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            <name>Aspen Veterinary Resources, Ltd.</name>
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                        <name>SULFADIMETHOXINE<suffix>40%</suffix>
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                              <name>SULFADIMETHOXINE</name>
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                                    <name>SULFADIMETHOXINE</name>
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                              <name>SODIUM FORMALDEHYDE SULFOXYLATE</name>
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                              <name>SODIUM HYDROXIDE</name>
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                              <name>water</name>
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               <text>
                  <paragraph>
                     <content styleCode="bold">Sulfadimethoxine Injection 40%</content>
                     <br/>
                     <content styleCode="bold">(sulfadimethoxine)</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">ANTIBACTERIAL</content>
                     <br/>
                     <content styleCode="bold">Each mL contains 400 mg Sulfadimethoxine</content>
                     <br/>
                     <content styleCode="bold">Caution:</content> Federal law restricts this drug to use by or on the order of a<br/>licensed veterinarian.</paragraph>
                  <paragraph>
                     <content styleCode="bold">RESTRICTED DRUG (California), USE ONLY AS DIRECTED</content>
                     <br/>
                     <content styleCode="bold">NOT FOR USE IN HUMANS</content>
                     <br/>
                     <content styleCode="bold">KEEP OUT OF REACH OF CHILDREN</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="bold">DESCRIPTION: </content>Sulfadimethoxine Injection 40% is a low-dosage, rapidly absorbed, long-acting sulfonamide, effective for the<br/>treatment of shipping fever complex, bacterial pneumonia, calf diphtheria and foot rot in cattle. Sulfadimethoxine is a white,<br/>almost tasteless and odorless compound. Chemically, it is N<sup>1</sup>-(2,6 dimethoxy-4-pyrimidinyl) sulfanilamide. The structural<br/>formula is:</paragraph>
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                  <paragraph>
                     <content styleCode="bold">ACTIONS:</content> Sulfadimethoxine has been demonstrated clinically or in the laboratory to be effective against a variety of organisms,<br/>such as <content styleCode="italics">streptococci</content>,<content styleCode="italics"> klebsiella</content>,<content styleCode="italics"> proteus</content>,<content styleCode="italics"> shigella</content>,<content styleCode="italics"> staphylococci</content>,<content styleCode="italics"> escherichia</content>, and<content styleCode="italics"> salmonella</content>.<sup>1,2</sup> The systemic sulfonamides which<br/>include sulfadimethoxine are bacteriostatic agents. Sulfonamides competitively inhibit bacterial synthesis of folic acid (pteroylglutamic<br/>acid) from para-aminobenzoic acid. Mammalian cells are capable of utilizing folic acid in the presence of sulfonamides.</paragraph>
                  <paragraph>   The tissue distribution of sulfadimethoxine, as with all sulfonamides, is a function of plasma levels, degree of plasma protein binding,<br/>and subsequent passive distribution in the tissues of the lipid-soluble un-ionized form. The relative amounts are determined by both<br/>its pKa and by the pH of each tissue. Therefore, levels tend to be higher in less acid tissue and body fluids or those diseased tissues<br/>having high concentrations of leucocytes.<sup>2</sup>
                  </paragraph>
                  <paragraph>   Slow renal excretion results from a high degree of tubular reabsorption,<sup>3</sup> and plasmaprotein binding is very high, providing a<br/>blood reservoir of the drug. Thus, sulfadimethoxine maintains higher blood levels than most other long-acting sulfonamides. Single,<br/>comparatively low doses of sulfadimethoxine give rapid and sustained therapeutic blood levels.<sup>1</sup>
                  </paragraph>
                  <paragraph>   To assure successful sulfonamide therapy (1) the drug must be given early in the course of the disease, and it must produce a high<br/>sulfonamide level in the body rapidly after administration, (2) therapeutically effective sulfonamide levels must be maintained in the<br/>body throughout the treatment period, (3) treatment should continue for a short period of time after the clinical signs have disappeared,<br/>and (4) the causative organisms must be sensitive to this class of drugs.</paragraph>
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               <text>
                  <paragraph>
                     <content styleCode="bold">TOXICITY AND SAFETY:</content> Data regarding acute (LD<sub>50</sub>) and chronic toxicities of sulfadimethoxine indicate the drug is very safe.<br/>The LD<sub>50</sub> in mice is greater than 2 g/kg body weight when administered intraperitoneally and greater than 16 g/kg when<br/>administered orally.<br/>   In dogs receiving massive single oral doses of 3.2 g/kg body weight, diarrhea was the only adverse effect observed. Dogs given<br/>160 mg/kg body weight orally daily for 13 weeks showed no sign of toxicity.<br/>   In cattle sulfadimethoxine has been shown to be safe through extensive clinical use with other dosage forms. In addition, studies<br/>with intravenous administration of Sulfadimethoxine Injection 40% have demonstrated that hemolysis of erythrocytes does not occur<br/>by this route of administration. Sulfadimethoxine has a relatively high solubility at the pH normally occurring in the kidney, precluding<br/>the possibility of precipitation and crystalluria.</paragraph>
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               <code code="34067-9" codeSystem="2.16.840.1.113883.6.1" displayName="INDICATIONS &amp; USAGE SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">INDICATIONS:</content> Sulfadimethoxine Injection 40% is indicated for the treatment of bovine respiratory disease complex (shipping fever<br/>complex) and bacterial pneumonia associated with <content styleCode="italics">Pasteurella</content> spp. sensitive to sulfadimethoxine; necrotic pododermatis (foot rot)<br/>and calf diphtheria caused by<content styleCode="italics"> Fusobacterium necrophorum (Sphaerophorus necrophorus)</content>, sensitive to sulfadimethoxine.</paragraph>
                  <paragraph>
                     <content styleCode="bold">LIMITATIONS:</content> Sulfadimethoxine is not effective in viral or rickettsial infections, and as with any anti-bacterial agent, occasional<br/>failures in therapy may occur due to resistant microorganisms. The usual precautions in sulfonamide therapy should be observed.</paragraph>
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               <code code="53412-3" codeSystem="2.16.840.1.113883.6.1" displayName="RESIDUE WARNING SECTION"/>
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                  <paragraph>
                     <content styleCode="bold">RESIDUE WARNINGS:</content> Milk taken from animals during treatment and for 60 hours (5 milkings) after the latest treatment must not<br/>be used for food. Do not administer within 5 days of slaughter. A withdrawal period has not been established for this product in<br/>pre-ruminating calves. Do not use in calves to be processed for veal.</paragraph>
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                  <paragraph>
                     <content styleCode="bold">PRECAUTIONS:</content> During treatment period, make certain that animals maintain adequate water intake.<br/>If animals show no improvement within 2 or 3 days, consult your veterinarian.<br/>Tissue damage may result from perivascular infiltration.</paragraph>
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               <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
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                  <paragraph>
                     <content styleCode="bold">DOSAGE AND ADMINSTRATION:</content> Sulfadimethoxine Injection 40% must be administered only by the intravenous route in cattle.<br/>Cattle should receive 1 mL of Sulfadimethoxine Injection 40% per 16 pounds of body weight (55 mg/kg) as an initial dose,<br/>followed by 0.5 mL per 16 pounds of body weight (27.5 mg/kg) every 24 hours thereafter. Sulfadimethoxine boluses may be<br/>utilized for maintenance therapy in cattle. Representative weights and doses are indicated in the following table:</paragraph>
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                  <paragraph>Length of treatment depends on the clinical response. In most cases treatment for 3 to 5 days is adequate. Treatment should be<br/>continued until the animal is asymptomatic for 48 hours.</paragraph>
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                  <paragraph>
                     <content styleCode="bold">DIRECTIONS FOR INTRAVENOUS INJECTION:</content>
                     <br/>
                     <content styleCode="bold">Equipment needed-</content>
                     <br/>1. A nose lead and/or halter sufficiently strong enough to effectively restrain or hold the animal's head steady so that the intravenous<br/>    injection can be made with ease.<br/>2. Hypodermic needles, 16 or 18 gauge and 2 inches long. Only new, sharp and sterile hypodermic needles should be used. Dull needles<br/>    should be discarded. Extra needles should always be available in case of the needle being used should become clogged.<br/>3. Hypodermic syringes, 40 or 50 mL sterile disposable or reusable glass syringes should be available.<br/>4. Alcohol (70%) or equally effective antiseptic for disinfecting the skin.<br/>
                     <content styleCode="bold">Preparation of equipment -</content> Glass syringes and regular hypodermic needles should be thoroughly cleaned and washed. Following this, the<br/>needles and syringes should be immersed in boiling water for 30 minutes prior to each injection. Regular hypodermic needles should not<br/>be used more than 3-4 times as repeated skin puncturing and boiling of the needles causes them to become quite dull. Disposable<br/>hypodermic needles and syringes should not be used more than once.<br/>
                     <content styleCode="bold">Restraint of animal -</content> The cow should preferably be in a stanchion for maximum restraint. If this is not possible, the animal should be<br/>restrained in a manner to prevent excessive movement. A nose lead should be applied and the animal's head turned sidewise to stretch<br/>the skin and tense the muscles of the neck region. (See Figure 1).<br/>
                     <content styleCode="bold">Locating the jugular vein -</content> Once the animal has been restrained (as above), you will notice a long depression of the skin from below<br/>the angle of the jaw to just above the shoulder. This is known as the jugular furrow or jugular groove. The jugular vein is located<br/>just under the jugular groove. (See Fig. 1).<br/>
                     <content styleCode="bold">Preparation of Sulfadimethoxine Injection 40% for injection -</content> The rubber cap of the bottle should be thoroughly cleaned with 70% alcohol<br/>or other satisfactory antiseptic. The correct amount of Sulfadimethoxine Injection 40% for treatment should be calculated (see dosage<br/>directions) and that amount withdrawn into a syringe. (See Figure 2). One or two syringefuls of air should be injected into the bottle<br/>first to make withdrawing the drug easier. Sulfadimethoxine Injection 40% should preferably be at room temperature when filling syringes<br/>and when injecting intravenously.<br/>
                     <content styleCode="bold">Entering the vein -</content> The skin of the injection area should be clean and free of dirt. Cotton saturated with 70% alcohol (or suitable<br/>antiseptic) should be used to wipe the injection site.<br/>   Apply pressure over the jugular vein close to the shoulder. This will reduce the flow of blood to the heart and cause the jugular vein<br/>to bulge or enlarge. (See Figure 3). When the jugular vein has been "raised", insert the hypodermic needle at a 45 degree angle through<br/>the skin just underneath the jugular vein. The beveled edge of the hypodermic needle should be up. (See Figure 4).<br/>   After the skin has been punctured, the point of the needle should be directed toward the side of the vein and pushed into the center of<br/>the vein. (See Figure 5). When the needle is in the center of the vein, there will be a free flow of blood back through the needle.<br/>Release external pressure when you are sure the needle is within the vein.<br/>
                     <content styleCode="bold">Injecting the Sulfadimethoxine Injection 40% -</content> After the needle has been accurately inserted into the jugular vein, firmly attach the<br/>syringe containing Sulfadimethoxine Injection 40% to the inserted hypodermic needle. Caution, be sure syringe is free of air. Exert<br/>firm pressure on the plunger of the syringe to inject the Sulfadimethoxine Injection 40% while the barrel is held firmly. The injection<br/>should be made moderately slow - never rapidly.<br/>   If the animal moves, causing resistance in pushing the plunger of the syringe, or if a bubble of the drug is noted under the skin, the<br/>needle is no longer within the vein. The needle should be repositioned.<br/>   When the injection is completed, quickly withdraw the syringe and needle with a quick pull and apply light pressure over the injection<br/>site with alcohol and cotton to minimize bleeding from the puncture site.</paragraph>
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               <code code="34084-4" codeSystem="2.16.840.1.113883.6.1" displayName="ADVERSE REACTIONS SECTION"/>
               <text>
                  <paragraph>To report suspected adverse drug events, for technical assistance or to obtain a copy of the Safety Data Sheet (SDS), contact<br/>Huvepharma, Inc. at 1-877-994-4883 or www.huvepharma.us. For additional information about adverse drug experience reporting<br/>for animal drugs, contact FDA at 1-888-FDA-VETS or http://www.fda.gov/reportanimalae.</paragraph>
                  <paragraph>
                     <content styleCode="bold">NOTE:</content> Store at room temperature. Should crystallization occur at cold temperatures, crystals will dissolve either by storing in room<br/>temperature for several days or by heating the vial in warm water. Crystallization and redissolution do not impair the efficacy of the<br/>product.</paragraph>
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                  <paragraph>
                     <content styleCode="bold">HOW SUPPLIED:</content>
                     <content styleCode="bold">Sulfadimethoxine Injection 40%</content> is available in 250 mL sterile multiple dose containers.<br/>Sulfadimethoxine Injection 40% – Each mL contains 400 mg sulfadimethoxine compounded with 20% propylene glycol, 1%<br/>benzyl alcohol, 0.1 mg disodium edetate, 1 mg sodium formaldehyde sulfoxylate, and pH adjusted with sodium hydroxide.</paragraph>
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               <code code="34093-5" codeSystem="2.16.840.1.113883.6.1" displayName="REFERENCES SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">REFERENCES</content>
                     <br/>1. Data on file from Hoffmann-La Roche Inc., Nutley, New Jersey.<br/>2. Stowe, C.M., THE SULFONAMIDES, in Jones. L.M. (ed.), Veterinary Pharmacology and Therapeutics, Ames, Iowa, Iowa State University Press. 1965, chapter 33.<br/>3. Baggot, J.D., SOME ASPECTS OF DRUG PERSISTENCE IN DOMESTIC ANIMALS, Res. Vet. Sci. 11:2, 130, 1970</paragraph>
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                  <paragraph>
                     <content styleCode="bold">CONTENTS:</content>
                     <br/>EACH mL CONTAINS: 400 mg sulfadimethoxine compounded with 20% propylene glycol, 1% benzyl alcohol, 0.1 mg disodium<br/>edetate, 1 mg sodium formaldehyde sulfoxylate, and pH adjusted with sodium hydroxide.</paragraph>
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                  <paragraph>
                     <content styleCode="bold">DOSAGE:</content>
                  </paragraph>
                  <paragraph>To be administered in amounts to provide 25 mg/lb (55 mg/kg) for initial dose, followed by 12.5 mg/lb (27.5 mg/kg) for maintenance<br/>doses every 24 hours.</paragraph>
                  <paragraph>During treatment period, make certain that animals maintain adequate water intake.</paragraph>
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                     <content styleCode="bold">Approved by FDA under ANADA # 200-038</content>
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                     <br/>Aspen Veterinary Resources,® Ltd.<br/>Liberty, MO 64068<br/>www.aspenveterinaryresources.com</paragraph>
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