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==Introduction==
The following drug dosages are taken from multiple sources and neither their efficacy nor safety can be assured since the information may have been extrapolated from animals other than lizards.
There will be interspecific variation.
Since lizards are poikilothermic, their metabolism is affected by the ambient temperature. The pharmacokinetics of any drug will therefore vary with the temperature. The lizard will need to be kept at the higher end of its POTZ.
There are no drugs preparations licensed for reptiles. Drugs licensed for use in other species may be administered under the responsibility of the veterinary surgeon who has the lizard 'under his care'.
==Antimicrobials==
Sample all suspected infections for microscopy, culture and sensitivity.
The majority of bacterial infections in lizards are by Gram-negative organisms, particularly Enterobacteriacae.
Therapy may be required before the results of bacterial sensitivity tests are known.
Aminoglycosides and quinolones are effective against most aerobic pathogens and there is little bacterial resistance to them.
The fluoroquinolone derivative enrofloxacin is bacteriocidal (inhibit microbial DNA gyrase) and is well distributed to tissues. It is active against a wide range of Gram-negative organisms as well Gram-positives and Mycoplama spp. It is not effective against anaerobes.
Carbenicillin and ceftazidime are good broad-spectrum antibiotics useful against anaerobes as well as most Gram-negative pathogens. If Pseudomonas spp. and anaerobes are present, ceftazidime is the most appropriate choice.
The following has also been advised: amikacin in combination with ampicillin for respiratory infections; chloramphenicol for gastrointestinal infections; an aminoglycoside in combination with a broad spectrum penicillin for general systemic infections.
All aminoglycosides may affect neuromuscular transmission leading to muscle weakness and cause nephrotoxicity especially in reptiles kept at more than 25°C. They are also more toxic in gravid females.
Any antibiotic therapy, but particularly gentamycin, should be accompanied by fluids to maintain adequate renal function and reduce the possibility of nephrotoxicity.
Amikacin
Potentially nephrotoxic but no published data
Administer fluids concurrently
Frequently used with a penicillin or a cephalosporin
2.5 mg/kg IM then 2.5-5 mg q72h
50 mg/10ml saline x 30 min nebulisation q12h
Maintenance temperature if species POTZ unknown is 25°C
Amoxicillin
Use with an aminoglycoside
20 mg/kg SC, IM q24h
Maintenance temperature if species POTZ unknown is 26°C
Ampicillin
May be used with an aminoglycoside
3-6 mg/kg PO q12-24h
3-10 mg/kg IM, SC q12-24h
Carbenicillin
May be used with an aminoglycoside but at different time of day
400 mg/kg IM, SC q24h
Maintenance temperature if species POTZ unknown is 30°C
Cefoperazone
Published data in tegus
125 mg/kg IM q24h
Cefotaxime
May be used with an aminoglycoside
20-40 mg/kg IM q24h
100 mg/10ml saline x 30 min nebulisation q12h
Ceftazidime
20 mg/kg IM q72h
Maintenance temperature if species POTZ unknown is 30°C
Cefuroxime
50 mg/kg IM q48h
Maintenance temperature if species POTZ unknown is 30°C
Cephuroxime
50 mg/kg IM q48h
Cephalexin
20-40 mg/kg PO q12h
Cephaloridine
10 mg/kg IM, SC q12h
Cephalothin
20-40 mg/kg IM q12h
Chloramphenicol
May cause pigmentation changes in chameleons
20 mg/kg PO, IM, SC q12h
40mg/kg PO, IM, SC q24h
Chlortetracycline
200mg/kg PO 24h
Ciprofloxacin
11 mg/kg PO q48-72h
Clindamycin
2.5-5 mg/kg PO q12h
5 mg/kg PO q24h
Dihydrostreptomycin
Administer fluids concurrently
5 mg/kg IM q12-24h
Dimetridazole
40 mg/kg PO q24h 5d
Doxycycline
5-10 mg/kg PO q24h 10-45d
Enrofloxacin
5-10mg/kg q24h PO, IM, SC, ICo
1-3 ml of 50 mg/250ml sterile water for nasal flush q12-24h with parenteral antibiotics
Gentamycin
Do not use in animals over 20kg
2.5 mg/kg SC q72h
10-200 mg/15ml saline x 30 min nebulisation q12h
Maintenance temperature if species POTZ unknown is 24°C
Kanamycin
Administer fluids concurrently
10 mg/kg SC, IM, IV q24h
Maintenance temperature if species POTZ unknown is 24°C
Lincomycin
Potentially nephrotoxic
Administer fluids concurrently
6 mg/kg q12-24h
Metronidazole
May be administered concurrently with amikacin
Low dose may stimulate depressed immune system
12.5-40 mg/kg q24h > 7d
100-275 mg/kg PO as a single dose
Oxytetracycline
May produce local reaction at injection site
6-10 mg/kg IM, IV q24h
Penicillin, benzathine , benzathine
May be administered concurrently with amikacin
10,000 units/kg IM q48-96h
Penicillin G
Infrequently used
10,000-20,000 units/kg IM, SC, IV, ICo q8-12h
Piperacillin
Administer fluids concurrently
May be used with an aminoglycoside
50-100 mg/kg IM q24h
100-200 mg/kg IM q24-48h in chameleons
100 mg/10ml saline x 30 min nebulisation q12h
Streptomycin
Potentially nephrotoxic
Administer fluids concurrently
Avoid with renal/hepatic dysfunction
10 mg/kg IM q12-24h
Sulphadiazine
Administer fluids concurrently
Do not use with renal impaired animals
25 mg/kg PO q24h
Sulphadimethoxine
Potentially nephrotoxic
Administer fluids concurrently
90 mg/kg IM then 45 mg/kg q24h
Tetracycline
May disturb the normal intestinal microflora
10 mg/kg PO q24h
Ticarcillin
Administer fluids concurrently
50-100 mg/kg IM q24h
Tobramycin
Potentially nephrotoxic
Administer fluids concurrently
Potentiated by â-lactams
2 mg/kg IM q24h
2.5 mg/kg IM q12h in chameleons
Trimethoprim/sulphadiazine
Administer fluids concurrently
15 mg/kg IM q24
Trimethoprim/sulphamethoxaline
Administer fluids concurrently
10-30 mg/kg PO q24h
Tylosin
Reported useful for mycoplasma respiratory infections
5 mg/kg IM q24 10-60d
==Antifungals==
Fungal infections are not uncommon in reptiles and can be the primary disease agent or secondary in already compromised individuals. Antifungal drugs may be useful but treatment regimens have not been established adequately.
Amphotericin- B
Potentially nephrotoxic
Can be used with ketaconazole
Administer slowly
0.5 mg/kg IV q48-72h
5 mg/150ml saline x 1h nebulisation q12h 7d
Fluconazole
5 mg/kg PO q24h
Griseofulvin
Limited success
20-40 mg/kg PO q72h 5 Rxs
Itraconazole
Has been used in spiny lizards (Sceloporus spp.) at 23.5 mg/kg
Ketaconazole
Potentially hepatotoxic
15-30 mg/kg PO q24h 2-4w
Nystatin
100,000 IU/kg PO q24h 2-4 w
==Antiparasitic==
Parasitic infections are common in lizards especially wild caught specimens.
Environmental treatment is important.
Albendazole
Antinematode
50 mg/kg PO as a single dose
Emetine
Antiamoeba, antitrematode
0.5 mg/kg IM, SC q24h 10d
Fenbendazole
Antinematode
100 mg/kg PO as a single dose
Ivermectin
Antinematode, antiascarid
May cause skin discoloration at injection site in chameleons
Not for use in chelonia
-0.2 mg/kg IM, SC, PO
Repeat as appropriate
Levamisole
Antinematode including lungworms
Avoid concurrent use with chloramphenicol
Avoid in debilitated animals
Low dose may stimulate depressed immune system
Can be used IM but less effective
10 mg/kg SC, ICo, repeat in 2 weeks
200 mg/kg PO as a single dose
Metronidazole
antiprotozoal
100 mg/kg PO q3d 2-3w
125-250 mg/kg PO, repeat in 2 weeks
40 mg/kg PO, repeat in 2 weeks for trichomonad ocular lesions in geckos
200 mg/kg PO, repeat in 2 weeks for trichomonad SC lesions in geckos
Nitrofurazone
Anticoccidia
Seldom used
25.5 mg/kg PO
Oxfendazole
Antinematode
68 mg/kg PO as a single dose
Paronomycin
Antiamoeba
35-100 mg/kg PO q24h up to 4w
Praziquantel
Anticestode, antitrematode
3.5-7.5 mg/kg SC
100 mg/kg PO
Pyrantel palmoate
Antinematode
5mg/kg PO, repeat in 2w
Sulphadiazine, sulphamerazine
Anticoccidia
Administer fluids concurrently
Do not use with renal impaired animals
25 mg/kg PO q24h 3w
50 mg/kg q24h 3d, then 3d off, then 3d on
75 mg/kg PO then 45 mg/kg q24h 5d
Thiabendazole
Antinematode
50-100 mg/kg PO, repeat in 2w
==Anaesthesia associated drugs==
Acetylpromazine
Pre-anaesthetic
0.05-0.5 mg/kg
Alphadolone/alphaxalone
Saffan 3 mg/ml alphadolone and 9 mg/ml alphaxalone giving a 12mg/ml solution
Induction and maintenance of general anaesthesia
6-9 mg/kg IV
9-15 mg/kg IM
Incremental doses according to the animal's response
Atropine
Pre-anaesthetic
Use with bradycardia
0.01-0.1 mg/kg IM,SC
Buprenorphine
Analgesic
0.005-0.02 mg/kg IM q24-48h
Butorphanol
Analgesic
No established dose
Diazepam
No established dose
Doxapram
Respiratory stimulant
5 mg/kg IV
Halothane
Gaseous anaesthetic
3-4% induction
1.5-3% maintenance
Isoflurane
Inhalational anaesthetic of choice
Less hepatotoxic than other inhalants
Rapid induction and recovery in lizards
Up to 6% induction
2-3% maintenance
Ketamine
Muscle relaxation and analgesia may be marginal
Prolonged recovery with higher doses
Larger reptiles require lower dose
Painful at injection site
Questionable safety in debilitated animals
Avoid use with renal impairment
Lizards require lower dose than other reptiles
10-30 mg/kg IM as a sedative, facilitates intubation
Useful in large lizards (11.6 mg/kg) in combination with midazolam (0.34-0.35 mg/kg)
Lignocaine
Local anaesthetic
Midazolam
May be useful in some species
2 mg/kg
Pentobarbitone
Euthanasia
60 mg/kg IV, ICo
Propofol
Injectable anaesthetic of choice
Rapid induction and rapid recovery
10 mg/kg IV
Additional doses of 10% of the original may be administered for maintenance
Tiletamine/ zolazepam
Not generally used but useful in larger lizards
5.5 mg/kg in a 55kg komodo dragon (Varanus komodoensis) led to easy handling within 30 minutes but heavy sedation the day after the anaesthetic
10-40 mg/kg IM- 8-20 minute induction, 2-10 hour recovery in smaller individuals
Xylazine
Infrequently used
0.1-1.25 mg/kg IV, IM
==Hormones==
Arginine vasotocin
Use in dystocia
Administer after calcium
More effective than oxytocin
0.01-1.0 mg/kg IV, ICo
Calcitonin
May be useful in MBD
Administer after calcium supplementation
Do not use if hypocalcaemic
Administer fluids concurrently
50 IU IM and repeat in 2w
Dexamethasone
Septic/traumatic shock
0.6-1.25 mg/kg IV,IM
Oxytocin
Dystocias
Administer after calcium supplementation
2-5 Iu/kg IM
Prednisolone
Septic/traumatic shock
5-10mg/kg IV, IM
==Nutritional support==
Calcium borogluconate
MBD
Hypocalcaemia
Hypocalcaemic dystocia
10-50 mg/kg IM, SC, ICo
Calcium carbonate
PO
Calcium glubionte
MBD
Hypocalcaemia
Hypocalcaemic dystocia
10-50 mg/kg PO
Calcium gluconate
MBD
Hypocalcaemia
Hypocalcaemic dystocia
100-200 mg/kg IM, SC, ICo
Calcium lactate / calcium glycerophosphate
MBD
Hypocalcaemia
Hypocalcaemic dystocia
1-25 mg/kg IM, SC
Vitamin A
Hypovitaminosis A
Overdose will cause epidermal sloughing
1,000-2,000 IU/kg IM, SC q7d 2-6w
Vitamin B complex
Hypovitaminosis B
Appetite stimulant
5-10mg/kg IM,SC
Vitamin B12
Appetite stimulant
0.05 mg/kg IM,SC
Vitamin C
Supportive treatment for bacterial infections
Ulcerative stomatitis
10-20 mg/kg IM,Sc q24h
100-250 mg/kg PO q24h
Vitamin D3
MBD
Hypocalcaemia
Herbivores sensitive to excess
Give PO preferably
100 IU/kg IM, repeat in 1w
200 IU/kg IM, repeat in 4w
200 IU/kg PO q7d
Vitamin E
Hypovitaminosis E
50-100 mg IM
Vitamin K1
Hypovitaminosis K
May aid formation of clotting factors
0.25-0.50 mg/kg IM
==Miscellaneous agents==
Allopurinol
Decreases production of uric acid
Dose not established
Aminophylline
Bronchodilator
2-4 mg/kg IM
Atropine
OP toxicity
0.1-0.2 mg/kg IM
Cimetidine
Gastric and duodenal ulcerations
Oesophageal and gastric reflux
4 mg/kg PO, IM q8-12h
Flunixin meglumine
Non-steroidal anti-inflammatory
0.1-0.5 mg/kg IM, SC q12-24h 1-2d
Furosemide
Diuretic
5 mg/kg PO, IM, IV q12-24h