|
|||
|
DRUGS & SUPPLEMENTS
|
Motilium
What do you feel about the cost of the medicine? Is it expensive? |
Motilium uses
- Description
- Indications
- Dosage and administration
- Directions for administration
- Contraindication
- Warnings
- Human warnings
- Precautions
- Adverse reactions
- Information for horse owners
- Clinical pharmacology
- Effectiveness
- Animal safety
- Storage information
- How supplied
- References
CAUTION
Federal law (USA) restricts this drug to use by or on the order of a licensed veterinarian.
For oral use in horses only.
DESCRIPTION
Motilium is D2 dopamine receptor antagonist. Chemically, Motilium is 6-chloro-3-[1-[3-(2-oxo-3H-benzimidazol-1-yl)propyl]piperidin-4-yl]-1H-benzimidazol-2-one.
The structural formula is:
INDICATIONS
For prevention of fescue toxicosis in periparturient mares.
DOSAGE AND ADMINISTRATION
Orally administer 0.5 mg/lb (1.1 mg/kg) once daily starting 10 to 15 days prior to Expected Foaling Date (EFD). Treatment may be continued for up to 5 days after foaling if mares are not producing adequate milk after foaling.
DIRECTIONS FOR ADMINISTRATION
- Determine the appropriate dose for the body weight of the mare based on the dosing table below. One cc will treat 220 lb (100 kg) of body weight.
Weight (lb)
Weight (kg)
cc Motilium (mg)
550-660 250-300 3 330 661-880 301-400 4 440 881-1100 401-500 5 550 1101-1320 501-600 6 660 - Turn the dial ring until the edge of the ring nearest the tip of the syringe lines up with the dose to be delivered.
- Remove the syringe cap.
- Make sure the horse's mouth is free of food or other obstructions.
- Insert the nozzle of the syringe through the interdental space of the horse's mouth and deposit the gel on the back of the tongue by depressing the plunger.
- Recap the syringe.
This is a 25 cc multi-dose syringe. Please note that for subsequent doses, it will be necessary to adjust for previous doses. For example, if the intended dose for a horse is 5 cc, then the dial ring is set at 5 cc for the first dose, at 10 cc for the second dose, at 15 cc for the third dose, at 20 cc for the fourth dose, and at 25 cc for the fifth dose.
CONTRAINDICATION
Horses with hypersensitivity to Motilium should not receive Motilium Gel.
WARNINGS
Failure of passive transfer of immunoglobulins (IgG) may occur when using Motilium Gel even in the absence of leakage of colostrum or milk. All foals born to mares treated with Motilium Gel should be tested for serum IgG concentrations.
Do not use in horses intended for human consumption.
HUMAN WARNINGS
Not for use in humans. For oral use in animals only. Keep this and all drugs out of reach of children. Pregnant and lactating women should use caution when handling Motilium Gel, as systemic exposure to Motilium may affect reproductive hormones. Motilium is not approved for any indication in humans in the US. The safety of Motilium in lactating women and their nursing children has not been evaluated. Consult a physician in case of accidental human exposure.
PRECAUTIONS
Motilium Gel may lead to premature birth, low birth weight foals or foal morbidity if administered > 15 days prior to the expected foaling date. Accurate breeding date(s) and an expected foaling date are needed for the safe use of Motilium Gel.
The safety of Motilium Gel has not been evaluated in breeding, pregnant and lactating mares other than in the last 45 days of pregnancy and the first 15 days of lactation. The safety in stallions has not been evaluated. The long term effects on foals born to mares treated with Motilium Gel have not been evaluated.
Do not use in horses with suspected or confirmed gastrointestinal blockage, as Motilium is a prokinetic drug (it stimulates gut motility).
Use of Motilium Gel may cause a false positive on the milk calcium test used to predict foaling.
Motilium is a known P-glycoprotein substrate1 and its main metabolic pathway in humans is through CYP3A4. Significant inhibition of Motilium metabolism may occur when co-administered with drugs such as erythromycin2 and ketoconazole3. This could result in significantly greater Motilium drug exposure (multi-fold increase) when used with these drugs.
ADVERSE REACTIONS
The most common adverse reactions associated with treatment with Motilium Gel are premature lactation (dripping of milk prior foaling) and failure of passive transfer.
In a laboratory effectiveness study with 32 periparturient mares (17 treated with Motilium Gel and 15 treated with vehicle control) 3/17 (18%) mares treated with Motilium Gel experienced premature lactation. In the 25 foals (16 foals of mares treated with Motilium Gel and 9 foals of vehicle control mares) evaluated for passive transfer, failure of passive transfer occurred in 13/16 (81%) foals of mares treated with Motilium Gel and 8/9 (89%) foals of control mares. Failure of passive transfer in foals of mares treated with Motilium Gel was not solely due to physical loss of colostrum through premature lactation, because 77% of Motilium Gel treated mares that did not drip milk prior to foaling had foals with failure of passive transfer.
In a field study with 279 periparturient mares treated with Motilium Gel, premature lactation was reported in 3 mares (1%) and failure of passive transfer was reported in 3 foals (1%).
In two additional field studies, a total of 2,556 mares were treated with Motilium Gel or a bioequivalent formulation for 2,730 breeding seasons. Horses in these studies were treated with Motilium Gel for varying durations. Of the 2,730 breeding seasons evaluated, premature lactation was reported in 262 mares (9.6%), failure of passive transfer was reported in 50 foals (1.8%), and premature parturition (gestation length ≤ 320 days) occurred in 13 mares (<0.5%).
INFORMATION FOR HORSE OWNERS
Owners should be aware that treatment with Motilium Gel may result in failure of passive transfer of immunoglobulins to the foal and that this may occur even when the mare does not drip milk. Owners should be advised that all foals born to mares treated with Motilium Gel should be tested for serum immunoglobulin (IgG) concentrations. Owners should be informed that Motilium Gel causes false positives on the milk calcium test used to predict foaling. Owners should be directed on the proper use of the multi-dose dosing syringe, including how to set the dial ring for accurate dosing after the first dose.
CLINICAL PHARMACOLOGY
Motilium is a D2 dopamine receptor antagonist that blocks the agonistic action of fescue alkaloids at the cellular level. Unlike other D2 antagonist drugs, Motilium does not readily cross the blood-brain barrier4. Distribution studies with radio-labeled drug in animals have shown wide tissue distribution, but low brain concentration. Small amounts of the drug cross the placenta in rats5. In humans, Motilium is 91-93% bound to plasma proteins. Motilium in humans undergoes rapid and extensive hepatic metabolism by hydroxylation and N-dealkylation1. Urinary and fecal excretions of Motilium in humans amount 31 and 66% of the oral dose, respectively. The proportion of the drug excreted unchanged in humans is small (10% of fecal excretion and approximately 1% of urinary excretion). The average terminal plasma half-life of Motilium administered orally to horses is approximately 6 hours with very low systemic bioavailability.
EFFECTIVENESS
A randomized, masked, controlled, laboratory effectiveness study evaluated the effectiveness of 1.1 mg/kg Motilium Gel administered once daily beginning 10 to 15 days prior to the expected foaling date (EFD - defined as 340 days after the median breeding) and continuing up to 5 days after foaling for the prevention of fescue toxicosis. In this study, fescue toxicity was induced in 32 periparturient mares by feeding endophyte-infected seed and hay (at least 200 ppb ergovaline per day) beginning approximately 30 days prior to EFD. A total of 17 mares were treated with Motilium Gel and 15 mares were treated with a vehicle control. Twenty-seven mares (13 Motilium Gel and 14 vehicle control) were included in the statistical analysis. Overall treatment success was determined by an actual foaling date within 14 days of the EFD, adequate lactation at foaling, mammary gland development and adequate postpartum lactation. Motilium Gel was superior to the vehicle control.
| Treatment Group (number mares) | Treatment Success | Pearson X2 Test |
|---|---|---|
| Vehicle Control (14) | 7% (1 / 14) | Test statistic = 16.320 |
| Motilium Gel (13) | 92% (12 / 13) | p-value < 0.0000 |
| Treatment Group (number mares) | Mean gestation length in days | Percent adequate milk production at foaling | Percent adequate mammary gland development at foaling |
|---|---|---|---|
| Vehicle Control (14) | 346 | 33% (3 / 9) | 30% (3 / 10) |
| Motilium Gel (13) | 337 | 100% (13 / 13) | 100% (13 / 13) |
| Test Statistic | t statistic = 3.754 p = 0.0014 | Pearson X2 = 8.793 p = 0.0030 | Pearson X2 = 9.984 p = 0.0016 |
One mare treated with Motilium Gel was carrying twins. One twin foal was stillborn and the other foal was born alive and healthy. Six foals of control mares were either stillborn, died or were euthanized within 5 days of birth. Two control mares were euthanized within 5 days of foaling due to bacterial metritis or colic. Dystocia occurred in 1 mare treated with Motilium Gel and 4 control mares. One mare treated with Motilium Gel and three control mares experienced retained placentas.
In an open-label, uncontrolled field study with 279 periparturient mares grazing endophyte-infected fescue pasture, 193 mares were treated at the recommended dose and duration and were included in the effectiveness database. Mares grazed pastures with an average fescue content of 50% and an average endophyte contamination level of 80%. The mares had an average gestation length of 340 days. Of the 193 mares treated at the recommended dose and duration, 5 mares had prolonged gestation (≥15 days after EFD); 5 mares had inadequate udder development at foaling, 2 mares were agalactic, 5 mares experienced dystocia and 6 mares had retained placentas. Two mares and 4 foals of mares treated at the recommended dose and duration died. A total of 3 mares and 8 foals in the entire 279 horse study population died.
ANIMAL SAFETY
In a target animal safety study Motilium Gel was administered orally to 32 healthy periparturient mares once daily at 0X, 1X, 3X or 5X the maximum exposure dose estimated for a 550 lb mare. Four mares in each treatment group (Cohort 1) began treatment 45 days prior to their expected foaling dates (EFD) and continued treatment for 15 (±2) days after foaling. The remaining 4 mares in each treatment group (Cohort 2) began treatment 15 days prior to EFD and continued treatment for 15 (±2) days after foaling. Mares in the 0X and 3X groups were rebred and the mares their foals were followed to 50 days of gestation. EFD was calculated as 340 days after the median breeding date.
| Number of mares started on treatment: | |||
|---|---|---|---|
| Treatment group | Dose | 45 days before EFD (Cohort 1) | 15 days before EFD (Cohort 2) |
| 1 | (0X) 0.0 mg/kg | 4 | 4 |
| 2 | (1X) 1.46 mg/kg | 4 | 4 |
| 3 | (3X) 4.38 mg/kg | 4 | 4 |
| 4 | (5X) 7.30 mg/kg | 4 | 4 |
Mares treated with Motilium Gel had a higher incidence of premature parturition. There was a significant decrease in gestation length, with corresponding lower birth weights of foals, in mares treated with Motilium Gel beginning 45 days prior to EFD (Cohort 1). Mares treated with Motilium Gel beginning 45 days prior to EFD foaled and average of 27 days early (range 12 to 40 days early.) Mares treated with Motilium Gel begininning 15 days prior to EFD foaled an average of 5 days early (range 12 days early to 5 days late). (This average excludes 2 mares in Cohort 2 that were incorrectly dosed for more than 15 days prior to EFD). Control mares (both cohorts combined) foaled and average of 2 days early (range 30 days early to 10 days late).
Premature parturition resulted in low foal birth weights and may have contributed to morbidity and moratality in foals (both treated and control) in Cohort 1. Four out of 12 foals born to mares treated with Motilium Gel on Cohort 1 died or were euthanized within 11 days of birth. These foals were born 12 to 40 days early. One control foal in Cohort 2 (born 30 days early) died at 14 days. Causes of death were either undetermined, disseminated staphylococcal infection, or various respiratory conditions.
Mares treated with Motilium Gel had a higher incidence of dripping milk (96%) prior to parturition than control mares (50%). More mares treated with Motilium Gel (71%) dripped milk 3 or more days prior to parurition than control mares (0%). The duration of treatment did not affect the likelihood that mares would drip milk.
| Cohort | 0X | 1X | 3X | 5X |
|---|---|---|---|---|
| 1 | 0 | 3 | 3 | 4 |
| 2 | 0 | 2 | 2 | 4 |
Failure of passive transfer occured in all groups; however, there was a greater incidence of IgG concentrations <400 mg/dL in foals of mares treated with Motilium Gel. The incidence of failure of passive transfer also increased with dose. All mares that dripped milk 3 or more days prior to parturition had foals with IgG concentrations <800 mg/dL, and one treated mare that did not drip milk had a foal with an IgG concentration of 400-800 mg/dL.
| # Foals (percentage) | Overall incidence of <800 mg/dL | ||||
|---|---|---|---|---|---|
| Treatment Group | #Foals | <400 mg/dL | 400-800 mg/dL | ≥800 mg/dL | |
| 0X | 8 | 3 (38%) | 2 (25%) | 3 (38%) | 63% |
| 1X | 6 | 3 (50%) | 1 (17%) | 2 (33%) | 67% |
| 3X | 7 | 5 (71%) | 1 (14%) | 1 (14%) | 86% |
| 5X | 8 | 7 (88%) | 1 (13%) | 0 (0%) | 100% |
Foals of mares treated with Motilium Gel experienced more diarrhea and loose stool than foals of control mares during the treatment phase (first 15 days of life). All episodes of diarrhea were self-limiting and resolved without treatment.
| Treatment group (n=8 foals/group) | # Foals (percentage) |
|---|---|
| 0X | 1 (12.5%) |
| 1X | 4 (50%) |
| 3X | 6 (75%) |
| 5X | 5 (63%) |
Mares treated with Motilium Gel generally had higher white blood cell counts (WBC) and/or granulocyte counts and gamma glutamyl transferase (GGT) and/or alkaline phosphatase (ALP) concentrations than control mares. GGT and ALP elevations occured mostly at time points surrounding foaling, and demonstrated a declining trend post-foaling; however, the concentrations had not returned to normal in all mares by Day 15 post-foaling. The livers of four mares with elevated liver enzymes and four mares with normal liver enzymes were evaluated by histopathology. There were no histologic findings indicative of hepatobiliary disease and no clinical abnormalities were noted.
More foals of mares treated with Motilium Gel had granulocyte and/or neutrophil counts below the reference range on the day of foaling than foals born to control mares. The decreased neutrophil counts in foals of mares treated with Motilium Gel occcured more commonly in foals born more than 25 days prior to EFD. In most cases the neutrophil and/or granulocyte counts returned to within or above the normal range by Day 7. Foals of mares treated with Motilium Gel had higher ALP concentrations than foals of control mares. Additionally, several foals of mares treated with Motilium Gel also had elevations in GGT.
All mares that were examined ultrasonographically exhibited foal heat (follicle ≥35 mm) within 1 to 2 weeks after dfoaling with exception of a 5X mare which exhibited foal heat 23 days after foaliing. Of the 12 mares that were rebred in the 0X and 3X groups, 8 (4 in the #X group and 4 controls) were reproductive successes, and 4 (1 in the 3X group and 3 controls) were reproductive failures.
| Treatment group | # Mares bred | Pregnant at Day 50 (percentage) |
|---|---|---|
| 0X | 7 | 4 (57%) |
| 3X | 5 | 4 (80%) |
STORAGE INFORMATION
Store at controlled room temperature 25°C (77°F) with excursions between 15°-30°C (59°-86°F) permitted. Recap after each use.
HOW SUPPLIED
Motilium Gel is supplied in disposable, multi-dose, 25 cc syringes, each containing 2.75 g of Motilium suspended in an oral gel. Each cc of gel contains 110 mg of Motilium. The net weight of each syringe is approximately 26 g. Syringes are supplied in single carton and six per carton.
| Motilium Gel 1 Syringe Carton | NDC 17033-326-01 |
| Motilium Gel 6 Syringe Carton | NDC 17033-326-06 |
REFERENCES
- Pal D and Mitra AK. MDR- and CYP3A4-Mediated Drug-Drug Interactions. Journal of Neuroimmune Pharmacology 1: 323-339; 2006.
- Ung D, Parkman HP, and Nagar S. Metabolic Interactions Between Prokinetic Agents Motilium and Erythromycin: an in vitro Analysis. Xenobiotica 39(10): 749-756; 2009.
- Medicines Control Council. Interaction Between Ketoconazole and Motilium and the Risk of QT Prolongation-Important Safety Information. South African Medical Journal 96(7): 596; 2006.
- The European Agency for the Evaluation of Medicinal Products. Motilium and Associated Names (London, 2002).
- Heykants J, Knaeps A, Meuldermans W, and Michiels M. On the Pharmacokinetics of Motilium in Animals and Man. I. Plasma Levels of Motilium in Rats and Dogs. Age Related Absorption and Passage through the Blood Brain Barrier in Rats. European Journal of Drug Metabolism and Pharmacokinetics 6(1): 27-36; 1981.
NADA 141-314, Approved by FDA.
NDC: 17033-326-06
| TAKE TIME | OBSERVE LABEL DIRECTIONS |
Distributed by:
Dechra Veterinary Products, 7015 College Boulevard, Suite 525, Overland Park, KS 66211
For a copy of the Material Safety Data Sheet (MSDS) or to report adverse reactions call Dechra Veterinary Products at (866) 933-2472.
US Patents 5,372,818; 6,534,536; 6,224,895
© 2010 Dechra Ltd
Motilium Gel is a registered trademark of Dechra Ltd. All rights reserved.
Figure
Motilium pharmaceutical active ingredients containing related brand and generic drugs:
Motilium available forms, composition, doses:
Motilium destination | category:
Motilium Anatomical Therapeutic Chemical codes:
Motilium pharmaceutical companies:
References
- Dailymed."EQUIDONE (DOMPERIDONE) GEL [DECHRA VETERINARY PRODUCTS]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
- "domperidone". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
- "domperidone". http://www.drugbank.ca/drugs/DB0118... (accessed August 28, 2018).
Frequently asked Questions
Can i drive or operate heavy machine after consuming Motilium?Depending on the reaction of the Motilium after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Motilium not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Motilium addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
Review
sdrugs.com conducted a study on Motilium, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Motilium consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.Visitor reports
Visitor reported useful
No survey data has been collected yetVisitor reported side effects
No survey data has been collected yetVisitor reported price estimates
No survey data has been collected yetThree visitors reported frequency of use
How often in a day do you take the medicine?Are you taking the Motilium drug as prescribed by the doctor?
Few medications can be taken Twice in a day more than prescribed when the doctor's advice mentions the medicine can be taken according to frequency or severity of symptoms. Most times, be very careful and clear about the number of times you are taking the medication. The report of sdrugs.com website users about the frequency of taking the drug Motilium is mentioned below.
| Visitors | % | ||
|---|---|---|---|
| Twice in a day | 2 | 66.7% | |
| Once in a day | 1 | 33.3% | |
One visitor reported doses
What is the dose of Motilium drug you are taking?According to the survey conducted among sdrugs.com website users, the maximum number of people are using the following dose 6-10mg. Few medications come in only one or two doses. Few are specific for adult dose and child dose. The dose of the medicine given to the patient depends on the severity of the symptom/disease. There can be dose adjustments made by the doctor, based on the progression of the disease. Follow-up is important.
| Visitors | % | ||
|---|---|---|---|
| 6-10mg | 1 | 100.0% | |
One visitor reported time for results
What is the time duration Motilium drug must be taken for it to be effective or for it to reduce the symptoms?Most chronic conditions need at least some time so the dose and the drug action gets adjusted to the body to get the desired effect. The stastistics say sdrugs.com website users needed > 3 month to notice the result from using Motilium drug. The time needed to show improvement in health condition after using the medicine Motilium need not be same for all the users. It varies based on other factors.
| Visitors | % | ||
|---|---|---|---|
| > 3 month | 1 | 100.0% | |
Visitor reported administration
No survey data has been collected yetOne visitor reported age
| Visitors | % | ||
|---|---|---|---|
| 1-5 | 1 | 100.0% | |
Visitor reviews
There are no reviews yet. Be the first to write one! |
The information was verified by Dr. Rachana Salvi, MD Pharmacology