Pharmacotherapy in reptiles

univ. prof. Zdenek Knotek, DVM, PhD

University of Veterinary and Pharmaceutical Sciences Brno
Czech Republic
 Pharmacokinetism - temperature
Reptiles are ectotherm vertebrates.
Their metabolism is dependent (influenced
with) on external temperature.
In nature reptiles try to keep the body in
preferred body temperature (PBT) optimal
condition for metabolic pathways.

Patients keep their PBT - spending maximum

time in special part of the terraria - behavioral
thermoregulation.
 Pharmacokinetism - temperature
Reptiles are ectotherm vertebrates.
Preferred optimum temperature zone (POTZ) is
condition for PBT.
Keep your patients in POTZ during
treatment, anaesthesia, surgery, recovery
period.
Lower (suboptimal) temperatures prolong
the recovery time.
Lower (suboptimal) temperatures increase
the risk of overdose drugs (aminoglycosides).
Special anatomy/physiology of reptiles

Quadriped reptiles - renal portal system.

Presence/absence urinary bladder ventral

extension of urodeum.

Central organ for final urine production.

 Special anatomy/physiology of reptiles
The most of snake species have only the right
lung.
Do not insert the endotracheal tube into left
lung rudiment.
Reptiles have very low respiratory frequence.
It is lowest within anaesthesia.
Reptiles can tolerate very low oxygen
concentration in peripheral blood (organs,
tissues).
Semia-quatic/aquatic reptiles shunt of blood
circulation within the period of submergence.
Special anatomy/physiology of reptiles
GIT in carnivorous reptiles (crocodiles,
aquatic terapins,
snakes and some lizards) short distance.
Transit time for contrast fluids (X-ray), food,
drug metabolites is short (days).

GIT in herbivorous reptiles (land tortoises,

lizards) long.
Transit time for contrast fluids (X-ray), food,
drug metabolites is long, very slow passage
(weeks).
 DIAGNOSIS and TREATMENT

1 Think before treat !

2 Disease is complex !
3 Concurrent diseases !
4 Patient is complex !
5 Topical and/or systemic treatment !
6 Follow the recommendations !
7 Reptiles- crocodiles, chelonians, snakes,
lizards
 DIAGNOSIS and TREATMENT

EMERGENCY ?
Reptiles are generally presented injured or ill.
Good history - valuable lead to the problem.
In many cases - only an illusion.
Prepare your own questionare protocol
origin of the reptile
housing system
feeding regimen
temperature, air humidity, water, substrate,
UVB any previous treatment?
previous reproductive activity?
The success of treating a critical patient
relies very heavily on the environment in
which the animal must recover.
When possible make visually-separated
housing for each of the reptile patients.
They may experience unnecessary extra
stress in a living with visual contact with
other reptiles (predators).
Basic equipment to practice with reptiles
a gram scale
a lightweight plastic transport containers
endoscope (2.7 mm or less)
Xray
microscope with oil immersion capability
quick-staining kit for smears and cytology,
centrifuge, haemocytometer
biochemistry testing system.
 Side effects
Aminoglycosides

amikacin, gentamycin, kanamycin, netilmycin,

tobramycin

+ G- bacterial infections

glomerular filtration

- nephrotoxic (neurotoxic, ototoxic, cardiotox) efects

 Side effects

Tetracyclin ATBs

doxycyclin, chlortetracyclin, oxytetracyclin, tetracyclin

+ G+ i G- infections,

low nephrotoxic

- teratogenic (pregnanc), nauzea, vomitus,

hepatotoxicefekt (liver steatosis),

bacteriostatic
 Side effects

Quinolon

enrofloxacin, ciprofloxacin

+ G+ a G- infekc,

suspect teratogenic (pregnancy),

negative influence on bones (growth, joints)

 Metronidazole

+ (Clostridia, Entamoeba, Hexamita)

- neurotoxic efect
of reccommended doses
(heavy reptiles)
 Ivermectin

+ (endoparasites, ectoparasites)
- toxic for tortoises, turtles
 Administartion
Per os + GIT
Per cloacam

Parenteral
SC, IM, IPP, IV, IO
 Metabolic (Allometric) scalling

BMR (kcal) = K.H0.75

birds - passerine birds (K = 129)
birds - non-passerine birds (K = 78)
mammals (K = 70)
reptiles (K = 10)
 Antimicrobial agents ATB
Agent Dosage Comments

Acyclovir 80 mg/kg PO q24h x10 Tortoises (herpes)

Topical (5% ointment) q12h Tortoises (herpes)

Ampicilin
20 mg/kg IM q24h x 7 Tortoises
Amikacin Nephrotoxic agent
2.5 mg/kg IM, SC q72h x 7
Gentamycin 1.75 - 2.5 mg/kg IM q72 h x7
Nephrotoxic agent
Kanamycin 5 - 15 mg/kg q24 - 48 x 5 - 7 Nephrotoxic agent
 Antimicrobial agents ATB
Agent Dosage Comments

Chloramphenicol 20 - 50 mg/kg PO q24h x 7

Streptomycin 6 - 10 mg/kg IM q24h x 5 - 7

Tetracycline
25 - 50 mg/kg IM, PO q24h x 6
Tylosine
5 - 10 mg/kg IM q24h x10 crocodiles
Cindamycin
2.5 - 5 mg/kg PO q12-24h x 7
Doxycycline 50(1)+25(3 - 6)mg/kg IM q48 - 72h x 6
 Antimicrobial agents ATB
Agent Dosage Comments

Cefotaxime 20 - 40 mg/kg IM q24h x 7 - 14

Ceftazidime
20 mg/kg IM q72h x 14 - 21
Cephalexin 20 - 40 mg/kg IM q12h x 7
Cephalothin 20 - 40 mg/kg IM q48h x 7 chelonians
Cephazolin 20 - 40 mg/kg IM q24h x 7 - 14
Cephoperazone 125 mg/kg IM q24h x 7 lizards
 Antimicrobial agents ATB
Agent Dosage Comments

Enrofloxacin 10(15) mg/kg SC, PO q24h x 7 - 21

Ciprofloxacin q48h x 3 - 5
10 mg/kg PO
Metronidazole
20 - 50 mg/kg PO q24h x 3 - 5
Trimethoprim /
30(1)+15 mg/kg q24h x 10 - 14
sulfamethoxazole

Sulphadimidine 50 mg/kg PO q24h x 10

Sulphamerazine 25 mg/kg PO q24h x 7

 Antifungal agents antimycotics
Agent Dosage Comments

Amphotericin B 0.5 - 1 mg/kg PO, IPP q24 - 48h x 28

Griseofulvin 20 - 40 mg/kg PO q72h x 5
Clotrimazole ointment
topical
Fluconazole
5 mg/kg PO q24h x 28

Itraconazole 24 mg/kg PO q24h x 28

Ketoconazole 15 - 30 mg/kg PO q24h x 28
 Antifungal agents antimycotics
Agent Dosage Comments

Chlorhexidine 20 ml/gal water bath Lizards - dermatoph.

Malachite green 0.15 mg/l water x 1 hr q24h x 14

Miconazole topical ointment

Nystatin
100 000 i.u./kg PO q24h x 10
Tolnaftate 1%
topical q12h
cream
 Antiparasitic agents
Parasites Agent Dosage

Metronidazole 20 40 (100) mg/kg 3x

Amoeba Dimetridazole 40 mg/kg q24h x 4

Paromomycin 35 60 mg/kg after week

Metronidazole 20 40 (100) mg/kg 3x

Flagellata Dimetridazole 40 mg/kg q24h x 4

Ronidazole 10 mg/kg q24h x 10

 Antiparasitic agents
Parasites Agent Dosage

Toltrazuril 10 mg/kg q72h x 5

Coccidia Sulfadimethoxine 75 90 mg/kg I.day

40 45 mg/kg II. IV.
Sulfamethoxydiazine 40 60 mg/kg q24h x 4

Sulfadiazine 20 50 mg/kg q24h x 3

Cryptosporidium Trimethoprim / 30 60 mg/kg q24h x 7

sulfa
Spiramycin 160 mg/kg q24h x 10
 Antiparasitic agents
Parasites Agent Dosage

Ivermectin 0.2 mg/kg SC

Chelonians
Trematoda Praziquantel 10 30 mg/kg q14 days

Ivermectin 0.2 mg/kg SC

Chelonians
Cestoda Praziquantel 10 30 mg/kg q14 days

Niclosamid 150 mg/kg q14 days

 Antiparasitic agents
Parasites Agent Dosage

Fenbendazole 10 30 mg/kg q 14 days

Pyrantel pamoate 5 mg/kg q 14 days

Nematoda Ivermectin 0.2 mg/kg SC

Chelonians
Piperazine 40 60 mg/kg q 14 days

Albendazole 50 mg/kg q 14 days

Mebendazole 20 100 mg/kg q 14 days

 Hormones + steroids
Agent Dosage Comments

Arginine vasotocin 0.5 - 1.0 g/kg IV,IPP q12 - 24h

Oxytocin 1 - 10 i.u./kg IM after 2x calcium inj.
Calcitonin 1.5 i.u./kg SC q8h x 2 - 3
Dexamethasone 2 - 4 mg/kg IM q24h x 3
Prednisolone 2 - 5 mg/kg IM, PO chronic pain
Nandrolone 1 mg/kg IM anabolic, PHA
 Nutritional / mineral / fluid support
Agent Dosage Comments

Ca - gluconate - hypocalcemia
borogluconate 10 - 50mg/kg IM
Ca - gluconate 100mg/kg IPP, SC q8h MBD, seizures
Iodine 2 - 4 mg/kg PO q24h x 2 - 3w

Iron dextran 12 mg/kg IM 1 - 2 x w, crocodiles

Lactated Ringer
10 - 25 ml/kg SC, IPP q24h
s solution
 Nutritional / mineral / fluid support
Agent Dosage Comments

Vitamin A 1000 - 5000 i.u./kg IM q7-14d x 4

Vitamin B q24h x 3-7 days
complex 25 mg thiamine/kg PO
Vitamin C 10 - 20 mg/kg SC, IM q24h
Vitamin D3 200 i.u./kg IM, PO q7days
Vitamin E 1 i.u./kg IM
25 mg/kg IM hypovitaminosis
Vitamin K1 1000 - 5000 i.u./kg IM coagulopaties
 Miscellaneous agents
Agent Dosage Comments

Allopurinol 10 - 20 mg/kg PO q24h

Sucralfate 500 - 1000 mg/kg PO q6 - 8h
Cimetidine 4 mg/kg PO, IM q8 - 12h
Cisapride 0.5 - 2.0 mg/kg PO q24h
Furosemide 5 mg/kg PO, IM q12 - 24h
Metoclopramide 0.06 - 5 mg/kg PO q24h x 7
 Miscellaneous agents
Agent Dosage Comments

Lactulose
0.5 ml/kg PO q24h
Liquid paraffin 25 (1:1 electr)/kg PO q24h, constipation
Dioctyl Na
1 - 5 mg/kg PO constipation
sulfosuccinate
Barium sulfate
5 - 20 ml/kg PO GIT contrast