Naxdom

Domperidone:

• 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
• Naxdom (Domperidone) reviews

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

Naxdom (Domperidone) is D₂ dopamine receptor antagonist. Chemically, Naxdom (Domperidone) is 6-chloro-3-[1-[3-(2-oxo-3H-benzimidazol-1-yl)propyl]piperidin-4-yl]-1H-benzimidazol-2-one.

The structural formula is:

Chemical Structure

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	Naxdom (Domperidone) (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 Naxdom (Domperidone) should not receive Naxdom (Domperidone) Gel.

WARNINGS

Failure of passive transfer of immunoglobulins (IgG) may occur when using Naxdom (Domperidone) Gel even in the absence of leakage of colostrum or milk. All foals born to mares treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel, as systemic exposure to Naxdom (Domperidone) may affect reproductive hormones. Naxdom (Domperidone) is not approved for any indication in humans in the US. The safety of Naxdom (Domperidone) in lactating women and their nursing children has not been evaluated. Consult a physician in case of accidental human exposure.

PRECAUTIONS

Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel.

The safety of Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel have not been evaluated.

Do not use in horses with suspected or confirmed gastrointestinal blockage, as Naxdom (Domperidone) is a prokinetic drug (it stimulates gut motility).

Use of Naxdom (Domperidone) Gel may cause a false positive on the milk calcium test used to predict foaling.

Naxdom (Domperidone) is a known P-glycoprotein substrate¹ and its main metabolic pathway in humans is through CYP3A4. Significant inhibition of Naxdom (Domperidone) metabolism may occur when co-administered with drugs such as erythromycin² and ketoconazole³. This could result in significantly greater Naxdom (Domperidone) drug exposure (multi-fold increase) when used with these drugs.

ADVERSE REACTIONS

The most common adverse reactions associated with treatment with Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel and 15 treated with vehicle control) 3/17 (18%) mares treated with Naxdom (Domperidone) Gel experienced premature lactation. In the 25 foals (16 foals of mares treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel and 8/9 (89%) foals of control mares. Failure of passive transfer in foals of mares treated with Naxdom (Domperidone) Gel was not solely due to physical loss of colostrum through premature lactation, because 77% of Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel or a bioequivalent formulation for 2,730 breeding seasons. Horses in these studies were treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel should be tested for serum immunoglobulin (IgG) concentrations. Owners should be informed that Naxdom (Domperidone) 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

Naxdom (Domperidone) is a D₂ dopamine receptor antagonist that blocks the agonistic action of fescue alkaloids at the cellular level. Unlike other D₂ antagonist drugs, Naxdom (Domperidone) 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, Naxdom (Domperidone) is 91-93% bound to plasma proteins. Naxdom (Domperidone) in humans undergoes rapid and extensive hepatic metabolism by hydroxylation and N-dealkylation¹. Urinary and fecal excretions of Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel and 15 mares were treated with a vehicle control. Twenty-seven mares (13 Naxdom (Domperidone) 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. Naxdom (Domperidone) Gel was superior to the vehicle control.

One mare treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel and 4 control mares. One mare treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) 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.

Mares treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel beginning 45 days prior to EFD (Cohort 1). Mares treated with Naxdom (Domperidone) Gel beginning 45 days prior to EFD foaled and average of 27 days early (range 12 to 40 days early.) Mares treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel had a higher incidence of dripping milk (96%) prior to parturition than control mares (50%). More mares treated with Naxdom (Domperidone) 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.

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 Naxdom (Domperidone) 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 of mares treated with Naxdom (Domperidone) 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.

Mares treated with Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) 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 Naxdom (Domperidone) Gel had higher ALP concentrations than foals of control mares. Additionally, several foals of mares treated with Naxdom (Domperidone) 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.

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

Naxdom (Domperidone) Gel is supplied in disposable, multi-dose, 25 cc syringes, each containing 2.75 g of Naxdom (Domperidone) suspended in an oral gel. Each cc of gel contains 110 mg of Naxdom (Domperidone). The net weight of each syringe is approximately 26 g. Syringes are supplied in single carton and six per carton.

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 Naxdom (Domperidone) and Erythromycin: an in vitro Analysis. Xenobiotica 39(10): 749-756; 2009.
• Medicines Control Council. Interaction Between Ketoconazole and Naxdom (Domperidone) 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 Naxdom (Domperidone) in Animals and Man. I. Plasma Levels of Naxdom (Domperidone) 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

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

Naxdom (Domperidone) Gel is a registered trademark of Dechra Ltd. All rights reserved.

Figure

Naproxen Sodium:

• Naxdom information
• Naxdom indications
• Naxdom warnings
• Naxdom intake guidelines
• Naxdom dosage
• Naxdom overdose
• Naxdom missed dose
• Naxdom side effects
• Naxdom drug reactions
• Naxdom (Naproxen Sodium) reviews

Naxdom information

Naxdom (Naproxen Sodium) is an anti-inflammatory non-steroidal anti-inflammatory (NSAID) medicine. Naxdom (Naproxen Sodium) Actavis's actions help reduce the chemicals found in the patient's organism that are usually responsible for the triggering of inflammation and pain.

Naxdom indications

Naxdom (Naproxen Sodium) is a drug normally prescribed in the treatment of pain, stiffness or inflammation that are usually triggered by medical disorders such as Gout, Osteoarthritis, menstruation abdominal cramps, rheumatoid arthritis, ankylosing spondylitis, injury, buritis and tendonitis.

Naxdom (Naproxen Sodium) could also be prescribed in the treatment of other medical conditions that have not been mentioned here.

Naxdom warnings

While the patient is following a treatment with Naxdom (Naproxen Sodium) Actavis, he or she should avoid consuming big amounts of alcohol. It is recommended that alcohol drinks should be entirely avoided as they increase the danger of stomach bleeding. Therefore, if the patient is consuming more than 3 bottles of different alcoholic beverages he or she might not be allowed to start a treatment with Naxdom (Naproxen Sodium) Actavis.

Naxdom (Naproxen Sodium) can lead to drowsiness and dizziness. If you are following a treatment with this drug you should be careful while performing actions that require mental and physical alertness. The treatment with Naxdom (Naproxen Sodium) should be carefully monitored in the case of patients suffering from any of the next medical disorders:

Allergic reactions to Aspirin (or any other NSAIDs)

Bleeding disorder

Liver problems

High blood pressure

Heart failure

Congestive heart disease

Fluid retention

Ulcer

Kidney disease

Stomach bleeding

If you are suffering from any of these medical disorders you might not be allowed to start a treatment with Naxdom (Naproxen Sodium) Actavis.

Naxdom (Naproxen Sodium) is a Category B FDA pregnancy drug. Therefore it is not considered to be harmful to an unborn child. However, if you are pregnant, consult with your doctor before starting a treatment with Naxdom (Naproxen Sodium) Actavis. Naxdom (Naproxen Sodium) (one of Naxdom (Naproxen Sodium) Actavis's main ingredients) can pass into breast milk. If you are nursing an infant you should consult with your doctor before starting a treatment with Naxdom (Naproxen Sodium) Actavis.

Naxdom intake guidelines

Naxdom (Naproxen Sodium) ought to be taken in just like your doctor told you to. Do not disobey the physician's instructions.

You should accompany each dose of the drug with a glass of water (from 6 to 8 ounces of liquid). Do not take Naxdom (Naproxen Sodium) on an empty stomach as it can cause stomach upset. Do not stop your treatment with this drug without your doctor's consent even if you do not feel better after a few days of treatment.

Naxdom dosage

Ask your doctor to calculate the dose of Naxdom (Naproxen Sodium) that suits you best. The correct dosage varies from one person to another, as it depends on a couple of factors.

Naxdom overdose

Reported Naxdom (Naproxen Sodium) overdose symptoms are:

Nausea

Excessive sweating

Vomiting

Tingling sensation in legs and arms

Blurred vision

No or little urine production

Shallow and slow breathing

Stomach pains

Numbness

Ringing in the ears

If you are experiencing any of the symptoms listed here, you are in need of medical attention (inform your doctor immediately).

Naxdom missed dose

Naxdom (Naproxen Sodium) can be taken in when you need it or on a regular basis. If you are following a treatment with Naxdom (Naproxen Sodium) Actavis, try not to miss any of your doses. If you happen to miss one take it as soon as possible. If it is almost time for another dose, skip the one that you have missed and continue with your regular schedule. You should not take in a double dose of this drug.

Naxdom side effects

Very serious side effects of Naxdom (Naproxen Sodium) are bloody vomit or bloody stools.

Other dangerous side effects of Naxdom (Naproxen Sodium) are:

Allergic reactions (difficulty while breathing, throat closing, hives, swelling of mouth, lips and tongue).

Tingling

Muscle cramps

Mouth ulcers

Numbness

Fluid retention

Jaundice

Ringing in the ears

Stomach cramps or stomach upsets, indigestion or heartburn

Other side effects of the drug are:

Dizziness

Nausea

Headache

Fatigue

Depression

Dry mouth

Weakness

Irregular menstruation

There are other mild side effects that can also occur if you are taking Naxdom (Naproxen Sodium) Actavis. Inform your physician if you feel anything disturbing or unusual.

Naxdom drug reactions

You should inform your doctor if you are following a treatment with any of the drugs listed here:

Aspirin

NSAIDs

Cold and cough medicines

Steroids (like prednisone)

Anti coagulants

Insulin

Lithium

Probenecid

Pepto-Bismol

If you are taking any of these drugs you may not be allowed to start taking Naxdom (Naproxen Sodium) Actavis. Ask for your doctor's advice before you start a treatment with this drug.