Chapter 4 Reptiles
TABLE 4-1 Antimicrobial Agents Used in Reptiles.a,b
| Agent | Dosage | Species/Comments |
|---|---|---|
| Amikacin | — | Potentially nephrotoxic; maintain hydration; frequently used with a penicillin or cephalosporin |
| 26 μg/kg/hr via osmotic infusion pump implant295 | Corn snakes/PD; 1.7 mg/kg IM loading dose at time of implant | |
| 3.48 mg/kg IM once151 | Pythons/PD (ball pythons) | |
| 5 mg/kg IM, then 2.5 mg/kg q72h192 | Gopher snakes/PD; house at high end of optimum temperature range during treatment | |
| 5 mg/kg IM, then 2.5 mg/kg q72h10,286 | Lizards | |
| 2.5-3 mg/kg IM q72h × 5 treatments304 | Sea turtles | |
| 5 mg/kg IM q48h35 | Gopher tortoises/PD; 30°C (86°F) | |
| 2.25 mg/kg IM q72h140 | Alligators/PD | |
| 50 mg/10 mL saline × 30 min nebulization q12h96 | Most species/pneumonia; aminophylline at 25 mg/9 mL of sterile saline in nebulizer before antibiotics for bronchodilation253 | |
| Amoxicillin | 10 mg/kg IM q24h62 | Most species/use with an aminoglycoside |
| 22 mg/kg PO q12-24h64,83 | Most species/use with an aminoglycoside | |
| Ampicillin | — | May use with an aminoglycoside |
| 3-6 mg/kg PO, SC, IM q12-24h83,92 | Most species | |
| 10-20 mg/kg SC, IM q12h144 | Most species, including chameleons | |
| 20 mg/kg IM q24h243 | Chelonians | |
| 50 mg/kg IM q12h86,280 | Tortoises | |
| Azithromycin | 10 mg/kg PO q2-7d48 | Ball pythons/PD; single dose study; may cause nonregenerative anemia; Mycoplasma, Cryptosporidium, Giardia and other susceptible organisms; location dictates dosage frequency: skin, q3d; respiratory tract, q5d; liver/kidneys, q7d |
| Carbenicillin | 200 mg/kg IM q24h128 | Carpet pythons/PD |
| 400 mg/kg IM q24h172 | Snakes/PD; 30°C (86°F) | |
| 400 mg/kg SC, IM q24h10 | Lizards/may use with an aminoglycoside (administer at different time of day) | |
| 200-400 mg/kg IM q48h243 | Chelonians/may use with an aminoglycoside; may cause skin sloughing in desert tortoises; fluid therapy recommended | |
| 400 mg/kg IM q48h171 | Chelonians/PD (Testudo spp) | |
| Cefoperazone (Cefobid, Pfizer) | 100 mg/kg IM q96h86 | Snakes/PD (false water cobras; 24°C [75°F]) |
| 125 mg/kg IM q24h86 | Lizards/PD (tegus; 24°C [75°F]) | |
| Cefotaxime | 20-40 mg/kg IM q24h92,243 | Most species/may use with an aminoglycoside |
| 100 mg/10 mL saline × 30 min nebulization q24h226 | Most species/pneumonia | |
| Ceftazidime | 20-40 mg/kg SC, IM, q48-72h86,286,305 | Most species/in chameleons use q24h |
| 20 mg/kg SC, IM, IV q72h10,170 | Snakes/PD; 30°C (86°F); especially effective against gram-negative aerobes (i.e., Pseudomonas) | |
| 22 mg/kg IM, IV q72h289 | Sea turtles | |
| Ceftiofur sodium | 2.2 mg/kg IM q48h64 | Snakes |
| 5 mg/kg SC, IM q24h20 | Lizards/PD (green iguanas) | |
| 2.2 mg/kg IM q24h64 | Turtles | |
| 4 mg/kg IM q24h64,92 | Tortoises/upper respiratory infection | |
| Cefuroxime | 100 mg/kg IM q24h64,92 | Most species, including snakes/30°C (86°F); may use with an aminoglycoside |
| Cephalexin | 20-40 mg/kg PO q12h86 | Most species/unknown absorption |
| Cephalothin | 20-40 mg/kg IM q12h86,92,291 | Most species |
| Chloramphenicol | — | Most species/public health concern; reserve for meningitis or encephalitis caused by susceptible organisms |
| 40 mg/kg PO, SC, IM q24h, or 20 mg/kg PO, SC, IM q12h86,143,243 | Most species/20 mg/kg may be given q24h in larger crocodilians | |
| 40 mg/kg SC q24h33 | Snakes/PD (gopher snakes, 29°C [84°F]) | |
| 50 mg/kg SC q12-72h45,86 | Snakes/PD; q12h in indigo, rat, king snakes; q24h in boids, moccasins; q48h in rattlesnakes; q72h in red-bellied water snakes | |
| Chlorhexidine (Nolvasan 2%, Fort Dodge) | Topical 0.05% aqueous solution q24h212 | All species/topical disinfection; dermatitis; infectious stomatitis; periodontal disease in lizards q24h |
| 1:30 solution28,225 | Most species/topical disinfection; infectious stomatitis; abscess lavage; middle ear infection flush in box turtles | |
| Chlortetracycline | 200 mg/kg PO q24h86,291 | Most species |
| Ciprofloxacin (Cipro, Bayer) | 10 mg/kg PO q48h64 | Most species |
| 11 mg/kg PO q48-72h160 | Pythons/PD (reticulated pythons) | |
| Ciprofloxacin ophthalmic ointment or drops (Ciloxan, Alcon) | Topical189 | All species/infectious stomatitis; gingivitis |
| Clarithromycin | 15 mg/kg PO q48-72h148,308 | Tortoises/PD (desert tortoises); upper respiratory tract disease (mycoplasmosis) |
| Clindamycin | 5 mg/kg PO q12h291 | Most species/gram-positive bacteria and anaerobes |
| Danofloxacin | 6 mg/kg SC, IM197 | Loggerhead sea turtles |
| 6 mg/kg SC q48h × 30 days190 | Tortoises/mycoplasmosis | |
| Dihydrostreptomycin | 5 mg/kg IM q12-24h83,291 | Most species/maintain hydration |
| Doxycycline (Vibramycin, Pfizer) | 5-10 mg/kg PO q24h × 10-45 days143,291 | Most species/respiratory infection (i.e., mycoplasmosis) |
| 50 mg/kg IM, then 25 mg/kg q72h31,280 | Tortoises/Hermann’s tortoise 27°C (81°F) | |
| Enrofloxacin (Baytril, Bayer) | 5-10 mg/kg q24h PO, SC, IM, ICe291 | Most species/IM administration is painful and may result in tissue necrosis and sterile abscesses; may cause skin discoloration or tissue necrosis if given SC |
| 6.6 mg/kg IM q24h, or 11 mg/kg IM q48h160 | Pythons/PD (reticulated pythons); Pseudomonas | |
| 10 mg/kg IM q48h315 | Snakes/PD (Burmese pythons); Pseudomonas | |
| 5 mg/kg PO, IM q24h205 | Lizards/PD (green iguanas); marked pharmacokinetic variability with PO administration may make IM more suitable in critically ill animals | |
| 10 mg/kg IM q5d130 | Monitors/PD (savannah monitors); preliminary data | |
| 5 mg/kg IM q24-48h249 | Chelonians and most other reptiles/PD (gopher tortoises); hyperexcitation, incoordination, diarrhea reported in a Galapagos tortoise39 | |
| 5 mg/kg IM q12-24h257 | Chelonians/PD (Indian star tortoises); q12h for Pseudomonas and Citrobacter; q24h for other bacteria | |
| 5 mg/kg IM q48h304 | Sea turtles | |
| 10 mg/kg IM q24h280 | Chelonians/PD (Hermann’s tortoises) | |
| 5 mg/kg IV q36-72h117,200 | Crocodilians/PD; PO pharmacokinetics not fully determined; mycoplasmosis | |
| Nasal flush 50 mg/250 mL sterile water; 1-3 mL/naris q24-48h143 | Tortoises/URT syndrome; use until no more discharge (5-10 days); may use concurrently with parenteral antibiotics | |
| Gentamicin | — | Nephrotoxicity has been reported,223 especially in snakes; maintain hydration; use with a penicillin or cephalosporin |
| 2.5 mg/kg IM q72h33,34 | Snakes/PD (gopher snakes) | |
| 2.5-3 mg/kg IM, then 1.5 mg/kg q96h125 | Snakes/PD (blood pythons) | |
| 3 mg/kg IM q>96h11 | Turtles/PD (eastern box turtles; 29°C [84°F]); lower dose may be more appropriate | |
| 5 mg/kg IM q72h243 | Chelonians | |
| 6 mg/kg IM q72-96h255 | Turtles/PD (red-eared sliders; 24°C [75°F]) | |
| 1.75-2.25 mg/kg IM q72-96h140 | Crocodilians/PD (alligators); respiratory infection | |
| Gentamicin ophthalmic ointment or drops | Topical83 | Most species/superficial ocular infection; lesions in oral cavity |
| Gentamicin/betamethasone ophthalmic drops (Gentocin Durafilm, Schering-Plough) | 1-2 drops to eye q12-24h148 | Tortoises/upper respiratory infections; may also be given as a reverse nasal flush q48-72h or intranasal q12-24h |
| Kanamycin | 10-15 mg/kg IM, IV q24h (or divided doses)64,83 | Most species/24°C (75°F); give with fluid therapy; avoid in cases of dehydration or renal or hepatic dysfunction |
| Lincomycin | 5 mg/kg IM q12-24h64 | Most species/wound infection; potentially nephrotoxic; maintain hydration |
| 10 mg/kg PO q24h64 | Most species | |
| Marbofloxacin | 10 mg/kg PO q48h49 | Ball pythons/PD |
| Metronidazole | 20 mg/kg PO q48h × ≥7 days87 | Most species/anaerobes |
| 50 mg/kg PO q24h × 7-14 days160 | Most species/may be administered concurrently with amikacin for broader spectrum; because of potential side effects at this dose, a lower dose may be prudent | |
| 20 mg/kg PO q48h25,167 | Snakes/PD (corn and rat snakes) | |
| 20 mg/kg PO q24-48h168 | Iguanas/PD; use q24h for resistant anaerobes | |
| Oxytetracycline | 6-10 mg/kg PO, IM, IV q24h64,83 | Most species/may produce local inflammation at injection site |
| 5-10 mg/kg IM q24h148 | Tortoises/upper respiratory tract infection (mycoplasmosis) | |
| 10 mg/kg IM, IV q5d116 | Crocodilians/PD (alligators; 27°C [81°F]); mycoplasmosis | |
| Penicillin, benzathine | 10,000-20,000 U/kg IM q48-96h86 | Most species/may use with an aminoglycoside |
| Penicillin G | 10,000-20,000 U/kg SC, IM, IV, ICe q8-12h83 | Most species/infrequently used |
| Piperacillin | 50-100 mg/kg IM q24h64,83 | Most species/broad-spectrum bactericidal agent; maintain hydration; may use with an aminoglycoside |
| 50 mg/kg IM, then 25 mg/kg q24h64,291 | Snakes | |
| 100 mg/kg IM q48h126 | Snakes/PD (blood pythons) | |
| 100-200 mg/kg SC, IM q24-48h144 | Chameleons | |
| 100 mg/10 mL saline × 30 min nebulization q12h226 | Most species/pneumonia | |
| Polymyxin B sulfate, neomycin sulfate, bacitracin zinc ointment | Topical96 | All species/rostral abrasions, dermal wounds |
| Povidone-iodine solution (0.05%) or ointment | Topical/lavage83,239 | All species/fungal dermatitis; dermatophilosis; contaminated wound; can soak in 0.005% aqueous solution ≤1 hr q12-24h |
| Silver sulfadiazine cream (Silvadene, Marion) | Topical q24-72h188 | All species/broad-spectrum antibacterial for skin (i.e., wounds, burns) or oral cavity; dressing is generally not necessary |
| Streptomycin | 10 mg/kg IM q12-24h83 | Most species/potentially nephrotoxic; maintain hydration; avoid in cases of dehydration or renal or hepatic dysfunction |
| Sulfadiazine | 25 mg/kg PO q24h291 | Most species/maintain hydration |
| Sulfadimethoxine | 90 mg/kg IM, then 45 mg/kg q24h83 | Most species/potentially nephrotoxic; maintain hydration |
| Ticarcillin (Ticar, SmithKline-Beecham) | 50-100 mg/kg IM q24h83 | Most species/maintain hydration |
| 50-100 mg/kg IM, IV q24-48h195 | Loggerhead sea turtles/PD | |
| Tobramycin | — | Potentially nephrotoxic; maintain hydration; potentiated by ß-lactams |
| 2.5 mg/kg IM q24-72h64,92 | Most species | |
| 10 mg/kg IM q24-48h64 | Chelonians/can be given q48h in tortoises; fluid therapy recommended | |
| Trimethoprim/sulfadiazine | — | Maintain hydration; parenteral form must be compounded |
| 15-25 mg/kg PO q24h291 | Most species | |
| 20-30 mg/kg IM q24-48h160 | Most species | |
| 30 mg/kg IM q24h × 2 days, then q48h64,83,86 | Most species/can administer PO, SC | |
| Trimethoprim/sulfamethoxazole | 10-30 mg/kg PO q24h83 | Most species/maintain hydration |
| Tylosin | 5 mg/kg IM q24h × 10-60 days64,92 | Most species/mycoplasmosis |
a Because reptiles are ectothermic, pharmacokinetics of drugs are influenced by ambient temperature. Antimicrobial therapy should be conducted at the upper end of the patient’s preferred (selected) optimum temperature zone.
b See Table A-4 for antimicrobial combination therapies, some of which are commonly used in reptiles.
TABLE 4-2 Antiviral Agents Used in Reptiles.
| Agent | Dosage | Species/Comments |
| Acyclovir | ≥80 mg/kg PO q24h88 | Tortoises/PD; herpesvirus; poor oral absorption |
| 80 mg/kg PO q8h or 240 mg/kg/day PO207 | Tortoises/herpesvirus; uncertain efficacy; unlikely to eliminate infection; combine with supportive care | |
| Topical (5% ointment) q12h83 | All species/antiviral (i.e., herpesvirus-associated dermatitis) | |
| Chlorhexidine solution | 0.5% dilution, topical on oral lesions q24h154 | Tortoises/herpesvirus |
TABLE 4-3 Antifungal Agents Used in Reptiles.
| Agent | Dosage | Species/Comments |
|---|---|---|
| Amphotericin B | 0.5 mg/kg IV q48-72h84 | Most species/nephrotoxic; can use in combination with ketoconazole; administer slowly |
| 0.5-1 mg/kg IV, ICe q24-72h × 14-28 days64 | Most species/aspergillosis | |
| 1 mg/kg IT q24h × 14-28 days142 | Most species/respiratory infection; dilute with water or saline | |
| 0.1 mg/kg intrapulmonary q24h × 28 days118 | Greek tortoises/pneumonia | |
| 1 mg/kg q24h ICe × 2-4 wk175 | Crocodilians | |
| 5 mg/150 mL saline × 1 hr nebulization q12h × 7 days136 | Most species/pneumonia | |
| Chlorhexidine (Nolvasan 2%, Fort Dodge) | 20 mL/gal water bath309 | Lizards/dermatophytosis |
| Clotrimazole (Veltrim, Haver-Lockhart; Otomax, with gentamicin and betamethasone, Schering-Plough) | Topical263 | Most species/dermatitis; may bathe q12h with dilute organic iodine prior to use |
| F10 super concentrate disinfectant (Health and Hygiene, Roodeport, South Africa) | 1:250 nasal flush, 0.1 mL each nare q24h43 | Terrestrial chelonians |
| Fluconazole | 5 mg/kg PO q24h309 | Lizards/dermatophytosis |
| 21 mg/kg SC once, then 10 mg/kg SC 5 days later107,194 | Loggerhead sea turtles/PD | |
| Griseofulvin | 20-40 mg/kg PO q72h × 5 treatments263 | Most species/dermatitis; limited success |
| 15 mg/kg PO q72h145–147 | Most species | |
| Itraconazole | 5 mg/kg PO q24h199 | Most species/some hepatotoxicity noted when used for Chrysosporium anamorph of Nannizziopsis vriesii |
| 10 mg/kg PO q24h219 | Snakes | |
| 5 mg/kg PO q24h113 | Panther chameleons | |
| 10 mg/kg PO q48h × 60 days22 | Chameleons (Parson’s)/osteomyelitis | |
| 23.5 mg/kg PO q24h90 | Lizards/PD (spiny lizards); following a 3-day treatment, a therapeutic plasma concen-tration persists for 6 days beyond peak concentration; treatment interval was not determined | |
| 5 mg/kg PO q24h or 15 mg/kg PO q72h196 | Kemp’s Ridley sea turtles | |
| Ketoconazole | — | May use antibiotics concomitantly to prevent bacterial overgrowth; may use concurrently with thiabendazole |
| 15-30 mg/kg PO q24h × 14-28 days92 | Most species | |
| 25 mg/kg PO q24h × 21 days137 | Snakes, turtles | |
| 15 mg/kg PO q72h145–147 | Most species | |
| 15-30 mg/kg PO q24h × 14-28 days204,244 | Chelonians/PD (gopher tortoises); systemic infection | |
| 50 mg/kg PO q24h × 14-28 days291 | Crocodilians | |
| Malachite green | 0.15 mg/L water × 1 hr bath × 14 days64 | Dermatitis |
| Miconazole (Monistat-Derm, Ortho) | Topical263 | Most species/dermatitis; may bathe q12h with dilute organic iodine before use |
| Nystatin | 100,000 U/kg PO q24h × 10 days136 | Most species/enteric yeast infections; limited success |
| Thiabendazole | 50 mg/kg PO q24h × 14 days138 | Chelonians/pneumonia; dermatitis; may use concurrently with ketoconazole |
| Tolnaftate 1% cream (Tinactin, Schering-Plough) | Topical q12h prn3 | Most species/dermatitis; may bathe q12h with dilute organic iodine before use |
| Voriconazole | 10 mg/kg PO302 | Bearded dragons/no hepatotoxicity noted when used for Chrysosporium anamorph of Nannizziopsis vriesii |
| 5 mg/kg SC132 | Red-eared sliders/exceeded MIC only until 4 hr post-injection; 26°C (78°F) |
TABLE 4-4 Antiparasitic Agents Used in Reptiles.
| Agent | Dosage | Species/Comments |
|---|---|---|
| Albendazole | 50 mg/kg PO291 | Most species/ascarids |
| Carbaryl powder (5%) | Lightly dust animal and environment; rinse after 1 hr; repeat in 7 days75,86 | Lizards; snakes/mites |
| Chloroquine | 125 mg/kg PO q48h × 3 treatments291 | Tortoises/hemoprotozoa |
| Dichlorvos (Vapona No-Pest Strip; United Industries) | 6 mm strip/10 ft3 in cage × 3 hr q48h × 2-4 wk83,311 | Most species/mites; toxicity occurs;86 prevent contact with animals (e.g., place strip above cage or inside perforated container); avoid in cases of renal or hepatic dysfunction; remove water container; use is discouraged |
| Dimetridazole (Emtryl, Rhône-Poulenc) | — | Not available in the United States |
| 100 mg/kg PO once, repeat in 2 wk307 | Most species/amoebae | |
| 40 mg/kg PO q24h × 5-8 days136,210 | Snakes (except milk and indigo)/amoebae; flagellates | |
| 40 mg/kg PO, repeat in 14 days307 | Milk and indigo snakes/amoebae; flagellates | |
| Emodepside (1.98%) + praziquantel (7.94%) (Profender, Bayer) | 1.12 mL/kg213,267 | Many species/PD; nematodes; cestodes; aquatic turtles must be kept dry for 48 hr after application; appears to be safe, but needs more safety and efficacy data |
| Fenbendazole | — | Drug of choice for nematodes; may have an antiprotozoan effect; may cause leukopenia, avoid in septicemic patients230 |
| 25-100 mg/kg PO q14d for up to 4 treatments31,136,158 | All species/nematodes | |
| 50 mg/kg PO q24h × 3-5 days86,161,162 | All species/nematodes (× 3 days); flagellates and giardia in chameleons (× 5 days) | |
| 100 mg/kg once94 | Tortoises/nematodes; shedding of ova continues for 30 days | |
| Fipronil (0.29%; Frontline Spray, Merial) | Spray or wipe on then wash off in 5 min q7-10d prn75,86 | Most species/mites, ticks; beware of reactions to alcohol carrier; needs safety evaluation38 |
| Imidocloprid and moxidectin (Advantage multi/Advocate, Bayer) | 0.2 mg/kg topical q14d × 3 treatments103 | Lizards/eliminated hookworms and pinworms; needs safety and pharmacokinetic evaluation |
| Ivermectin | — | Do not use in chelonians,298 crocodilians, indigo snakes, or skinks31,162,291 |
| 0.2 mg/kg PO, SC, IM, repeat in 14 days10,76,307 | Snakes (except indigos), lizards (except skinks)31/nematodes (including lungworms),180 mites; can dilute with propylene glycol for oral use; colored animals may have skin discoloration at injection site; rare adverse effects reported in chameleons, possibly associated with breakdown of parasites;10 do not use within 10 days of diazepam or tiletamine/zolazepam; rare death and occasional nervous system signs, lethargy, or inappetence have been reported;162 used for pentastomids in monitor lizards (with dexamethasone 0.2 mg/kg q2d)76 | |
| 5-10 mg/L water topical spray q3-5d up to 28 days162 | Snakes (except indigos), lizards (except skinks)/mites; less effective than fipronil; spray on skin and in newly cleaned cage, then allow to dry before replacing water dish | |
| Levamisole (Levasole 13.65%, Mallinckrodt) | 5-10 mg/kg SC, ICe, repeat in 14 days160 | Most species/5 mg/kg in chelonians;243 10 mg/kg in lizards,10 snakes;136 nematodes (including lungworms); very narrow range of safety; main advantage is that it can be administered parenterally; avoid concurrent use with chloramphenicol; avoid use in debilitated animals; low dose may stimulate depressed immune system; can be used IM, but less effective |
| Mebendazole | 20-25 mg/kg PO, repeat in 14 days prn136,291 | Most species/strongyles, ascarids |
| Metronidazole | — | Protozoan (i.e., flagellates, amoebae) overgrowth; may stimulate appetite; may cause severe neurologic signs at doses >200 mg/kg;220 death occurred in indigo and mountain king snakes at 100 mg/kg;136 for small patients, injectable form can be administered PO; oral liquid is not available in the United States, but can be compounded |
| 40-100 mg/kg PO, repeat in 10-14 days83 | Most species/flagellate overgrowth | |
| 20 mg/kg PO q48h25 | Corn snakes/PD; 28°C (82°F); protozoa | |
| 40 mg/kg PO, repeat in 14 days86,136 | Uracoan rattler, milk, tricolor king, and indigo snakes/flagellates | |
| 40-60 mg/kg PO q7d × 2-3 doses287 | Chameleons/flagellates; amoebae | |
| 40-200 mg/kg PO, repeat in 14 days216 | Geckos/ocular lesions (40 mg/kg) and subcutaneous lesions (200 mg/kg) caused by Trichomonas | |
| 50 mg/kg PO q24h × 2-5 days161 | Chameleons/when accompanied by increased gastrointestinal symptoms | |
| 20 mg/kg ICe q48h131 | Red-eared sliders/PD; ICe administration not recommended; needs further safety evaluation | |
| 25 mg/kg PO q24h × 5 days or 50 mg/kg PO q14d prn96 | Chelonians (tortoises)/amoebae; use 25 mg/kg dosage for clinically ill cases | |
| Milbemycin | 0.25-0.5 mg/kg SC prn24 | Chelonians/nematodes; parenteral form is not commercially available in the United States; fenbendazole preferred |
| Nitrofurazone | 25.5 mg/kg PO306 | Most species/coccidia; seldom used |
| Olive oil | Coat skin q7d10,75 | Most species, especially small, delicate lizards/mites; wash animal with mild soap (and rinse well) the next day; messy to use; environment must be treated with acaricide |
| Oxfendazole (Benzelmin, Fort Dodge) | 66 mg/kg PO, repeat in 14-28 days prn100 | Most species/nematodes |
| Paromomycin (Humatin, Parke Davis) | 35-100 mg/kg PO q24h × ≤28 days83,136,307 | Most species/amoebae |
| 100 mg/kg PO q24h × 7 days, then 2 ×/wk × 3 mo51 | Snakes/cryptosporidia; reduced clinical signs and oocyte shedding; does not eliminate the organism | |
| 300-360 mg/kg PO q48h × 14 days245 | Lizards (gila monsters)/cryptosporidia | |
| 300-800 mg/kg PO q24h prn47 | Geckos/cryptosporidia; reduced clinical signs; does not eliminate the organism | |
| Permethrin (Provent-a-Mite, Pro Products) | Environmental treatment, 1 sec of spray/ft2; wait until dry before returning animal to enclosure75 | Lizards, snakes/mites; ticks; FDA approved; safe and effective; wash immediately if accidentally applied to skin |
| Topical75 | Tortoises/ticks | |
| Piperazine | 40-60 mg/kg PO, repeat in 14 days291 | Most species/ascarids |
| 100-200 mg/kg PO129 | Crocodilians | |
| Ponazuril | 30 mg/kg PO q48h × 2 treatments26,221 | Bearded dragons/coccidiosis |
| Praziquantel (see also Emodepside) | 8 mg/kg PO, SC, IM, repeat in 14 days10,144,291 | Most species/cestodes, trematodes; higher dosages have been administered86 |
| 5-10 mg/kg PO q14d161 | Chameleons/flukes may best be left untreated if not causing a problem | |
| 25-50 mg/kg PO q3h × 3 treatments1,139 | Sea turtles (green, loggerhead)/PD; spirorchidiasis | |
| Pyrantel pamoate | 5 mg/kg PO, repeat in 14 days162 | Most species/nematodes |
| 25 mg/kg PO q24h × 3 days; repeat in 3 wk86,210 | Most species/ascarids, hookworms, pinworms | |
| Pyrethrin spray (0.09%) | Topical q7d × 2-3 treatments75 | Most species/use water-based sprays labeled for kittens and puppies; apply with cloth; can also spray cage, wash out after 30 min; use sparingly and with caution; pyrethroids are safer (see permethrin, resmethrin) |
| Quinacrine (Atabrine, Winthrop) | 19-100 mg/kg PO q48h × 14-21 days306 | Most species/some hematozoa |
| Quinine sulfate | 75 mg/kg PO q48h × 14-28 days306 | Most species/some hematozoa; toxic at >100 mg/kg q24h; ineffective against exoerythrocytic forms |
| Resmethrin spray or shampoo (Durakyl, DVM Pharmaceuticals) | Topical, repeat q≥10d prn75 | Most species/mites; a pyrethroid; safer than pyrethrins; use with care; spray (0.35%) or shampoo entire animal, then rinse off immediately in running, tepid water; protect eyes (other than snakes) with 1 drop of mineral oil; lightly spray environment, wipe off in 5-10 min |
| Spiramycin (Spirasol, May and Baker) | 160 mg/kg PO q24h × 10 days, then 2 ×/wk for 3 mo51 | Snakes/cryptosporidia; may reduce clinical signs and oocyte shedding; does not eliminate the organism |
| Sulfadiazine, sulfamerazine | — | Most species/coccidia; avoid sulfa drugs in cases of dehydration, urinary calculi, or renal dysfunction220 |
| 75 mg/kg PO, then 45 mg/kg q24h × 5 days83,161,306 | Most species/coccidia | |
| 25 mg/kg PO q24h × 21 days10,138,306 | Snakes, lizards/coccidia | |
| Sulfadimethoxine | 50 mg/kg PO q24h × 3-5 days, then q48h prn162 | Most species/coccidia; ensure adequate hydration and renal function |
| 90 mg/kg PO, IM, IV, then 45 mg/kg q24h × 5-7 days83,136,306 | Most species/coccidia | |
| Sulfadimidine (33% solution) | 0.3-0.6 mL/kg PO q24h × 10 days306 | Most species/coccidia; alternatively, 0.3-0.6 mL/kg, then 0.15-0.3 mL/kg q24h × 10 days |
| 1 oz/gal drinking water × 10 days306 | Most species/coccidia | |
| Sulfamethazine | 25 mg/kg PO, IM q24h × 21 days306 | Most species/coccidia |
| 50 mg/kg PO q24h × 3 days, off 3 days, on 3 days100 | Most species/coccidia | |
| 75 mg/kg PO, IM, IV, then 40 mg/kg q24h × 5-7 days92,136 | Most species/coccidia; ensure adequate hydration and renal function | |
| Sulfamethoxydiazine | 80 mg/kg SC, IM, then 40 mg/kg q24h × 4 days306 | Most species/coccidia; ensure adequate hydration and renal function |
| Sulfaquinoxaline | 75 mg/kg PO, then 40 mg/kg q24h × 5-7 days136 | Most species/coccidia |
| Thiabendazole | 50-100 mg/kg PO, repeat in 14 days84,136 | Most species/nematodes; fenbendazole preferred |
| Toltrazuril 5% (Baycox, Bayer) | 5-15 mg/kg q24h × 3 days68 | Bearded dragons/coccidiosis |
| 15 mg/kg q48h × 10 days; discontinue for 2 wk; repeat q48h × 10 days prn247 | Tortoises/intranuclear coccidiosis; needs safety, efficacy, and pharmacokinetic study | |
| Trimethoprim/sulfa | — | Most species/coccidia; avoid potentiated sulfa drugs in cases of dehydration or renal dysfunction220 |
| 30 mg/kg PO q24h × 2 days, then q48h × 21 days10,306 | Most species/coccidia | |
| 30 mg/kg IM q24h × 2 days, then 15 mg/kg IM q48h × 10-28 days306 | Most species/coccidia | |
| 30 mg/kg PO q24h × 14 days, then 1-3 ×/wk × 3-6 mo51 | Most species/cryptosporidia; can reduce shedding but does not clear infection | |
| Water | Bath × 30 min75,185 | Snakes, lizards/mites; use lukewarm (29°C [85°F]) water; monitor to avoid drowning; not 100% effective; does not kill mites on head; must treat environment with acaricide |
TABLE 4-5 Chemical Restraint/Anesthetic Agents Used in Reptiles.
| Agent | Dosage | Species/Comments |
|---|---|---|
| Acepromazine | 0.05-0.25 mg/kg IM143 | Most species/can be used as a preanesthetic with ketamine |
| 0.1-0.5 mg/kg IM217,242 | Most species/preanesthetic; reduce by 50% if used with barbiturates | |
| Alphaxalone (Alfaxan, Jurox) | — | Not available in the United States |
| 6-9 mg/kg IV, or 9-15 mg/kg IM173 | Most species/good muscle relaxation; variable results; drug requires more evaluation; may have violent recovery;12 don’t use within 10 days of DMSO treatment | |
| 6-15 mg/kg IM, IV273 | Most species | |
| 9 mg/kg IV266 | Snakes, lizards/induction; not effective for blotched blue-tongued skinks | |
| 15 mg/kg IM217 | Lizards, chelonians/induction, 35-40 min; duration, 15-35 min; good muscle relaxation; variable results | |
| 24 mg/kg ICe104 | Chelonians (red-eared sliders)/surgical anesthesia with good relaxation | |
| Atipamezole (Antisedan, Pfizer) | Give same volume SC, IV, IP as medetomidine or dexmedetomidine (5 × medetomidine or 10 × dexmedetomidine dose in mg)a,78,278 | Most species/medetomidine and dexmedetomidine reversal; causes severe hypotension in gopher tortoises when given IV56 |
| 0.2-0.5 mg/kg IM77 | Chelonians/shell repair 5-10 min before finished | |
| 0.5-0.75 mg/kg IM256 | Chelonians | |
| Atropine | 0.01-0.04 mg/kg SC, IM,27 IV,84 ICe270 | Most species/preanesthetic; bradycardia; rarely indicated; generally use only in profound or prolonged bradycardia;270 may help prevent intracardiac shunting;145 ineffective at this dose in green iguanas241 |
| 0.5 mg/kg IM, IV, IT, IO220 | Most species/bradycardia, decrease secretions, CPR | |
| Butorphanol | — | Butorphanol combinations follow; see ketamine for combinations |
| 0.4-1 mg/kg SC, IM270 | Most species/analgesia; sedation; preanesthetic | |
| 0.5-2 mg/kg IM or 0.2-0.5 mg/kg IV, IO18 | Most species/preanesthetic | |
| 1-2 mg/kg IM18 | Snakes/analgesia | |
| 0.05 mg/kg IM q24h × 2-3 days184 | Lizards (iguanas)/analgesia | |
| 1-1.5 mg/kg SC, IM270 | Lizards/administer 30 min prior to isoflurane for smooth, shorter induction | |
| 0.2 mg/kg IM109,256 | Chelonians/tranquilizer | |
| Butorphanol (B)/medetomidine (M) | (B) 0.4 mg/kg + (M) 0.08 mg/kg IM93 | Green tree monitor/sedation |
| Butorphanol (B)/midazolam (M) | (B) 0.4 mg/kg + (M) 2 mg/kg IM16 | Most species/preanesthetic; administer 20 min before induction |
| Chlorpromazine | 0.1-0.5 mg/kg IM84 | Most species/preanesthetic; not commonly used |
| 10 mg/kg IM12 | Chelonians/preanesthetic | |
| Dexmedetomidinea (Dexdomitor; Pfizer) | — | α2 agonist that has replaced medetomidinea |
| Diazepam | — | See ketamine for combinations; muscle relaxation; give 20 min prior to anesthesia; potentially reversible with flumazenil; drug interaction with ivermectin |
| 0.5 mg/kg IM, IV220 | All species/seizures | |
| 2.5 mg/kg IM, IV264 | Most species/seizures | |
| 0.2-0.8 mg/kg IM270 | Snakes/use in conjunction with ketamine for anesthesia with muscle relaxation | |
| 0.2-2 mg/kg IM, IV273 | Snakes, lizards | |
| 2.5 mg/kg PO270 | Iguanas/reduce anxiety, which often leads to aggression | |
| 0.2-1 mg/kg IM270,273 | Chelonians/use in conjunction with ketamine for anesthesia with muscle relaxation | |
| Disoprofol | 5-15 mg/kg IV to effect30 | All species/anesthesia; similar characteristics to propofol; not available in the United States |
| Doxapram | 5 mg/kg IM, IV16 q10min prn | Most species/respiratory stimulant; reduces recovery time; reported to partially “reverse” effects of dissociatives174 |
| 4-12 mg/kg IM, IV270 | Most species/respiratory stimulant | |
| 20 mg/kg IM, IV, IO220 | Most species/respiratory stimulant | |
| Epinephrine (1:1000) | 0.5-1 mg/kg IV, IO, IT220 | Most species/CPR, cardiac arrest |
| Etorphine (M-99, Wildlife Pharmaceuticals) | Crocodilians, chelonians/very potent narcotic; crocodilians: induction, 5-30 min; duration, 30-180 min; chelonians: induction, 10-20 min; duration, 40-120 min; not very effective in reptiles other than alligators;242 poor relaxation; adequate for immobilization and minor procedures; requires an antagonist; limited use because of expense and legal restrictions | |
| Flumazenil (Romazicon, Hoffman-LaRoche) | — | All species/reversal of benzodiazepines, including diazepam and midazolam; seldom indicated |
| 1 mg/20 mg of zolazepam177 IM, IV256 | Crocodilians, chelonians/reversal of zolazepam | |
| Gallamine (Flaxedil, American Cyanamid) | Crocodiles/results in flaccid paralysis, but no analgesia; larger animals require lower dosage; reverse with neostigmine;178 use in alligators questionable; unsafe in alligators at ≥1 mg/kg,242 deaths reported in American alligators and false gharials175 | |
| Crocodilians | ||
| Glycopyrrolate | 0.01 mg/kg SC,27 IM, IV16 | Most species/preanesthetic; for excess oral or respiratory mucus; rarely indicated; generally use only in profound or prolonged bradycardia; may be preferable to atropine;84 does not work at this dose in green iguanas241 |
| Haloperidol | 0.5-10 mg/kg IM q7-14d290 | Boids/aggression management |
| Hyaluronidase (Wydase, Wyeth) | 25 U/dose SC177 | Crocodilians/combine with premedication, anesthetic, or reversal drugs to accelerate SC absorption |
| Isoflurane | Most species/inhalation anesthetic of choice in reptiles; induction, 6-20 min; recovery, 30-60 min; not as smooth in reptiles compared to other animals; intubation and intermittent positive pressure ventilation advisable; may preanesthetize with low dose propofol, ketamine, etc. | |
| 5% via chamber in 5 L O2/min124 | Green iguanas/15-35 min loss of righting reflex; mean MAC, 1.62%; pH 7.49 | |
| Ketamine | — | Ketamine combinations follow; muscle relaxation and analgesia may be marginal; prolonged recovery with higher doses; larger reptiles require lower dose; painful at injection site; safety is questionable in debilitated patients; avoid use in cases with renal dysfunction; snakes may be permanently aggressive after ketamine anesthesia;12 generally recommend use only as a preanesthetic prior to isoflurane for surgical anesthesia |
| 10 mg/kg SC, IM q30min27 | Most species/maintenance of anesthesia; recovery, 3-4 hr | |
| 20-60 mg/kg IM, or 5-15 mg/kg IV143 | Most species/muscle relaxation improved with midazolam or diazepam | |
| 22-44 mg/kg SC, IM12,13 | Most species/sedation | |
| 55-88 mg/kg SC, IM13 | Most species/surgical anesthesia; induction, 10-30 min; recovery, 24-96 hr | |
| 10-20 mg/kg IM219,220 | Snakes, chelonians/sedation | |
| 20-60 mg/kg SC, IM27,149 | Snakes/sedation; induction, 30 min; recovery, 2-48 hr | |
| 60-80 mg/kg IM31 | Snakes/light anesthesia; intermittent positive pressure ventilation may be needed at higher doses | |
| 5-10 mg/kg220,270 | Lizards, snakes/decreases the incidence of breath-holding during chamber induction | |
| 20-30 mg/kg IM74 | Iguanas/sedation (i.e., facilitates endotracheal intubation); preanesthetic; requires lower dose than other reptiles | |
| 30-50 mg/kg SC, IM27,149 | Lizards/sedation; variable results | |
| 20-60 mg/kg IM127,149,242 | Chelonians/sedation; induction, 30 min; recovery, ≥24 hr; potentially dangerous in dehydrated and debilitated tortoises | |
| 25 mg/kg IM, IV304 | Sea turtles/sedation; used at higher doses (50-70 mg/kg); recovery times may be excessively long and unpredictable; combination of ketamine and acepromazine gives a more rapid induction and recovery | |
| 38-71 mg/kg ICe310 | Green sea turtles/anesthesia; induction, 2-10 min; duration, 2-10 min; recovery, <30 min | |
| 60-90 mg/kg IM149,217 | Chelonians/light anesthesia; induction, <30 min; recovery, hours to days; requires higher doses than most other reptiles | |
| 20-40 mg/kg (sedation) to 40-80 mg/kg (anesthesia) SC, IM, ICe177 | Crocodilians/induction, <30-60 min; recovery, hours to days; in larger animals, 12-15 mg/kg may permit tracheal intubation;270 not recommended alone in Nile crocodiles169 | |
| 20-100 mg/kg IM175 | Crocodilians/lower dose for sedation, higher for anesthesia (requires intermittent positive pressure ventilation for hours) | |
| Ketamine (K)/acepromazine (A) | — | See (K) and (A) for dosage recommendations |
| Ketamine (K)/butorphanol (B) | See (K) dosages + (B) ≤1.5 mg/kg IM270 | Snakes/anesthesia with improved muscle relaxation |
| (K) 10-30 mg/kg + (B) 0.5-1.5 mg/kg IM270 | Chelonians/minor surgical procedures (i.e., shell repair) | |
| Ketamine (K)/diazepam (D) | See (K) dosages + (D) 0.2-0.8 mg/kg IM270 | Snakes/anesthesia with improved muscle relaxation |
| (K) 60-80 mg/kg217 + (D) 0.2-1 mg/kg IM270 | Chelonians/anesthesia; muscle relaxation | |
| Ketamine (K)/medetomidine (M)a | — | Medetomidine is no longer commercially available, but can be compounded;a reverse medetomidine with atipamezole |
| (K) 10 mg/kg + (M) 0.1-0.3 mg/kg IM65 | Most species | |
| (K) 5-10 mg/kg IM + (M) 0.1-0.15 mg/kg IM, IV111 | Lizards (iguanas) | |
| (K) 3-8 mg/kg + (M) 0.025-0.08 mg/kg IV179 | Giant tortoises (Aldabra) | |
| (K) 4 mg/kg + (M) 0.04 mg/kg IM115 | Green sea turtles | |
| (K) 4-10 mg/kg + (M) 0.04-0.14 mg/kg IM77 | Chelonians/sedation and muscle relaxation for shell repair | |
| (K) 5 mg/kg + (M) 0.05 mg/kg IV42 | Loggerhead sea turtles/induction of anesthesia for intubation | |
| (K) 5 mg/kg + (M) 0.05 mg/kg IM236 | Tortoises (gopher)/light anesthesia; tracheal intubation; inconsistent results | |
| (K) 5-10 mg/kg IM + (M) 0.1-0.15 mg/kg IM, IV111 | Tortoises (small-medium) | |
| (K) 7.5 mg/kg + (M) 0.075 mg/kg IM236 | Tortoises (gopher)/anesthesia; tracheal intubation | |
| (K) 10-20 mg/kg IM + (M) 0.15-0.3 mg/kg IM, IV111 | Turtles (fresh water) | |
| (K) 5-10 mg/kg + (M) 0.1-0.15 mg/kg IM114 | Alligators/adults | |
| (K) 10-15 mg/kg + (M) 0.15-0.25 mg/kg IM114 | Alligators/juveniles | |
| Ketamine (K)/midazolam (M) | (K) 20-40 mg/kg + (M) ≤2 mg/kg IM23 | Chelonians/sedation; muscle relaxation |
| (K) 60-80 mg/kg217 + (M) ≤2 mg/kg IM270 | Chelonians/anesthesia; muscle relaxation | |
| Ketamine (K)/propofol (P) | (K) 25-30 mg/kg IM217 + (P) 7 mg/kg IV250 | Chelonians/administer propofol ≈70-80 min post-ketamine; see propofol |
| Lidocaine (0.5-2%) | Local or topical270 | Most species/local analgesia; infiltrate to effect (e.g., 0.01 mL 2% lidocaine used for local block for IO catheter placement in iguanas);14 often used in conjunction with chemical immobilization |
| Medetomidinea | — | Medetomidine is no longer commercially available, but can be compounded;a reverse with atipamezole; produces poor immobilization alone; see ketamine and butorphanol for combinations |
| 0.1-0.15 mg/kg IM16 | Most species | |
| 0.06-0.15 mg/kg272 | Lizards | |
| 0.15 mg/kg IM277,278 | Desert tortoises, crocodilians/sedation; incomplete immobilization; generally produces bradycardia and bradypnea | |
| 0.04-0.15 mg/kg IM175 | Crocodilians/need to reverse | |
| Methohexital (Brevital, Lilly) | — | Recovery time of red-sided garter snakes at 21°C (70°F), 125 min; 26°C (79°F), 86 min; 31°C (88°F), 64 min; thinner snakes had longer recovery times; if within 5 wk of parturition, mean recovery time 2x as long as nongravid; time post-feeding had no effect at 1, 3, 10 days248 |
| 5-20 mg/kg SC,13 IV84 | Most species/induction, 5-30 min; recovery, 1-5 hr; use at 0.125-0.5% concentration; much species variability; decrease dose 20-30% for young animals; avoid use in debilitated animals | |
| 9-10 mg/kg SC,233 ICe | Colubrids/induction, ≥22 min; recovery, 2-5 hr; does not produce soft tissue irritation seen with other barbiturates; may need to adjust dosage in obese snakes | |
| Metomidate | 10 mg/kg IM65,265 | Snakes/profound sedation; not available in the United States |
| Midazolam | — | See butorphanol, ketamine for combinations; can be reversed by flumazenil |
| 2 mg/kg IM12,13 | Most species/preanesthetic; increases the efficacy of ketamine; effective in snapping turtles, not in painted turtles13 | |
| 0.5-2 mg/kg272 | Lizards | |
| 1.5 mg/kg IM238 | Turtles (red-eared sliders)/sedation; onset, 5.5 min; duration, 82 min; recovery, 40 min; much individual variability | |
| Naloxone | 4 mg/kg IM93 | Green tree monitor/reversal of butorphanol |
| Neostigmine |  Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
|