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VETMEDIN®-CA1 (pimobendan) Chewable Tablets

INDICATIONS

VETMEDIN®-CA1 (pimobendan) Chewable Tablets are indicated for the delay of onset of congestive heart failure in dogs with Stage B2 preclinical myxomatous mitral valve disease (2019 American College of Veterinary Internal Medicine Consensus Statement1).

 

It is a violation of Federal law to use VETMEDIN®-CA1 other than as directed in the labeling. Conditionally approved by FDA pending a full demonstration of effectiveness under application number 141-556. Adverse reactions not related to disease progression in dogs receiving VETMEDIN-CA1 included diarrhea, vomiting, pain, lameness, arthritis, urinary tract infection, and seizure.

CLINICAL BENEFITS

The unique mode of action of VETMEDIN®-CA1 (pimobendan) Chewable Tablets acts as both a positive inotrope and potent, balanced vasodilator, simultaneously dilating veins and arteries. In this form, the chew enters the GI tract and is rapidly dissolved and absorbed.

 

  • Proprietary formulation ensures optimal bioavailability that in turn ensures optimal therapeutic effect

  • Recommended by the American College of Veterinary Internal Medicine (Specialty of Cardiology) panel as part of first-line therapy in dogs diagnosed with Stage B2 myxomatous mitral valve disease (MMVD) to ensure optimal patient outcomes1    

  • Beef-flavored chewable tablet ensures high levels of acceptability that in turn promotes compliance2,3

  • Meets FDA standards of product safety, stability, and strength

DOSAGE & ADMINISTRATION

VETMEDIN®-CA1 (pimobendan) Chewable Tablets should be administered orally at a total daily dose of 0.23 mg/lb (0.5 mg/kg) body weight.

 

  • The total daily dose should be divided into 2 portions that are not necessarily equal, and the portions should be administered approximately 12 hours apart (ie, morning and evening)

  • Any suitable combination of whole or half tablets may be used

  • The tablets are scored and the calculated dosage should be provided to the nearest half-tablet increment

 

Dosage Chart

Image
Dosage chart for Vetmedin CA1

 

Please note: These examples given in the dosage chart do not necessarily depict the only way to provide the correct dose. Other combinations of whole and half tablets may also be appropriate.

SAFETY

Conditionally approved by FDA pending a full demonstration of effectiveness under application number 141-556.

 

It is a violation of Federal law to use VETMEDIN-CA1 other than as directed in the labeling.

 

Contraindications: Do not administer VETMEDIN®-CA1 (pimobendan) Chewable Tablets in cases of hypertrophic cardiomyopathy, aortic stenosis, or any other clinical condition where an augmentation of cardiac output is inappropriate for functional or anatomical reasons.

 

Do not administer VETMEDIN-CA1 to dogs with Stage A or B1 preclinical myxomatous mitral valve disease (MMDV) (2019 ACVIM Consensus Statement1) due to the risk of cardiac pathology associated with exaggerated hemodynamic responses to VETMEDIN-CA1.

 

Warnings:

User Safety Warnings: Not for use in humans. Keep this and all medications out of reach of children. Consult a physician in case of accidental ingestion by humans.

 

Animal Safety Warnings: Keep VETMEDIN-CA1 in a secure location out of reach of dogs, cats, and other animals to prevent accidental ingestion or overdose.

 

At 3 and 5 times the recommended dosage, administered over a 6-month period of time, pimobendan caused an exaggerated hemodynamic response in the normal dog heart, which was associated with cardiac pathology (See Target Animal Safety).

 

Precautions: For use only in dogs with preclinical MMVD that have a moderate or loud mitral murmur due to mitral regurgitation and cardiomegaly (Stage B2 MMVD, 2019 ACVIM Consensus Statement1). A diagnosis of MMVD should be made by means of a comprehensive physical and cardiac examination, which should include radiography and echocardiography.

 

Stage B2 cardiomegaly is diagnosed based on meeting all three of the following criteria:

 

  • Radiographic vertebral heart score (VHS) >10.5, and

  • Echocardiographic left atrium/aorta ratio (LA/Ao ratio) ≥1.6, and

  • Echocardiographic left ventricular internal diastolic diameter normalized to body weight (LVIDDN) ≥1.7.

 

Echocardiographic examination is recommended in all cases to diagnose MMVD and confirm cardiomegaly. If therapy is initiated prior to the development of cardiomegaly, treated dogs are at risk for cardiac pathology associated with exaggerated hemodynamic responses to VETMEDIN-CA1.

 

If only radiographic examination is possible, cardiomegaly may be diagnosed in cases where the VHS ≥11.5 and the vertebral left atrial size (VLAS) ≥3.0.1,4 If radiographic cardiomegaly does not meet both of these criteria, an echocardiogram should be performed prior to the initiation of therapy with VETMEDIN-CA1.

 

VETMEDIN-CA1 has not been evaluated in dogs receiving concomitant heart medications.

 

The safety of VETMEDIN-CA1 has not been established in dogs with asymptomatic heart disease caused by etiologies other than MMVD. The safe use of VETMEDIN-CA1 has not been evaluated in dogs younger than 6 months of age, dogs with congenital heart defects, dogs with diabetes mellitus or other serious metabolic diseases, dogs used for breeding, or pregnant or lactating bitches.

 

Adverse Reactions: The most common side effects seen in dogs with Stage B2 MMVD while taking VETMEDIN-CA1 Chewable Tablets are cough, vomiting, diarrhea, lethargy, and localized pain (such as in the neck or legs). Adverse reactions not related to disease progression in dogs receiving VETMEDIN-CA1 included diarrhea, vomiting, pain, lameness, arthritis, urinary tract infection, and seizure. 

 

For more information, please see full prescribing information.

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Start Treating Patients at Stage B2

VETMEDIN-CA1 Chewable Tablets are designed to slow the progression of myxomatous mitral valve disease and delay the onset of heart failure in your patients.

 

  • VETMEDIN-CA1 Chewable Tablets have a dual mode of action, relaxing the blood vessels carrying blood to and from the heart, and improving heart muscle function to help the heart work more efficiently.

 

  • Based on a study, dogs treated with VETMEDIN-CA1 demonstrated an average of 15 months of prolonged, symptom-free life compared to dogs treated with a placebo.3
A very handsome dog

Catch It Early, Make a Difference

According to the 2019 American College of Veterinary Internal Medicine (ACVIM) consensus guidelines, Stage B2 MMVD refers to asymptomatic dogs that have more advanced mitral valve regurgitation that meet clinical trial criteria used to identify dogs that should benefit from initiating treatment to delay the onset of heart failure.1

 

The ACVIM consensus statement recommends the following diagnostic criteria to diagnose Stage B2 MMVD:1

  • Murmur intensity ≥3/6
  • Echocardiographic left atrium/aorta ratio (LA/Ao ratio) in the right-sided short axis view in early diastole ≥1.6
  • Left ventricular internal diameter in diastole, normalized for body weight (LVIDDN) ≥1.7
  • Breed-adjusted radiographic vertebral heart score (VHS) >10.5

 

If only radiographic examination is possible, cardiomegaly may be diagnosed in cases where the VHS ≥11.5 and the vertebral left atrial size (VLAS) ≥3.0.1,4 If radiographic cardiomegaly does not meet both of these criteria, an echocardiogram should be performed prior to the initiation of therapy.1

Catch It Early, Make a Difference

According to the 2019 American College of Veterinary Internal Medicine (ACVIM) consensus guidelines, Stage B2 MMVD refers to asymptomatic dogs that have more advanced mitral valve regurgitation that meet clinical trial criteria used to identify dogs that should benefit from initiating treatment to delay the onset of heart failure.1

 

The ACVIM consensus statement recommends the following diagnostic criteria to diagnose Stage B2 MMVD:1

  • Murmur intensity ≥3/6
  • Echocardiographic left atrium/aorta ratio (LA/Ao ratio) in the right-sided short axis view in early diastole ≥1.6
  • Left ventricular internal diameter in diastole, normalized for body weight (LVIDDN) ≥1.7
  • Breed-adjusted radiographic vertebral heart score (VHS) >10.5

 

If only radiographic examination is possible, cardiomegaly may be diagnosed in cases where the VHS ≥11.5 and the vertebral left atrial size (VLAS) ≥3.0.1,4 If radiographic cardiomegaly does not meet both of these criteria, an echocardiogram should be performed prior to the initiation of therapy.1

A very handsome dog

MMVD Can Lead to CHF

Learn about myxomatous mitral valve disease: a heart condition that most commonly leads to congestive heart failure (CHF), and affects small and medium-sized dogs. 

Image of a heart with MMVD.

Myxomatous Mitral Valve Disease

 

  • A heart condition where deterioration of the valve prevents closure of the valve leaflets, allowing blood to leak back into the left atrium.
  • A common type of chronic valvular heart disease (CVHD), which accounts for roughly 75% of canine heart diseases.5,6
  • Up to 85% of small-breed dogs will have some form of CVHD by 15 years.1,7
  • Common at-risk breeds include: Cavalier King Charles Spaniel, Pekingese, Pomeranian, Miniature Pinscher, Boston Terrier, Miniature Poodle, Toy Poodle, Chihuahua.

Myxomatous Mitral Valve Disease

 

  • A heart condition where deterioration of the valve prevents closure of the valve leaflets, allowing blood to leak back into the left atrium.
  • A common type of chronic valvular heart disease (CVHD), which accounts for roughly 75% of canine heart diseases.5,6
  • Up to 85% of small-breed dogs will have some form of CVHD by 15 years.1,7
  • Common at-risk breeds include: Cavalier King Charles Spaniel, Pekingese, Pomeranian, Miniature Pinscher, Boston Terrier, Miniature Poodle, Toy Poodle, Chihuahua.
Image of a heart with MMVD.

Three Signs to Know if Your Patient Is Progressing From Stage B2 MMVD to Stage C Failure

When you are on the lookout for CHF in a patient, look especially for these 3 signs. They’re the most accurate measure for identifying a dog who will go into heart failure:

 

1. Increased heart size, demonstrated by Vertebral Heart Sum (VHS)

2. Increased Heart Rate (HR)

3. Increased Respiratory Rate (RR) and Increased Resting Respiratory Rate (RRR)

VETMEDIN-CA1 vs Compounded Pimobendan

  • VETMEDIN-CA1 is the only FDA-conditionally approved drug for treating Stage B2 MMVD in dogs.

 

  • Compounded preparations are not equivalent to generic drug products. According to the AVMA, generic drug products have a demonstrated bioequivalence in safety and efficacy with the pioneer FDA-approved drug product; compounded substances have not.8

Studies & Resources

Learn more about VETMEDIN-CA1 Chewable Tablets and what you can do to help your patients with Stage B2 MMVD. See the clinical studies and access useful resources.

 

ACVIM
The American College of Veterinary Internal Medicine’s official website has continuing education resources, certification trainings, and more.
 
The Cardiac Education Group is a notfor-profit of board-certified veterinary cardiologists, with resources on the diagnosis, treatment, and management of heart disease in dogs and cats.
 
 
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Additional Resources from CEG

Find resources on the diagnosis, treatment, and management of heart disease in dogs and cats from the not for-profit Cardiac Education Group.

The Cardiac Education Group logo

Additional Resources from CEG

Find resources on the diagnosis, treatment, and management of heart disease in dogs and cats from the not for-profit Cardiac Education Group.

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Download Our App

Download the “My Pets Heart2Heart” app, which helps dog owners to count and record their dog’s resting respiratory rate and send that information back to you.

The My Pets Heart2Heart logo

Download Our App

Download the “My Pets Heart2Heart” app, which helps dog owners to count and record their dog’s resting respiratory rate and send that information back to you.

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Sign up for BI-Connect™

Manage your online orders, connect with our customer care team, and unlock free continuing education courses all in one place by signing up for BI-CONNECT.

The BI-Connect Logo

Sign up for BI-Connect™

Manage your online orders, connect with our customer care team, and unlock free continuing education courses all in one place by signing up for BI-CONNECT.

The Cardiac Education Group logo

Additional Resources from CEG

Find resources on the diagnosis, treatment, and management of heart disease in dogs and cats from the not for-profit Cardiac Education Group.

The Cardiac Education Group logo

Additional Resources from CEG

Find resources on the diagnosis, treatment, and management of heart disease in dogs and cats from the not for-profit Cardiac Education Group.

The My Pets Heart2Heart logo

Download Our App

Download the “My Pets Heart2Heart” app, which helps dog owners to count and record their dog’s resting respiratory rate and send that information back to you.

The My Pets Heart2Heart logo

Download Our App

Download the “My Pets Heart2Heart” app, which helps dog owners to count and record their dog’s resting respiratory rate and send that information back to you.

FAQs

What is CA1?

CA1 stands for Conditional Approval-1 and denotes the first conditional approval granted by the Food and Drug Administration (FDA) for VETMEDIN® (pimobendan). 

 

VETMEDIN-CA1 is indicated for the delay of onset of clinical signs of heart failure in dogs with B2, preclinical (asymptomatic with a systolic mitral murmur and evidence of increased heart size) myxomatous mitral valve disease (MMVD).1.

 

What is conditional approval?

The FDA grants conditional approval for animal drugs to treat serious, life-threatening diseases for which there are no approved therapies available. Drug safety has been demonstrated, and the drug is manufactured in accordance with full approval standards. As per the FDA, drug effectiveness is likely (ie, “reasonable expectation of effectiveness”) while full effectiveness data are being collected.

 

What is the difference between conditional approval and full approval?

For both conditional approval and full approval, the drug company must prove, among other things, that the animal drug is safe when used according to the label. Both VETMEDIN and VETMEDIN-CA1 have extensive data demonstrating product safety.1,3 The difference lies in the effectiveness requirement.

 

For full approval, the drug company must provide “substantial evidence” of the drug’s effectiveness. For conditional approval, the drug has a “reasonable expectation of effectiveness,” but has not yet proven that it meets the “substantial evidence” standard of effectiveness for full approval.

 

Conditionally approved animal drugs must state on the labeling: “Conditionally approved by FDA pending a full demonstration of effectiveness under application number 141-556.”

 

Which product should I prescribe?

Prescribe the appropriate product for the patient based on the stage of heart disease at the time of prescription (ie, VETMEDIN for Stage C or D CHF, or VETMEDIN-CA1 for Stage B2 preclinical MMVD dogs).

 

What presentations of VETMEDIN-CA1 are available?

1.25 mg and 5 mg oblong half-scored chewable tablets, with 50 tablets per bottle.

 

IMPORTANT SAFETY INFORMATION:

VETMEDIN® (pimobendan) Chewable Tablets are for use in dogs with clinical evidence of heart failure only. The most common side effects reported in field studies were poor appetite, lethargy, diarrhea, dyspnea, azotemia, weakness, and ataxia. VETMEDIN should not be given in case of hypertrophic cardiomyopathy, aortic stenosis, or any other clinical condition where an augmentation of cardiac output is inappropriate for functional or anatomical reasons. For more information, please refer to the package insert.

References

  1. Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019;33(3):1127-1540
  2.  VETMEDIN®-CA1 (pimobendan) Chewable Tablets [package insert]. Duluth, GA: Boehringer Ingelheim Animal Health USA Inc.; 2022.
  3. VETMEDIN®-CA1 (pimobendan) Chewable Tablets [Freedom of Information Summary; NADA 141-556]. Duluth, GA: Boehringer Ingelheim Animal Health USA Inc.; 2022.
  4.  Malcolm EL, Visser LC, Phillips KL, Johnson LR. Diagnostic value of vertebral left atrial size as determined from thoracic radiographs for assessment of left atrial size in dogs with myxomatous mitral valve disease. J AM Vet Med Assoc. 2018;253(8):1038-1045. 
  5. Lombard CW, Jöns O, Bussadori CM; for the VetSCOPE Study. Clinical efficacy of pimobendan versus benazepril for the treatment of acquired atrioventricular valvular disease in dogs. J Am Anim Hosp Assoc. 2006;42(4):249-261.
  6. Rush JE. Chronic valvular heart disease in dogs. Proceedings from the 26th Annual Waltham Diets/OSU Symposium for the Treatment of Small Animal Cardiology; October 19–20, 2002. Available at: www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2988. Accessed August 23, 2022.
  7.  Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Intern Med. 2009;23(6):1142-1150.
  8. Veterinary compounding. American Veterinary Medical Association website. Accessed July 20, 2022. www.avma.org/resources-tools/avma-policies/veterinary-compounding.

Trademarks

VETMEDIN® is a registered trademark of Boehringer Ingelheim Vetmedica GmbH, used under license. BI-CONNECT™ and logo is a trademark of Boehringer Ingelheim Animal Health USA Inc. All other trademarks are the property of their respective owner. ©2022 Boehringer Ingelheim Animal Health USA Inc., Duluth, GA. All rights reserved.

US-PET-0497-2022
VETMEDIN IMPORTANT SAFETY INFORMATION

VETMEDIN®-CA1 (pimobendan) are for use only in dogs with preclinical MMVD that have a moderate or loud mitral murmur due to mitral regurgitation and cardiomegaly (Stage B2 MMVD, 2019 ACVIM Consensus Statement1). VETMEDIN-CA1 is conditionally approved by FDA pending a full demonstration of effectiveness under application number 141-556. A diagnosis of MMVD should be made by means of a comprehensive physical and cardiac examination, which should include radiography and echocardiography. The most common side effects seen in dogs with Stage B2 MMVD while taking VETMEDIN-CA1 Chewable Tablets are cough, vomiting, diarrhea, lethargy and localized pain (such as in the neck or legs). Adverse reactions not related to disease progression in dogs receiving VETMEDIN-CA1 included diarrhea, vomiting, pain, lameness, arthritis, urinary tract infection, and seizure.  For more information, please refer to the package insert.

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