top of page

Maropitant

Grade

Visceral Analgesia

Initial Treatment

  • 4 mg/kg, SC/IV, q24h

Subsequent Treatment

Some pharmacokinetic data is available for the rabbit (Ozawa et al., 2019; Sadar et al., 2022). 


  • Rabbits require higher SC doses than dogs to achieve similar plasma levels. 

  • Information regarding oral dosing and pharmacokinetic data supporting a suggested q24h dosing interval is limited. 

Additional Medications

  • Where used, maropitant has generally been employed alongside other analgesics (e.g. meloxicam and buprenorphine) and motility-modifying agents.

Patient Support

  • Patients suited to maropitant use generally require fluid therapy, nutritional support, and supportive nursing.

Suitability

Indications for maropitant use in the rabbit remain unclear as an analgesic benefit is yet to be confirmed. 


  • One pharmacodynamic study failed to demonstrate beneficial analgesia at 2 and 10 mg/kg SC, and doses of 10 mg/kg SC were associated with hyporexia and hypomotility (Roeder et al., 2023).

Patient Preparation

  • No specific patient preparation is recommended before maropitant therapy. 

Formulations

  • In the UK, maropitant is not authorised for rabbits. It is available as a 10mg/ml injectable solution and 16, 24, 60, and 160 mg tablets. 



Therapeutics

​

Sole Use 

  • As the ability to diagnose and monitor rabbit pain is limited, and maropitant is yet to be shown to have pain-reducing properties in this species, sole use is not yet advised. Use without additional agents with known analgesic benefits may leave the patient in unacceptable pain; therefore, additional analgesic agents are always advised where patients are considered to be in pain or are to undergo a painful procedure.

MultiModal Use

  • We recommend that additional agents are always used alongside Maropitant in the rabbit. Suitable analgesia agents include NSAIDs, opiates and additional adjuvant analgesic agents such as ketamine. The evidence for effective multimodal use is weak/absent.

Treatment Goals

  • Reduction in clinical signs associated with pain, reduction of pain, and improved speed of patient recovery.

Treatment Endpoints

  • Undefined. 

Therapeutic Monitoring

Recommendations are extrapolations from human and animal data and datasheet information. 


  • Patients should be monitored for potential pain using standardised grimace scales and pain-related behaviour scores.

  • Patients should be monitored for appetite, activity and faecal output. 

Efficacy Profile

Whether extrapolations of analgesic benefits through human and animal data are valid in rabbits is still being determined. Maropitant may be devoid of analgesic benefits in this species. 


  • In one study, Maropitant at 2 and 10 mg/kg, SC, did not provide statistically significant analgesia compared to placebo control (Roeder et al., 2023). 

Adverse Effects Profile

Comments are extrapolations of human and animal data and datasheet information.


  • Some preparations are associated with pain on injection, and subsequent skin reactions are possible (Ozawa et al., 2019; Sadar et al., 2022). 

  • Doses of 10mg/kg SC are associated with reduced appetite and faecal output (Roeder et al., 2023).

Contraindications

Comments are extrapolations of human and animal data  (Roeder et al., 2023) and datasheet information.


  • Maropitant should not be used as sole agent analgesia in animals perceived to be experiencing pain. 

  • Caution with hepatic dysfunction, as maropitant is hepatically metabolised.

  • Accidental skin and eye exposure should be avoided. Employ copious lavage should it occur.

Pregnancy

Recommendations are extrapolations of human and animal data and datasheet information.


  • Avoid use because safety and efficacy have not been established in pregnant rabbits. 

Lactation

Recommendations are extrapolations of human and animal data and datasheet information.


  • Avoid use because safety and efficacy have not been established in lactating rabbits. 

Male Fertility

  • No information is located.

Female Fertility

No information is located.

Neonates

No information is located.

Interactions

Interaction comments are extrapolations derived from human and animal data.


  • Maropitant undergoes hepatic metabolism; therefore, it may interact with other medications that rely upon similar metabolic pathways.

Alternative Products 

  • Additional analgesic agents such as opiates and NSAIDs should always be employed when used to treat pain in rabbits. 

Alternative Protocols

  • The optimum dosing of maropitant for analgesia and optimum dosing frequency have not yet been determined. If maropitant has a place as a rabbit analgesia agent, it is likely to be administered at a dose between 2 and 10 mg/kgs, SC once or twice a day.  



Evidence

​

All Journal Data Accessed

  1. Alvillar, B.M., Boscan, P., Mama, K.R., Ferreira, T.H., Congdon, J., Twedt, D.C., 2012. Effect of epidural and intravenous use of the neurokinin-1 (NK-1) receptor antagonist maropitant on the sevoflurane minimum alveolar concentration (MAC) in dogs. Vet Anaesth Analg 39, 201–205. https://doi.org/10.1111/j.1467-2995.2011.00670.x

  2. Corrêa, J.M.X., Soares, P.C.L.R., Niella, R.V., Costa, B.A., Ferreira, M.S., Junior, A.C.S., Sena, A.S., Sampaio, K.M.O.R., Silva, E.B., Silva, F.L., Lavor, M.S.L., 2019. Evaluation of the Antinociceptive Effect of Maropitant, a Neurokinin-1 Receptor Antagonist, in Cats Undergoing Ovariohysterectomy. Vet Med Int 2019, 9352528. https://doi.org/10.1155/2019/9352528

  3. Epstein, M.E., 2014. Adjunctive, Pain-Modifying, Analgesic Drugs. Topics in Companion Animal Medicine, Approaches to Pain Management 29, 30–34. https://doi.org/10.1053/j.tcam.2014.07.001

  4. Fukazawa, Y., Maeda, T., Kiguchi, N., Tohya, K., Kimura, M., Kishioka, S., 2007. Activation of spinal cholecystokinin and neurokinin-1 receptors is associated with the attenuation of intrathecal morphine analgesia following electroacupuncture stimulation in rats. J Pharmacol Sci 104, 159–166. https://doi.org/10.1254/jphs.fp0070475

  5. Huang, S.-C., Korlipara, V.L., 2010. Neurokinin-1 receptor antagonists: a comprehensive patent survey. Expert Opin Ther Pat 20, 1019–1045. https://doi.org/10.1517/13543776.2010.495121

  6. Khan, A., Khan, S., Kim, Y.S., 2019. Insight into Pain Modulation: Nociceptors Sensitization and Therapeutic Targets. Curr Drug Targets 20, 775–788. https://doi.org/10.2174/1389450120666190131114244

  7. Kinobe, R.T., Miyake, Y., 2020. Evaluating the anti-inflammatory and analgesic properties of maropitant: A systematic review and meta-analysis. Vet J 259–260, 105471. https://doi.org/10.1016/j.tvjl.2020.105471

  8. Lamb, S., 2017. Large bowel resection and anastomosis in a domestic rabbit following obstruction. Journal of Exotic Pet Medicine 26, 224–229. https://doi.org/10.1053/j.jepm.2017.05.002

  9. Le, K., 2017. MAROPITANT | Elsevier Enhanced Reader. Journal of Exotic Pet Medicine 26, 305–309. https://doi.org/10.1053/j.jepm.2017.08.007

  10. Lee, M.T., Chiu, Y.-T., Chiu, Y.-C., Hor, C.C., Lee, H.-J., Guerrini, R., Calo, G., Chiou, L.-C., 2020. Neuropeptide S-initiated sequential cascade mediated by OX1, NK1, mGlu5 and CB1 receptors: a pivotal role in stress-induced analgesia. J Biomed Sci 27, 7. https://doi.org/10.1186/s12929-019-0590-1

  11. Mansfield, C., Beths, T., 2015. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract 56, 27–39. https://doi.org/10.1111/jsap.12296

  12. Marquez, M., Boscan, P., Weir, H., Vogel, P., Twedt, D.C., 2015. Comparison of NK-1 Receptor Antagonist (Maropitant) to Morphine as a Pre-Anaesthetic Agent for Canine Ovariohysterectomy. PLoS One 10, e0140734. https://doi.org/10.1371/journal.pone.0140734

  13. Narishetty, S.T., Galvan, B., Coscarelli, E., Aleo, M., Fleck, T., Humphrey, W., McCall, R.B., 2009. Effect of refrigeration of the antiemetic Cerenia (maropitant) on pain on injection. Vet Ther 10, 93–102.

  14. Niyom, S., Boscan, P., Twedt, D.C., Monnet, E., Eickhoff, J.C., 2013. Effect of maropitant, a neurokinin-1 receptor antagonist, on the minimum alveolar concentration of sevoflurane during stimulation of the ovarian ligament in cats. Vet Anaesth Analg 40, 425–431. https://doi.org/10.1111/vaa.12017

  15. Okano, S., Ikeura, Y., Inatomi, N., 2002. Effects of Tachykinin NK1 Receptor Antagonists on the Viscerosensory Response Caused by Colorectal Distention in Rabbits. J Pharmacol Exp Ther 300, 925–931. https://doi.org/10.1124/jpet.300.3.925

  16. Ozawa, S.M., Hawkins, M.G., Drazenovich, T.L., Kass, P.H., Knych, H.K., 2019. Pharmacokinetics of maropitant citrate in New Zealand White rabbits (Oryctolagus cuniculus). Am. J. Vet. Res. 80, 963–968. https://doi.org/10.2460/ajvr.80.10.963

  17. Roeder, M., Boscan, P., Rao, S., Proença, L., Guerrera, W., Grayck, M., Gish, M., Sullivan, M.N., Sadar, M.J., 2023. Use of maropitant for pain management in domestic rabbits (Oryctolagus cuniculus) undergoing elective orchiectomy or ovariohysterectomy. Journal of Exotic Pet Medicine 47, 14–20. https://doi.org/10.1053/j.jepm.2023.07.001

Species Specific Data

  1. Lamb, S., 2017. Large bowel resection and anastomosis in a domestic rabbit following obstruction. Journal of Exotic Pet Medicine 26, 224–229. https://doi.org/10.1053/j.jepm.2017.05.002

  2. Okano, S., Ikeura, Y., Inatomi, N., 2002. Effects of Tachykinin NK1 Receptor Antagonists on the Viscerosensory Response Caused by Colorectal Distention in Rabbits. J Pharmacol Exp Ther 300, 925–931. https://doi.org/10.1124/jpet.300.3.925

  3. Ozawa, S.M., Hawkins, M.G., Drazenovich, T.L., Kass, P.H., Knych, H.K., 2019. Pharmacokinetics of maropitant citrate in New Zealand White rabbits (Oryctolagus cuniculus). Am. J. Vet. Res. 80, 963–968. https://doi.org/10.2460/ajvr.80.10.963

  4. Roeder, M., Boscan, P., Rao, S., Proença, L., Guerrera, W., Grayck, M., Gish, M., Sullivan, M.N., Sadar, M.J., 2023. Use of maropitant for pain management in domestic rabbits (Oryctolagus cuniculus) undergoing elective orchiectomy or ovariohysterectomy. Journal of Exotic Pet Medicine 47, 14–20. https://doi.org/10.1053/j.jepm.2023.07.001

  5. Sadar, M.J., McGee, W.K., Au, G.G., Kendall, L.V., Gustafson, D.L., Boscan, P., 2022. Pilot pharmacokinetics of a higher dose of subcutaneous maropitant administration in healthy domestic rabbits (Oryctolagus cuniculus). Journal of Exotic Pet Medicine 41, 1–2. https://doi.org/10.1053/j.jepm.2021.12.006

Substance-Specific Data

  1. Alvillar, B.M., Boscan, P., Mama, K.R., Ferreira, T.H., Congdon, J., Twedt, D.C., 2012. Effect of epidural and intravenous use of the neurokinin-1 (NK-1) receptor antagonist maropitant on the sevoflurane minimum alveolar concentration (MAC) in dogs. Vet Anaesth Analg 39, 201–205. https://doi.org/10.1111/j.1467-2995.2011.00670.x

  2. Corrêa, J.M.X., Soares, P.C.L.R., Niella, R.V., Costa, B.A., Ferreira, M.S., Junior, A.C.S., Sena, A.S., Sampaio, K.M.O.R., Silva, E.B., Silva, F.L., Lavor, M.S.L., 2019. Evaluation of the Antinociceptive Effect of Maropitant, a Neurokinin-1 Receptor Antagonist, in Cats Undergoing Ovariohysterectomy. Vet Med Int 2019, 9352528. https://doi.org/10.1155/2019/9352528

  3. Epstein, M.E., 2014. Adjunctive, Pain-Modifying, Analgesic Drugs. Topics in Companion Animal Medicine, Approaches to Pain Management 29, 30–34. https://doi.org/10.1053/j.tcam.2014.07.001

  4. Fukazawa, Y., Maeda, T., Kiguchi, N., Tohya, K., Kimura, M., Kishioka, S., 2007. Activation of spinal cholecystokinin and neurokinin-1 receptors is associated with the attenuation of intrathecal morphine analgesia following electroacupuncture stimulation in rats. J Pharmacol Sci 104, 159–166. https://doi.org/10.1254/jphs.fp0070475

  5. Huang, S.-C., Korlipara, V.L., 2010. Neurokinin-1 receptor antagonists: a comprehensive patent survey. Expert Opin Ther Pat 20, 1019–1045. https://doi.org/10.1517/13543776.2010.495121

  6. Khan, A., Khan, S., Kim, Y.S., 2019. Insight into Pain Modulation: Nociceptors Sensitization and Therapeutic Targets. Curr Drug Targets 20, 775–788. https://doi.org/10.2174/1389450120666190131114244

  7. Kinobe, R.T., Miyake, Y., 2020. Evaluating the anti-inflammatory and analgesic properties of maropitant: A systematic review and meta-analysis. Vet J 259–260, 105471. https://doi.org/10.1016/j.tvjl.2020.105471

  8. Lee, M.T., Chiu, Y.-T., Chiu, Y.-C., Hor, C.C., Lee, H.-J., Guerrini, R., Calo, G., Chiou, L.-C., 2020. Neuropeptide S-initiated sequential cascade mediated by OX1, NK1, mGlu5 and CB1 receptors: a pivotal role in stress-induced analgesia. J Biomed Sci 27, 7. https://doi.org/10.1186/s12929-019-0590-1

  9. Mansfield, C., Beths, T., 2015. Management of acute pancreatitis in dogs: a critical appraisal with focus on feeding and analgesia. J Small Anim Pract 56, 27–39. https://doi.org/10.1111/jsap.12296

  10. Marquez, M., Boscan, P., Weir, H., Vogel, P., Twedt, D.C., 2015. Comparison of NK-1 Receptor Antagonist (Maropitant) to Morphine as a Pre-Anaesthetic Agent for Canine Ovariohysterectomy. PLoS One 10, e0140734. https://doi.org/10.1371/journal.pone.0140734

  11. Narishetty, S.T., Galvan, B., Coscarelli, E., Aleo, M., Fleck, T., Humphrey, W., McCall, R.B., 2009. Effect of refrigeration of the antiemetic Cerenia (maropitant) on pain on injection. Vet Ther 10, 93–102.

  12. Niyom, S., Boscan, P., Twedt, D.C., Monnet, E., Eickhoff, J.C., 2013. Effect of maropitant, a neurokinin-1 receptor antagonist, on the minimum alveolar concentration of sevoflurane during stimulation of the ovarian ligament in cats. Vet Anaesth Analg 40, 425–431. https://doi.org/10.1111/vaa.12017

  13. Okano, S., Ikeura, Y., Inatomi, N., 2002. Effects of Tachykinin NK1 Receptor Antagonists on the Viscerosensory Response Caused by Colorectal Distention in Rabbits. J Pharmacol Exp Ther 300, 925–931. https://doi.org/10.1124/jpet.300.3.925

  14. Soares, P.C.L.R., Corrêa, J.M.X., Niella, R.V., de Oliveira, J.N.S., Costa, B.A., Silva Junior, A.C., Sena, A.S., Pinto, T.M., Munhoz, A.D., Martins, L.A.F., Silva, E.B., Lavor, M.S.L., 2021. Continuous Infusion of Ketamine and Lidocaine Either with or without Maropitant as an Adjuvant Agent for Analgesia in Female Dogs Undergoing Mastectomy. Vet Med Int 2021, 4747301. https://doi.org/10.1155/2021/4747301

Review Data 

  1. Epstein, M.E., 2014. Adjunctive, Pain-Modifying, Analgesic Drugs. Topics in Companion Animal Medicine, Approaches to Pain Management 29, 30–34. https://doi.org/10.1053/j.tcam.2014.07.001

  2. Khan, A., Khan, S., Kim, Y.S., 2019. Insight into Pain Modulation: Nociceptors Sensitization and Therapeutic Targets. Curr Drug Targets 20, 775–788. https://doi.org/10.2174/1389450120666190131114244

  3. Le, K., 2017. MAROPITANT | Elsevier Enhanced Reader. Journal of Exotic Pet Medicine 26, 305–309. https://doi.org/10.1053/j.jepm.2017.08.007

SPC Datasheets

  1. Arocenia 10 mg/ml Solution for Injection for Dogs and Cats: 

  2. https://www.vmd.defra.gov.uk/productinformationdatabase/product/A013210

  3. Cerenia 16 24 60 & 160 mg tablets for dogs & Cerenia 10 mg/ml solution for injection for dogs and cats: https://www.ema.europa.eu/en/documents/product-information/cerenia-epar-product-information_en.pdf

  4. Prevomax 10 mg/ml Solution For Injection For Dogs And Cats: 

  5. https://www.dechra.co.uk/Admin/Public/DWSDownload.aspx?File=%2fFiles%2fFiles%2fProductDownloads%2fuk%2fPrevomax_SPC_UKIE.pdf

  6. Vetemex 10 mg/ml solution for injection for dogs and cats

  7. https://www.vmd.defra.gov.uk/productinformationdatabase/files/SPC_Documents/SPC_1553305.PDF

  8. Vominil 10 mg/ml Solution for Injection for Dogs and Cats

  9. https://www.vmd.defra.gov.uk/productinformationdatabase/current/search-results#:~:text=Great%20Britain-,Vominil%2010%20mg/ml%20Solution%20for%20Injection%20for%20Dogs%20and%20Cats,-VetViva%20Richter%20GmbH

Expert Opinion | Authors

  1. 1317822 Extrapolation of pharmacological properties in man and veterinary species. Some material employed in collating the data displayed here was taken from veterinary product datasheets or extrapolated from pharmacology texts.

Expert Opinion | Other Literature

  1. Smith, Molly V. Textbook of Rabbit Medicine,  3rd Edition. Elsevier Limited, 102022.  VitalBook file.

Monograph Details

​

bottom of page