DRUGS INDICATED IN REPTILES

OUTLINE

Therapeutic Considerations

Routes of administration of drugs

Dosgae forms

Dosing of drugs- Aloometric scaling

Commonly used drugs- analgesics, sedatives and

their dosages

Commonly used drugs- antimicrobials: antibiotics,

anthelmintics, fluids, miscellaneous drugs and their

 REPTILES
LIZARDS

CHELONIANS (TURTLES, TORTOISES, TERRAPINS)

SNAKES

CROCODILES
THERAPEUTIC CONSIDERATIONS IN REPTILES

Dosages for drugs are still based on experience, often

extrapolated from treatments and indications in
companion animals.

In most cases, there are no specific drugs on the market

for these exotic pets.

The most important possibility is to prepare the

treatments using drugs available for man and /or
companion animals
 THERAPEUTIC CONSIDERATIONS IN REPTILES ..contd
ECTOTHERMS:
Body temperature is reliant on the environmental
temperature. (higher than the surroundings)
Control their body temperature through behavioural
means rather than internal thermoregulation as occurs
in mammals and birds
Provision of Heat is the single MOST important factor
when treating a sick or injured reptile
These animals remain active for short periods of time,
then have rests in between activity
 ATR (Active Temperature Range0

This is the temperature range where reptiles are capable

of normal, voluntary activity.
Below this temperature reptiles will just simply shut
down until the temperatures are more suitable.
Each species of reptile has a different ATR.
 POTZ (The Preferred Optimal Temperature Range/Zone)

Refers to the specific temperature range selected by a particular

species of reptile when presented with a thermal gradient.
Each reptile species has its own POTZ - its physiology is functioning
at its best.
Ability to heal and recover will be most efficient while it is within
the POTZ.
Long term recovery and survival of the animal if maintained in its
POTZ.
In emergency: safely housed at 29.5C to 32C until they are
stabilised and then maintained at the upper end of the their POTZ.
Improper ambient temperature- Unpredicatble response to
medications.
Temperature < or > the POTZ for the species being treated then
stress and debilitation may ensue.
Even when the stated therapeutic temperature is within the POTZ
for the species being treated, constant exposure to a fixed
temperature is likely to be stressful.
Heat Considerations
Not to overheat the patient.
Every species of animal, not just reptiles, has a Critical
Thermal Maximum where the animal loses voluntary control
and is incapable of thermoregulating.
The use of a continuous cloacal thermometer to monitor core
body temperature can be useful to prevent hyperthermia.
Not to burn the patient: . Hot water bottles, heat packs and
heat mats are all capable of inflicting severe burns.
Radiant heat is generally considered to be the best way to
provide heat as it allows for a temperature gradient to be
established
Severely ill patients may not be able to successfully
thermoregulate and as such may be better in an enclosure
with a fixed temperature until they are more stable.
 RENAL PORTAL SYSTEM

Well-developed renal portal system; blood from the caudal half of the

body passes through the kidneys before reaching the systemic venous

circulation.(prior to circulating back to the heart)

Drugs injected into the caudal half of the body may have a significantly

reduced half-life if excreted via tubular secretion.

The blood that enters the kidneys via the renal portal system is used to

ensure there is adequate perfusion of the renal tubules and does not

undergo glomerular filtration.

 RENAL PORTAL SYSTEM.CONTD

When blood flow through the glomerulus is decreased as a water-

conservation mechanism the renal portal system continues to

provide a blood supply to the renal tubules , preventing
ischaemic necrosis.

Also, the large bladder of chelonians may act as a drug reservoir

and lead to a secondary therapeutic peak many hours after drug

administration.

The shell of tortoises, turtles, - is largely living tissue; therefore,

all chelonian medication should be based on total body weight.

 Clinical Implications of Renal Portal System
Injections of drugs given in the caudal half of the body - have

the potential to be excreted by the kidneys before they entered

the rest of the circulation.

Drugs that are excreted by glomerular filtration (e.g.

aminoglycosides)- likely not to have any greater toxic effects of the
kidneys if injected in the caudal half of the body.

Drugs with potential tubular toxic effects (e.g. quinolones,

cephalosporins and penicillins) should be injected in the caudal half of

the body with caution in the dehydrated patient.
 Great variation in the degree of development of the

renal portal system across reptile species and that

the renal portal system- may not have any
significant effect on drug kinetics.

However suggestion that injections should, be

given in the cranial half of the body.
 ROUTES OF ADMINISTRATION/METHODS OF MEDICATIONS IN
REPTILES

Oral
Parenteral/ Injectable
(subcutaneous,
intramuscular, , intracardiac,
intravenous, intracoelomic,
intraosseous, intrasynovial,
or intratracheal )
Inhalational (Nebulization)
Topical (Percloacal)
Intralesional
Medicated water/ food.
Selection of routes of
administration
Severity of infection
Number of animals to be
treated
The ability of the owner to
administer the medication
Formulation available.
 Oral Dosage Forms
Tablets:
Grinding the tablet, making a
suspension and feeding it by
esophageous canula can
overcome the problem.
Coated tablets in reptiles with a
muscular gizzard, which will
destroy the coating and give HCl
and pepsin full access to the
drug.??
Should become trapped in the
esophagus.
When protective coatings are
disrupted and the vehicles altered,
the stability of the product may be
compromised.
Capsules
Preferably administered into an empty
esophagus-stomach.
Useful for the treatment of individual
patient.
The location of the entrapment of
capsules is particulary disturbing
because some medications given to
reptiles may cause esophageal lesions.
Solutions and suspensions
are frequently used for direct
administration to reptile patients.
An advantage
the direct administration to
stomach may only hardly result in
regurgitation or inhalation (risk of
aspiration pneumonia is limited).
Medication of feed or water

Feed medication (minerals) - a reliable way of medicating

the patient, as long as the reptile is still eating normally.
Crushed calcium tablets, oral suspensions, and powders
can be mixed with moist foods.
Medication in water in reptile medicine controversial.???
Big influence of factors- unacceptance, poor solubility,
and day length.
often refuse to drink water with an abnormal taste, which may
result in dehydration.
many drugs (vitamins) are stable for only a short time in water,
which necessitates frequent changes.

.
 PO (per os)
Difficult route - , given the vast numbers of sharp teeth and the
glottis.
Need to watch out for the glottis that sits on the tongue at the back
of the mouth in most reptiles
in chameleons and snakes, the glottis will be behind the tongue
sheath.
Using a French catheter or feeding/dosing tube attached to a
syringe, - insert it into the mouth, sliding it down one side of the
mouth or the other to avoid accidentally threading it into the
glottis.
When expressing fluids or liquid nutrition (slurries) into a reptile,
do it slowly enough so that it flows down towards the stomach,
rather than so fast that it backs up into the mouth.

If fluid or slurry backs up into a reptiles mouth, stop forcing the

fluid or slurry through the tube.
Tilt the reptile with its head downward to let the fluid or slurry
run out of his mouth and let him catch his breath.
 SUBCUTANEOUS
The needle, held at a slant, is inserted between the scales
deep enough to get through the skin.
The fluid is then expressed slowly out of the syringe. If more
fluid than can be injected at one site must be administered,
remove the needle and insert in another site.
Preferred sites
Lizards- shoulder blade area
Chelonians- in the loose skin in the shoulder areas
Snakes- midway between the muscle groups along either side
of the spine on the back and the lateral midline of the body
Injections made in the shoulder area need to avoid the neck
(cervical) to avoid any damage that could lead to neurological
complications
 INTRAMUSCULAR (IM)
Lizards - in the muscle groups in the front legs or in
the muscles along the back and neck

Chelonians - in the muscle groups in the front legs or

in the muscles in the shoulder area

Snakes- midway between the muscle groups along

either side of the spine on the back and the lateral
midline of the body
 INTRAOCOELOMIC/INTRAPERITONEAL
Fluids may be injected directly into the body cavity.
Quickly absorbed and more fluid can be administered at one time
Caution: placing the needle, and the slant of the needle. If done
incorrectly, you could puncture an organ or the intestine.
A mark can be made on most reptiles, using povidone-iodine or
even nail polish (formaldehyde and tuolene free), around the
injection site to help you remember. Insert the needle between two
scales, not through a scale.
Lizards- the right side of the lower abdomen to avoid the urinary
bladder
Chelonians- the loose skin cranial to the rear legs.
Snakes - the lower third of the body due to the need to avoid the
lung(s).
INTRACOELOMIC route
TORTOISES
Maximum levels of 20 - 25 ml/kg/day only can be given,
otherwise due to the confines of the shell, the fluids place too much
pressure on the lung fields.
Access sites include the area cranial to the hind limbs
Same site as from subcutaneous routes, but the chief difference
being depth.
The concern with this route is that the bladder lies in this area, and
if full may be punctured.
The other route-cr anial access site. : is located lateral to the
neck and medial to the front limb.
The needle is kept close and parallel to the plastron and a inch
needle may be inserted to the level of the hub.
 INTRAVENOUS
Snake- The caudal vein and the heart.
The caudal vein is accessed caudal to the cloaca, between 25 and
50% down the tail, and avoiding the paired hemipenes of males.
Lizards- the ventral midline caudal vein, best accessed 2080%
down the tail.
Chelonians- jugular vein, subcarapacial sinus, and dorsal
coccygeal veins.
The left and right jugular veins are preferred because of the reduced
risk of lymphatic contamination.
 INTRAOSSEOUS ROUTE (INFUSION)
For use in lizards, small crocodilians and chelonia.
Not POSSIBLE in SNAKES
Chelonians- the intraosseous needle can be inserted into
the distal tibia or the medullary cavity of the vertical shell
that connects the carapace and plastron.
Intraosseous needles are taped in position using zinc oxide
tape, incorporating a loop of the extension line to reduce
catheter tension.
Syringe drivers are used to control the infusion rate.
Intraosseous technique can be used in reptiles as small as 75
grams and most consider it as the parenteral route of
choice.
 INTRAOSSEOUS
Hypoderm ic/spinal needles of 23 - 25 gauge sizes may be used.
LIZARDS:
Proximal femur- accessed from the fossa created between the greater
trochanter and the hip joint.
Difficult due to the 90 degree angle the femur often forms with the pelvis.
Distal femur
this is relatively easy to access from the stifle joint. It does provide
restrictions
to the movement of the stifle joint, but it is easier to bandage the catheter
in to this site and access to the medullary cavity of the femur is certainly
ea sier via this route.
Sedation or anaesthesia is required
Proximal tibia
spinal needle or hypodermic needle may be screwed into the tibial crest
region in a proximo-distal manner
INTRAOSSEOUS
The needle is directed into the medullary cavity of a long bone,
and aspiration of marrow or radiography can verify correct
positioning.
Great care must be exercised when dealing with osteodystrophic
lizards in order to avoid limb fractures.
Infusion rates for IV and intraosseous administration are similar.
As a general guide 0.81.2 mL/kg/hr is suitable for
rehydration purposes, but in cases of severe dehydration or shock
or during surgery 35 mL/kg/hr can be given for 23 hr
 INTRAOSSEOUS
TORTOISES
Plastro-carapacial junction/pillar
The pillar of shell which connects the plastron to the carapace.
It is approached from the caudal aspect, just cranial t o one of the
hind-limbs.
The spinal/hypodermic needle (21 - 23 gauge) is screwed into the
shell attempting to keep the angle of insertion parallel with the
outer wall of the shell, so entering the shell bone marrow cavity.
In larger older species, the shell may be too tough to allow
penetration in this
Proximal tibia
Approached as for lizards.
The area is thoroughly scrubbed and the hypodermic/spinal
needle is screwed into the tibial crest in the direction of the long
axis of the tibia distally
 NEBULISATION

Drugs as such poorly distributed to lungs

Blood air barrier is thicker in reptiles than in mammals,
a poorly developed or absent cough reflex
fact that caseous, impenetrable purulent discharges are
common
many of the most effective antibiotics such as the
aminoglycosides are potentially toxic if given in effective
doses systemically,
Aerosolised administration of these drugs. Others- soluble steroids
in inflammatory conditions, antiseptics, bronchodilators and
agents aimed at reducing the viscosity of respiratory secretions.
 Metabolic dosing (Allometric scaling )
It is based on the principle that amount of drug to be administered
to animals is more related to daily energy use than to body
weight.
Allometric scaling calculates the drug dose and dosing frequency using
metabolic rate rather than body weight. The basic allometric equations are
shown below, in which W = body weight (kg) and K = energy constant,
which is 10 for reptiles.
These equations can be used to calculate a dose and dose frequency for a
species for which no data are available, by using pharmacokinetic data
from a known species (control), whether another reptile, or mammal or
bird.
The average basal metabolic rate is expressed by the formula
BMR (kcal) = K.W 0.75.

The constant (K=10) is related to the optimal or preferred body

temperature.
Based on the calculated daily minimal energy requirement of the patient
the amount of drug for treatment of that animal can easily be calculated
expressed in mg/kcal.
 The calculated dosages are starting dosages. The dosage
should be adapted for the effect.
The main success of treatment of reptiles- is not the choice
of the right drug.
Many factors can cause differences in clearance such as
rates of biotransformation, protein binding, hepatic enzyme
activity, enterohepatic cycling.
Among reptiles there is no single allometric equation that
could be applied to all animals
The problem with metabolic scaling is that reptiles represent a very
heterogeneous group of vertebrates and no single equation relating
metabolic rate to body mass can be developed for calculating antibiotics
dosages.
Analgesics, Sedatives, and Anesthetics Used in Reptiles

Ketamine: 20 - 60 mg/kg IM
(McConnell and Hughey 1987
 ISOFLURANE
a) Give 5% isoflurane and oxygen in a clear plastic bag or
induction chamber. Fill chamber with gas and seal. Induction time
may take 30 - 60 minutes, but can be shortened to 15 - 30 minutes
with increased depth of anesthesia if animal is injected with 10-20
mg/kg of ketamine (SubQ or IM).
Patient should be kept warm by placing on a water blanket
Surgical anesthesia can be determined by the loss of righting
reflex.
Maintenance levels are 3-5% (if isoflurane used alone).
If apnea occurs during or after anesthesia, discontinue gas
anesthetic and apply gentle manual ventilation 2 - 4 times per
minute with small doses of doxapram IV. Normal respiration
generally resumes in 3-5 minutes
 ANTIMICROBIALS
( R - rabbits; Rd - rodents; F ferrets; A - avian; Rp reptiles)
Most bacterial infections in reptiles are caused by Gram-negative
bacteria,- Pseudomonas,Aeromonas, E.Coli,
Citrobacter, Klebsiella, and Proteus spp.
Antibacterial therapy must usually be given while awaiting the
results of bacterial sensitivity tests.
Amikacin, ceftazidime, and enrofloxacin or ciprofloxacin are
often preferred
In severe infections, amikacin may be combined with ampicillin
or amoxicillin for respiratory tract infections or with ceftazidime
for generalized or systemic infections.
Chloramphenicol in combination with neomycin may be given for
GI infections.
Metronidazole, lincomycin, or clindamycin- for anaerobic
infections.
 Chloramphenicol (R, A, Rd, F)
Chloramphenicol is a broad-spectrum (has a wide range of
antibacterial effectiveness), bacteriostatic antibiotic.
It exerts its antibacterial effects against aerobic G(-) and G(+)
organisms, some anaerobicbacteria, Chlamydia, Rickettsia and
Mycoplasma.
Of the G(-) bacteria, it is very effective against Salmonella, has
some antibacterial activity against E. coli and is impotent against
Pseudomonas.
Chloramphenicol can be administered to a patient by various
routes, but most commonly it is given either by injection into the
muscle, or orally with a dropper directly into the mouth.
DOSE: For most species using the sodium succinate salt: 20 - 50 mg/kg IM or
SubQ for up to 3 weeks. Chloramphenicol is often a good initial choice until
sensitivity results are available. (Gauvin 1993)
 Advantage of reaching relatively high concentrations in
some of the internal organs such as the kidneys, liver, heart
and central nervous system

Not an ideal drug for patients that are

immunocompromised, such as the snake with a severe
respiratory infection that has been housed at sub-optimal
temperatures.
Should not be used in combination with bactericidal drugs.
Has a potential for causing human toxicity (aplastic anemia),
there is a tendency to steer away from prescribing this drug to
out patients.
Staff members should always take necessary precautions when
handling the drug.
Tetracyclines (eg. Chlortetracycline,
Oxytetracycline, Doxycycline) (Rd, A)

Bacteriostatic at standard doses.

Wide spectrum of activity against aerobic and anaerobic G(-)
and G(+) bacteria.
Excellent effectiveness against the unusual bacteria such as
Mycoplasma and Chlamydia.
Doxycycline has the most potential for clinical use in exotics,
especially in birds and rodents.
Administered by either the oral route, including both direct
administration with a dropper or mixed into the feed, and via
injection.
Doxycycline: 10 mg/kg PO once daily for 4 weeks. Useful for bacterial respiratory
infections in tortoises having suspected Mycoplasma infections.
 Poorly absorbed after oral dosing

In mammals concurrent consumption of milk has been shown to

decrease absorption of tetracycline by as much as 70%.

Birds on an oral prescription of a tetracycline drug should be watered

with de-ionized or soft water to prevent interference with the

absorption of the drug.

Likewise, during treatment, any oral vitamin or mineraL supplements

should be suspended until after treatment is finished.

. TETRACYCLINE:
For turtles and tortoises: 10 mg/kg PO once daily for 7 days (useful in
ulcerative stomatitis caused by Vibrio) (Gauvin 1993
Penicillins (eg. Penicillin, Amoxicillin, Carbenicillin, Piperacillin)
(*R, A, Rp)
Bactericidal in rapidly growing or replicating organisms.
Quiescent bacteria are resistant.
Effective against the G(+) bacteria and Pasteurella.
Oxacillin is an example of newer group of narrow spectrum
penicillinase-resistant penicillins now available for treatment of
Staph bacteria.
Ampicillin, amoxicillin and hetacillin are extended spectruM
penicillins with some activity against G(-) bacteria, but like the
original penicillins, they are destroyed bypenicillinase.
Antipseudomonal: Carbenicillin and piperacillin
Very effective when used in combination with the
aminoglycosides, having a synergistic effect.
(Gut flora in rabbits and rodents are of the G (+) type, using
penicillins can often times have lethal effects).
Cephalosporins (A, Rp)

Bactericidal, effective against rapidly growing bacteria and

ineffective against resting bacteria.
Spectrum :both the G(-) and G(+) bacteria.
The first generation - cephalexin, (spectrum similar to
amoxicillin)
The second generation: Cefachlor and cefuroxime . (more
effective against the G-)
The third generation cephalosporins: cefotaxime , ceftazidime
against Pseudomonas.
 Aminoglycosides (eg. Gentamicin, Amikacin)
(R, A, Rd, F, Rp)
Bactericidal, but they have little effect against the G(+) bacteria, and
are ineffective against the anaerobes.
Toxic effect on: kidneys, the ears and the neuromuscular system.
By combining an aminoglycoside with a penicillin the antibacterial
spectrum includes both the aerobic and anaerobic G(+) and G(-)
bacteria, as well as the serious Pseudomonas species.
Tobramycin: 2.5 mg/kg once daily IM (Gauvin 1993)

Gentamicin: a) For bacterial gastritis in snakes: 2.5 mg/kg IM every 72 hours with oral
neomycin 15 mg/kg plus oral live lactobacillus. (Burke 1986)
b) For bacterial shell diseases in turtles: 5 - 10 mg/kg daily in water turtles, every other day
in land turtles and tortoises for 7-10 days. Used commonly with a beta-lactam antibiotic.
Recommend beginning therapy with 20 ml/kg fluid injection. Maintain hydration and
monitor uric acid levels when possible. (Rosskopf 1986)
 Sulfa drugs (eg. Sulfadimethoxine, Trimethoprim-
sulfamethoxazole) (R, A, Rd, F, Rp)
The most common in non-domestic medicine,
Trimethoprim-sulfamethoxazole - Synergistic action against
bacteria, thus making the combination bactericidal.
It has a broad spectrum of effectiveness, including some of the
serious G(-) bacteria such as Klebsiella.
Used with caution in dehydrated patients.
Anemias in some patients and allergicreactions in others.
Trimethoprim-sulfamethoxazole is available either as an injectable
antibiotic or in a highly palatable oral form.
In addition to its effectiveness as an antibiotic, it also has some
use as a treatment for protozoal infections caused by coccidia
SULPHADIAZINE TRIMETHOPRIM:
: 30 mg/kg IM (upper part of body) once daily for 2 treatments, then every othe day for 5-
12 treatments. May be useful for enteric infections. (Gauvin 1993)
Quinolones (Ciprofloxacin, Enrofloxacin)(R, A, Rd, F, Rp)

Ciprofloxacin and enrofloxacin are broad spectrum,

bactericidal antimicrobials.
They are effective against many of the G(+ and G(-)
bacteria, including the penicillinase producing
Staphylococcus and some of the Pseudomonas species.
In addition, they are very effective against the
Mycoplasmas.
Gastrointestinal upset, seizures in some animals and joint
defects in young or growing animals.
Not recommended to animals in their growth stage.

:Enrofloxacin: For respiratory infections:5 mg/kg IM every 5 days for 25 days;

For chronic respiratory infections in tortoises: 15 mg/kg IM every 72 hours for 5-7 treatments.
METRONIDAZOLE
For anaerobic infections in most species:150 mg/kg PO once;
repeat in one week.
For amoeba and flagellates in most species: 100 - 275 mg/kg PO
once; repeat in 1-2 weeks. In Drymarchon spp., Lampropeltis
pyromelana, & lampropeltis zonata: 40mg/kg PO once; repeat in 2
weeks (Gauvin 1993)
TYLOSIN HCl:
For tortoises: 5 mg/kg IM once daily for at least 10 days. Used primarily for chronic
respiratory infections or when Mycoplasma is suspected (Gauvin 1993)
 ANTIFUNGALS
Fungal and yeast infections :
GI mycoses are particularly common in reptiles that have been
maintained on inappropriately longterm broad-spectrum antibacterials.
Cutaneous mycoses can often be treated by debridement and the
topical application of antifungals.
GI infections can be treated with nystatin, while systemic infections
may require ketoconazole or fluconazole.
In cases of pulmonary mycoses, antifungal medication may be given by
nebulization or intratracheal or intrapulmonary injection.

ANTIVIRALS
Herpesviruses can cause severe morbidity and mortality in chelonians.
Acyclovir has been used with some success during the early stages
COMMON ANTIMICROBIAL AGENTS USED IN REPTILES
( SOURCE: MERCK VET MANUAL)
Amikacin
Amoxycillin

Ampicillin

Amphotericin B
CIMETIDINE:
In most species: 4 mg/kg PO q8-12h (Gauvin 1993)

DEXAMETHASONE SODIUM PHOSPHATE

For septic shock in most species: 0.1 - 0.25 , mg/kg IV or IM (Gauvin 1993)

FENBENDAZOLE
50 - 100 mg/kg PO once; repeat in 2-3 weeks; effective against strongyloides.

FUROSEMIDE:
Reptiles: 5 mg/kg IV or IM as needed. (Gauvin 1993)
KETOCONAZOLE
For most species:15 - 30 mg/kg PO once daily for 2-4 weeks. (Gauvin
1993); For fungal shell diseases in turtles/tortoises: 25 mg/kg PO once a
day for 2-4 weeks (Rosskopf 1986)
LEVOTHYROXINE SODIUM
For hypthyroidism in tortoises: 0.02 mg/kg PO every other day. (Gauvin 1993
Cephalothin: 20 - 40 mg/kg IM q12 hours (Gauvin 1993)
 Mycoplasma

Cefotaxime: 20 - 40 mg/kg IM once daily for 7-14 days. (Gauvin 1993)

 PARASITICIDALS
Parasiticide overdosage may lead to drug toxicity, which may be seen as

neurologic signs, including seizures.

Ivermectin is contraindicated in Chelonia, and adverse reactions have

been reported in some iguanid lizards, skinks, and Indigo snakes.

Ivermectin: For most nematodes, ectoparasites: a) For lizards, snakes, and
alligators: 0.2 mg/kg (200 microg/kg) IM, SubQ, or PO once; repeat in 2
weeks
Milbemycin has been successfully used in box tortoises and terrapins but
it is recommended that milbemycins be avoided in all Chelonians
Permethrin is licensed for use in reptiles and appears safe and effective

against mites and ticks

ECTOPARASITICDALS
Atropine

BETHANECHOL CHLORIDE
Uses/Indications - In veterinary medicine, bethanechol is used primarily to
stimulate bladder contractions in small animals. It also can be used as an
esophageal or general GI stimulant, but metoclopramide and/or neostigmine
have largely supplanted it for these uses.
Reptiles: 2.5 mg/kg SQ (McConnell and Hughey 1987)
CALCITONIN SALMON
In small animals, calcitonin has been used as adjunctive therapy to control
hypercalcemia./ hypervitaminosis D

Reptiles: For hypercalcemia in Green iguanas in combination with fluid

therapy: 1.5 IU/kg SubQ q8h for several weeks if necessary. (Gauvin 1993)
CALCIUM SALTS: Ca GLUCONATE, Ca GLUCEPTATE, Ca CHLORIDE, Ca LACTATE
Reptiles: For egg binding in combination with oxytocin (oxytocin: 1 - 10 IU/kg IM.):
Calcium glubionate: 10 -50 mg/kg IM as needed until calcium levels back to normal or
egg binding is resolved. Use care when giving multiple injections. Calcium/oxytocin is
not as effective in lizards as in other species. (Gauvin 1993)

OXYTOCIN
a) For egg binding in combination with calcium (Calcium glubionate: 10 -50 mg/kg IM as
needed until calcium levels back to normal or egg binding is resolved): oxytocin: 1 10
IU/kg IM. Use care when giving multiple injections. Not as effective in lizards as in other
species. (Gauvin 1993)
PRAZIQUANTEL
For cestodes and some trematodes in most species: 7.5 mg/kg PO once; repeat in 2
weeks PO (Gauvin 1993); b) For removal of common tapeworms in snakes: 3.5 - 7
mg/kg (Roberson 1988a)
PREDNISOLONE SODIUM SUCCINATE:
For shock in most species 5 - 10 mg/kg IV as needed. (Gauvin 1993
STANOZOLOL
For most species post-surgically and in very debilitated animals: 5 mg/kg IM once a
week as needed. (Gauvin 1993)
 FLUIDS
Lactated Ringers
As with cats and dogs, this form of fluid is useful as a general-
purpose rehydration/maintenance fluid.
It is particularly useful for reptiles suffering from metabolic
acidosis such as those described above with chronic gastro-
intestinal problems but can also be used for fluid therapy after
routine surgical procedures.
Glucose/Saline Combinations
These are useful for reptiles and amphibians as they may have
been through periods of anorexia prior to treatment, and
therefore may well be borderline hypoglycaemic.
In addition for reptiles with renal disease and elevated potassium
levels these fluids are the fluid types of choice
PROTEIN AMINO ACID/B VITAMIN SUPPLEMENTS
At rate of 1 ml/kg body weight/day. They are particularly good in cases where the
patient is malnourished or has been suffering from a protein losing enteropathy
such as cases of heavy parasitism or a protein losing nephropathy to help replace
some of the compounds needed for replenishment.
It is also a useful supplement for patients with hepatic disease or severe exudative
skin diseases such as heater burns.
COLLOIDAL FLUIDS
When direct venous access has been achievable, and there is some evidence that
they may be used via the intraosseous route. Their usage is, as with cats and dogs,
for when a serious loss of blood occurs, in order to support central blood pressure.
This may be a temporary measure whilst a blood donor is selected, or if none is
available, the only means of attempting to support such a patient
ORAL FLUIDS/ELECTROLYTES
Reptile and amphibian practice for those patients experiencing mild dehydration,
and for home administration.
Many products available for cats and dogs, and may be used for reptiles, but as with
the crystalloid fluids, it is advisable to over-dilute these oral electrolytes by
approximately 10 % otherwise their concentration will be greater than the reptiles
ECF and so water will move from the body into the GI tract
 Sources
Exotic and Laboratory Animals section in The Merck Veterinary
Manual, http://www.merckmanuals.com
www. ivis.org
www.kvh.com.au
Veterinary Drug Handbook, Third Edition, 1999 by Donald C.
Plumb, Pharm.D. PharmaVet Publishing ,White Bear Lake,
Minnesota
Gauvin, J. (1993). Drug therapy in reptiles. Seminars in Avian
& Exotic Med. 2(1): 48-59 in
Back-to-basics, The Reptile Consult. Simon J Girling, British
Veterinary Zoological Sociey Proceedings November 2008 pg-
57 -