RE: Degen Myelopathy

[Guest guest]

This is from Plumb's...

Aminocaproic Acid

Prescriber Highlights

May be useful for treating degenerative myelopathies in dogs;

efficacy not well documented

Treatment may be very expensive, especially in large dogs

Contraindicated in DIC

Infrequently causes GI distress

Chemistry

An inhibitor of fibrinolysis, aminocaproic acid is a synthetic

monamino carboxylic acid occurring as a fine, white crystalline

powder. It is slightly soluble in alcohol and freely soluble in

water and has pKa's of 4.43 and 10.75. The injectable product has

its pH adjusted to approximately 6.8. Aminocaproic acid may also be

known by the acronym EACA.

Storage/Stability/Compatibility

Products should be stored at room temperature. Avoid freezing liquid

preparations. Discoloration will occur if aldehydes or aldehydic

sugars are present. When given as an intravenous infusion, normal

saline, D5W and Ringer's Injection have been recommended for use as

the infusion diluent.

Pharmacology

Aminocaproic acid inhibits fibrinolysis via its inhibitory effects

on plasminogen activator substances and via some antiplasmin action.

Aminocaproic acid is thought to affect degenerative myelopathy by

its antiprotease activity, thereby reducing the activation of

inflammatory enzymes that damage myelin.

Uses/Indications

Aminocaproic acid has been used as a treatment to degenerative

myelopathy (seen primarily in German shepherds), but no controlled

studies documenting its efficacy were located. There is interest in

evaluating aminocaproic acid for adjunctive treatment of

thrombocytopenia in dogs, but efficacy and safety for this purpose

remains to be investigated. In humans, it is primarily used for

treating hyperfibrinolysis-induced hemorrhage.

Pharmacokinetics

In humans, the drug is rapidly and completely absorbed after oral

administration. The drug is well distributed in both intravascular

and extravascular compartments and penetrates cells (including red

blood cells). It unknown if the drug enters maternal milk. It does

not bind to plasma proteins. Terminal half-life is about 2 hours in

humans and the drug is primarily renally excreted as unchanged drug.

Contraindications/Precautions

Aminocaproic acid is contraindicated in patients with active

intravascular clotting. It should be used when the benefits outweigh

the risks in patients with preexisting cardiac, renal or hepatic

disease.

Reproductive/Nursing Safety

Some, but not all, animal studies have demonstrated teratogenicity;

use when risk to benefit ratio merits. In humans, the FDA

categorizes this drug as category C for use during pregnancy (Animal

studies have shown an adverse effect on the fetus, but there are no

adequate studies in humans; or there are no animal reproduction

studies and no adequate studies in humans.)

Adverse Effects/Warnings

In dogs treated, about 1% exhibit symptoms of GI irritation.

Overdosage/Acute Toxicity

There is very limited information on overdoses with aminocaproic

acid. The IV lethal dose in dogs is reportedly 2.3 g/kg. At lower IV

overdosages, tonic-clonic seizures were noted in some dogs. There is

no known antidote, but the drug is dialyzable.

Drug Interactions

Hypercoagulation states may occur in patients receiving estrogens.

Laboratory Considerations

Serum potassium may be elevated by aminocaproic acid especially in

patients with preexisting renal failure.

Doses

Dogs

For adjunctive treatment of degenerative myelopathy (seen primarily

in German shepherds):

1. In combination with exercise, vitamin support (vitamin B-

complex, vitamin E), and analgesia (if required; using

acetaminophen): Aminocaproic acid: 500 mg (regardless of size of

animal, approximate dose is 15 mg/kg) PO q8h. Mix 192 ml of the 250

mg/ml injection with 96 ml of hematinic compound (e.g. Lixotinic®)

producing a 288 ml final volume. Give 3 ml per dose (500 mg). Store

solution in refrigerator. Clinical improvement seen within 8 weeks.

(Clemmons 1991)

Client Information

Drug costs to treat a German shepherd-sized dog can be substantial.

Dosage Forms/Approval Status/Withholding Times

Veterinary-Approved Products: None

Human-Approved Products:

Aminocaproic Acid; Tablets 500 mg; Amicar® (Immunex); (Rx)

Aminocaproic Oral Solution 250 mg/ml in pints; Amicar® (Immunex);

(Rx)

Aminocaproic Acid Injection for Intravenous Infusion 250 mg/ml (5

gram) in 20 ml and 96 ml vials; Amicar® (Immunex); generic; (Rx)

Aminocaproic acid may also be known by these synonyms and

internationally registered trade names: acidum aminocaproicum, CL-

10304 CY-116, EACA, epsilon aminocaproic acid, JD-177, NSC-26154,

Capracid®, Capramol®, Caproamin®, Caprolisin®, Epsicaprom®,

Hemocaprol®, Hemocid®, Hexalense®, or Ipsilon®.

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>

> Hi all. Does anyone have a dosing regimen and a source for the

> chemical grade of aminocaproic acid for DM dogs?

> Thanks!

> Mindy , DVM CCRT pending

>

[Guest guest]

We call in a script to the lab in Florida (www.westlabpharmacy.com) and have

the owners get it directly from them. It is much cheaper for the client that

way.

Laurie McCauley, DVM

TOPS Veterinary Rehabilitation

Grayslake,

IL

drmc@...

www.tops-vet-rehab.com

From: VetRehab [mailto:VetRehab ] On Behalf Of Mindy , DVM

Sent: Monday, December 18, 2006

1:10 PM

To: VetRehab

Subject: Degen

Myelopathy

Hi all. Does anyone have a dosing regimen and a source

for the

chemical grade of aminocaproic acid for DM dogs?

Thanks!

Mindy , DVM CCRT pending

[Guest guest]

I added Dr. McCauley's pharmacy contact to the database under professional resources. Patti"Dr. Laurie McCauley" wrote: We call in a script to the lab in Florida (www.westlabpharmacy.com) and have the owners

get it directly from them. It is much cheaper for the client that way. Laurie McCauley, DVM TOPS Veterinary Rehabilitation Grayslake, IL drmctops-vet-rehab www.tops-vet-rehab.com

From: VetRehab [mailto:VetRehab ] On Behalf Of Mindy , DVMSent: Monday, December 18, 2006 1:10 PMTo: VetRehab Subject:

Degen Myelopathy Hi all. Does anyone have a dosing regimen and a source for the chemical grade of aminocaproic acid for DM dogs?Thanks!Mindy , DVM CCRT pending Patti Triola, PT, CCRT Dogs In Motion, In Home Canine Rehabilitation & Wellness / fax: / mobile:

www.dogsinmotion.net Il. State Liaison, Animal PT SIG, APTA Founder of the Suburban Chicagoland Dachshund Lovers It's a Dachshund Thing, you wouldn't understand.