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Alfaxan ® Anaesthetic Injection Alfaxan ® FAQs Repeatable. Reliable. Relax.
Alfaxan® Anaesthetic Injection
Alfaxan® FAQs
Repeatable. Reliable. Relax.
What is the active ingredient of Alfaxan®?
Alfaxan® Anaesthetic Injectionisananaestheticinductionagentregisteredforuseindogsandcats,containingtheneurosteroid,alfaxalone.Thismoleculeissimilarinstructuretoprogesterone.
What is the mode of action of Alfaxan®?
Alfaxalone,theactiveingredient,actsatthesametrans-membraneGABAAreceptorasother(non-dissociative)anaestheticinductiondrugs.Itbindstoasiteonthereceptorresultingintheopeningofthechloridepore,allowingentryofchlorideions.[1,2]Thiscauseshyperpolarisationoftheneuroneandinhibitionofimpulsetransmissionwhichgivesthemoleculeitsanaestheticproperties.
What species is Alfaxan® registered for?
Alfaxan®isregisteredforuseasaninduction–and/ormaintenance–anaestheticagentindogsandcats.
Where is Alfaxan® marketed?
Alfaxan®iscurrentlymarketedinAustralia,NewZealand,Canada,UK,Ireland,France,Germany,Spainandanumberofothercountries.ItawaitsregistrationintheUSA.
How is Alfaxan® administered?
Alfaxan®isadministeredbyintravenousinjectioninthedogandbyeitherintravenousorintramuscularinjectioninthecat.
What is the dose rate of Alfaxan®?
ThedoserateforAlfaxan®is2mg/kgindogsand5mg/kgincats.Thistranslatesto1mLper5kilogramofbodyweightindogsand2.5mLper5kilogrambodyweightincats.
NB: The product should be given slowly to effect. The required dose should be determined and then given intravenously at the rate of a quarter of the calculated dose at every 15 seconds.
Duringadministrationthepatientshouldbemonitoredfordepthofanaesthesiaintheusualway.Ifpremedicantshavebeenusedthepatientmayreachthedesiredlevelofanaesthesiabeforetheentiredosehasbeenadministered.
How long does anaesthesia last following administration of Alfaxan®?
Thedurationofunconsciousnesswillvaryamongpatientsduetoavarietyofinternalandexternalfactors,howeverfollowingadministrationofAlfaxan®atrecommendeddosageshealthyun-premedicatedcatscanbeexpectedtoremainanaesthetisedforapproximately25minutesandhealthy,un-premedicateddogsforapproximately10minutes.
How safe is Alfaxan®?
Acute tolerancetoover-dosagewithAlfaxan®hasbeendemonstratedatupto5 timestherecommendeddoseof5mg/kgincatsandupto10 timestherecommendeddoseof2mg/kgindogs.[3,4]
Repeated overdosingofAlfaxan®at5 timestherecommendedrateindogsand5 timestherecommendedrateincats,at48hourintervalson3occasionsover7days,causednoadverseeffects.[5,6]
Frequently asked questions about Alfaxan®
How effective is Alfaxan®?
Alfaxan®hasnowbeenroutinelyusedinmorethanamillionsurgicalproceduresincountriesacrosstheglobe.Thesurgeriesinclude(butarenotlimitedto)castration,ovariohysterectomy,dentistry,cancerremoval,eyeandearsurgery,orthopaedicproceduresandarangeofclinicaltaskswhereanaesthesiaisdeemedappropriate–MRI,radiology,abscesscleaningandwounddebridement.Infact,inanysituationwhereanaesthesiaisrequired,Alfaxan®hasbeenusedsafelyandeffectively.
InasurveyofveterinaryanaesthesiainAustralia–whereitwasfirstintroducedintheearly2000s–responsesshowedthatAlfaxan®iscurrentlyusedforover50%ofallinductionsindogsandover75%ofallinductionsincats.[7]
Can Alfaxan® be used in sighthounds?
Alfaxan®hasbeenproventobeareliableandeffectiveanaestheticinductionagentinsighthounds.[8]
Can Alfaxan® be used in Caesarean section?
Alfaxan®hasbeenproventobereliableandeffectiveasananaestheticinductionagentincanineCaesareansection.[9]
Has Alfaxan® been used in other species beside dogs and cats?
Alfaxan®hasbeenusedinresearchstudiesinawiderangeofproduction,laboratoryandexoticanimalspecies.ManypapershavebeenpublishedonitsuseinsuchspeciesandJurox,makersofAlfaxan®,carrythisdataonfile.
What is the best procedure to optimise results with Alfaxan®?
Asmentionedabove,alfaxalone,theactiveingredientofAlfaxan®isarapidlyactinganaesthetic.Whenadministeringtheproductthesolutionshouldbegivenslowlytoeffect.Rapidadministrationofthetotaldosemaycauseapnoeainsomepatients.
Alsothetransitiontomaintenanceongaseousanaesthesiashouldoccurimmediatelyafterintubation.DelaysinmovingtogaseousanaesthesiacouldresultinthepatientlighteningandthusrequiringfurtherdosesduetotheshortactingnatureofAlfaxan®.
Theuseofpremedicationagents,aswellaspaincontrol,acrosstheentireanaestheticprocedureisrecommended.Thetwinconceptsofconsidered poly-pharmacyandbalanced anaesthesia–basedontheuseofarangeofeffectiveagents–allowsreductioninindividualdoses,thusreducingpotentialsideeffectsaswellasensuringapain-andstress-freeprocedure.Thisincreasestheprobabilityofasmoothinduction,easytransition,reliablemaintenanceanduneventfulrecovery:allassistinginachievingoptimumoutcomesforthepatient.
Is Alfaxan® compatible with the premedicants that I’m currently using?
Alfaxan®hasbeenprovencompatiblewiththemajorgroupsofpremedicationagentsincludingphenothiazines(acepromazine),anticholinergics(atropine),benzodiazepines(diazepam,midazolam),-2-adrenoreceptoragonists(xylazine,medetomidine,anddexmedetomidine),opiates(methadone,morphine,butorphanol,buprenorphine,hydromorphone)andNSAIDS(carprofen,meloxicam)aswellasthenormalgaseousmaintenanceagents.[8-21]
Can Alfaxan® be used for TIVA?
Yes.Alfaxan®isregisteredfortheinductionand/ormaintenanceofanaesthesiainboththedogandcat.MaintenancecanbeachievedeitherbyContinuousRateInfusion(CRI)orrepeatedbolusadministration.Seetheproductleaflet/insertfordetails.
What are the pharmacokinetic and pharmacodynamic profiles of Alfaxan®?
TheactiveingredientofAlfaxan®,alfaxalone,israpidlyeliminatedfromthebodyafterasingledose,beingcompletelyclearedwithinafewhours.[22]
Alfaxan®hasminimaleffectofcardiovascularfunction.[23],24]Thereforebloodpressureiswellmaintainedandprovidesacceptabletissueperfusion,importantinsustainingnormaltissue/organfunction.
Alfaxan®,administeredasrecommended,causesminimaldose-dependentrespiratorydepression.[25,26]Thereforepatientsbreathenormally–assistinginsmoothtransitiontogaseousmaintenance.
Does Alfaxan® cause tissue damage if given peri-vascularly?
No. Alfaxan®isaclear,aqueous,pHneutraliso-osmolarsolution.Thereforeitcausesnotissuedamageifinadvertentlygivenperi-vascularly.[27]
Do I need to use a muscle relaxant when I use Alfaxan®?
Alfaxan®providesgoodmusclerelaxation.[23,24]Thereforethereisnoneedforadjunctivemusclerelaxants.
What sort of induction and transition can I expect?
WithAlfaxan®thereisnoinductionexcitementfromsub-anaestheticdoses.[25,26]Thereforetheinjectioncanbegivenslowlytoeffect.Thismeansthepatientchoosesthetotaldoserequired,reducingtheriskofrespiratorydepressionandallowingasmoother,morerapidtransitiontomaintenancewithagaseousagent.
What are the traps for the inexperienced when using Alfaxan®?
Themajortrapistogivethesolutiontoorapidly.Manyveterinarianshaveexperiencedexcitementwithotheranaestheticagentsinthepast,hencethetendencyto‘getthrough’theinductionphasequickly.ThisistheoppositeofwhatisrequiredwithAlfaxan®.ThemottoforinductionwithAlfaxan®is“give slowly, to effect.”
Also,alfaxaloneisquitespecificinitssiteofaction,withalmostcompleteactivityasaresultofeffectsoftheGABAAreceptor.Thismeansthatalfaxalonedoesnotofferanalgesiaorleadtosomeoftheeuphoriceffectsthatotheranaestheticdrugsmayofferinrecovery.Asaresult,Alfaxan®shouldbeusedinconjunctionwithothermedicationstoaddresspainandrapidreturntoconsciousnessduringtherecoveryperiod.
How long may a broached vial of Alfaxan® be kept for further use?
Alfaxan®doesnotcontainapreservative,thusavialcannotbekeptindefinitelyonceitisopened.However,broachedvialscanbestoredunderrefrigeratedconditions(4˚C)forupto7daysprovidedcontaminationisavoided.
Further questions?
PleasecontactyourlocalJuroxrepresentativeorJuroxtechnicalmanagementviathe Alfaxan®websiteatwww.alfaxan.com
References1. JuroxandRicera,Aninvitrostudyevaluatingthebindingofalfaxalone
to various nuclear receptors (Ricera Study No. AA94464). Records inHouse,2010.
2. JuroxandRicera,Aninvitrostudyevaluatingthebindingofalfaxaloneto various abuse receptors (Ricera Study No. AA94047). Records inHouse,2010.
3. Muir,W.,etal.,Thecardiorespiratoryandanestheticeffectsofclinicaland supraclinical doses of alfaxalone in cats. Veterinary AnaesthesiaandAnalgesia,2009.36(1):p.42-54.
4. Muir,W.,etal.,Cardiorespiratoryandanestheticeffectsofclinicalandsupraclinicaldosesofalfaxalone indogs.VeterinaryAnaesthesiaandAnalgesia,2008.35(6):p.451-462.
5. Whittem,T.andPasloske,P.,RD9604.03–H005.EightdaytargetanimalsafetystudyofintravenousAlfaxan®CDRTUindogsadministeredeveryotherday.2004,JuroxPty.Ltd.
6. Pasloske,K.andWhittem,T.,JX9604.07-H004.A targetanimalsafetystudy in cats after administration of Alfaxan® CD RTU as single,repeated injectionsondays0, 2and5atdosesof5, 15or25mg/kg.2004,0nfileatJuroxPtyLtd.
7. BaronStrategicServices.AnaesthesiaMarketResearch.JuroxvetsurveyreportOct11.OnfileatJuroxPty.Ltd.,Rutherford,NSW.Australia.
8. Pasloske, K., et al., Plasma pharmacokinetics of alfaxalone in bothpremedicated and un-premedicated Greyhound dogs after single,intravenous administration of Alfaxan® at a clinical dose. Journal ofVeterinaryPharmacologyandTherapeutics,2009.32:p.510-513.
9. Metcalfe,S.,etal.,Amulti-centreclinical trialevaluating theefficacyand safety of Alfaxan® administered to bitches for induction ofanaesthesia prior to caesarean section. In 33rd World small AnimalCongress.2008.Dublin,Ireland:WSAVA/FECAVA.
10. Ambros, B., et al., Comparison of the anesthetic efficacy andcardiopulmonary effects of continuous rate infusions of alfaxalone in2-hydroxypropyl--cyclodextrinandpropofolindogs.Am.J.vet.Res.,2008.69(11):p.1391-8.
11. Heit, M.C., et al., Cardiovascular and respiratory safety of Alfaxan®CD RTU in cats premedicated with acepromazine, medetomidine,midazolamorbutorphanol.InACVIM.2004.
12. Amengual,M.,etal.,Anevaluationofanaestheticinductioninhealthydogs using rapid intravenous injection of propofol or alfaxalone.VeterinaryAnaesthesiaandAnalgesia,2012:p.n/a.
13. Herbert, G.L., et al., Alfaxalone for total intravenous anaesthesia indogs undergoing ovariohysterectomy: a comparison of premedicationwith acepromazine or dexmedetomidine. Veterinary Anaesthesia andAnalgesia,2012:p.n/a.
14. Jansen,K.S.andJ.J.Uilenreel,Acomparisonbetweenalfaxaloneand
propofol continuous rate infusions in a total intravenous anaesthesiaprotocol for canine surgical patients. 2009, Faculty of VeterinaryMedicine–UniversityofUtrecht.
15. Jimenez, C.P., et al., Evaluation of the quality of recovery afteradministration of propofol or alfaxalone for induction of anaesthesiain dogs anaesthetized for magnetic resonance imaging. VeterinaryAnaesthesiaandAnalgesia,2012.39(2):p.151-159.
16. Maddern,K.,etal.,Alfaxaloneinductiondosefollowingadministrationof medetomidine and butorphanol in the dog. Veterinary AnaesthesiaandAnalgesia,2010.37(1):p.7-13.
17. Taboada, M. F. and Murison, P.J., Induction of anaesthesia withalfaxaloneorpropofolbeforeisofluranemaintenanceincats.VeterinaryRecord,2010.167(3):p.85-89.
18. Mathis,A.,etal.,Comparisonofqualityofrecovery fromanaesthesiaincatsinducedwithpropofoloralfaxalone.VeterinaryAnaesthesiaandAnalgesia,2012.39(3):p.282-290.
19. Murison, P.J. and Taboada M.F., Effect of propofol and alfaxalone onpainafterovariohysterectomyincats.VeterinaryRecord,2010.166(11):p.334-335.
20. Psatha, E., et al., Clinical efficacy and cardiorespiratory effects ofalfaxalone, or diazepam/fentanyl for induction of anaesthesia in dogsthatareapooranaestheticrisk.VeterinaryAnaesthesiaandAnalgesia,2011.38:p.24-36.
21. Zaki, S., et al., Clinical evaluation of Alfaxan-CD® as an intravenousanaestheticinyoungcats.AustralianVeterinaryJournal,2009.87(3):p.82-87.
22. Child, K.J., et al., Metabolism and excretion of CT1341 in the rat. InSteroidAnaesthesia,1972.RoyalCollegeofPhysicians,London.
23. Muir,W.,etal.,Thecardiorespiratoryandanestheticeffectsofclinicaland supraclinical doses of alfaxalone in cats. Veterinary AnaesthesiaandAnalgesia,2009.36(1):p.42-54.
24. Muir,W.,etal.,Cardiorespiratoryandanestheticeffectsofclinicalandsupraclinicaldosesofalfaxalone indogs.VeterinaryAnaesthesiaandAnalgesia,2008.35(6):p.451-462.
25. Pasloske,K., etal.,Amulticentreclinical trialevaluating theefficacyand safety of Alfaxan®-CD RTU administered to dogs for inductionand maintenance of anaesthesia. In British Small Animal VeterinaryAssociationCongress.2005.Birmingham,UK.
26. Pasloske,K., etal.,Amulticentreclinical trialevaluating theefficacyand safety of Alfaxan®-CD RTU administered to cats for inductionand maintenance of anaesthesia. In British Small Animal VeterinaryAssociationCongress.2007.Birmingham,UK.
27. Heit,M.C.,etal.,SafetyandefficacyofAlfaxan®CDRTUadministeredoncetocatssubcutaneouslyat10mg/kg.InACVIM,2004.
For more information contact:
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