Torbugesic Injection-Hyperdrug

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Uses
HORSE
As an analgesic
Torbugesic Injection is a centrally acting analgesic and may be used for the relief of moderate to severe pain in the horse. Clinical studies in the horse have shown that Torbugesic Injection alleviates abdominal pain associated with torsion, impaction, intussusception, parturition and spasmodic and tympanic colic.
As a sedative
When given after the administration of detomidine hydrochloride: Clinical studies have shown that this combination achieved a profound sedation in the horse. The degree of sedation achieved rendered horses unaffected by sound, tactile stimuli or any surrounding activity.
The sedative combination of Torbugesic Injection and detomidine hydrochloride has been successfully used for the following procedures: radiography, clipping, wound suturing, dentistry, standing castration, hoof care, rectal examination and passing a stomach tube.
Profound sedation is also achieved using Torbugesic after the administration of romifidine.
DOG
As an analgesic
For the relief of moderate to severe pain in dogs. Clinical studies have shown that Torbugesic Injection can provide suitable analgesia after a variety of surgical procedures such as orthopaedic and soft tissue surgery.
As a sedative
For sedation in conjunction with medetomidine hydrochloride. Although sedation can occur with Torbugesic Injection alone, clinical studies have verified that deep to profound sedation is achieved by Torbugesic Injection in conjunction with a dose range of medetomidine making it suitable for a range of procedures including ear cleaning, wound management, anal gland flush, cast application, radiography and (at the higher dose rate) as a premedicant to ketamine anaesthesia (see below).
As a pre-anaesthetic
It has also been shown that pre-anaesthetic use of Torbugesic Injection has resulted in a dose-related reduction in the dose of thiopental sodium needed to induce anaesthesia, which will also reduce the risk of anaesthetic respiratory depression.
Clinical studies have verified that the use of Torbugesic Injection in conjunction with acepromazine provides a suitable analgesic and sedative premedicant to general anaesthesia. The dose of the Torbugesic can be adjusted according to the level of analgesia required. The use of the combination has resulted in a dose related reduction in the dose of either thiopental sodium or propofol needed to induce anaesthesia.
As an anaesthetic in combination with medetomidine and ketamine
Torbugesic Injection may be used as a triple anaesthetic combination with medetomidine and Ketaset™. This provides surgical anaesthesia suitable for a range of procedures including castrations and spays.
CAT
As an analgesic
Torbugesic Injection may be used for the relief of pain in the cat. Pre-operative use of Torbugesic Injection can provide analgesia during surgery. Clinical studies have demonstrated that Torbugesic Injection can provide analgesia after a variety of surgical procedures such as spays, orthopaedic and soft tissue surgery.
As a sedative in combination with medetomidine hydrochloride
Although no sedation occurs when using Torbugesic Injection alone in the cat, clinical studies have verified that profound sedation is achieved by using Torbugesic Injection in conjunction with medetomidine, making it suitable for radiography, fracture examination/casting, dematting, ear cleaning, wound management and other minor procedures.
As an anaesthetic in combination with medetomidine and ketamine
Torbugesic Injection may be used as a triple anaesthetic combination with medetomidine and Ketaset. This provides surgical anaesthesia suitable for a range of procedures including castrations and spays.

Presentation Torbugesic Injection is a clear colourless solution containing as active ingredient butorphanol as tartrate (USP) 10 mg/ml. The product also contains 0.1 mg/ml benzethonium chloride (PhEur) as an antimicrobial preservative. Uses HORSE As an analgesic Torbugesic Injection is a centrally acting analgesic and may be used for the relief of moderate to severe pain in the horse. Clinical studies in the horse have shown that Torbugesic Injection alleviates abdominal pain associated with torsion, impaction, intussusception, parturition and spasmodic and tympanic colic. As a sedative When given after the administration of detomidine hydrochloride: Clinical studies have shown that this combination achieved a profound sedation in the horse. The degree of sedation achieved rendered horses unaffected by sound, tactile stimuli or any surrounding activity. The sedative combination of Torbugesic Injection and detomidine hydrochloride has been successfully used for the following procedures: radiography, clipping, wound suturing, dentistry, standing castration, hoof care, rectal examination and passing a stomach tube. Profound sedation is also achieved using Torbugesic after the administration of romifidine. DOG As an analgesic For the relief of moderate to severe pain in dogs. Clinical studies have shown that Torbugesic Injection can provide suitable analgesia after a variety of surgical procedures such as orthopaedic and soft tissue surgery. As a sedative For sedation in conjunction with medetomidine hydrochloride. Although sedation can occur with Torbugesic Injection alone, clinical studies have verified that deep to profound sedation is achieved by Torbugesic Injection in conjunction with a dose range of medetomidine making it suitable for a range of procedures including ear cleaning, wound management, anal gland flush, cast application, radiography and (at the higher dose rate) as a premedicant to ketamine anaesthesia (see below). As a pre-anaesthetic It has also been shown that pre-anaesthetic use of Torbugesic Injection has resulted in a dose-related reduction in the dose of thiopental sodium needed to induce anaesthesia, which will also reduce the risk of anaesthetic respiratory depression. Clinical studies have verified that the use of Torbugesic Injection in conjunction with acepromazine provides a suitable analgesic and sedative premedicant to general anaesthesia. The dose of the Torbugesic can be adjusted according to the level of analgesia required. The use of the combination has resulted in a dose related reduction in the dose of either thiopental sodium or propofol needed to induce anaesthesia. As an anaesthetic in combination with medetomidine and ketamine Torbugesic Injection may be used as a triple anaesthetic combination with medetomidine and Ketaset™. This provides surgical anaesthesia suitable for a range of procedures including castrations and spays. CAT As an analgesic Torbugesic Injection may be used for the relief of pain in the cat. Pre-operative use of Torbugesic Injection can provide analgesia during surgery. Clinical studies have demonstrated that Torbugesic Injection can provide analgesia after a variety of surgical procedures such as spays, orthopaedic and soft tissue surgery. As a sedative in combination with medetomidine hydrochloride Although no sedation occurs when using Torbugesic Injection alone in the cat, clinical studies have verified that profound sedation is achieved by using Torbugesic Injection in conjunction with medetomidine, making it suitable for radiography, fracture examination/casting, dematting, ear cleaning, wound management and other minor procedures. As an anaesthetic in combination with medetomidine and ketamine Torbugesic Injection may be used as a triple anaesthetic combination with medetomidine and Ketaset. This provides surgical anaesthesia suitable for a range of procedures including castrations and spays.

Dosage and administration HORSE For analgesia Dose rate: 5 ml/500 kg (equivalent to 0.1 mg butorphanol/kg) bodyweight, by intravenous injection. The dose may be repeated as required. Analgesic effects are seen within 15 minutes of injection. For sedation in combination with detomidine hydrochloride A dose rate in the region of 0.1 ml Domosedan™/100 kg (equivalent to 12 μg detomidine hydrochloride/kg) should be given intravenously followed within 5 minutes by a dose rate in the region of 0.25 ml Torbugesic Injection/ 100 kg (equivalent to 25 μg butorphanol/kg) intravenously. Clinical experience has shown that a total dose 0.5 ml Domosedan and 1.0 ml Torbugesic Injection affords effective, safe sedation in horses above 200 kg bodyweight. For sedation in combination with romifidine A dose of 0.4–1.2 ml Sedivet™/100 kg bodyweight (equivalent to 40–120 μg romifidine/kg) followed by 0.2 ml Torbugesic Injection/100 kg bodyweight (equivalent to 20 μg butorphanol/kg) should be administered intravenously.

NB.Detomidine should be administered up to 5 minutes before the Torbugesic dose

* Above example based on a dose rate of 60 μg romifidine/kg bodyweight. NB. Romifidine should be administered up to 5 minutes before the Torbugesic dose. DOG For analgesia Administer by intravenous, intramuscular or subcutaneous injection routes using aseptic technique. Rapid IV injection should be avoided. Dose rate 0.2–0.3 ml/10 kg (equivalent to 0.2–0.3 mg butorphanol/kg) bodyweight. Torbugesic Injection should be administered before terminating anaesthesia to provide analgesia in the recovery phase. Analgesic effects are seen within 15 minutes. For continuous analgesia the dose may be repeated as required. For sedation in combination with medetomidine hydrochloride Torbugesic Injection should be administered at 0.1 ml/10 kg (equivalent to 0.1 mg butorphanol/kg) together with 0.1–0.25 ml Domitor™/10 kg (equivalent to 10–25 μg medetomidine/kg) depending on degree of sedation required, both by either intramuscular or intravenous injection. Domitor and Torbugesic may be administered in the same syringe. However, the vials should have separate needles inserted for withdrawal to minimise the risk of cross contamination. Allow 20 minutes for profound sedation to develop before commencing the procedure. Reversal with 0.1–0.25 ml Antisedan™/10 kg bodyweight (equivalent to 50–125 μg atipamezole/kg) results in sternal recumbency approximately 5 minutes later and standing approximately a further 2 minutes later.

* Based on a mean dose rate of 0.25mg butorphanol/kg.

* Based on a dose rate of 0.1 mg butorphanol/kg and 10μg medetomidine/kg

* Based on a dose rate of 0.1 mg butorphanol/kg and 25μg medetomidine/kg

*Pre-anaesthetic doses: based on dose rate of 0.10 mg butorphanol/kg For use as a pre-anaesthetic Used as a pre-anaesthetic, the Torbugesic Injection dose should be reduced to 0.1-0.2 ml/10 kg (0.1-0.2 mg butorphanol/kg), given 15 minutes prior to induction. For use as a pre-anaesthetic in combination with acepromazine Torbugesic Injection should be administered at 0.1ml/10kg bodyweight (equivalent to 0.1 mg butorphanol/kg) together with 0.1ml of 2mg/ml acepromazine/10kg bodyweight (equivalent to 0.02 mg acepromazine/kg) by intramuscular or intravenous injection. Torbugesic and acepromazine may be combined and administered in the same syringe. However the vials should have separate needles inserted for withdrawal to minimise the risk of cross contamination.

* Based on a dose rate of 0.1 mg butorphanol/kg bodyweight ** Based on a dose rate of 0.02 mg acepromazine/kg bodyweight Allow at least 20 minutes for onset of action but the time between premedication and induction is flexible from 20-120 minutes. The dose of butorphanol may be increased to 0.2mg/kg (equivalent to 0.2ml Torbugesic Injection/10kg bodyweight) if the animal is already experiencing pain before the procedure commences, or if a higher plane of analgesia is required during surgery. For anaesthesia in combination with medetomidine and ketamine Administer Torbugesic Injection at 0.1 ml/10 kg (equivalent to 0.1 mg butorphanol/kg) and Domitor at 0.25 ml/10 kg (equivalent to 25 μg medetomidine/kg) by intramuscular injection. Domitor and Torbugesic may be combined and administered in the same syringe. However, the vials should have separate needles inserted for withdrawal to prevent the risk of cross-contamination. Dogs become recumbent in approximately 6 minutes and lose their pedal reflex in approximately 14 minutes. Ketaset Injection should be administered 15 minutes following the first injection at 0.5 ml/10 kg (equivalent to 5 mg ketamine/kg) by intramuscular injection. The pedal reflex returns approximately 53 minutes following administration of the Ketaset Injection. Sternal recumbency is attained approximately 35 minutes later followed by standing a further 36 minutes later. CAT For pre-operative analgesia 0.2 ml/5 kg bodyweight (equivalent to 0.4 mg butorphanol/kg), should be administered either by subcutaneous or intramuscular injection. Clinical studies have shown that administering the butorphanol dose 5 minutes prior to induction with either acepromazine/ketamine or xylazine/ketamine given intramuscularly will provide analgesia when surgery commences. The arousal time will not be significantly altered. With intravenous induction agents, butorphanol should be administered 15–30 minutes prior to administration of the anaesthetic. For post-operative analgesia 0.2 ml/5 kg bodyweight (equivalent to 0.4 mg butorphanol/kg), should be administered by either subcutaneous or intramuscular injection 15 minutes prior to recovery. Alternatively, 0.05 ml per 5 kg (equivalent to 0.1 mg butorphanol/kg), by intravenous injection can be used. For sedation in combination with medetomidine hydrochloride Torbugesic Injection should be administered at 0.2 ml/5 kg bodyweight (equivalent to 0.4 mg butorphanol/kg) together with 0.25 ml Domitor/5 kg bodyweight (equivalent to 50 μg medetomidine/kg) both by either intramuscular or subcutaneous injection. Domitor and Torbugesic may be combined and administered in the same syringe. However, the vials should have separate needles inserted for withdrawal to prevent the risk of cross contamination. Local anaesthetic infiltration should be used for wound suturing. Reversal with 0.125 ml Antisedan/5 kg bodyweight (equivalent to 125 μg atipamezole/kg) results in sternal recumbency approximately 4 minutes later and standing 1 minute later.

* Based on a dose rate of 0.1 mg butorphanol/kg ** Based on a dose rate of 25μg medetomidine/kg *** Based on a dose rate of 5 mg ketamine/kg NB: It is NOT advisable to reverse this combination in the dog with atipamezole.

* Based on a mean dose rate of 0.4mg butorphanol/kg **Based on a mean dose rate of 0.1mg butorphanol/kg

*Based on a dose rate of 0.4mg butorphanol/kg **Based on a dose rate of 50μg medetomidine/kg For anaesthesia in combination with medetomidine and ketamine:

(a) Intramuscular Administer Torbugesic Injection at 0.2 ml/5 kg (equivalent to 0.4 mg butorphanol/kg), 0.4 ml Domitor/5 kg (equivalent to 80 μg medetomidine/kg) and Ketaset Injection at 0.25 ml/5 kg (equivalent to 5 mg ketamine/kg). Domitor, Torbugesic and Ketaset may be combined and administered in the same syringe. However, the vials should have separate needles inserted for withdrawal to prevent the risk of cross-contamination. Cats become recumbent in 2–3 minutes following injection. Loss of the pedal reflex occurs 3 minutes post-injection. Reversal with 0.2 ml Antisedan/5 kg (equivalent to 200 μg atipamezole/kg) results in return of the pedal reflex 2 minutes later, sternal recumbency 6 minutes later and standing 31 minutes later. (b) Intravenous Administer Torbugesic Injection at 0.05 ml/5 kg (equivalent to 0.1 mg butorphanol/kg), 0.2 ml Domitor/5 kg (equivalent to 40 μg medetomidine/kg) and Ketaset Injection, depending on depth of anaesthesia required, at a dose rate of 0.06–0.13 ml/5 kg (equivalent to 1.25–2.5 mg ketamine/kg) by intravenous injection. Torbugesic, medetomidine and Ketaset Combination for Feline Anaesthesia – (IM) Weight of Cat – kgs:— Dose of *Torbugesic (10 mg/ml) – mls:— Dose of **medetomidine (1 mg/ml) – mls:— Dose of ***Ketaset (100 mg/ml) – mls:— 1.5 0.06 0.12 0.08 2 0.08 0.16 0.10 2.5 0.10 0.20 0.13 3 0.12 0.24 0.15 3.5 0.14 0.28 0.18 4 0.16 0.32 0.20 4.5 0.18 0.36 0.23 5 0.20 0.40 0.25 * Based on a dose rate of 0.4 mg butorphanol/kg ** Based on a dose rate of 80μg medetomidine/kg *** Based on a dose rate of 5 mg ketamine/kg Approximate time scales when using the triple combination intravenously.

*In conjunction with butorphanol at 0.1mg/kg and medetomidine at 40 μg/kg. Domitor and Torbugesic may be combined and administered in the same syringe. However, the vials should have separate needles inserted for withdrawal to prevent the risk of cross-contamination. Reversal with 0.1 ml Antisedan/5 kg (equivalent to 100 μg atipamezole/kg) results in return of the pedal reflex 4 minutes later, sternal recumbency 7 minutes later and standing 18 minutes later.

* Based on a dose rate of 0.1 mg butorphanol/kg ** Based on a dose rate of 40μg medetomidine/kg *** Based on a dose rate of 2.5 mg ketamine/kg Contra-indications, warnings, etc Before using any combinations consult the contra-indications and warnings that appear on the other products' data sheets. HORSE: Torbugesic Withdrawal period: Zero days Do not use in horses with a history of liver disease. The most commonly observed side-effect is slight ataxia which may persist for 3–10 minutes. Mild sedation may occur in approximately 15% of horses. Torbugesic/detomidine hydrochloride combination Withdrawal period: Torbugesic injection zero days but when used in combination please consult the other product’s data sheet for the withdrawal period for that product. Do not use in horses with a history of liver disease. The combination should not be used in pregnant animals nor in animals suffering from colic. Routine cardiac auscultation should be performed prior to use of this combination. Do not use the combination in horses with a pre-existing cardiac dysrhythmia or bradycardia. Mild to severe ataxia may be encountered but clinical studies have shown that horses are unlikely to collapse. Normal precautions should be observed to prevent patient self-injury. Torbugesic/romifidine combination Withdrawal period: Torbugesic injection zero days but when used in combination please consult the other product’s data sheet for the withdrawal period for that product. Do not use in horses with a history of liver disease. The combination should not be used during the last month of pregnancy. DOG If respiratory depression occurs, naloxone may be used as an antidote. Do not use in dogs with a history of liver disease. Transient ataxia, anorexia and diarrhoea have been reported as occurring rarely. When using Torbugesic Injection as a pre-anaesthetic the use of an anti-cholinergic, such as atropine will protect the heart against possible narcotic-induced bradycardia. When administering as an intravenous injection do not inject as a bolus. CAT If respiratory depression occurs, naloxone may be used as an antidote. Do not use in cats with a history of liver disease. Cats should be weighed to ensure that the correct dose is calculated. Use of either insulin syringes or 1 ml graduated syringes is recommended to ensure accurate dosing. Marked sedation does not occur in cats when Torbugesic Injection is used as a sole agent. Mydriasis is likely to occur. Operator warning Butorphanol has opioid-like activity. Precautions should be taken to avoid accidental injection/self-injection with this potent drug. If accidental self-injection occurs, seek immediate medical attention showing a copy of product literature. Wash splashes from skin and eyes immediately