Efficacy and Safety of Selamectin

(Stronghold®/Revolution™) Used
Off-Label in Exotic Pets
Maggie Fisher, DVM, DiplEVPC1
Wieland Beck, DVM, DiplEVPC2
Melanie J. Hutchinson, DVM1
1
Shernacre Cottage
Malvern, UK
2
Institute for Comparative Tropical Medicine and Parasitology
Faculty of Veterinary Medicine
Ludwig-Maximilians-University Munich
Munich, Germany

KEY WORDS: selamectin; exotics; off- Products (EMEA) on 25 November 1999

label; ectoparasites; endoparasites as the first endectocide for use in dogs and
ABSTRACT cats in Europe. The commercial formula-
tion of selamectin has label claims for the
Selamectin, a novel avermectin compound,
treatment of otodectic mange caused by
is reviewed and discussed for its efficacy
Otodectes cynotis in dogs and cats and for
against naturally occurring infestations and
sarcoptic mange due to Sarcoptes infestation
infections of Ctenocephalides felis, Otodec-
in dogs. It also has claims against fleas and
tes cynotis, and Dirofilaria immitis in ferrets;
biting lice in dogs and cats, Toxocara spp in
different flea species, Psoroptes cuniculi,
dogs and cats, and hookworms in cats. It is
Cheyletiella spp, and Leporacarus gibbus in
licensed as a heartworm preventative with
rabbits; different chewing lice, Trixacarus
efficacy against larval stages of Dirofilaria
caviae, and Chirodiscoides caviae in guinea
immitis. Thus, the commercial formulation
pigs; Ornithonyssus bacoti and Demodex
of selamectin offers small animal practitio-
spp in hamsters and gerbils; Polyplax spp
ners an effective treatment for some com-
and fur mites in rats and mice; different
mon, troublesome parasitic conditions of
flea species, Demodex erinacei, Crenosoma
cats and dogs.
striatum, and Capillaria spp in hedgehogs;
The care of companion animals includ-
and chewing lice in birds. The efficacy and
ing exotic pets other than dogs and cats is
safety of selamectin used off-label in exotic
also the responsibility of the small animal
pets are detailed and discussed in this paper.
veterinary surgeon, and whilst dogs and cats
Practical experiences and results suggest
remain the main pets throughout Europe,
that selamectin is effective against a variety
there is an upsurge in ownership of pets
of ecto- and endoparasites.
other than dogs and cats. This is not the first
INTRODUCTION time that more exotic species have been kept
Selamectin as a spot-on formulation (Strong- as pets; indeed, in eighteenth century Paris,
hold®/Revolution™, Pfizer Ltd) received the keeping of exotic animals as household
marketing authorisation from the European pets was not uncommon.1 What perhaps is
Agency for the Evaluation of Medicinal different on this occasion is the importance

Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007. 87

being given by veterinarians to the under- haematomas, and torticollis may result.10
standing and appropriate treatment of dis- Because of the anatomical characteristics of
eases acquired by these animal species. As the ear of the ferret, conventional treatment
in other species, ecto- and endoparasites are involving instillation of drops is of very lim-
important causes of disease, ectoparasites ited efficacy. A single topical application of
being the most common cause of dermatoses approximately 15-mg selamectin per ferret
in small mammals, except chinchillas.2,3 has been reported to be highly effective in
Because there are few medicines li- the treatment of this irritant infestation.8,11,12
censed for the treatment of pets other than
Nematodes
dogs or cats, practitioners often turn to off-
label use of products that are available for Dirofilaria immitis
the treatment of other species. Selamectin Dirofilaria immitis, the heartworm, is a
has proved to be no exception as, follow- filarial nematode infecting dogs, cats, fer-
ing approval and becoming widely avail- rets, and occasionally humans. It is transmit-
able across Europe, it has been used for the ted by the bite of an infected mosquito that
treatment of a broad range of hosts. This is transfers infective third stage larvae to the
legitimate under the cascade whereby vet- new host when it takes a blood meal. Clini-
erinary surgeons can use a product without cal signs associated with the adult parasite,
a label claim in non-food producing animals found primarily in the pulmonary artery, are
when there is no suitable product for that associated with interference with heart func-
indication in that host.4 This paper reviews tion and pulmonary hypertension.13 Clinical
the published data on selamectin use in pets signs include dyspnoea, cough, pale mucous
other than dogs and cats.
membranes, lethargy, dehydration, and
FERRETS anorexia.14,15 Oedema, ascites, and pulmo-
Fleas nary congestion may be seen.14 If untreated,
D immitis infection may lead to death14 and
Flea infestations in ferrets are usually due to
as few as 5 adult worms may be fatal to a
the cat flea, Ctenocephalides felis5,6 (Figure
1), and clinical signs are similar to those ferret.16
seen in cats and dogs.7,8 In a clinical trial, Control in endemic areas is based on
ferrets were treated topically with selamectin prophylactic treatments to eliminate the third
at either 6 or 18 mg/kg body weight monthly and fourth stage larvae before they begin to
for 4 months. These ferrets were experi- migrate towards the heart, as treatment and
mentally infested with fleas 4, 11, 25, and subsequent death of adult worms may result
18 days after each treatment, with surviving in pulmonary thromboembolism.13 In a clini-
fleas being counted 3 days later. Both doses cal trial, 10 ferrets were treated topically
were 100% effective for between 7 and 21 with either 6 or 18 mg/kg body weight sela-
days post-treatment.9 Moorman-Roest8 suc- mectin monthly for 4 months. Ferrets were
cessfully controlled flea infestation in ferrets inoculated with D immitis larvae 30 days
utilizing monthly applications of 15-mg prior to the first treatment. Efficacy of treat-
selamectin per ferret, regardless of weight. ment was assessed 24 days after the fifth
Otodectes cynotis dose, 173 days post inoculation. Selamectin
Otoacariasis in the ferret is caused by the was 99.5% effective in preventing heart-
ear mite Otodectes cynotis. Clinical signs worm infection at a dose rate of 6 mg/kg and
include a brown waxy exudate from the 100% effective at a dose rate of 18 mg/kg
external ear canal, intense aural irritation, body weight.9 Kramer et al12 report use of
head-shaking, and scratching at the ears.6,8 selamectin in ferrets without problems at a
In severe infestations, secondary bacterial dose of 18 mg/kg body weight monthly for
infections, self-excoriation, eczema, aural heartworm prevention.

88 Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007.

Figure 1. The cat flea (Ctenocephalides felis).

RABBITS mation, crusting, ceruminous exudate of

the ear canal with excoriation of pinnae due
Fleas
to scratching, head shaking, and, in severe
Domesticated rabbits can be infested by the infestations, torticollis due to secondary bac-
cat flea Ctenocephalides felis, by Spilopsyl-
terial infection.7,20-22 In addition, the mites
lus cuniculi where there is contact with
can spread to the body of the host causing a
wild rabbits,17,18 and by Pulex irritans,
pruritic, crusting dermatitis of the head and
Echidnophaga gallinacean, or Nosopsyllus
neck18 and ventral abdomen and urogenital
fasciatus.7 Infestation may be asymptomatic,
region.7
or a hypersensitivity reaction to flea bites
may develop, with alopecia resulting from The efficacy and safety of selamectin
scratching and biting,5 resulting in a pruritic was assessed in rabbits naturally infested
papular dermatitis.7 Van Praag19 recom- with Psoroptes cuniculi by McTier et al.23
mends a single topical dose of selamectin at Selamectin was applied onto the skin at the
a dose rate of 18 mg/kg body weight for flea base of the neck to give a minimum dose-rate
control with a repeated treatment 30 days of 6 or 18 mg/kg body weight, either once
later if required. or twice at 28 days apart. No live mites were
recovered from any selamectin-treated rabbit
Mites from Day 7 up to 56 days after treatment,
Psoroptes cuniculi while all placebo treatment rabbits remained
Psoroptes mites are cosmopolitan ectopara- heavily infested with viable ear mites. In a
sites of several mammalian hosts. The ear case study,24 a 4-month-old male dwarf rabbit
mite, Psoroptes cuniculi, mainly affects rab- and its 3 cage mates diagnosed with Pso-
bits and is a common cause of otitis externa roptes cuniculi infection were treated with
(Figure 2). Clinical signs include inflam- a single dose of 15 mg selamectin. Within

Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007. 89

Figure 2. A rabbit with ear canker due to Psoroptes cuniculi.

Figure 3. The fur mite of rabbits (Cheyletiella parasitovorax).

90 Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007.

1 week after treatment, no ear mites were normal healthy adult animals.25 However, in
detected. Beck11 recommends treatment of heavy infestations or where there is underly-
Psoroptes cuniculi in rabbits with selamec- ing disease, alopecia, moist dermatitis, mild
tin, applying a single dose of 15 or 30 mg, scurf, and pruritus may occur.25 Treatment
depending on body weight of the animal. with selamectin, repeated at monthly inter-
Cheyletiella spp vals until live mites are no longer detected,
is recommended by Hughes18 at the dose rate
Cheyletiella mites are commonly found
of 15 mg for rabbits weighing less than 2.3
on rabbits and are thought to be a normal
kg and 45 mg for those weighing more than
commensal.7,25 Cheyletiella parasitovorax
2.3 kg.
(Figure 3) is the species associated with the
rabbit, but members of the genus Cheyle- GUINEA PIGS
tiella are not considered host specific.26 A Lice
common clinical description of Cheyleti-
Four species of chewing lice, Gliricola
ella infestation is of “walking dandruff,”
porcelli, Gyropus ovalis,7 Trimenopon
describing the effect of the movement of the
hispidum,11 and Trimenopon jenningsi,30 are
relatively large mites amongst the many skin
commonly found on guinea pigs, especially
scales shed into the coat resulting from a
those kept in colonies. Although normally
heavy infestation.27 Other signs are variable
asymptomatic, heavy infestations may cause
and include pruritic dermatitis and alope-
pruritus, scaling and alopecia,5,10 erythema,
cia.11,28 Infection is highly contagious and
and papules, particularly around the ears,30
spreads through direct transmission or via
with anorexia and even epileptiform seizures
fomites and is zoonotic.27 Human infection
in severe cases.11 Beck10 recommends 15 mg
is commonly associated with a papular, pru-
selamectin for animals weighing less than
ritic rash, often on the forearms7,18,29 follow-
800 g body weight and 30 mg for animals
ing close contact with the infested pet.
heavier than 800 g body weight applied as a
Beck11 recommends treatment of spot-on to the skin of the neck.
cheyletielliosis in rabbits with selamectin,
applying a single dose of 15 or 30 mg, Mites
dependent on body weight, to the skin of Trixacarus caviae
the neck. Hughes19 recommends treatment Sarcoptiform mange in guinea pigs is caused
with selamectin, 15 mg for rabbits weigh- by the mite Trixacarus caviae, which is
ing less than 2.3 kg and 45 mg for those similar in appearance to Sarcoptes scabiei
weighing more than 2.3 kg, with a second var canis but is much smaller.30 Infesta-
treatment 1 month after to kill emerging tion in pet guinea pigs was first reported by
larvae. A 5-month-old rabbit diagnosed with Beresford-Jones et al.31 Infestations cause
cheyletielliosis and Pasteurella spp infection intense pruritus, leading to severe self-trau-
was treated with selamectin at a dose of 6 ma, with lesions of erythema, papules and
mg/kg body weight topically, 2 treatments hyperkeratosis, alopecia, and lichenifica-
14 days apart.28 Reduced clinical signs were tion occurring in chronic infestations.10,30,32
observed within 1 week of treatment and Severely affected or untreated animals may
were much improved by 1 month after initial have seizures10,29 and may die from an-
treatment. However the rabbit died suddenly orexia.7 Some animals act as asymptomatic
carriers.7,30
of unknown cause, 22 days after the second
treatment.28 Beck10 recommends treatment with
selamectin at a dose of 15 mg for animals
Leporacarus gibbus weighing less than 800 g body weight and
The fur mite, Leporacarus gibbus, is a 30 mg for animals heavier than 800 g body
cosmopolitan species and is often found weight applied as a spot-on to the skin of the
in the fur of rabbits.25 It is thought to be a neck as a treatment for this highly irritant
commensal ectoparasite, asymptomatic in ectoparasitic infestation.

Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007. 91

Chirodiscoides caviae Demodex spp
The fur-mite commonly found on guinea Demodectic mange caused by Demodex
pigs is Chirodiscoides caviae. Infestations criceti and Demodex aurati in hamsters5 and
may be asymptomatic, but a heavy infesta- Demodex meriones in gerbils7 is relatively
tion may lead to pruritus, alopecia, ery- common. Infestation is usually asymptom-
thema, and scaling with increased grooming atic, but scaling and alopecia may develop
activity leading to self-trauma and ulcerative as a result of underlying chronic debilitating
dermatitis.30 Concurrent infestation with disease.5 Demodectic mange in hamsters
Trixacarus caviae7 or lice30 may occur. can be treated with selamectin, at a dose
Good results in the treatment of this rate of 6-18 mg/kg body weight, 1 drop 6%
parasite have been achieved with 2 applica- selamectin applied to the skin weekly from
tions of 12 mg/kg body weight selamectin a pipette.37
with a 2-week interval.30 In a clinical case,33 RATS AND MICE
a 3-year-old guinea pig with a body weight
Lice
of 600 g was treated with a single topical ap-
plication of 30 mg selamectin. Clinical signs Polyplax spp are blood-sucking anopluran
improved within 1 week of treatment, and lice; Polyplax serrata infests both rats and
pruritus had ceased within a few days. There mice whereas Polyplax spinulosa infests
were no adverse effects following treatment. rats only.7 Infestation results in pruritus and
For convenience, Beck10 recommends that a scaling dermatosis7 with excoriation and
localised alopecia.10 If infestations are left
small guinea pigs (those weighing less than
untreated, so much blood maybe removed
800 g body weight) are treated with 15 mg
from the hosts that anemia and even death
selamectin and those weighing 800 g or
may occur.38 Beck10,11 recommends selamec-
more are treated with 30 mg selamectin ap-
tin, 1 drop from a 15-mg pipette, for treat-
plied as a spot-on to the skin of the neck.
ment of lice in rats and mice.
HAMSTERS AND GERBILS
Mites
Mites Myocoptes musculinus, Myobia musculi, and
Ornithonyssus bacoti Radfordia affinis are the common fur mites
of mice.5 Radfordia ensifera infests rats.7
Ornithonyssus bacoti, the blood-sucking
Infestation is usually asymptomatic but may
tropical rat mite, has a worldwide distri-
result in scaling, crusting, pruritus, excoria-
bution7 and is zoonotic.29,33,34 Fox et al35
tion, and alopecia where there is underlying
reported the first case of Ornithonyssus
debilitating disease or poor housing condi-
bacoti found on a pet hamster in the UK in
tions.7,10 Ornithonyssus bacoti also infests
2002, and Beck36 reported a case of infesta- rats and mice, and Pizzi et al39 reported an
tion on 2 pet gerbils in Germany. In the case outbreak of O bacoti in pet rats in the UK in
reported by Fox et al,35 infestation was as- 2003.
ymptomatic; however, in the case published In a clinical trial, mice infested with
by Beck,36 the gerbils presented with severe M musculi and M musculinus were treated
pruritus, excoriations, and unusual grooming with selamectin at either 12 or 24 mg/kg
behaviour. Heavy infestation may result in body weight on 2 occasions with a 30-day
anemia and death.7 Beck36 treated the gerbils interval. Evaluation of treatment was made
with 1 drop of selamectin from a 15-mg at 15-day intervals following the first treat-
pipette. Seven days after treatment, no mites ment up to Day 90. Thirty days after the
were found in the hair coat. No adverse ef- first treatment, efficacy was 98.8% for the
fects were seen following treatment. Clean- 12-mg/kg group and 89.9% for the 24-mg/
ing and decontamination of the environment kg group. Both treatments were 100% effec-
is important to prevent re-infestation.36 tive by Day 90.40 Beck11 suggests treatments

92 Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007.

with selamectin, using 1 drop from a 15-mg caponis, Goniodes dissimilis, Goniodes
pipette, for mites in rats and mice. gigas, and Goniocotes gallinae.7 They spend
HEDGEHOG their whole life cycle on the bird7 feeding on
skin scales, scabs, feathers, and down.
Fleas Beck44 described the case of a buz-
A survey conducted in Germany found zard that was found unable to fly. Clinical
that hedgehogs were infested with the flea examination revealed no injuries, but a
species Archaeopsylla erinacei, Ceratophyl- heavy infestation of non-speciated lice was
lus gallinae, and Ctenocephalides felis.41 diagnosed; the parasites were observed with
Animals may be heavily infested with fleas the naked eye moving on the skin of the
and show signs of weakness, anaemia, and bird. Microscopic examination confirmed
pruritus.10 Beck11 recommends a single topi- the presence of lice on the head, neck, back,
cal application of 30 mg selamectin onto the and underside of the wings. A single 15-mg
skin of the hosts’ neck or back. dose of selamectin was applied topically
Mites onto the skin of the neck and within 3 days,
all parasites had disappeared and the bird
Demodex erinacei
was released back into the wild.
Demodicosis caused by the mite Demo-
dex erinacei is rarely seen in hedgehogs. DISCUSSION
Beck42 reported a case of a hedgehog with Compounds previously used for the treat-
demodicosis and Trichophyton spp mycosis. ment and control of ectoparasites in exotic
The main clinical sign was severe cranial pets usually involve multiple dosing, which
alopecia. The animal was treated with anti- increases the likelihood of owner non-com-
mycotics and selamectin at a dose of 45 mg pliance and therefore ineffective treatment.
as a spot-on. Seven days after treatment, the Traditional routes of administration, for
hedgehog’s condition had greatly improved example injection, bathing, or instilla-
and no mites were observed. Four weeks tion of acaricide into the ear canal, can be
post-treatment, the animal was completely time-consuming, difficult, distressing, and
recovered. painful, not to mention the likelihood with
some exotics of injury to the veterinarian or
Nematodes
technician. The use of selamectin applied as
Capillaria spp and Crenosoma striatum a spot-on formulation on a single occasion
Schmäschke et al43 reported the failure of for ectoparasite control provides a means of
treatment with selamectin at dose-rates of safely and effectively treating animals with
6 or 15 mg/kg body weight to remove the minimum stress and a maximum of owner
lungworms Capillaria aerophila and Creno- compliance. Stronghold™ is produced in a
soma striatum, and intestinal Capillaria spp. range of colour-coded single-use pipettes,
BIRDS each providing a defined quantity of sela-
mectin, in a 6% or 12% solution. Depending
Lice on the dose required for an exotic animal,
Chewing lice are commonly found on wild treatment may involve administration of all
birds44 and are important ectoparasites of or part of the contents of a pipette; treatment
domestic birds and represent many species regimens employed in different hosts against
of biting lice7; because they are in constant various parasites are summarised in Table 1.
danger of being eaten by their hosts, they The pharmacokinetic profile and ef-
are less sluggish than the species that infest ficacy of a topically applied drug that exerts
mammals, and they may develop enormous its activity following systemic absorption
populations.45 The important species found depends upon the permeability of the skin to
on domestic birds are Cuclotogaster heter- which the drug is applied, and the formula-
graphus, Menacanthus stramineus, Lipeurus tion of the topical presentation. Inter-species

Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007. 93

Table 1. Simplified Treatment Regimens for Use of Selamectin in Exotic Pets
Host Species Parasite Dose Rate Additional Information
Ferret Fleas (Ctenocephalides 6-18 mg/kg body weight Repeat monthly treatments may
felis) 15 mg be required

Ear mites (Otodectes 15 mg Adjust the dose rate for small or

cynotis) young animals
Heartworm (Dirofilaria 18 mg/kg body weight Prophylaxis: repeat treatment at
immitis) monthly intervals
Rabbit Fleas 18 mg/kg body weight Repeat treatment in 30 days may
be required
Ear mites (Psoroptes 6-18 mg/kg body weight
cuniculi) 15 mg
30 mg
Mites (Cheyletiella spp, 15 mg for animals ≥2.3 Cheyletiella spp – Second treat-
Leporacarus gibbus) kg body weight ment required after 1 month to
kill emerging larvae
45 mg for animals >2.3 Leporacarus gibbus – repeat
kg body weight treatment at monthly intervals
until mites no longer seen
Guinea pig Lice 15 mg for animals ≤800
g body weight
30 mg for animals >800
g body weight
Mites 15 mg for animals ≤800
g body weight
30 mg for animals >800
g body weight
Hamster and Mites 1 drop from a 15-mg
gerbil pipette
Rat and Lice 1 drop from a 15-mg
mouse pipette
Mites 1 drop from a 15-mg
pipette
Hedgehog Fleas (Archaeopsylla 30 mg
erinacei)
Mites (Demodex spp) 45 mg
Bird Lice 15 mg

variation in absorption of selamectin has Selamectin has a favourable safety pro-

been recognised: it has been shown that the file48,49 and is well-tolerated by cats and dogs,
maximum concentration (Cmax) of selamectin including ivermectin-sensitive collies.50 All
in cats is much higher than in dogs, possibly treatments described in this paper were well-
due to the greater transdermal flux rate in tolerated. One death was reported in a rabbit
cats than in dogs.46 Comparative data in rats treated 22 days previously,28 and this case is
shows that the Cmax is reached more slowly reported for completeness, although the au-
than in cats but more quickly than in dogs.47 thors do not believe that that treatment was a
Comparative data for most other mammals likely cause of death given the time interval
and birds are not yet available. between treatment and death.

94 Intern J Appl Res Vet Med • Vol. 5, No. 3, 2007.

 The development of drug resistance 10. Beck W: Common endo- and ectoparasitic diseases
in small mammals – clinical feature, diagnosis
is always a concern as the length of time and treatment. A review of the literature and own
a product has been marketed increases. experiences. Tierärztl Prax 2004;32(K):311-321.
Macrocyclic lactones for use in companion 11. Beck W: Common ectoparasitic diseases and
animals have been available since the early dermatophytoses in small mammals, birds and
reptiles. Prakt Tierarzt 2003;84:752-762.
1990s, and to date there are no published or
12. Kramer M, Jones R, Kelleher S, Grant K: Selected
anecdotal reports of resistance to the target drugs for ectoparasite control in exotic species.
pathogens. However, when formulating EXOTIC DVM 2002;4:19-21.
parasite control strategies, consideration 13. Ferasin L: Disease risks for the traveling pet: heart-
worm disease. In Practice 2004;26:350-357.
should be given to combining management
14. Fox JG: Parasitic diseases. In: Biology and
and parasiticidal treatment in a manner that Diseases of the Ferret. 2nd edition. Philadelphia:
effectively controls the parasites without un- Lippincott, Williams and Wilkin; 1998.
necessary parasiticide overuse. 15. Göbel T: Infectious diseases in ferrets. NAVC
Small Animal & Exotic Proc Orlando, Florida; 13-
A wide range of ectoparasites on exotic 17 January 2001:859-861.
pets have been successfully controlled with 16. Bowman DD: In: Georgis’ Parasitology for Veteri-
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Efficacy of imidacloprid (Advantage®) on rabbits
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against certain endoparasites that infest flea (Ctenocephalides felis). NAVC Small Animal
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Numerous parasites can be found in or on 18. Hughes JE: Diagnosis and treatment of selected
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bits. 2003; ©MediRabbit.com.
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20. Beck W: Ear mange in domestic rabbit caused by
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