

Cardalis® Loyalty Programme

Vet’s signature

Vet’s signature

Vet’s signature

Vet’s signature

Vet’s signature

Vet’s signature

Date:

Date:

Date:

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Date:

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CardioDose app

CAD

28 6

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Furosemide to eliminate signs of congestion Flexible dosage for precise treatment

ACVIM 2009 recommendations1 Long term use of furosemide

Long term use in dogs with CHF2,6,8,9

Libeo: the easy to use furosemide

The ACVIM consensus group recommend using furosemide from stage C of CVHD**.

AAt risk

No treatment

MurmurNo cardiac

enlargement

MurmurCardiac

enlargement

Heart Failure Heart Failure Heart Failure Heart Failure

HOSPITALISED AT HOME

Failure orHistory of failure

B1 B2 Ca Cc Da Dc

Asymptomatic Symptomatic

VETERINARY

Refractory Refractory

HOSPITALISED AT HOME

VETERINARY

No treatment Furosemide, ACEi*, Pimobendan

Furosemide, ACEi,Spironolactone*,

Pimobendan

Furosemide, Pimobendan*

Furosemide, Spironolactone,

Pimobendan

ACEi*

Summarised from the 2009 ACVIM consensus statement (J. Vet Intern Med) (*: majority recommendations)

Acute Stage C Chronic Stage C Acute Stage D Chronic Stage D

!

When?As soon as the dog shows signs of congestion such as oedema.

Using furosemide in practice

Suspicion of oedema at the time of clinical examination a thoracic radiograph should be done to confirm the diagnosis5,6.

• Auscultation: Presence of heart murmur with or without cough

• Increased respiratory effort and/or dyspnoea

• Sleeping respiratory rate higher than 30 breaths per minute.3,4

Clinical examination

Diagnosis

Treatment with Furosemide to:

The dosage of furosemide should be adjusted to keep patients free from clinical signs; the optimal dose being the lowest effective dose2,7,9. Using the lowest effective dose helps to reduce the risk of side-effects that lower quality of life as perceived by the pet owner, including urinating in the home, restlessness at night, sub-clinical dehydration and reduced responsiveness to furosemide.

To determine this Minimum Effective Dose (MED), the dosage is reduced progressively (every week, as shown in the example below). The owner should monitor the dog’s resting respiratory rate every day. When the respiratory rate increases, it means that the MED must be increased.

Furosemide activates the Renin-Angiotensin-Aldosterone System (RAAS) when given alone. Therefore when used chronically it should be used with other treatments, such as an ACE Inhibitor and spironolactone to prevent harmful effects caused by the RAAS.5,7,9,10,11 Aldosterone levels in furosemide-treated dogs have been shown to increase by up to 3x. This can cause additional fibrosis of the heart muscle.

4-way break tablets:• Optimal management of the minimum effective dose.• Precise dosage at each stage of the disease. • Improved quality of life.

Specifically formulated for the vet market• Chicken flavoured to make dosing even easier.• Optimised pet owner compliance with your recommendations.• Suitable for even the smallest of patients.

Resolve oedema

Resolve dyspnoea

Reduce respiratory rate

3

2

1

00 1 2 3 4 5 6 7 8 9 10 11 12

weeks13

Libeo® 10mgother furosemide 10mg

Num

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Controlled reduction in MED using Libeo quarters compared to a tablet that is halved

Libeo® improves dosing accuracy at every stage of treatment

1. Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. . J Vet Intern Med. 2009;23(6):1142-50.2. Borgarelli M, Haggstrom J. Canine degenerative myxomatous mitral valve disease: natural history, clinical presentation and therapy. Vet Clin North Am Small Anim Pract. 2010 Jul;40(4):651-63.3. Rishniw M, Ljungvall I, Porciello F, et al. Sleeping respiratory rates in apparently healthy adult dogs. Res Vet Sci. 2012;93(2):965-9.4. Ohad DG, Rishniw M, Ljungvall I, et al. Sleeping and resting respiratory rates in dogs with subclinical heart disease. J Am Vet Med Assoc. 2013;243(6):839-43.5. Le Bobinnec G. Le suivi thérapeutique du chien insuffisant cardiaque. Le point vétérinaire. 1998;29 (188) :33-43.6. Ferasin L, Crews L, Biller DS, et al. Risk factors for coughing in dogs with naturally acquired myxomatous mitral valve disease. J Vet Intern Med. 2013;27(2):286-92.

** Chronic Valvular Heart DiseaseACVIM = American College of Veterinary Internal Medicine

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a dog with heart disease before the onset of congestive heart failure

a dog with heart disease in congestive heart failure

7. Martin, M. Canine congestive heart failure: An approach to case management, Veterinary Times, No. 03, 2012.8. Kochevar DT. Diuretics. In: Riviere JE, Papich MG, eds. Veterinary pharmacology & therapeutics. 9th edition. 2009.647-661.9. Strickland KN. Pathophysiology and therapy of heart failure. In: Tilley LP, Smith FWK Jr, Oyama MA, Sleeper MM, eds. Manual of canine and feline cardiology. 4th edition. 2008. 303-304.10. Lantis AC, Ames MK, Atkins CE, et al. Aldosterone breakthrough with benazepril in furosemide-activated renin-angiotensin-aldosterone system in normal dogs. J Vet Pharmacol Ther. 2015;38(1):65-73.11. Uechi M, Matsuoka M, Kuwajima E, et al. The effects of the loop diuretics furosemide and torasemide on diuresis in dogs and cats. J Vet Med Sci. 2003;65(10):1057-61.

Libeo® 4-way break tablets allow the patient to be managed at the MED as their needs change

Initial dose rate of 1mg/kg/day; 25kg dog. MED reduced weekly as clinical signs improve. At 12 weeks, the respiratory rate increases and so the dose is increased to achieve stability. For illustrative purposes only.