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Salix® is indicated for the treatment of edema, (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. It is an effective diuretic possessing a wide therapeutic range. Pharmacologically it promotes the rapid removal of abnormally retained extracellular fluids. The rationale for the efficacious use of diuretic therapy is determined by the clinical pathology producing the edema. The continued use of heart stimulants, such as digitalis or its glycosides, is indicated in cases of edema involving cardiac insufficiency.
SALIX® is a highly effective diuretic-saluretic which if given in excessive amounts may result in dehydration and electrolyte imbalance, enhancing the risk of circulatory collapse, thrombosis, and embolism. The animal should be observed for early signs of fluid depletion with electrolyte imbalance, and corrective measures should be administered. See package insert for full information regarding contraindications, warnings, and precautions. Salix® may lower serum calcium levels and cause tetany in rare cases of animals having an existing hypocalcemic tendency. Milk taken from dairy cattle during treatment and for 48 hours (four milkings) after the last treatment must not be used for food. Cattle must not be slaughtered for food within 48 hours following last treatment. Do not use in horses intended for human consumption.
For the horse, the individual dose is 250 mg to 500 mg (5 to 10 mL) administered intramuscularly or intravenously once or twice daily at 6 to 8 hour intervals until desired results are achieved. The veterinarian should evaluate the degree of edema present and adjust dosage schedule accordingly. Do not use in horses intended for human consumption.
Diuresis may be initiated by the parenteral administration of Salix® Injection and then maintained by oral administration.
The dosage should be adjusted to the individual's response. In severe edematous or refractory cases, the dose may be doubled or increased by increments of 1 mg per pound body weight. The established effective dose should be administered once or twice daily. The daily schedule of administration can be timed to control the period of micturition for the convenience of the client or veterinarian. Mobilization of the edema may be most efficiently and safely accomplished by utilizing an intermittent daily dosage schedule, i.e., every other day or 2 to 4 consecutive days weekly.
The solution is acceptable for use when clear, colorless to pale yellow to pale brown. Do not use this solution if it appears discolored. Do not puncture the stopper more than 32 times.
CONTRAINDICATIONS - PRECAUTIONS Salix® is a highly effective diuretic-saluretic which if given in excessive amounts may result in dehydration and electrolyte imbalance. Therefore, the dosage and schedule may have to be adjusted to the patient's needs. The animal should be observed for early signs of electrolyte imbalance, and corrective measures administered. Early signs of electrolyte imbalance are: increased thirst, lethargy, drowsiness or restlessness, fatigue, oliguria, gastro-intestinal disturbances and tachycardia. Special attention should be given to potassium levels. Salix® may lower serum calcium levels and cause tetany in rare cases of animals having an existing hypocalcemic tendency.
Although diabetes mellitus is a rarely reported disease in animals, active or latent diabetes mellitus may on rare occasions be exacerbated by Salix®. While it has not been reported in animals the use of high doses of salicylates, as in rheumatic diseases, in conjunction with Salix® may result in salicylate toxicity because of competition for renal excretory sites.
Transient loss of auditory capacity has been experimentally produced in cats following intravenous injection of excessive doses of Salix® at a very rapid rate.
Electrolyte balance should be monitored prior to surgery in patients receiving Salix®. Imbalances must be corrected by administration of suitable fluid therapy.
Salix® is contraindicated in anuria. Therapy should be discontinued in cases of progressive renal disease if increasing azotemia and oliguria occur during the treatment. Sudden alterations of fluid and electrolyte imbalance in an animal with cirrhosis may precipitate hepatic coma, therefore observation during period of therapy is necessary. In hepatic coma and in states of electrolyte depletion, therapy should not be instituted until the basic condition is improved or corrected. Potassium supplementation may be necessary in cases routinely treated with potassium-depleting steroids.
WARNINGS Salix® is a highly effective diuretic and if given in excessive amounts as with any diuretic may lead to excessive diuresis which could result in electrolyte imbalance, dehydration and reduction of plasma volume enhancing the risk of circulatory collapse, thrombosis, and embolism. Therefore, the animal should be observed for early signs of fluid depletion with electrolyte imbalance, and corrective measures administered. Excessive loss of potassium in patients receiving digitalis or its glycosides may precipitate digitalis toxicity. Caution should be exercised in animals administered potassium-depleting steroids.
It is important to correct potassium deficiency with dietary supplementation. Caution should be exercised in prescribing enteric-coated potassium tablets.
There have been several reports in human literature, published and unpublished, concerning non-specific small-bowel lesions consisting of stenosis, with or without ulceration, associated with the administration of enteric-coated thiazides with potassium salts. These lesions may occur with enteric-coated potassium tablets alone or when they are used with nonenteric-coated thiazides, or certain other oral diuretics. These small-bowel lesions may have caused obstruction, hemorrhage, and perforation. Surgery was frequently required, and deaths have occurred. Available information tends to implicate enteric-coated potassium salts, although lesions of this type also occur spontaneously. Therefore, coated potassium-containing formulations should be administered only when indicated and should be discontinued immediately if abdominal pain, distention, nausea, vomiting, or gastro-intestinal bleeding occurs.
Human patients with known sulfonamide sensitivity may show allergic reactions to Salix®; however, these reactions have not been reported in animals.
Sulfonamide diuretics have been reported to decrease arterial responsiveness to pressor amines and to enhance the effect of tubocurarine. Caution should be exercised in administering curare or its derivatives to patients undergoing therapy with Salix® and it is advisable to discontinue Salix® for one day prior to any elective surgery.
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