Issue link: https://www.e-digitaleditions.com/i/1478196
12 Covetrus | ph: 855.724.3461 | fx: 888.329.3861 | northamerica.covetrus.com FOR ORAL USE IN HORSES ONLY CAUTION Federal ( U.S.A. ) law restricts this drug to use by or on the order of a licensed veterinarian. NADA #141-268 Approved by FDA DESCRIPTION Diclazuril, (±) -2,6-dichloro-α- (4-chlorophenyl ) -4- (4,5- dihydro-3,5-dioxo-1,2,4-triazin-2 ( 3H ) -yl ) benzeneacetonitrile, has a molecular formula of C 17 H 9 CI 3 N 4 O 2 , a molecular weight of 407.64, and a molecular structure as follows: Diclazuril is an anticoccidial ( antiprotozoal ) compound with activity against several genera of the phylum Apicomplexa. PROTA ZIL ® ( diclazuril ) is supplied as oral pellets containing 1.56 % diclazuril to be mixed as a top-dress in feed. Inert ingredients include dehydrated alfalfa meal, wheat middlings, cane molasses and propionic acid ( preservative ) . INDICATIONS PROTA ZIL ® (1.56 % diclazuril ) Antiprotozoal Pellets are indicated for the treatment of equine protozoal myeloencephalitis ( EPM ) caused by Sarcocystis neurona in horses. DOSAGE AND ADMINISTRATION Dosage: PROTAZIL ® (1.56% diclazuril) is administered as a top dress in the horse's daily grain ration at a rate of 1 mg diclazuril per kg (0.45 mg diclazuril/lb) of body weight for 28 days. The quantity of PROTAZIL ® necessary to deliver this dose is 64 mg pellets per kg (29 mg pellets/lb) of body weight. Administration: To achieve this dose, weigh the horse (or use a weigh tape)). Scoop up PROTAZIL ® to the level (cup mark) corresponding to the dose for the horse's body weight using the following chart: Weight Range of Horse (lb) mLs of Pellets Weight Range of Horse (lb) mLs of Pellets 275 - 524 20 1275 - 1524 60 525 - 774 30 1525 - 1774 70 775 - 1024 40 1775 - 2074 80 1025 - 1274 50 - - One 2.4-lb bucket of PROTAZIL ® will treat one 1274-lb horse for 28 days. One 10-lb bucket of PROTAZIL ® will treat five 1100-lb horses for 28 days. CONTRAINDICATIONS Use of PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets is contraindicated in horses with known hypersensitivity to diclazuril. WARNINGS For use in horses only. Do not use in horses intended for human consumption. Not for human use. Keep out of reach of children. PRECAUTIONS The safe use of PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets in horses used for breeding purposes, during pregnancy, or in lactating mares has not been evaluated. The safety of PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets with concomitant therapies in horses has not been evaluated. ADVERSE REACTIONS There were no adverse effects noted in the field study which could be ascribed to diclazuril. To report suspected adverse reactions, to obtain a MSDS, or for technical assistance call 1-800-224-5318. CLINICAL PHARMACOLOGY The effectiveness of diclazuril in inhibiting merozoite production of Sarcocystis neurona and S. falcatula in bovine turbinate cell cultures was studied by Lindsay and Dubey (2000 ). 1 Diclazuril inhibited merozoite production by more than 80% in cultures of S. neurona or S. falcatula treated with 0.1 ng/mL diclazuril and greater than 95% inhibition of merozoite production ( IC 95 ) was observed when infected cultures were treated with 1.0 ng/mL diclazuril. The clinical relevance of the in vitro cell culture data has not been determined. PHARMACOKINETICS IN THE HORSE The oral bioavailability of diclazuril from the PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets at a 5 mg/kg dose rate is approximately 5%. Related diclazuril concentrations in the cerebrospinal fluid (CSF) range between 1% and 5% of the concentrations observed in the plasma. Nevertheless, based upon equine pilot study data, CSF concentrations are expected to substantially exceed the in vitro IC 95 estimates for merozoite production ( Dirikolu et al., 1999 ) 2 . Due to its long terminal elimination half-life in horses (approximately 43-65 hours), diclazuril accumulation occurs with once- daily dosing. Corresponding steady state blood levels are achieved by approximately Day 10 of administration. EFFECTIVENESS Two hundred and fourteen mares, stallions, and geldings of various breeds, ranging in age from 9.6 months to 30 years, were enrolled in a multi-center field study. All horses were confirmed EPM-positive based on the results of clinical examinations and laboratory testing, including CSF Western Blot analyses. Horses were administered PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets at doses of 1, 5, or 10 mg diclazuril/kg body weight as a top-dress on their daily grain ration for 28 days. The horses were then evaluated for clinical changes via a modified Mayhew neurological scale on Day 48 as follows: 0. Normal, neurological deficits not detected. 1. Neurological deficits may be detectable at normal gaits; signs exacerbated with manipulative procedures (e.g., backing, turning in tight circles, walking with head elevation, truncal swaying, etc.). 2. Neurological deficit obvious at normal gaits or posture; signs exacerbated with manipulative procedures. 3. Neurological deficit very prominent at normal gaits: horses give the impression they may fall (but do not) and buckle or fall with manipulative procedures. 4. Neurological deficit is profound at normal gait: horse frequently stumbles or trips and may fall at normal gaits or when manipulative procedures were utilized. 5. Horse is recumbent, unable to rise. Each horse's response to treatment was compared to its pre-treatment values. Successful response to treatment was defined as clinical improvement of at least one grade by Day 48 ± conversion of CSF to Western Blot-negative status for S. neurona or achievement of Western Blot-negative CSF status without improvement of 1 ataxia grade. Forty-two horses were initially evaluated for effectiveness and 214 horses were evaluated for safety. Clinical condition was evaluated by the clinical investigator's subjective scoring and then corroborated by evaluation of the neurological examination videotapes by a masked panel of three equine veterinarians. Although 42 horses were evaluated for clinical effectiveness, corroboration of clinical effectiveness via videotape evaluation was not possible for one horse due to missing neurologic examination videotapes. Therefore, this horse was not included in the success rate calculation. Based on the numbers of horses that seroconverted to negative Western Blot status, and the numbers of horses classified as successes by the clinical investigators, 28 of 42 horses ( 67%) at 1 mg/kg were considered successes. With regard to independent expert masked videotape assessments, 10 of 24 horses (42%) at 1 mg/kg were considered successes. There was no clinical difference in effectiveness among the 1, 5, and 10 mg/kg treatment group results. Adverse events were reported for two of the 214 horses evaluated for safety. In the first case, a horse was enrolled showing severe neurologic signs. Within 24 hours of dosing, the horse was recumbent, biting, and exhibiting signs of dementia. The horse died, and no cause of death was determined. In the second case, the horse began walking stiffly approximately 13 days after the start of dosing. The referring veterinarian reported that the horse had been fed grass clippings and possibly had laminitis. ANIMAL SAFETY PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets were administered to 30 horses (15 males and 15 females, ranging from 5 to 9 months of age) in a target animal safety study. Five groups of 6 horses each (3 males and 3 females) received 0, 5 (5X), 15 (15X), 25 (25X) or 50 (50X) mg diclazuril/ kg (2.27mg/lb) body weight/day for 42 consecutive days as a top-dress on the grain ration of the horse. The variables measured during the study included: clinical and physical observations, body weights, food and water consumption, hematology, serum chemistry, urinalysis, fecal analysis, necropsy, organ weights, gross and histopathologic examinations. The safety of diclazuril top-dress administered to horses at 1 mg/kg once daily cannot be determined based solely on this study because of the lack of an adequate control group (control horses tested positive for the test drug in plasma and CSF). However, possible findings associated with the drug were limited to elevations in BUN, creatinine, and SDH and less than anticipated weight gain. Definitive test article-related effects were decreased grain/top-dress consumption in horses in the 50 mg/ kg group. In a second target animal safety study, PROTAZIL ® (1.56% diclazuril) Antiprotozoal Pellets were administered to 24 horses (12 males and 12 females, ranging from 2 to 8 years of age). Three groups of 4 horses/sex/group received 0, 1, or 5 mg diclazuril/kg body weight/day for 42 days as a top-dress on the grain ration of the horse. The variables measured during the study included physical examinations, body weights, food and water consumption, hematology, and serum chemistry. There were no test article-related findings seen during the study. STORAGE INFORMATION Store between 15°C to 30°C (59°F to 86°F). HOW SUPPLIED PROTAZIL ® (1.56 % diclazuril) Antiprotozoal Pellets are supplied in 2.4-lb (1.1 kg) and 10-lb (4.5 kg) buckets. REFERENCES 1. Lindsay, D. S., and Dubey, J. P. 2000. Determination of the activity of diclazuril against Sarcocystis neurona and Sarcocystis falcatula in cell cultures. J. Parasitology, 86 (1):164–166. 2. Dirikolu, L., Lehner, F., Nattrass, C., Bentz, B. G., Woods, W. E., Carter, W. E., Karpiesiuk, W. G., Jacobs, J., Boyles, J., Harkins, J. D., Granstrom, D. E. and Tobin, T. 1999. Diclazuril in the horse: Its identification and detection and preliminary pharmacokinetics. J. Vet. Pharmacol. Therap. 22:374–379. 2 Giralda Farms, Madison, NJ 07940 Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. 07-2014 211.x.3.0.3 1. James et al. Seroprevalences of anti-Sarcocystis neurona and anti-Neospora Hughesi antibodies among healthy equids in the United States. JAVMA, June 1, 2017, Vol. 250, No. 11 , Pages 1291-1301 (https://doi.org/10.2460/javma.250.11.1291) 2. Reed SM, et al. Equine Protozoal Myeloencephalitis: An Updated Consensus Statement with a Focus on Parasite Biology, Diagnosis, Treatment and Prevention. J Vet Intern Med 2016;30:491–502. 3. NAHMS. Equine Protozoal Myeloencephalitis (EPM) in the U.S. In: USDA:APHIS:VS, ed. Centers for Epidemiology and Animal Health. Fort Collins, Colorado: NAHMS; 2001:1–46. Client communication: Tips for talking EPM diagnostics As practitioners, we often face the eager client who confidently walks in and says, "Doc, I need this horse tested for EPM," or "I'm pretty sure it's EPM, can you get him started on an EPM treatment?" 1. Remind owners that EPM can be the "master of disguise" and mimic many neurologic diseases. It's important to evaluate all potential causes of the horse's illness before rushing to EPM testing and/or treatment. 2. More than two-thirds of healthy U.S. horses are carrying antibodies to S. neurona – the primary causative organism of EPM – without showing clinical signs. Only a very small percentage (<1%) of horses succumb to clinical disease. 1 3. If the horse does not have EPM, it will not respond to an EPM treatment and you've wasted time and money without getting to the root cause of the issue. This can prolong suffering for the horse. 4. Increase client confidence in your diagnostic workup by explaining the importance of a thorough history on the horse, as well as a physical and neurological examination along with proper antibody testing to rule EPM in (or out). We cannot rely on one without the other. 5. Emphasize the importance of continued vigilance with regular veterinary examinations to ensure treatment success and ongoing care and management of the horse with EPM. 6. Reinforce early veterinary intervention for any horse showing signs of neurological disease. The earlier disease is caught and treatment begins, the better the outcome.