Novel Emesis Induction Option for Dogs
Sponsored by Vetoquinol
Quick and effective induction of emesis is vital to good outcomes in cases of toxic ingestion; however, classic emetic options have their limitations. Clevor® (ropinirole ophthalmic solution), a new, FDA-approved emetic for dogs, can help overcome these limitations, giving practitioners a novel and reliable way to induce emesis.1
Max's Case
Max, an 11-year-old, 62-lb (28-kg) neutered male Labrador retriever, is presented for acute ingestion of an unknown amount of ibuprofen that was consumed some time within 30 minutes prior to presentation. The owner had placed the ibuprofen bottle on the kitchen counter and left the house to run a quick errand, only to return and find the bottle empty and chewed up on the floor. Max is currently receiving carprofen (50 mg twice daily) for osteoarthritis and has a history of lymphoma, which has been treated with chemotherapy in the past and is currently in remission.
Immediate induction of emesis is recommended. Hydrogen peroxide is best avoided for Max to prevent its potential adverse effects, and apomorphine is less than ideal because Max has been known to have difficult venipunctures since chemotherapy. Instead, emesis is induced with Clevor. The Clevor dose administration chart is consulted, and 2 drops are placed in each eye. Max vomits 3 times within 10 minutes, bringing up a small amount of digested food and 15 whole ibuprofen tablets.
The Need for Fast, Reliable Induction of Emesis
Inappropriate ingestions are common in veterinary medicine. Nearly 88% of dogs have eaten something inappropriate at least once, and three-quarters of these dogs are repeat offenders.2 This common behavior is not limited to puppies. In fact, only 23% of dogs that eat things they should not are <1 year of age.2
Toxic ingestions comprise an important and concerning subset of these inappropriate ingestions. In 2020, the ASPCA Animal Poison Control Center alone advised more than 370,500 cases of toxic ingestions, a 13% increase from the previous year, with human over-the-counter medications being their most commonly called about toxicity for a third year in a row.3,4 In many such toxic ingestion cases, quick induction of emesis is key.
Past Challenges
Apomorphine and hydrogen peroxide, common options for emesis induction in dogs, can be effective emetics but are not without their challenges.5-7 Hydrogen peroxide may cause esophagitis, duodenal lesions, and gastric lesions (including ulcers), which is especially worrisome in cases of NSAID ingestion such as Max’s.6 Apomorphine may unfavorably inhibit vomiting through activation of μ-opioid receptors when high or repeated doses are used.7
In addition, acquisition and administration of a compounded apomorphine tablet, which is not FDA approved for veterinary use, can pose problems. An apomorphine tablet can be placed in the conjunctival sac until it dissolves; otherwise, injectable apomorphine must be specially compounded, potentially limiting its availability to some practitioners. IV administration can also be difficult in certain patients due to temperament and stress, and it requires time to gather supplies, calculate a dose, and access a vein.
Clevor: The New Solution
Clevor, the only FDA-approved emetic for dogs, can help the veterinary team overcome these emesis induction challenges. Clevor’s active ingredient, ropinirole, is a full dopamine agonist with selectivity for dopamine D2-type receptors, readily targeting them in the chemoreceptor trigger zone to induce vomiting.1,7 This mechanism of action is effective, resulting in 86% of dogs vomiting after a single dose.1 In a placebo-controlled study, 51% of the dogs receiving ropinirole vomited within 10 minutes of administration and 95% vomited within 30 minutes, the timeframe classified by the study as treatment success.7 In addition, Clevor’s selectivity allows for effective repeat administration if necessary, as well as reversal with a dopamine antagonist (eg, metoclopramide).7
Clevor’s administration as an eye drop makes it fast and injection-free.1,7 It is available in a convenient, ready-to-use dropper that provides immediate treatment for dogs weighing between 4 lb (1.8 kg) and 220.5 lb (100 kg).1 A chart on the package insert provides straightforward dosing recommendations for the number of drops required based on weight, which allows for administration without the need for time-consuming calculations or measurements.1
Conclusion
Emesis induction often occurs in emergency situations, making ease of administration, speed, and efficacy of paramount importance. Clevor addresses these needs, providing clinicians with a powerful and life-saving new tool for their emergency toolbox.
CLEVOR® is indicated for the induction of vomiting in dogs.
IMPORTANT SAFETY INFORMATION: Do not use in dogs with central nervous system depression or seizures. Do not use in cases of ingestion of sharp foreign objects, corrosive agents (acids or alkalis), volatile substances or organic solvents. CLEVOR® should not be administered in cases with corneal ulceration, ocular irritation, or ocular injury. Do not use when there is a known sensitivity to ropinirole or the inactive ingredients. ADVERSE REACTIONS MAY INCLUDE: Transient mild or moderate hyperemia of the eye, ocular discharge, protrusion of the 3rd eyelid and blepharospasm, transient mild lethargy and increased heart rate. Not recommended for use in breeding, pregnant or lactating dogs. CLEVOR® has not been evaluated in dogs with heart or liver impairments or dogs younger than 4.5 months or less than 4 pounds. Dopamine antagonists, neuroleptics and other medicines with antiemetic properties may reduce the effectiveness of ropinirole. CLEVOR® should be administered by a veterinary professional. Gloves and protective eyewear should be worn when administering. Not for use in humans. Keep out of reach of children. For complete product safety information, visit vetoquinolusa.com/clevor-info.