Benazepril Hydrochloride

ben-ay′zeh-pril hye-droe-klor′ide

Trade and other names: Lotensin (human preparation) and Fortekor, Benazecare (veterinary preparation)

Functional classification: Vasodilator, angiotensin-converting enzyme (ACE) inhibitor

Pharmacology and Mechanism of Action

ACE inhibitor. Inhibits conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and will also stimulate sympathetic stimulation, renal hypertension, and synthesis of aldosterone. The inhibition of aldosterone will decrease sodium and water retention. Benazepril, like other ACE inhibitors, will produce vasodilation and decrease aldosterone-induced congestion. ACE inhibitors also contribute to vasodilation by increasing concentrations of some vasodilating kinins and prostaglandins. Unlike enalapril, benazepril has a dual mode of elimination through the kidneys and liver. Duration of ACE-inhibiting action is 16-24 hours, despite a short plasma half-life, because of high-affinity binding to ACE.

Indications and Clinical Uses

Benazepril, like other ACE inhibitors, is used to treat hypertension and CHF. Evidence shows that it may decrease the likelihood of developing cardiomyopathy in some dogs, but other studies failed to show this benefit. For treatment of occult mitral valve disease in dogs, there has not been a benefit of therapy. It may benefit some cats in heart failure or with systemic hypertension; however, some cats with hypertension may not respond, and ACE inhibitors are not considered a primary treatment for hypertension in cats. Benazepril has limited antihypertensive effects in cats with naturally occurring renal disease but may be effective in slowing the progression of renal failure. In studies in which it has been used in cats with renal insufficiency, it was associated with a small reduction in systemic hypertension, reduced glomerular filtration pressure, decreased glomerular hypertension, reduction in urine protein loss, and an increase in glomerular filtration rate (GFR), but no overall benefits on survival. In dogs it produces similar benefits to animals with renal disease (decreased proteinuria, increased GFR, and lower blood pressure), but it does not increase survival.

Instructions for Use

Dose is based on approved use in dogs in Europe and Canada. Monitor renal function and electrolytes 3-7 days after initiating therapy and periodically thereafter. In studies in cats there was no benefit to doses higher than 0.5-1 mg/kg/day.

Patient Monitoring and Laboratory Tests

Monitor patients carefully to avoid hypotension. With all ACE inhibitors, monitor electrolytes and renal function 3-7 days after initiating therapy and periodically thereafter.

Formulations

Benazepril is available in 5-, 10-, 20-, and 40-mg tablets.

Stability and Storage

Store in a tightly sealed container, protected from light, and at room temperature. Stability of compounded formulations has not been evaluated.

Large Animal Dosage

No dose has been reported for large animals.

Regulatory Information

Do not administer to animals intended for food.

RCI Classification: 3

Betamethasone

bay-tah-meth′ah-sone

Trade and other names: Celestone, betamethasone acetate, and betamethasone benzoate

Functional classification: Corticosteroid

Pharmacology and Mechanism of Action

Potent, long-acting corticosteroid. Anti-inflammatory and immunosuppressive effects are approximately 30 times more than cortisol. Anti-inflammatory effects are complex but primarily occur via inhibition of inflammatory cells and suppression of expression of inflammatory mediators.

Indications and Clinical Uses

Betamethasone is used for treatment of inflammatory and immune-mediated disease. It is used for similar indications as prednisolone and dexamethasone.

Precautionary Information

Instructions for Use

Betamethasone is used for similar indications as dexamethasone because of similar potency and duration of effect. Topical forms of betamethasone also are available.

Patient Monitoring and Laboratory Tests

Monitor CBC and plasma cortisol.

Formulations

Betamethasone is available in 600-mcg (0.6-mg) tablets and 3 mg/mL sodium phosphate injection.

Stability and Storage

Store in a tightly sealed container, protected from light, and at room temperature. Stability of compounded formulations has not been evaluated.

Small Animal Dosage

Dogs and Cats

• Anti-inflammatory effects: 0.1-0.2 mg/kg q12-24h PO.

• Immunosuppressive effects: 0.2-0.5 mg/kg q12-24h PO.

Large Animal Dosage

• 0.05-0.1 mg/kg q24h IM or PO.

Regulatory Information

No withdrawal times are established for animals intended for food (extralabel use).

RCI Classification: 4

Bethanechol Chloride

beh-than′eh-kole klor′ide

Trade and other names: Urecholine

Functional classification: Cholinergic

Pharmacology and Mechanism of Action

Muscarinic, cholinergic agonist. Parasympathomimetic. Bethanechol stimulates gastric and intestinal motility. It also stimulates contraction of urinary bladder via muscarinic receptor activation. Bethanechol, like other carbamoyl esters, resists hydrolysis by acetylcholinesterase to produce a more sustained response. The onset of action is usually 10 minutes after injection and 30-60 minutes after oral administration. Duration of effect is 4-6 hours.

Indications and Clinical Uses

Bethanechol is used in small animals to increase contraction of urinary bladder. In large animals it may increase gastrointestinal motility, but the efficacy for treating GI stasis problems is questionable.

Instructions for Use

Administer injection SQ only. Doses are derived from extrapolation of human doses or via empiricism. There are no well-controlled efficacy studies available for veterinary species.

Bethanechol is no longer available from commercial sources, but some veterinary compounding pharmacists may be able to supply veterinarians.

Patient Monitoring and Laboratory Tests

Monitor GI function.

Formulations

Bethanechol is available in 5-, 10-, 25-, and 50-mg tablets and 5-mg/mL injection. (Commercial preparations are no longer available but are available through some compounding pharmacies.)

Stability and Storage

Store in a tightly sealed container at room temperature. Compounded oral suspensions prepared from tablets are not stable.

Small Animal Dosage

Dogs

• 5-15 mg/dog q8h PO (2.5 mg per dog for small dogs).

Cats

• 1.25-5 mg/cat q8h PO.

Large Animal Dosage

Horses

• 0.025 mg/kg SQ.

Cattle

• 0.07 mg/kg SQ.

Regulatory Information

No withdrawal times are established for animals intended for food (extralabel use). However, FARAD (1-888-873-2723) recommends a 21-day withdrawal time for slaughter.

RCI Classification: 4

Bisacodyl

biss-ah-koe′dil

Trade and other names: Dulcolax

Functional classification: Laxative

Pharmacology and Mechanism of Action

Laxative/cathartic. Bisacodyl acts via local stimulation of GI motility, most likely by irritation of bowel.

Indications and Clinical Uses

Bisacodyl is used as a laxative or for procedures in which bowel evacuation is necessary. It may be used with polyethylene glycol electrolyte solution (e.g., Golytely) to cleanse the bowel prior to endoscopy or surgical procedures.

Instructions for Use

Bisacodyl is available as an OTC tablet. Doses are derived from extrapolation of human doses or via empiricism. There are no well-controlled efficacy studies available for veterinary species. Onset of action is approximately 1 hour after administration.

Patient Monitoring and Laboratory Tests

Monitor electrolytes in animals if used chronically.

Formulations

Bisacodyl is available in 5-mg tablets.

Stability and Storage

Store in a tightly sealed container, protected from light, and at room temperature. Stability of compounded formulations has not been evaluated.

Small Animal Dosage

Dogs and Cats

• 5 mg/animal q8-24h PO.

Large Animal Dosage

No dose has been reported for large animals.

Regulatory Information

Do not administer to animals intended for food.

Bismuth Subsalicylate

biz′muth sub-sal-iss′ih-late

Trade and other names: Pepto-Bismol

Functional classification: Antidiarrheal

Pharmacology and Mechanism of Action

Antidiarrheal agent and GI protectant. Precise mechanism of action is unknown, but antiprostaglandin action of salicylate component may be beneficial for enteritis. The bismuth component is efficacious for treating infections caused by spirochete bacteria (Helicobacter pylori gastritis). Bismuth subsalicylate in Pepto-Bismol contains five sources of salicylate, which are absorbed systemically after oral administration. Bismuth subsalicylate also may be found in other antidiarrhea preparations, such as kaolin-pectin formulations (e.g., Kaopectate).

Indications and Clinical Uses

Bismuth subsalicylate is used for symptomatic treatment of diarrhea in small and large animals. Efficacy has not been established for animals. However, in people it has been shown effective for treating or preventing diarrhea caused by enterotoxigenic Escherichia coli (ETEC).

Instructions for Use

Bismuth subsalicylate is available as an OTC product. Doses are derived from extrapolation of human doses or via empiricism. There are no well-controlled efficacy studies available for veterinary species.

Patient Monitoring and Laboratory Tests

No specific monitoring is necessary.

Formulations

Bismuth subsalicylate is available in oral suspension in 262 mg/15 mL or 525 mg/mL in extra-strength formulation and 262-mg tablets. Two tablespoons (30 mL) contain 270-mg salicylate.

Stability and Storage

Store in a tightly sealed container, protected from light, and at room temperature. Stability of compounded formulations has not been evaluated.

Small Animal Dosage

Dogs and Cats

• 1-3 mL/kg/day (in divided doses) PO.

Large Animal Dosage

Calves

• 30 mL q30min for 8 doses PO.

Horses

• 1-2 mL/kg q6-8h PO.

Regulatory Information

No withdrawal times are established for animals intended for food (extralabel use). Because salicylate component may be systemically absorbed, withdrawal times should be considered for the salicylate component (similar to aspirin).

Bisoprolol fumarate

bis-oh′-proe-lol

Trade and other names: Zebeta

Functional classification: Antiarrhythmic, beta blocker

Pharmacology and Mechanism of Action

Bisoprolol is a synthetic beta₁-selective beta-adrenergic receptor blocker with a low affinity for beta₂-receptors in bronchial smooth muscle, blood vessels, and fat cells and no intrinsic sympathomimetic activity. Typical cardioselective effects include lower heart rate, decreased cardiac output, and inhibition of renin release by kidneys. At higher doses it will lose beta₁ selectivity and also inhibit some beta₂ receptors to affect bronchial and vascular smooth muscle. Clearance in dogs is balanced (60% metabolized by the liver and 40% excreted unchanged), distinguishing bisoprolol from lipophilic beta blockers such as carvedilol and metoprolol and hydrophilic beta blockers like atenolol. In dogs, bisoprolol has high and consistent oral absorption (91%) and a half-life of 4 hours. Although bisoprolol prolongs survival in human patients with heart failure, similar studies have not been conducted in dogs or cats.

Indications and Clinical Uses

Bisoprolol is a beta₁ blocker that is somewhat cardioselective and therefore is indicated for conditions that require a reduction in heart rate, heart conductivity, or contractility. Such conditions include tachyarrhythmias and atrial fibrillation. In people it is used to treat hypertension, but this use has not been explored in animals.

Instructions for Use

Dosing precautions are similar to other beta-blocking drugs.

Patient Monitoring and Laboratory Tests

Monitor heart rate and rhythm. Monitor blood pressure in patients prone to hypotension.

Formulations

Bisoprolol is available in 5- and 10-mg tablets.

Stability and Storage

Store in a tightly sealed container, protected from light, and at room temperature. Stability of compounded formulations has not been evaluated.

Small Animal Dosage

Dogs

• 0.1-0.2 mg/kg q8-12h, PO.

Cats

• No dose has been established for cats.

Large Animal Dosage

No dose has been reported for large animals.

Regulatory Information

No regulatory information is available. For extralabel use withdrawal interval estimates, contact FARAD at 1-888-USFARAD (1-888-873-2723).

Bleomycin Sulfate

blee-oh-mye′sin sul′fate

Trade and other names: Blenoxane

Functional classification: Anticancer agent

Pharmacology and Mechanism of Action

Anticancer antibiotic agent. Exact mechanism of action is unknown, but it may bind to DNA and prevent synthesis.

Indications and Clinical Uses

Bleomycin is used for treatment of various sarcomas and carcinomas.

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