4.1 Target species
4.2 Indications for use, specifying the target species
For the treatment of lameness and pain of degenerative joint disease/osteoarthrosis (non-infectious arthrosis) in the skeletally mature dog.
Do not use for the treatment of septic arthritis. In this case, appropriate antimicrobial therapy should be instigated.
Do not use in dogs with advanced liver or kidney impairment, or evidence of infection.
Do not use in dogs with blood disorders, coagulation disorders, bleeding or malignancy (especially haemangiosarcoma). Pentosan polysulfate has an anticoagulant effect.
Do not use during the peri-operative period.
Do not use in the skeletally immature dog (i.e. dogs whose long bone growth plates have not closed).
4.4 Special warnings for each target species
A clinical effect may not be observed until after the second injection of the course of treatment.
4.5 Special precautions for use
i. Special precautions for use in animals
Dogs should be weighed prior to administration to ensure accurate dosing.
Use with caution in dogs with history of pulmonary lacerations. Caution is also recommended in cases of hepatic impairment.
Do not exceed the standard dose. Increasing the recommended dose may result in exacerbation of stiffness and discomfort.
No more than 3 courses of 4 injections should be administered in a 12 month period.
ii. Special precautions for the person administering the veterinary medicinal product to animals
Care should be taken to avoid accidental self-injection. In the event of accidental injection, seek medical advice immediately and show the package leaflet or label to the physician. Wash splashes from eyes and skin immediately with water. Wash hands after use.
4.6 Adverse reactions (frequency and seriousness)
Emesis, diarrhoea, lethargy and anorexia have been reported following the use of pentosan polysulfate. These signs may be the result of a hypersensitivity reaction and may require appropriate symptomatic treatment including antihistamine administration.
Administration of the product at recommended dose rates results in increases of activated partial thromboplastin time (aPTT) and thrombin time (TT) which may persist for up to 24 hours after administration in healthy dogs. This very rarely results in clinical effects, but because of the fibrinolytic action of pentosan polysulfate sodium, the possibility of internal bleeding from a tumour or vascular abnormality should be considered if signs develop. It is recommended that the animal should be monitored for signs of blood loss and treated appropriately
Bleeding disorders such as nasal bleeding, haemorrhagic diarrhoea and haematomas have been reported.
Local reactions such as a transient swelling have been observed post injection.
4.7 Use during pregnancy, lactation or lay
Laboratory studies in rabbits showed embryotoxic effects associated with a primary effect on the parent at repeated daily doses 2.5 times the recommended dose.
The safety of the product in the pregnant bitch has not been studied, therefore use is not recommended in these circumstances.
The product should not be used at the time of parturition due to its anticoagulant effects.
Interaction with other medicinal products and other forms of interaction
NSAIDs and in particular aspirin should not be used in combination with pentosan polysulfate sodium as they may affect thrombocyte adhesion and potentiate the anticoagulant activity of the product. Corticosteroids have been shown to be antagonistic to a number of actions of pentosan polysulfate sodium. Furthermore, use of anti-inflammatory drugs may result in a premature increase in the dog’s activity, which may interfere with the therapeutic activity of the product.
Do not use concurrently with steroids or non-steroidal anti-inflammatory drugs, including aspirin and phenylbutazone.
Do not use concurrently with heparin, warfarin or other anti-coagulants.
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Amount(s) to be administered and administration route
Dosage: 3mg pentosan polysulfate sodium/kg bodyweight (equivalent to 0.3ml/10kg bodyweight) on four occasions, with an interval of 5-7 days between each administration.
Administration: By aseptic subcutaneous injection only of 0.3ml/10kg of bodyweight. An appropriately graduated syringe must be used to allow accurate administration of the required dose volume. This is particularly important when injecting small volumes.
Each case should be assessed individually by the veterinarian and an appropriate treatment program determined.
Overdose (symptoms, emergency procedures, antidotes), if necessary
Repeated daily overdoses of five times the recommended dose or more results in anorexia and depression, which are reversible upon withdrawal of the drug.
At overdose there may be hepatocellular damage and an associated, dose-dependent, elevation in ALT.
Increases in aPTT and TT are dose-dependent. At repeated doses greater than five times that recommended, these increases may persist beyond 1 week after administration in healthy dogs. Signs associated with these defects may include bleeding into the gastro-intestinal tract, body cavities and ecchymoses. At repeated doses greater than ten times that recommended there may be fatality as a result of gastro-intestinal haemorrhage.
If overdose occurs dogs should be hospitalised and observed and supportive therapy provided as deemed necessary by the veterinarian.