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               <title>Firocoxib Chewable Tablets for Dogs</title>
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                  <paragraph>For oral use in dogs only.</paragraph>
                  <paragraph>
                     <content styleCode="italics">
                        <content styleCode="bold">Caution: </content>
                     </content>Federal law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
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               <title>
                  <content styleCode="italics">Description:</content>
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                  <paragraph>Firocoxib Chewable Tablets for<br/>Dogs belongs to the coxib class of non-narcotic,<br/>non-steroidal anti-inflammatory drugs. Firocoxib is a<br/>white crystalline compound described chemically as<br/>3-(cyclopropylmethoxy)-4-(4-(methylsulfonyl)phenyl)-<br/>5,5-dimethylfuranone. The empirical formula is<br/>C17H20O5S, and the molecular weight is 336.4. The<br/>structural formula is shown below:</paragraph>
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               <title>
                  <content styleCode="italics">Pharmacokinetics:</content>
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                  <paragraph>The absolute bioavailability of Firocoxib Chewable Tablets for Dogs is approximately 38% when administered as a 5 mg/kg oral dose to fasted adult dogs. Firocoxib is rapidly cleared from the blood via hepatic metabolism and fecal excretion (CLsystemic = ~0.4 L/hr/kg). Despite<br/>a high level of plasma protein binding (96%), firocoxib exhibits a large volume of distribution (Vdλ of total drug = ~4.6 L/kg) and a terminal elimination half life of 7.8 hours (%CV = 30%). The oral drug absorption process is highly variable among subjects. Co-administration of firocoxib with food delays drug absorption (Tmax from 1 to 5 hours) and decreases peak concentrations (Cmax from 1.3 to 0.9 mcg/mL). However, food does not affect the overall oral bioavailability at the recommended dose.</paragraph>
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               <title>
                  <content styleCode="italics">Indications:</content>
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                  <paragraph>Firocoxib Chewable Tablets for Dogs are indicated for the control of pain and inflammation associated with osteoarthritis and for the control of<br/>post-operative pain and inflammation associated with soft-tissue and orthopedic surgery in dogs.</paragraph>
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               <title>
                  <content styleCode="italics">Dosage and Administration:</content>
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                  <paragraph>Always provide the Client Information Sheet with prescription. Carefully consider the potential benefits and risks of Firocoxib Chewable Tablets for Dogs and other treatment options before deciding to use Firocoxib Chewable Tablets for Dogs. Use the lowest effective dose for the shortest duration consistent with individual response. The recommended dosage of Firocoxib Chewable Tablets for Dogs for oral administration in dogs is 2.27 mg/lb (5.0 mg/kg) body weight once daily as needed for osteoarthritis and for 3 days as needed for postoperative pain and inflammation<br/>associated with soft-tissue and orthopedic surgery. The dogs can be treated with Firocoxib Chewable Tablets for Dogs approximately two hours prior to surgery. The tablets are scored and dosage should be calculated in half tablet increments. Firocoxib Chewable Tablets for Dogs can be administered with or without food.</paragraph>
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               <title>
                  <content styleCode="italics">Contraindications:</content>
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                  <paragraph>Dogs with known hypersensitivity to firocoxib should not receive Firocoxib Chewable Tablets for Dogs.</paragraph>
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                  <paragraph>Not for use in humans. Keep this and all medications out of the reach of children. Consult a physician in case of accidental ingestion by humans.</paragraph>
                  <paragraph>Keep Firocoxib Chewable Tablets for Dogs in a secure location out of reach of dogs, cats, and other animals to prevent accidental ingestion or overdose.</paragraph>
                  <paragraph>
                     <content styleCode="italics">
                        <content styleCode="bold">For oral use in dogs only. Use of this product at doses above the recommended 2.27 mg/lb (5.0 mg/ kg) in puppies less than seven months of age has been associated with serious adverse reactions, including death (see Animal Safety). Due to tablet sizes and scoring, dogs weighing less than 12.5 lb (5.7 kg) cannot be accurately dosed.</content>
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                  <paragraph>All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline data is recommended prior to and periodically during administration of any NSAID.</paragraph>
                  <paragraph>
                     <content styleCode="bold">Owners should be advised to observe for signs of potential drug toxicity (see Adverse Reactions and Animal Safety) and be given a Client Information Sheet about Firocoxib Chewable Tablets for Dogs.</content>
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                  <content styleCode="italics">Contact Information:</content>
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               <text>
                  <paragraph>To report suspected adverse drug events, for technical assistance or to obtain a copy of the Safety Data Sheet (SDS), contact Pegasus Laboratories, Inc. at 1-800-874-9764 or www.prnpharmacal.com.</paragraph>
                  <paragraph>For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at www.fda.gov/<br/>reportanimalae.</paragraph>
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                  <content styleCode="italics">Precautions:</content>
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                  <paragraph>This product cannot be accurately dosed in dogs less than 12.5 pounds in body weight.</paragraph>
                  <paragraph>Consider appropriate washout times when switching<br/>from one NSAID to another or when switching from corticosteroid use to NSAID use.</paragraph>
                  <paragraph>As a class, cyclooxygenase inhibitory NSAIDs<br/>may be associated with renal, gastrointestinal and<br/>hepatic toxicity. Sensitivity to drug-associated<br/>adverse events varies with the individual patient.<br/>Dogs that have experienced adverse reactions from<br/>one NSAID may experience adverse reactions from<br/>another NSAID. Patients at greatest risk for adverse<br/>events are those that are dehydrated, on concomitant<br/>diuretic therapy, or those with existing renal, cardiovascular,<br/>and/or hepatic dysfunction. Concurrent<br/>administration of potentially nephrotoxic drugs<br/>should be carefully approached and monitored.<br/>NSAIDs may inhibit the prostaglandins that maintain<br/>normal homeostatic function. Such anti-prostaglandin<br/>effects may result in clinially significant disease in<br/>patients with underlying or pre-existing disease that<br/>has not been previously diagnosed. Since NSAIDs<br/>possess the potential to produce gastrointestinal<br/>ulceration and/or gastrointestinal perforation,<br/>concomitant use of Firocoxib Chewable Tablets for<br/>Dogs with other anti-inflammatory drugs, such as<br/>NSAIDs or corticosteroids, should be avoided.<br/>The concomitant use of protein bound drugs with<br/>Firocoxib Chewable Tablets for Dogs has not been<br/>studied in dogs. Commonly used protein-bound<br/>drugs include cardiac, anticonvulsant, and behavioral<br/>medications. The influence of concomitant drugs<br/>that may inhibit the metabolism of Firocoxib<br/>Chewable Tablets for Dogs has not been evaluated.<br/>Drug compatibility should be monitored in patients requiring adjunctive therapy.</paragraph>
                  <paragraph>If additional pain medication is needed after the<br/>daily dose of Firocoxib Chewable Tablets for Dogs, a<br/>non-NSAID class of analgesic may be necessary.</paragraph>
                  <paragraph>Appropriate monitoring procedures should be<br/>employed during all surgical procedures. Anesthetic<br/>drugs may affect renal perfusion, approach concomitant<br/>use of anesthetics and NSAIDs cautiously. The<br/>use of parenteral fluids during surgery should be<br/>considered to decrease potential renal complications<br/>when using NSAIDs perioperatively.</paragraph>
                  <paragraph>The safe use of Firocoxib Chewable Tablets for Dogs<br/>in pregnant, lactating or breeding dogs has not been<br/>evaluated.</paragraph>
                  <paragraph/>
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                  <content styleCode="italics">Adverse Reactions:</content>
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                  <paragraph>
                     <content styleCode="bold">Osteoarthritis:</content> In controlled field studies, 128<br/>dogs (ages 11 months to 15 years) were evaluated<br/>for safety when given firocoxib chewable tablets at<br/>a dose of 2.27 mg/lb (5.0 mg/kg) orally once daily<br/>for 30 days. The following adverse reactions were<br/>observed. Dogs may have experienced more than<br/>one of the observed adverse reactions during the<br/>study.</paragraph>
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                     <caption>Adverse Reactions Seen in U.S. Field Studies</caption>
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                           <td>
                              <content styleCode="bold">
                                 <content styleCode="italics">Adverse Reactions</content>
                              </content>
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                              <content styleCode="italics">
                                 <content styleCode="bold">         Firocoxib</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">           n=128</content>
                                 </content>
                              </paragraph>
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                              <content styleCode="italics">
                                 <content styleCode="bold">Active</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">         Control</content>
                                 </content>
                              </paragraph>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">         n = 121</content>
                                 </content>
                              </paragraph>
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                           <td>Vomiting</td>
                           <td>               5</td>
                           <td>             8</td>
                        </tr>
                        <tr>
                           <td>Diarrhea</td>
                           <td>               1</td>
                           <td>            10</td>
                        </tr>
                        <tr>
                           <td>Decreased Appetite or Anorexia</td>
                           <td>               3 </td>
                           <td>             3 </td>
                        </tr>
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                           <td>Lethargy</td>
                           <td>               1 </td>
                           <td>             3 </td>
                        </tr>
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                           <td>Pain</td>
                           <td>               2 </td>
                           <td>             1 </td>
                        </tr>
                        <tr>
                           <td>Somnolence</td>
                           <td>               1 </td>
                           <td>             1 </td>
                        </tr>
                        <tr>
                           <td>Hyperactivity </td>
                           <td>               1 </td>
                           <td>             0 </td>
                        </tr>
                     </tbody>
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                  <paragraph>Firocoxib chewable tablets were safely used during<br/>field studies concomitantly with other therapies<br/>including vaccines, anthelmintics, and antibiotics.</paragraph>
                  <paragraph>
                     <content styleCode="bold">Soft-tissue Surgery:</content> In controlled field studies<br/>evaluating soft-tissue postoperative pain and inflam-<br/>mation, 258 dogs (ages 10.5 weeks to 16 years)<br/>were evaluated for safety when given firocoxib<br/>chewable tablets at a dose of 2.27 mg/lb (5.0 mg/<br/>kg) orally approximately 2 hours prior to surgery<br/>and once daily thereafter for up to two days. The<br/>following adverse reactions were observed. Dogs<br/>may have experienced more than one of the observed reactions during the study.</paragraph>
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                     <caption>Adverse Reactions Seen in the Soft-tissue Surgery Postoperative Pain in Field Studies </caption>
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                        <tr>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold"> Adverse Reactions</content>
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                           </td>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold">        Firocoxib</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">         Group</content>
                                 </content>
                              </paragraph>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">        n=127</content>
                                 </content>
                              </paragraph>
                           </td>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold">Control</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">     Group*</content>
                                 </content>
                              </paragraph>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">     n=131</content>
                                 </content>
                              </paragraph>
                           </td>
                        </tr>
                        <tr>
                           <td>Vomiting</td>
                           <td>            5</td>
                           <td>        6</td>
                        </tr>
                        <tr>
                           <td>Diarrhea</td>
                           <td>            1 </td>
                           <td>        1 </td>
                        </tr>
                        <tr>
                           <td>Bruising At Surgery Site </td>
                           <td>            1 </td>
                           <td>        0 </td>
                        </tr>
                        <tr>
                           <td>Respiratory Arrest</td>
                           <td>            1 </td>
                           <td>        0 </td>
                        </tr>
                        <tr>
                           <td>SQ Crepitusin Rear Leg and Flank</td>
                           <td>            1</td>
                           <td>        0</td>
                        </tr>
                        <tr>
                           <td> Swollen Paw</td>
                           <td>            1 </td>
                           <td>        0 </td>
                        </tr>
                     </tbody>
                  </table>
                  <paragraph>*Sham-dosed (pilled)</paragraph>
                  <paragraph>
                     <content styleCode="bold">Orthopedic Surgery:</content> In a controlled field study<br/>evaluating orthopedic pain and inflam-<br/>mation, 226 dogs of various breeds, ranging in age<br/>from 1 to 11.9 years in the firocoxib-treated groups<br/>and 0.7 to 17 years in the control group were evaluated<br/>for safety. Of the 226 dogs, 118 were given<br/>firocoxib chewable tablets at a dose of 2.27 mg/<br/>lb (5.0 mg/kg) orally approximately 2 hours prior<br/>to surgery and once daily thereafter for a total of<br/>three days. The following adverse reactions were<br/>observed. Dogs may have experienced more than<br/>one of the observed reactions during the study.</paragraph>
                  <paragraph/>
                  <table width="75%">
                     <caption>Adverse Reactions Seen in the Orthopedic Surgery Postoperative Pain Field Study </caption>
                     <tbody>
                        <tr>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold"> Adverse Reactions</content>
                              </content>
                           </td>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold">          Firocoxib</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">           Group</content>
                                 </content>
                              </paragraph>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">           n=118</content>
                                 </content>
                              </paragraph>
                           </td>
                           <td>
                              <content styleCode="italics">
                                 <content styleCode="bold">       Control</content>
                              </content>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">       Group*</content>
                                 </content>
                              </paragraph>
                              <paragraph>
                                 <content styleCode="italics">
                                    <content styleCode="bold">       n=108</content>
                                 </content>
                              </paragraph>
                           </td>
                        </tr>
                        <tr>
                           <td>Vomiting</td>
                           <td>               1</td>
                           <td>          0</td>
                        </tr>
                        <tr>
                           <td>Diarrhea</td>
                           <td>               2**</td>
                           <td>          1 </td>
                        </tr>
                        <tr>
                           <td>Bruising at Surgery Site</td>
                           <td>               2 </td>
                           <td>          3 </td>
                        </tr>
                        <tr>
                           <td>Inappetance/Decreased Appetite</td>
                           <td>               1 </td>
                           <td>          2 </td>
                        </tr>
                        <tr>
                           <td>Prexia </td>
                           <td>               0 </td>
                           <td>          1 </td>
                        </tr>
                        <tr>
                           <td>Incision Swelling, Redness </td>
                           <td>               9 </td>
                           <td>          5 </td>
                        </tr>
                        <tr>
                           <td>Oozing Incision </td>
                           <td>               2 </td>
                           <td>          0 </td>
                        </tr>
                     </tbody>
                  </table>
                  <paragraph>A case may be represented in more than one category</paragraph>
                  <paragraph>*Sham-dosed (pilled).</paragraph>
                  <paragraph>**One dog had hemorrhagic gastroenteritis</paragraph>
                  <paragraph>
                     <content styleCode="bold">Post-Approval Experience (Rev. 2009):</content> The<br/>following adverse reactions are based on postapproval<br/>adverse drug event reporting. The<br/>categories are listed in decreasing order of<br/>frequency by body system:</paragraph>
                  <paragraph>
                     <content styleCode="underline">Gastrointestinal:</content> vomiting, anorexia, diarrhea,<br/>melena, gastrointestinal perforation, hematemesis,<br/>hematachezia, weight loss, gastrointestinal ulceration,<br/>peritonitis, abdominal pain, hypersalivation,<br/>nausea</paragraph>
                  <paragraph>
                     <content styleCode="underline">Urinary:</content> elevated BUN, elevated creatinine, polydypsia,<br/>polyuria, hematuria, urinary incontinence,<br/>proteinuria, kidney failure, azotemia, urinary tract<br/>infection</paragraph>
                  <paragraph>
                     <content styleCode="underline">Neurological/Behavioral/Special Sense:</content> depression/<br/>lethargy, ataxia, seizures, nervousness, confusion,<br/>weakness, hyperactivity, tremor, paresis, head tilt,<br/>nystagmus, mydriasis, aggression, uveitis</paragraph>
                  <paragraph>
                     <content styleCode="underline">Hepatic:</content> elevated ALP, elevated ALT, elevated<br/>bilirubin, decreased albumin, elevated AST, icterus,<br/>decreased or increased total protein and globulin,<br/>pancreatitis, ascites, liver failure, decreased BUN</paragraph>
                  <paragraph>
                     <content styleCode="underline">Hematological:</content> anemia, neutrophilia, thrombocytopenia,<br/>neutropenia</paragraph>
                  <paragraph>
                     <content styleCode="underline">Cardiovascular/Respiratory:</content> tachypnea, dyspnea,<br/>tachycardia</paragraph>
                  <paragraph>
                     <content styleCode="underline">Dermatologic/Immunologic:</content> pruritis, fever, alopecia,<br/>moist dermatitis, autoimmune hemolytic anemia,<br/>facial/muzzle edema, urticaria</paragraph>
                  <paragraph>In some cases, death has been reported as an<br/>outcome of the adverse events listed above.</paragraph>
               </text>
               <effectiveTime value="20230724"/>
            </section>
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               <id root="b574d729-2776-41ac-9e37-cbd9bc9886ab"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <title>Contact Information:</title>
               <text>
                  <paragraph>To report suspected adverse<br/>drug events, for technical assistance or to obtain<br/>a copy of the Safety Data Sheet (SDS), contact<br/>Pegasus Laboratories, Inc. at 1-800-874-9764 or<br/>www.prnpharmacal.com.</paragraph>
                  <paragraph>For additional information about adverse drug<br/>experience reporting for animal drugs, contact<br/>FDA at 1-888-FDA-VETS or online at www.fda.gov/<br/>reportanimalae.</paragraph>
               </text>
               <effectiveTime value="20230720"/>
            </section>
         </component>
         <component>
            <section ID="Led34a22f-bae0-44a3-9109-c3f05639dfb1">
               <id root="d15517fe-0711-40d2-b351-fe0daef85cc0"/>
               <code code="50744-2" codeSystem="2.16.840.1.113883.6.1" displayName="INFORMATION FOR OWNERS/CAREGIVERS SECTION"/>
               <title>
                  <content styleCode="italics">Information for Dog Owners:</content>
               </title>
               <text>
                  <paragraph>Firocoxib Chewable<br/>Tablets for Dogs, like other drugs of its class, is<br/>not free from adverse reactions. Owners should be<br/>advised of the potential for adverse reactions and be<br/>informed of the clinical signs associated with drug<br/>intolerance. Adverse reactions may include vomiting,<br/>diarrhea, decreased appetite, dark or tarry stools,<br/>increased water consumption, increased urination,<br/>pale gums due to anemia, yellowing of gums,<br/>skin or white of the eye due to jaundice, lethargy,<br/>incoordination, seizure, or behavioral changes.</paragraph>
                  <paragraph>Serious adverse reactions associated with this<br/>drug class can occur without warning and in rare<br/>situations result in death (see Adverse Reactions).<br/>Owners should be advised to discontinue Firocoxib<br/>Chewable Tablets for Dogs and contact their veterinarian<br/>immediately if signs of intolerance are<br/>observed. The vast majority of patients with drug<br/>related adverse reactions have recovered when the<br/>signs are recognized, the drug is withdrawn, and<br/>veterinary care, if appropriate, is initiated. Owners<br/>should be advised of the importance of periodic<br/>follow up for all dogs during administration of<br/>any NSAID.</paragraph>
               </text>
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            </section>
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         <component>
            <section ID="L1418fe4b-a674-4d62-97b0-7813df1e326c">
               <id root="b2a82642-7d08-4d18-828f-6fb743f6656a"/>
               <code code="34090-1" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL PHARMACOLOGY SECTION"/>
               <title>
                  <content styleCode="italics">Clinical Pharmacology:</content>
               </title>
               <text>
                  <paragraph>Mode of action: Firocoxib<br/>Chewable Tablets for Dogs is a cyclooxygenaseinhibiting<br/>(coxib) class, non-narcotic, non-ste-<br/>roidal anti-inflammatory drug (NSAID) with anti-<br/>inflammatory and analgesic properties. There are two<br/>main cyclooxygenase enzymes, COX-1 and COX-2,<br/>and a newly discovered third enzyme, COX-3, which<br/>has yet to be fully characterized.1 Cyclooxygenase-1<br/>(COX-1) is the enzyme responsible for facilitating<br/>constitutive physiologic processes, e.g., platelet<br/>aggregation, gastric mucosal protection, and renal<br/>perfusion.2 It also is constitutively expressed in<br/>the brain, spinal cord, and reproductive tract.3<br/>Cyclooxygenase-2 (COX-2) is responsible for the<br/>synthesis of inflammatory mediators, but it is also<br/>constitutively expressed in the brain, spinal cord<br/>and kidneys.4, 5, 6 Cyclooxygenase-3 (COX-3) is also<br/>constitutively expressed in the canine and human<br/>brain and also the human heart.7 Results from in vitro</paragraph>
                  <paragraph>studies showed firocoxib to be highly selective for<br/>the COX-2 enzyme when canine blood was exposed<br/>to drug concentrations comparable to those observed<br/>following a once daily 5 mg/kg oral dose in dogs.8<br/>However, the clinical significance of these findings<br/>has not been established.</paragraph>
               </text>
               <effectiveTime value="20230720"/>
            </section>
         </component>
         <component>
            <section ID="L0382d142-29d1-4eca-9d7d-164f2496950f">
               <id root="86ab8d6d-6490-4702-9ce7-c233329ebc86"/>
               <code code="60563-4" codeSystem="2.16.840.1.113883.6.1" displayName="SUMMARY OF SAFETY AND EFFECTIVENESS"/>
               <title>
                  <content styleCode="italics">Effectiveness:</content>
               </title>
               <text>
                  <paragraph>Two hundred and forty-nine dogs of<br/>various breeds, ranging in age from 11 months to<br/>20 years, and weighing 13 to 175 lbs, were randomly<br/>administered firocoxib or an active control drug in<br/>two field studies. Dogs were assessed for lameness,<br/>pain on manipulation, range of motion, joint swelling,<br/>and overall improvement in a non-inferiority evalua-<br/>tionof firocoxib compared with the active control. At<br/>the study's end, 87% of the owners rated firoxib-<br/>treated dogs as improved. Eighty-eight percent<br/>of dogs treated with firocoxib were also judged<br/>improved by the veterinarians. Dogs treated with<br/>firocoxib showed a level of improvement in veteri-<br/>narian-assessed lameness, pain on palpation, range<br/>of motion, and owner-assessed improvement that<br/>was comparable to the active control. The level of<br/>improvement in firocoxib-treated dogs in limb weight<br/>bearing on the force plate gait analysis assessment<br/>was comparable to the active control.</paragraph>
                  <paragraph>In a separate field study, two hundred fifty-eight<br/>client-owned dogs of various breeds, ranging in<br/>age from 10.5 weeks to 16 years and weighing from<br/>7 to 168 lbs, were randomly administered firocoxib<br/>or a control (sham-dosed-pilled) for the control of<br/>postoperative pain and inflammation associated with<br/>soft-tissue surgical procedures such as abdominal<br/>surgery (e.g. ovariohysterectomy, abdominal<br/>cryptorchidectomy, splenectomy, cystotomy) or<br/>major external surgeries (e.g. mastectomy, skin<br/>tumor removal ≥8 cm). The study demonstrated<br/>that firocoxib-treated dogs had significantly lower<br/>need for rescue medication than the control<br/>(sham-dosed-pilled) in controlling postoperative<br/>pain and inflammation associated with soft-surgery.</paragraph>
                  <paragraph>A multi-center field study with 226 client-owned<br/>dogs of various breeds, and ranging in age from 1<br/>to 11.9 years in the firocoxib-treated groups and<br/>0.7 to 17 years in the control group was conducted.<br/>Dogs were randomly assigned to either the firocoxib<br/>or the control (sham-dosed-pilled) group for the<br/>control of postoperative pain and inflammation asso-<br/>ciated with orthopedic surgery. Surgery to repair<br/>a ruptured cruciate ligament included the following<br/>stabilization procedures: fabellar suture and/or<br/>imbrication, fibular head transposition, tibial plateau<br/>leveling osteotomy (TPLO), and ‘over the top’ technique.<br/>The study (n = 220 for effectiveness) demon-<br/>strated that foirocoxib-treated dogs had signifcantly<br/>lower need for rescue medication than the control<br/>(sham-dosed-pilled) in controlling postoperative<br/>pain and inflammation associated with orthopedic<br/>surgery.</paragraph>
               </text>
               <effectiveTime value="20230720"/>
            </section>
         </component>
         <component>
            <section ID="L50cbaa55-7d68-464d-9e69-ecd76d60ae11">
               <id root="e6d556a6-4964-4b90-8728-398b130cefc3"/>
               <code code="60563-4" codeSystem="2.16.840.1.113883.6.1" displayName="SUMMARY OF SAFETY AND EFFECTIVENESS"/>
               <title>
                  <content styleCode="italics">Animal Safety:</content>
               </title>
               <text>
                  <paragraph>Animal Safety: In a target animal safety study,<br/>firocoxib was administered orally to healthy adult<br/>Beagle dogs (eight dogs per group) at 5, 15, and 25<br/>mg/kg (1, 3, and 5 times the recommended total daily<br/>dose) for 180 days. At the indicated dose of 5 mg/<br/>kg, there were no treatment related adverse events.</paragraph>
                  <paragraph>Decreased appetite, vomiting, and diarrhea were<br/>seen in dogs in all dose groups, including unmedicated<br/>controls, although vomiting and diarrhea were<br/>seen more often in dogs in the 5X dose group.<br/>One dog in the 3X dose group was diagnosed with<br/>juvenile polyarteritis of unknown etiology after<br/>exhibiting recurrent episodes of vomiting and<br/>diarrhea, lethargy, pain, anorexia, ataxia, propriocep-<br/>tive deficits, decreased albumin lavels, decreased<br/>and then elevated platelet counts, increased bleeding<br/>times, and elevated liver enzymes. On histopathologic<br/>examination, a mild ileal ulcer was found in one<br/>5X dog. This dog also had a decreased serum albumin<br/>which returned to normal by study completion. One<br/>control and three 5X dogs had focal areas of inflam-<br/>mation in the pylorus or small intestine. Vacuolization<br/>without inflammatory cell infiltrates was noted in the<br/>thalamic region of the brain in three control, one 3X,<br/>and three 5X dogs. Mean ALP was within the normal<br/>range for all groups but was greater in the 3X and<br/>5X dose groups than in the control group. Transient<br/>decreases in serum albumin were seen in multiple<br/>animals in the 3X and 5X dose groups, and in one<br/>control animal.</paragraph>
                  <paragraph>In a separate safety study, firocoxib was administered<br/>orally to healthy juvenile (10-13 weeks of age)<br/>Beagle dogs at 5, 15, and 25 mg/kg (1, 3, and 5 times<br/>the recommended total daily dose) for 180 days. At<br/>the indicated (1X) dose of 5 mg/kg, on histopathologic<br/>examination, three out of six dogs had minimal<br/>periportal hepatic fatty change. On histopathologic<br/>examination, one control, one 1X, and two 5X dogs<br/>had diffuse slight hepatic fatty change. These animals<br/>showed no clinical signs and had no liver enzyme<br/>elevations. In the 3X dose group, one dog was<br/>euthanized because of poor clinical condition (Day<br/>63). This dog also had a mildly decreased serum<br/>albumin. At study completion, out of five surviving<br/>and clinically normal 3X dogs, three had minimal periportal<br/>hepatic fatty change. Of twelve dogs in the 5X<br/>dose group, one died (Day 82) and three moribund<br/>dogs were euthanized (Days 38, 78, and 79) because<br/>of anorexia, poor weight gain, depression, and in<br/>one dog, vomiting. One of the euthanized dogs had<br/>ingested a rope toy. Two of these 5X dogs had mildly<br/>elevated liver enzymes. At necropsy all five of the<br/>dogs that died or were euthanized had moderate<br/>periportal or severe panzonal hepatic fatty change;<br/>two had duodenal ulceration; and two had pancreatic<br/>edema. Of two other clinically normal 5X dogs (out<br/>of four euthanized as comparators to the clinically<br/>affected dogs), one had slight and one had moderate<br/>periportal hepatic fatty change. Drug treatment was<br/>discontinued for four dogs in the 5X group. These<br/>dogs survived the remaining 14 weeks of the study.<br/>On average, the dogs in the 3X and 5X dose groups<br/>did not gain as much weight as control dogs. Rate of<br/>weight gain was measured (instead of weight loss)<br/>because these were young growing dogs. Thalamic<br/>vacuolation was seen in three of six dogs in the<br/>3X dose group, five of twelve dogs in te 5X dose<br/>group, and to a lesser degree in two unmedicated<br/>controls. Diarrhea was seen in all dose groups,<br/>including unmedicated controls.</paragraph>
                  <paragraph>In a separate dose tolerance safety study involving a<br/>total of six dogs (two control dogs and four treated<br/>dogs), firocoxib was administered to four healthy<br/>adult Beagle dogs at 50 mg/kg (ten times the recommended<br/>daily dose) for twenty-two days. All dogs<br/>survived to the end of the study. Three of the four<br/>treated dogs developed small intestinal erosion or<br/>ulceration. Treated dogs that developed small intestinal<br/>erosion or ulceration had a higher incidence of<br/>vomiting, diarrhea, and decreased food consumption<br/>than control dogs. One of these dogs had severe<br/>duodenal ulceration, with hepatic fatty change and<br/>associated vomiting, diarrhea, anorexia, weight<br/>loss, ketonuria, and mild elevations in AST and<br/>ALT. All four treated dogs exhibited progressively<br/>decreasing serum albumin that, with the exception of<br/>one dog that developed hypoalbuminemia, remained<br/>within normal range. Mild weight loss also occurred<br/>in the treated group. One of the two control dogs and<br/>three of the four treated dogs exhibited transient<br/>increases in ALP that remained within normal range.</paragraph>
               </text>
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               <code code="44425-7" codeSystem="2.16.840.1.113883.6.1" displayName="STORAGE AND HANDLING SECTION"/>
               <title>
                  <content styleCode="italics">Storage:</content>
               </title>
               <text>
                  <paragraph>Store at controlled room temperature<br/>between 20-25°C (68-77°F), excursions permitted<br/>between 15-40°C (59-104°F).</paragraph>
                  <paragraph>To Request a Safety Data Sheet (SDS), call 1-800-<br/>874-9764.</paragraph>
               </text>
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            </section>
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         <component>
            <section ID="Lda956d00-7d0e-4fe6-be77-eea209bba63a">
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               <code code="34069-5" codeSystem="2.16.840.1.113883.6.1" displayName="HOW SUPPLIED SECTION"/>
               <title>
                  <content styleCode="italics">How supplied:</content>
               </title>
               <text>
                  <paragraph>Firocoxib Chewable Tablets for<br/>Dogs is available as round, beige to tan, half-scored<br/>tablets in two strengths, containing 57 mg or 227 mg<br/>firocoxib. Each tablet strength is supplied in 60 count<br/>and 180 count bottles.</paragraph>
               </text>
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               <code code="34093-5" codeSystem="2.16.840.1.113883.6.1" displayName="REFERENCES SECTION"/>
               <title/>
               <text>
                  <paragraph>
                     <sup>1</sup> Willoughby DA, Moore AR and Colville-Nash PR.<br/>COX-1, COX-2, and COX-3 and the future treat-<br/>ment of chronic inflammatory disease. Lancet<br/>2000;355:646-648.</paragraph>
                  <paragraph>
                     <sup>2</sup> Smith, et al., Pharmacological Analysis of Cyclo-<br/>oxygenase-1 in Inflammation. Proc. Natl. Acad. Sci.<br/>USA, Pharmacology 1998;95:13313-13318.</paragraph>
                  <paragraph>
                     <sup>3</sup> Jones CJ and Budsberg SC. Physiologic characteristics<br/>and clinical importance of the cyclooxygenase<br/>isoforms in dogs and cats. JAVMA<br/>2000;217(5):721-729.</paragraph>
                  <paragraph>
                     <sup>4</sup> Zhang, et al., Inhibition of Cyclo-oxygenase-2<br/>Rapidly Reverses Inflammatory Hyperalgesia and<br/>Prostaglandin E2 Production. JPET 1997;283:1069-<br/>1075.</paragraph>
                  <paragraph>
                     <sup>5</sup>Jones and Budsberg, pp. 721-729.</paragraph>
                  <paragraph>
                     <sup>6</sup>Zhang, et al., pp. 1069-1075.</paragraph>
                  <paragraph>
                     <sup>7</sup> Chandrasekharan NV, Dai H, et al. COX-3, a cyclooxygenase-<br/>1 variant inhibited by acetaminophen and<br/>other analgesic/antipyretic drugs: Cloning, structure<br/>and expression. Proc. Natl. Acad. Sci. USA,<br/>2002;99(21):13926-13931.</paragraph>
                  <paragraph>
                     <sup>8</sup>Data on file with the NADA 141-230.</paragraph>
               </text>
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               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <title/>
               <text>
                  <paragraph>Approved by FDA under ANADA # 200-751</paragraph>
                  <paragraph>Manufactured by:<br/>Pegasus Laboratories, Inc.<br/>Employee-Owned<br/>Pensacola, FL 32514</paragraph>
                  <paragraph>Se-•Qual™ and PRN™ are trademarks of<br/>Pegasus Laboratories, Inc.</paragraph>
                  <paragraph>Rev. 08-2022</paragraph>
                  <paragraph>Sē●Qual™ Products</paragraph>
                  <paragraph>By PRN™ Pharmacal</paragraph>
               </text>
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         <component>
            <section ID="L90e253bd-75f4-440c-b5a9-3bf0767ba177">
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               <code code="50744-2" codeSystem="2.16.840.1.113883.6.1" displayName="INFORMATION FOR OWNERS/CAREGIVERS SECTION"/>
               <title>Information for Dog Owners about<br/>Firocoxib Chewable Tablets for Dogs</title>
               <text>
                  <paragraph>
                     <content styleCode="bold">Firocoxib Chewable Tablets for Dogs</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">Firocoxib Chewable Tablets for Dogs are used for the control of</content>
                     <br/>
                     <content styleCode="bold">pain and inflammation due to osteoarthritis or associated with soft-</content>
                     <br/>
                     <content styleCode="bold">tissue and orthopedic surgery in your dog.</content>
                  </paragraph>
                  <paragraph>This summary contains important information about Firocoxib<br/>Chewable Tablets for Dogs. You should read this information before<br/>you start giving your dog Firocoxib Chewable Tablets for Dogs<br/>and review it each time your prescription is refilled. This sheet is<br/>provided only as a summary and does not take the place of instructions<br/>from your veterinarian. Talk to your veterinarian if you do not<br/>understand any of this information or you want to know more about<br/>Firocoxib Chewable Tablets for Dogs.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What is Firocoxib Chewable Tablets for Dogs?</content>
                     <br/>Firocoxib Chewable Tablets for Dogs is a veterinary prescription<br/>non-steroidal anti-inflammatory drug (NSAID) used to control pain<br/>and inflammation due to osteoarthritis, or associated with soft-tissue<br/>and orthopedic surgery in dogs.</paragraph>
                  <paragraph>Osteoarthritis is a painful condition caused by “wear and tear” of<br/>cartilage and other parts of the joints that may result in the following<br/>changes or signs in your dog:<br/>• Limping or lameness.<br/>• Decreased activity or exercise (reluctance to stand, climb stairs,<br/>jump or run, or difficulty performing these activities).<br/>• Stiffness or decreased movement of joints.</paragraph>
                  <paragraph>Firocoxib Chewable Tablets for Dogs is indicated for the control<br/>of postoperative pain and inflammation following soft-tissue and<br/>orthopedic surgeries (e.g. spays, cruciate ligament repair). Your<br/>veterinarian may administer Firocoxib Chewable Tablets for Dogs<br/>before the procedure and recommend that the dog be treated for a<br/>few days after going home.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What kind of results can I expect when my dog is on</content>
                     <br/>
                     <content styleCode="bold">Firocoxib Chewable Tablets for Dogs for osteoarthritis?</content>
                     <br/>While Firocoxib Chewable Tablets for Dogs is not a cure for<br/>osteoarthritis, it can control the pain and inflammation and improve<br/>your dog’s mobility.</paragraph>
                  <paragraph>• Response varies from dog to dog, but improvement can be quite<br/>dramatic.<br/>• In most dogs, improvement can be seen within days.<br/>• If Firocoxib Chewable Tablets for Dogs is discontinued or not<br/>given as directed, your dog's pain and inflammation may return.</paragraph>
                  <paragraph>What kind of results can I expect when my dog is on<br/>Firocoxib Chewable Tablets for Dogs for the control of pain and<br/>inflammation following soft-tissue and orthopedic surgery?<br/>• Firocoxib Chewable Tablets for Dogs allow your dog to recover<br/>more comfortably by controlling pain and inflammation following<br/>soft-tissue and orthopedic surgery.<br/>• Control of pain and inflammation may vary from dog to dog.<br/>• If Firocoxib Chewable Tablets for Dogs are not given according to<br/>your veterinarian’s directions, your dog’s pain may return.<br/>• Consult your veterinarian if your dog appears to be uncomfortable.</paragraph>
                  <paragraph>
                     <content styleCode="bold">Which dogs should not take Firocoxib Chewable Tablets for Dogs?</content>
                     <br/>Your dog should not be given Firocoxib Chewable Tablets for Dogs<br/>if he/she:<br/>• Has an allergic reaction to firocoxib, the active ingredient in<br/>Firocoxib Chewable Tablets for Dogs.<br/>• Has had an allergic reaction (such as hives, facial swelling, or red<br/>or itchy skin) to aspirin or other NSAIDs.<br/>• Is presently taking aspirin, other NSAIDs, or corticosteroids.<br/>• Is under 12.5 pounds in body weight.<br/>• Has pre-existing kidney or liver disease.<br/>• Has decreased appetite, vomiting or diarrhea.</paragraph>
                  <paragraph>
                     <content styleCode="bold">Firocoxib Chewable Tablets for Dogs should only be given to dogs.</content>
                     <br/>People should not take Firocoxib Chewable Tablets for Dogs.<br/>Keep Firocoxib Chewable Tablets for Dogs and all medications<br/>out of the reach of children. Call your physician immediately if you<br/>accidentally take Firocoxib Chewable Tablets for Dogs.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What to tell/ask your veterinarian before giving Firocoxib Chewable</content>
                     <br/>
                     <content styleCode="bold">Tablets for Dogs.</content>
                     <br/>Talk to your veterinarian about:<br/>• The signs of osteoarthritis you have observed in your dog, such<br/>as limping or stiffness.<br/>• The importance of weight control in the management of<br/>osteoarthritis.<br/>• What tests might be done before Firo coxib Chewable Tablets for<br/>Dogs is prescribed.<br/>• How often your dog may need to be examined by your veterinarian.<br/>• The risks and benefits of using Firocoxib Chewable Tablets for<br/>Dogs. Serious adverse reactions, including death, have been<br/>associated with Firocoxib Chewable Tablets for Dogs administration<br/>at doses above the recommended dose in puppies less than<br/>seven months of age.</paragraph>
                  <paragraph>Tell your veterinarian if your dog is currently experiencing or has ever<br/>had the following medical problems:<br/>• Any side effects from taking Firocoxib Chewable Tablets for Dogs<br/>or other NSAIDs, such as aspirin.<br/>• Any digestive upset (vomiting and/or diarrhea).<br/>• Any kidney disease.<br/>• Any liver disease.</paragraph>
                  <paragraph>Tell your veterinarian about:<br/>• Any other medical problems or allergies that your dog has now,<br/>or has had in the past.<br/>• All medicines that you are giving or plan to give to your dog,<br/>including those you can get without a prescription and any dietary<br/>supplements.</paragraph>
                  <paragraph>Tell your veterinarian if your dog:<br/>• Is under 7 months of age.<br/>• Is pregnant, nursing or if you plan to breed your dog.</paragraph>
                  <paragraph>
                     <content styleCode="bold">How to give Firocoxib Chewable Tablets for Dogs to your dog.</content>
                     <br/>Firocoxib Chewable Tablets for Dogs should be given according<br/>to your veterinarian’s instructions. Do not change the way you give<br/>Firocoxib Chewable Tablets for Dogs to your dog without first<br/>speaking with your veterinarian. Your veterinarian will tell you what<br/>amount of Firocoxib Chewable Tablets for Dogs is right for your dog<br/>and for how long it should be given. Firocoxib Chewable Tablets for<br/>Dogs may be offered to the dog by hand or you can place the tablet<br/>in your dog’s mouth. Firocoxib Chewable Tablets for Dogs may be<br/>given with or without food.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What are the possible side effects that may occur in my dog during</content>
                     <br/>
                     <content styleCode="bold">Firocoxib Chewable Tablets for Dogs therapy?</content>
                     <br/>Firocoxib Chewable Tablets for Dogs, like other NSAIDs, may cause<br/>some side effects. Serious side effects associated with NSAID<br/>therapy in dogs can occur with or without warning, and, in rare<br/>situations, result in death. The most common side effects associated<br/>with Firocoxib Chewable Tablets for Dogs therapy involve the digestive<br/>tract (vomiting and decreased food consumption). Liver and<br/>kidney problems have also been reported with NSAIDs. Look for the<br/>following side effects that may indicate your dog is having a problem<br/>with Firocoxib Chewable Tablets for Dogs:<br/>• Decrease or increase in appetite.<br/>• Vomiting.<br/>• Change in bowel movements (such as diarrhea, or black, tarry or<br/>bloody stools).<br/>• Change in behavior (such as decreased or increased activity level,<br/>incoordination, seizure, or aggression).<br/>• Yellowing of gums, skin, or whites of the eyes (jaundice).<br/>• Change in drinking habits (frequency or amount consumed).<br/>• Change in urination habits (frequency, color, or smell).<br/>• Change in skin (redness, scabs, or scratching).<br/>• Unexpected weight loss.</paragraph>
                  <paragraph>It is important to stop the medication and contact your<br/>veterinarian immediately if you think your dog has a medical<br/>problem or side effect while taking Firocoxib Chewable Tablets<br/>for Dogs. If you have additional questions about possible<br/>side effects, talk with your veterinarian or call 1-800-874-9764.</paragraph>
                  <paragraph>
                     <content styleCode="bold">Can Firocoxib Chewable Tablets for Dogs be given with other</content>
                     <br/>
                     <content styleCode="bold">medications?</content>
                     <br/>Firocoxib Chewable Tablets for Dogs should not be given with<br/>other NSAIDs (for example, aspirin, carprofen, etodolac, deracoxib,<br/>meloxicam, or tepoxalin) or corticosteroids (for example, prednisone,<br/>cortisone, dexamethasone, or triamcinolone).</paragraph>
                  <paragraph>Tell your veterinarian about all medications that you have given your<br/>dog in the past, and any medications you are planning to give with<br/>Firocoxib Chewable Tablets for Dogs. This should include other<br/>medicines that you can get without a prescription or any dietary<br/>supplements. Your veterinarian may want to check that all of your<br/>dog’s medicines can be given together.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What do I do in case my dog eats more than the prescribed amount</content>
                     <br/>
                     <content styleCode="bold">of Firocoxib Chewable Tablets for Dogs?</content>
                     <br/>Consult your veterinarian immediately if your dog eats more than the<br/>prescribed amount of Firocoxib Chewable Tablets for Dogs.</paragraph>
                  <paragraph>
                     <content styleCode="bold">What else should I know about Firocoxib Chewable Tablets</content>
                     <br/>
                     <content styleCode="bold">for Dogs?</content>
                     <br/>• This sheet provides a summary of information about Firocoxib<br/>Chewable Tablets for Dogs. If you have any questions or concerns<br/>about Firocoxib Chewable Tablets for Dogs, osteoarthritis pain, or<br/>post operative pain following soft-tissue and orthopedic surgery,<br/>talk with your veterinarian.<br/>• As with all prescribed medicines, Firocoxib Chewable Tablets<br/>for Dogs should only be given to the dog for which they were<br/>prescribed. They should be given to your dog only for the condition<br/>for which they were prescribed, at the prescribed dose.<br/>• It is important to periodically discuss your dog’s response to<br/>Firocoxib Chewable Tablets for Dogs tablets. Your veterinarian will<br/>determine if your dog is responding as expected and if your dog<br/>should continue receiving Firocoxib Chewable Tablets for Dogs.</paragraph>
                  <paragraph>
                     <content styleCode="italics">
                        <content styleCode="bold">Contact Information:</content>
                     </content> To report suspected adverse drug events, for<br/>technical assistance or to obtain a copy of the Safety Data Sheet<br/>(SDS), contact Pegasus Laboratories, Inc. at 1-800-874-9764 or<br/>www.prnpharmacal.com.</paragraph>
                  <paragraph>
                     <content styleCode="bold">For additional information about adverse drug experience reporting</content>
                     <br/>
                     <content styleCode="bold">for animal drugs, contact FDA at 1-888-FDA-VETS or online at</content>
                     <br/>
                     <content styleCode="bold">www.fda.gov/reportanimalae.</content>
                  </paragraph>
                  <paragraph>Approved by FDA under ANADA # 200-751</paragraph>
                  <paragraph>Rev. 08-2022</paragraph>
                  <paragraph>Sē●Qual™ Products by PRN™ Pharmacal</paragraph>
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