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   <code code="50575-0" codeSystem="2.16.840.1.113883.6.1" displayName="VFD TYPE A MEDICATED ARTICLE ANIMAL DRUG LABEL"/>
   <title>
      <content styleCode="bold">Elanco™</content>
   </title>
   <effectiveTime value="20251121"/>
   <setId root="1bc21181-efd2-4238-9c9b-89f334c8dbe7"/>
   <versionNumber value="7"/>
   <author>
      <time/>
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         <representedOrganization>
            <id extension="966985624" root="1.3.6.1.4.1.519.1"/>
            <name>Elanco US Inc.</name>
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               <code code="48780-1" codeSystem="2.16.840.1.113883.6.1" displayName="SPL product data elements section"/>
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               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code code="58198-0472" codeSystem="2.16.840.1.113883.6.69"/>
                        <name>Pulmotil 90</name>
                        <formCode code="C42938" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="GRANULE"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>tilmicosin phosphate</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIB">
                           <quantity>
                              <numerator unit="g" value="200"/>
                              <denominator unit="kg" value="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="SMH7U1S683" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>tilmicosin phosphate</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="XL4103X2E3" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>tilmicosin</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator unit="kg" value="10"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <code code="58198-0472-9" codeSystem="2.16.840.1.113883.6.69"/>
                              <formCode code="C43167" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BAG"/>
                           </containerPackagedProduct>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="NADA141064" root="2.16.840.1.113883.3.150"/>
                           <code code="C73593" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="NADA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20121018"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
            </section>
         </component>
         <component>
            <section ID="s1">
               <id root="ab1d292c-de26-4ce8-b393-7937b08a3379"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>AF0472 </paragraph>
                  <paragraph>
                     <content styleCode="bold">
                        <content styleCode="italics">Pulmotil™ 90</content>
                        <sub>TM</sub>
                     </content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">Net Weight:</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">10 kg (22.0 lb)</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">
                        <content styleCode="italics">Tilmicosin</content>
                     </content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">Type A Medicated Article</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">CAUTION:</content> Federal law restricts medicated feed containing this veterinary feed directive (VFD) drug to use by or on the order of a licensed veterinarian. </paragraph>
                  <paragraph>
                     <content styleCode="bold">For Use in Swine and Cattle Feeds Only.</content>
                  </paragraph>
                  <table width="30%">
                     <col width="29%"/>
                     <tbody>
                        <tr>
                           <td styleCode="Rrule Botrule Lrule Toprule " valign="top">
                              <paragraph>
                                 <content styleCode="bold">Do not feed undiluted.</content>
                              </paragraph>
                           </td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <effectiveTime value="20250814"/>
            </section>
         </component>
         <component>
            <section ID="s2">
               <id root="ae4cc1b9-23f5-40ae-b447-dbb88baa106a"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">Active Drug Ingredient:</content> Tilmicosin (as tilmicosin phosphate) 90.7 g per lb (200 g per kg) </paragraph>
                  <paragraph>
                     <content styleCode="bold">Inert Ingredients:</content> Ground corncobs. </paragraph>
               </text>
               <effectiveTime value="20250814"/>
            </section>
         </component>
         <component>
            <section ID="s3">
               <id root="2316e3e1-bc2b-4f7b-b8ba-e9c516060c02"/>
               <code code="34089-3" codeSystem="2.16.840.1.113883.6.1" displayName="DESCRIPTION SECTION"/>
               <title>Description: </title>
               <text>
                  <paragraph>Pulmotil is a formulation of the antibiotic tilmicosin. Tilmicosin is produced semi-synthetically and is in the macrolide class of antibiotics. Each kilogram of Type A Medicated Article contains 200 grams (0.44 lbs) of tilmicosin adsorbed onto ground corncobs. </paragraph>
               </text>
               <effectiveTime value="20250814"/>
            </section>
         </component>
         <component>
            <section ID="s4">
               <id root="6a2cab60-1108-45a8-94c4-26d22a7fb732"/>
               <code code="34067-9" codeSystem="2.16.840.1.113883.6.1" displayName="INDICATIONS &amp; USAGE SECTION"/>
               <title>Indications: </title>
               <effectiveTime value="20250814"/>
               <component>
                  <section ID="s5">
                     <id root="01d4bb0f-e309-4d39-9319-0b9e81157273"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Swine:</content> For the control of swine respiratory disease (SRD) associated with <content styleCode="italics">Actinobacillus pleuropneumoniae</content> and <content styleCode="italics">Pasteurella multocida.</content>
                        </paragraph>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
               <component>
                  <section ID="s6">
                     <id root="127aead0-180f-45e0-bca5-be146af0527d"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Cattle:</content> For the control of bovine respiratory disease (BRD) associated with <content styleCode="italics">Mannheimia haemolytica</content>, <content styleCode="italics">Pasteurella multocida</content> and <content styleCode="italics">Histophilus somni</content> in groups of beef and non-lactating dairy cattle, where active BRD has been diagnosed in at least 10% of the animals in the group. </paragraph>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="s7">
               <id root="9482db48-2c9a-42c2-9317-aead8c8e046d"/>
               <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
               <title>Feeding Directions: </title>
               <effectiveTime value="20250814"/>
               <component>
                  <section ID="s8">
                     <id root="921911e2-762e-4c4a-960a-626545b8a998"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Swine:</content> Tilmicosin is to be fed continuously at 181 grams to 363 grams per ton (200 ppm to 400 ppm) of Type C medicated feed as the sole ration for a 21-day period, beginning approximately 7 days before an anticipated disease outbreak. </paragraph>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
               <component>
                  <section ID="s9">
                     <id root="8a0c0634-1d7c-413e-818a-52d24a33b563"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Cattle:</content> Tilmicosin is to be fed continuously for a single, 14 day period at 568 grams to 757 grams (626 ppm to 834 ppm) per ton on a 100% dry matter basis of Type C medicated feed as the sole ration to provide 12.5 mg/kg of body weight/day. </paragraph>
                        <paragraph>
                           <content styleCode="bold">IMPORTANT: Must be thoroughly mixed in swine or cattle feeds before use.</content>
                        </paragraph>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="s10">
               <id root="5b233a5a-0531-493b-8226-38080ddd7814"/>
               <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
               <title>Mixing Directions: </title>
               <effectiveTime value="20250814"/>
               <component>
                  <section ID="s11">
                     <id root="514263c7-6dca-461a-90bc-1e47b6d87b7f"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">For Incorporation into Swine Feeds:</content> Thoroughly mix Pulmotil Type A medicated article with feed to provide a Type B medicated feed containing up to 36,300 grams tilmicosin per ton or to provide a complete Type C medicated feed containing 181 to 363 g tilmicosin per ton. Do not use in any feeds containing bentonite. Bentonite in feeds may affect the efficacy of tilmicosin. </paragraph>
                        <table width="100%">
                           <col width="27%"/>
                           <col width="28%"/>
                           <col width="27%"/>
                           <col width="17%"/>
                           <tfoot>
                              <tr>
                                 <td align="left" colspan="4" valign="top">
                                    <sup>a</sup>Pulmotil 90 contains 90.7 g tilmicosin phosphate per pound</td>
                              </tr>
                           </tfoot>
                           <tbody>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>Starting concentration of Pulmotil 90 Type A Medicated Article<sup>a</sup>
                                    </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule Toprule " valign="top">
                                    <paragraph>Amount of Type A Medicated Article to add per ton </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Botrule Toprule " valign="top">
                                    <paragraph>Resulting concentration in Type B Medicated Feed </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>pounds </paragraph>
                                 </td>
                                 <td align="center" styleCode="Botrule " valign="top">
                                    <paragraph>grams per ton </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" rowspan="3" styleCode="Rrule Lrule Botrule " valign="middle">
                                    <paragraph>90.7 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>400 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Toprule Botrule " valign="top">
                                    <paragraph>36,300 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>18.1 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>300 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Toprule Botrule " valign="top">
                                    <paragraph>27,200 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>13.6 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>200 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Toprule Botrule " valign="top">
                                    <paragraph>18,100 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>9.1 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" colspan="4" styleCode="Toprule Botrule " valign="top">
                                    <paragraph> </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>Starting concentration of Pulmotil 90 Type A Medicated Article<sup>a</sup>
                                    </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>Amount of Type A Medicated Article to add per ton </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>Resulting concentration in Type C Medicated Feed </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>pounds </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>grams per ton </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" rowspan="3" styleCode="Rrule Lrule Botrule " valign="middle">
                                    <paragraph>90.7 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>4 </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>363 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>3 </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>272 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule " valign="top">
                                    <paragraph>2 </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>181 </paragraph>
                                 </td>
                              </tr>
                           </tbody>
                        </table>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
               <component>
                  <section ID="s12">
                     <id root="367af0c7-38a4-4ae6-9c43-4a1da1bbe2d6"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">For Incorporation into Cattle Feeds:</content> Thoroughly mix Pulmotil Type A medicated article with feed to provide a Type B medicated feed containing up to 36,300 grams tilmicosin per ton on a 100% dry matter basis or to provide a complete Type C medicated feed containing 568 to 757 g tilmicosin per ton on a 100% dry matter basis. Complete Type C medicated feeds should not be pelleted. Do not use in any feeds containing bentonite, cottonseed meal, or cottonseed hulls. Bentonite, cottonseed meal, or cottonseed hulls in feeds may affect the efficacy of tilmicosin. </paragraph>
                        <table width="100%">
                           <col width="28%"/>
                           <col width="28%"/>
                           <col width="26%"/>
                           <col width="16%"/>
                           <tfoot>
                              <tr>
                                 <td align="left" colspan="4" valign="top">
                                    <sup>a</sup>Pulmotil 90 contains 90.7 g tilmicosin phosphate per pound <br/>
                                    <sup>b</sup>100% dry matter basis </td>
                              </tr>
                           </tfoot>
                           <tbody>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>Starting concentration of Pulmotil 90 Type A Medicated Article<sup>a</sup>
                                    </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>Amount of Type A Medicated Article to add per ton</paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>Resulting concentration in Type B Medicated Feed<sup>b</sup>
                                    </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>pounds</paragraph>
                                 </td>
                                 <td align="center" styleCode="Lrule Toprule Botrule " valign="top">
                                    <paragraph>grams per ton </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" rowspan="3" styleCode="Rrule Lrule Botrule " valign="middle">
                                    <paragraph>90.7 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>400 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Lrule Toprule Botrule " valign="top">
                                    <paragraph>36,300 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>18.1 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>200 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Lrule Toprule Botrule " valign="top">
                                    <paragraph>18,100 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>9.1 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>100 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Lrule Toprule Botrule " valign="top">
                                    <paragraph>9,070 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Toprule Botrule " valign="top">
                                    <paragraph>4.5 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" colspan="4" styleCode="Botrule " valign="top">
                                    <paragraph> </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Botrule " valign="top">
                                    <paragraph>Starting concentration of Pulmotil 90 Type A Medicated Article<sup>a</sup>
                                    </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>Amount of Type A Medicated Article to add per ton </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>Resulting concentration in Type C Medicated Feed<sup>b</sup>
                                    </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Lrule Botrule " valign="top">
                                    <paragraph>grams per pound </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>pounds </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>grams per ton </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="middle">
                                    <paragraph>90.7 </paragraph>
                                 </td>
                                 <td align="center" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>8.35 </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Lrule Toprule Botrule " valign="top">
                                    <paragraph>757 </paragraph>
                                 </td>
                              </tr>
                              <tr>
                                 <td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>6.26 </paragraph>
                                 </td>
                                 <td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
                                    <paragraph>568 </paragraph>
                                 </td>
                              </tr>
                           </tbody>
                        </table>
                     </text>
                     <effectiveTime value="20250814"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="s13">
               <id root="1566d049-da9c-40ff-a7dd-ae11a3f24ba8"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <title>CAUTION: </title>
               <text>
                  <paragraph>Do not allow horses or other equines access to feeds containing tilmicosin. The safety of tilmicosin has not been established in cattle or male swine intended for breeding purposes. </paragraph>
                  <paragraph>To assure both food safety and responsible use in cattle, the treatment of cattle with this medicated feed is required to be initiated within the first 45 days of the production period. The treatment should not occur concurrent with or following administration of an injectable macrolide, or within 3 days following administration of a non-macrolide injectable BRD therapy. </paragraph>
               </text>
               <effectiveTime value="20250814"/>
               <component>
                  <section ID="s14">
                     <id root="b8003cb4-a3dc-403d-851a-2aae445a4e01"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Swine:</content> Feed containing tilmicosin shall not be fed to pigs for more than 21 days during each phase of production without ceasing administration for reevaluation of antimicrobial use by a licensed veterinarian before re-initiating a further course of therapy with an appropriate antimicrobial. Veterinary Feed Directive (VFD) expiration date for swine must not exceed 90 days from the time of issuance. VFDs for tilmicosin phosphate shall not be refilled. </paragraph>
                     </text>
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                        <paragraph>
                           <content styleCode="bold">Cattle:</content> Use only in cattle fed in confinement for slaughter. Tilmicosin medicated feed treatment has not been evaluated in cattle with severe clinical disease. Cattle with severe clinical illness should be evaluated for individual treatment with an alternative non-macrolide therapy. The expiration date for a tilmicosin Veterinary Feed Directive (VFD) for cattle must not exceed 45 days from the time of issuance. VFDs for tilmicosin phosphate shall not be refilled. </paragraph>
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               <title>WARNINGS: </title>
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                        <paragraph>
                           <content styleCode="bold">RESIDUE WARNING: Swine:</content> Swine intended for human consumption must not be slaughtered within 7 days of the last treatment of this drug product. </paragraph>
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                        <paragraph>
                           <content styleCode="bold">RESIDUE WARNING: Cattle:</content> Cattle intended for human consumption must not be slaughtered within 28 days of the last treatment with this drug product. </paragraph>
                        <paragraph>This drug product is not approved for use in female dairy cattle 20 months of age or older. Use in these cattle may cause drug residues in milk. This drug product is not approved for use in calves intended to be processed for veal. A withdrawal period has not been established in pre-ruminating calves. </paragraph>
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                        <paragraph>
                           <content styleCode="bold">User Safety Warnings:</content> Avoid inhalation, oral exposure and direct contact with skin or eyes. Operators mixing and handling Pulmotil 90 should use protective clothing, impervious gloves, goggles and a NIOSH-approved dust mask. Wash thoroughly with soap and water after handling. If accidental eye contact occurs, immediately rinse thoroughly with water. If irritation persists, seek medical attention. Not for human consumption. Keep out of reach of children. The Safety Data Sheet contains more detailed occupational safety information. To report adverse effects in users, to obtain more information, or to obtain a Safety Data Sheet, call 1-800-428-4441. </paragraph>
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                        <paragraph>
                           <content styleCode="bold">Clinical Pharmacology:</content> Oral dosing of tilmicosin phosphate to swine at 181 to 363 g/ton of feed results in serum tilmicosin levels, which do not correlate with efficacy. Lung concentrations of tilmicosin are significantly higher than serum. Following 7 consecutive days of administering tilmicosin-medicated feeds to swine, the concentration of tilmicosin in respiratory tissues, phagocytic cells, and nasal secretions was significantly higher than that of plasma or serum. Lung levels are achieved within 2 days after beginning feeding and plateau by 4 days. Using <content styleCode="italics">in-vitro</content> incubation techniques, the ratio of intracellular to extracellular concentrations of tilmicosin for neutrophils, monocyte-macrophages and alveolar macrophages were 69, 19 and 17, respectively, after four hours of incubation. Although lower levels of accumulation were observed <content styleCode="italics">in-vivo</content>, swine alveolar macrophages have been shown <content styleCode="italics">in-vitro</content> and <content styleCode="italics">in-vivo</content> to concentrate large amounts of tilmicosin; these cells may be important for <content styleCode="italics">in-vivo</content> distribution of the drug and may serve as an important reservoir for tilmicosin in lung tissue. </paragraph>
                        <paragraph>Oral dosing of tilmicosin phosphate to cattle to target a dose of 12.5 mg/kg body weight resulted in serum tilmicosin concentrations above the analytical limit of quantification (0.5 ng/mL) within 12 hours following treatment administration. The relationship of serum tilmicosin concentration to lung tilmicosin concentration has not been determined following oral administration of tilmicosin. </paragraph>
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                        <paragraph>
                           <content styleCode="bold">Toxicology:</content> The cardiovascular system is the target of toxicity in laboratory and domestic animals given tilmicosin by oral or parenteral routes. Primary cardiac effects are increased heart rate (tachycardia) and decreased contractility (negative inotropy). Given orally, the median lethal dose is 800 mg/kg in fasted rats and 2250 mg/kg in non-fasted rats. No compound-related lesions were found at necropsy. Results of genetic toxicology studies were all negative. Results of teratology and reproduction studies in rats were all negative. The no effect level in dogs after daily oral doses for up to one year is 4 mg/kg of body weight. Tilmicosin was included in the diet of 18 adult horses for a period of 14 days at dose levels of 400, 1200 and 2000 ppm. Some horses at both the low and high dose levels demonstrated gastrointestinal disturbance with more severe colic evident at the higher levels. One horse died after consuming the 2000 ppm diet. A study was conducted in cattle administered oral tilmicosin at 12.5, 25.0 or 37.5 mg/kg for 42 days or administered 12.5 mg/kg of oral tilmicosin for 14 days followed by 20 mg/kg injection of tilmicosin or saline (volume equivalent). Cardiac lesions observed (one animal in the 12.5 mg/kg for 42 days treatment group; one animal in the 12.5 mg/kg for 14 days followed by tilmicosin injection treatment group) were not considered clinically significant as no other abnormalities were seen and the affected animals were clinically normal. </paragraph>
                        <paragraph>
                           <content styleCode="bold">Questions/Comments?</content> For technical assistance or to report side effects, contact Elanco US Inc. at 1-800-428-4441. For additional information about reporting side effects for animal drugs, contact FDA at 1-888-FDA-VETS or <linkHtml href="http://www.fda.gov/reportanimalae">http://www.fda.gov/reportanimalae</linkHtml>
                        </paragraph>
                        <paragraph>Storage Information: Store at less than or equal to 25°C (77°F). Excursions to 40°C (104°F) are acceptable. Avoid excessive moisture.</paragraph>
                        <paragraph>Not to be used after the date printed on the bag.</paragraph>
                        <paragraph>Restricted Drug (California) - Use Only as Directed</paragraph>
                        <paragraph>Approved by FDA under NADA # 141-064</paragraph>
                        <paragraph>Manufactured For: Elanco US Inc. Indianapolis, IN 46221</paragraph>
                        <paragraph>Pulmotil, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates.</paragraph>
                        <paragraph>© 2025 Elanco or its affiliates</paragraph>
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                        <paragraph>BG243087X <br/>YL243087X</paragraph>
                        <paragraph>LOT No.:<br/>D.O.M.:<br/>EXPIRY:</paragraph>
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                           <text>Figure</text>
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                  <paragraph>
                     <content styleCode="bold">
                        <content styleCode="italics">Elanco</content>
                        <sup>™</sup>
                     </content> AF0472 </paragraph>
                  <paragraph>
                     <content styleCode="bold">
                        <content styleCode="italics">Pulmotil</content>
                        <sup>™ </sup>
                        <content styleCode="italics">90</content>
                        <sub>TM</sub>
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                  <paragraph>
                     <content styleCode="bold">Net Weight:</content>
                     <br/>
                     <content styleCode="bold">10 kg (22.0 lb)</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">
                        <content styleCode="italics">Tilmicosin</content>
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