Intramuscular administration in horses involves the injection of medications directly into the muscle tissue. This method is commonly used for delivering vaccines, antibiotics, and other therapeutic agents. The technique requires knowledge of equine anatomy to ensure the injection is placed in the correct location, such as the neck or hindquarters, to minimize discomfort and avoid complications. Proper intramuscular administration can facilitate the absorption of medications into the bloodstream, allowing for effective therapeutic interventions. This page compiles peer-reviewed research studies and scholarly articles that explore the techniques, benefits, and potential complications associated with intramuscular administration in equine practice.
Wilson WD, Spensley MS, Baggot JD, Hietala SK.The pharmacokinetics and estimated bioavailability of amoxicillin were determined after IV, intragastric, and IM administration to healthy mares. After IV administration of sodium amoxicillin (10 mg/kg of body weight), the disposition of the drug was best described by a 2-compartment open model. A rapid distribution phase was followed by a rapid elimination phase, with a mean +/- SD half-life of 39.4 +/- 3.57 minutes. The mean volume of distribution was 325 +/- 68.2 ml/kg, and the mean body clearance was 5.68 +/- 0.80 ml/min.kg. It was concluded that frequent IV administration of sodium amoxic...
Brown CM, Kaneene JB, Walker RD.A survey of 584 veterinarians in equine practice was performed to determine their intramuscular injection techniques and the influence of those techniques on the development of clostridial myositis or cellulitis. Usable responses were obtained from 439 veterinarians (75.2%). Of these, 414 used a new needle and syringe for each injection, 241 swabbed the site with a cleansing/disinfectant agent, and 242 swabbed the top of multidose injection bottles with a similar solution. Only 2 clipped the hair at the injection site. Twenty eight of the respondents reported that at least 1 horse developed a ...
Nielsen IL, Jacobs KA, Huntington PJ, Chapman CB, Lloyd KC.Adverse reactions to intramuscular injections of procaine penicillin G are reported in 11 horses, five of which died. The clinical findings are presented and suggest central nervous involvement in most cases. Post mortem findings in one horse were consistent with anaphylaxis whereas in other cases the clinical findings, duration of treatment, speed of onset and subsequent completion of treatment supports diagnosis of an acute procaine toxicity syndrome.
Montesissa C, Carli S, Sonzogni O, Garlappi R.The pharmacokinetics of sodium amoxicillin were investigated after intravenous and intramuscular administration of a single dose of 15 mg kg-1 body-weight to five horses. A rapid distribution phase was noted after intravenous administration (t1/2 alpha about 20 minutes). The t1/2 beta values obtained after the intravenous and the intramuscular administration were significantly different (P less than 0.05). The bioavailability obtained was about 67 per cent. Plasma protein binding, evaluated in vitro, showed that the percentage of bound fraction was 37 to 38 per cent. It was concluded that sodi...
Sweeney RW, Beech J, Simmons RD, Soma LR.The pharmacokinetics of ticarcillin and clavulanic acid following administration by the intravenous (i.v.) and intramuscular (i.m.) routes were investigated in six normal adult horses. Following i.v. administration, the ticarcillin disposition data conformed to a two-compartment model with an elimination half-life of 1.0 h. The disposition of clavulanic acid was described by a one-compartment model with an elimination half-life of 0.40 h. Following i.m. administration, the half-lives of both drugs were prolonged (ticarcillin 1.8 h, clavulanic acid 1.2 h). The bioavailability of ticarcillin was...
Firth EC, Klein WR, Nouws JF, Wensing T.Single doses of sodium ampicillin (10 mg/kg) and kanamycin sulfate (5 mg/kg) were administered intramuscularly (i.m.) separately, and then together, to five pony mares. The plasma antibiotic concentration-time curves were constructed. The pharmacokinetic parameters of the antibiotics given separately were not altered by concurrent administration. Four of the five pony mares were then given the i.m. kanamycin/ampicillin combination 4 h after acute synovitis and fever had been induced by injection of lipopolysaccharide into the left intercarpal joint. The plasma concentration-time curves and the...
Sweeney RW, Beech J, Simmons RD.Serum concentrations of ticarcillin and clavulanic acid were measured in healthy foals (2 to 6 months old) given the drugs in combination by intravenous and intramuscular routes of administration. Five foals were administered 50 mg of ticarcillin/kg of body weight and 1.67 mg of clavulanic acid/kg, IV. Five foals were administered 100 mg of ticarcillin/kg and 3.33 mg of clavulanic acid/kg, IV, and 4 of those 5 were given the same combined dose IM. The elimination half-life of ticarcillin for intravenous administration was 0.83 hour for the low dosage and 0.96 hour for the high dosage. After in...
Traub-Dargatz JL, Bertone JJ, Gould DH, Wrigley RH, Weiser MG, Forney SD.Effects of a therapeutic dose of flunixin meglumine on gastric mucosa of horse foals were determined by endoscopy, double-contrast radiography, and gross and histologic examinations. Foals were administered 1.1 mg of flunixin meglumine/kg of body weight, PO/day for 30 days in an encapsulated form that was divided into 2 doses/day (group 1; n = 3) or by IM injection once a day (group 2; n = 7). Three control foals (group 3; n = 3) were administered capsules (n = 1) containing dextrose powder or IM injections (n = 2) of vehicle solution without flunixin meglumine. All 3 groups-1 foals given flun...
Boyd JS.A radio-opaque marker was injected intramuscularly at different levels and with needles of different lengths into the cervical musculature of a series of ponies and horses which were under profound anaesthesia prior to euthanasia. Subsequently the necks were sectioned and radiographed to determine the fate of the injected material. The results indicated that care was necessary in the selection of the level for injection in order to prevent deposition of material on to the periosteal surface of the cervical vertebrae or on to the ligamentum nuchae and fascial sheaths. The muscle mass over the t...
Plotka ED, Seal US, Eagle TC, Asa CS, Tester JR, Siniff DB.Forty-eight newly captured free-ranging feral stallions (Equus caballus) from two different locations and six captive stallions were immobilized using combinations of etorphine hydrochloride, xylazine hydrochloride and atropine sulfate with or without acepromazine. Six animals were immobilized twice, 1 mo apart. The drugs were administered either intramuscularly (n = 13) or intravenously (n = 44). Mean immobilization time (+/- SE) after intravenous (i.v.) injection of etorphine, xylazine and atropine was 55 +/- 4 sec (range 20 to 185 sec) compared to 708 +/- 131 sec (range 390 to 1,140 sec) fo...
Brown MP, Gronwall R, Gossman TB, Houston AE.Six healthy foals, from 4 to 6 days of age, were given a single IM injection of sodium cephapirin (250 mg/ml) at a rate of 20 mg/kg of body weight. Serum concentrations of cephapirin were measured serially over an 8-hour period. The mean peak serum concentration was 21.2 micrograms/ml at 10 minutes. The overall elimination rate constant was 1.06/hr and the elimination half-life was 0.70 hour. The apparent volume of distribution at steady state was 1.06 L/kg and plasma clearance was 1,105 ml/hr/kg.
Dodman NH, Shuster L, Court MH, Dixon R.Crib-biting in horses is a repetitive behavior pattern which may involve the activation of both narcotic receptors and dopamine receptors in the CNS. Crib-biting frequency, determined in 7 nontreated horses under controlled conditions, was usually linear for many hours and ranged from 0.3 to 14.9 bites/min. Intravenous or IM injections of narcotic antagonists decreased these rates to almost zero by about 20 minutes after the injection was given. The duration of the response to a single injection ranged from 20 minutes for naloxone to 4 hours or more for nalmefene and diprenorphine. Effective d...
McDowell KJ, Sharp DC, Grubaugh W.Eight ovariectomized pony mares were used to test the effect of various doses of progesterone (0, 50, 150, 450 mg/day, in oil, i.m., for 10 days) on progesterone and LH in the peripheral circulation, and on total protein and uteroferrin in uterine secretions. Progesterone increased uteroferrin, but there were no differences amongst doses of progesterone. Progesterone treatment decreased LH, and tended to increase total protein. Eighteen ovariectomized mares were given vehicle, oestradiol (10 mg/day, in oil, i.m.), progesterone or progesterone + oestradiol for 28 days. Both the last two steroid...
Jöchle W, Irvine CH, Alexander SL, Newby TJ.Nine mares received cannulae to collect blood from the pituitary venous outflow in the intercavernous sinus (ICS) and the jugular vein; in 4 mares, only jugular cannulae were used. Those 4 mares and 3 of the mares with cannulae in both positions received 7.5 mg luprostiol i.m. and 1 mare with both cannulae was treated with 3.75 mg uprostiol i.v. Blood samples were kept before and after treatment at 2-, 5- or 10-min intervals and concentrations of LH, FSH and GnRH were determined by RIA. Treatments resulted in an immediate sharp rise of LH and FSH in ICS and jugular blood samples within 2-10 mi...
Firth EC, Nouws JF, Driessens F, Schmaetz P, Peperkamp K, Klein WR.The plasma penicillin concentrations were determined in 5 horses given an IV injection of sodium penicillin G; plasma penicillin concentrations were also determined in a crossover experiment, where animals were given procaine penicillin G subcutaneously at 1 site and IM at 4 sites. The mean penicillin plasma peak concentration and bioavailability were highest after the drug was injected in the neck and biceps musculature. Injections in the gluteal muscle and in the subcutaneous sites resulted in similar, but lower, more persistent penicillin plasma concentrations and a lower bioavailability th...
Byars TD, Greene CE, Kemp DT.Warfarin-induced anticoagulation and reversal of the induced anticoagulation by vitamin K1 were evaluated in 4 mature horses. Each horse was given warfarin IV until the prothrombin (PT) time was prolonged by approximately 1.5 times the predosing base-line value. In experiment 1, we evaluated the time required for PT to return to the predosing value (PT reversal time) after warfarin administration was discontinued. Between each experiment, a 1-week rest period was allowed. In experiment 2, two doses of vitamin K1 (100 mg/dose) were administered IM 6 hours apart, and the PT was monitored hourly ...
Carter GK, Martens RJ, Brown SA, Martin MT.Pharmacokinetic values of sodium amoxicillin (22 mg/kg of body weight) in foals were determined after a single IM injection in 6 Quarter Horse foals at 3, 10, and 30 days of age. Serum amoxicillin concentrations were measured serially over a 24-hour period. The absorption of amoxicillin was rapid and followed a 1st-order elimination. Mean peak serum concentrations occurred 30 minutes after the injection in foals at all ages and were 17.31 +/- 9.59 micrograms/ml when the foals were 3 days old, 23.28 +/- 9.86 micrograms/ml when the foals were 10 days old, and 21.35 +/- 6.39 micrograms/ml when th...
Clarke KW, Taylor PM.Detomidine, given intravenously at doses of 5 to 30 (mean 13) micrograms/kg bodyweight (bwt), provided adequate sedation for a variety of clinical procedures in 93 per cent of administrations, and improved the ease of handling in the remaining animals. Side effects of ataxia and bradycardia were minimal at the lower dose rates. Higher doses were required for intramuscular use. In experimental trials 10 and 20 micrograms/kg bwt resulted in deep sedation and also significant hypertension and bradycardia of over 15 mins duration. Current literature on the use of detomidine in horses is reviewed.
Delbeke FT, Debackere M, Desmet N, Stevens M.Concentrations of the potent diuretic bumetanide were determined by a sensitive high performance liquid chromatographic procedure in plasma and urine from horses following intravenous and intramuscular administration of a dose rate of 15 micrograms/kg. The elimination half-life was found to be 6.3 min, the volume of distribution at steady state 68 ml/kg and the total plasma clearance 10.9 ml/min/kg. The onset of diuresis occurred within 15 min and diuresis was no longer apparent 1 h after i.v. administration. Given by the intramuscular (i.m.) route, bumetanide was rapidly absorbed; bioavailabi...
Brown MP, Gronwall RR, Houston AE.Four healthy adult mares were each given a single injection of sodium cefoxitin (20 mg/kg of body weight, IV), and serum cefoxitin concentrations were measured serially during a 6-hour period. The mean elimination rate constant was 1.08/hour and the elimination half-life was 0.82 hour. The apparent volume of distribution (at steady state) and the clearance of the drug were estimated at 0.12 L/kg and 259 ml/hr/kg, respectively. Each mare and 2 additional mares were then given 4 consecutive IM injections of sodium cefoxitin (400 mg/ml) at a dosage of 20 mg/kg. Cefoxitin concentrations in serum, ...
Brown MP, Gronwall RR, Houston AE.Six healthy adult horse mares were each given a single injection of sodium cephapirin (20 mg/kg of body weight, IV), and serum cephapirin concentrations were measured serially over a 6-hour period. The mean elimination rate constant was 0.78 hour-1 and the elimination half-life was 0.92 hours. The apparent volume of distribution (at steady state) and the clearance of the drug were estimated at 0.17 L/kg and 598 ml/hour/kg, respectively. Each mare was then given 4 consecutive IM injections of sodium cephapirin (400 mg/ml) at a dosage level of 20 mg/kg. Cephapirin concentrations in serum, synovi...
Baggot JD, Love DN, Stewart J, Raus J.The absorption and disposition kinetics of gentamicin were compared at two dosage levels (2 and 4 mg/kg bodyweight [bwt]) in one- and three-month-old foals. Following intramuscular (im) injection of single 2 mg/kg bwt doses, the drug was absorbed rapidly and produced peak serum concentration (18.2 mu 5.3 +/- g/ml, n = 8) at 30 mins. Much wider variations were associated with the amount of drug absorbed and the serum gentamicin concentrations after administration at the higher dosage level. The half-life of gentamicin was similar in the one-month-old (3.7 +/- 1.7 h, n = 8) and three-month-old (...
Brown MP, Gronwall RR, Martinez DS, Beal C.Six healthy pony foals, from 2 to 11 days of age, were given a single IM injection of amikacin sulfate (250 mg/ml) at a dosage rate of 7 mg/kg of body weight. Serum amikacin concentrations were measured serially over a 24-hour period. The mean peak serum concentration was 14.7 micrograms/ml at 0.5 hour. The elimination rate constant for amikacin was 0.24/hour, the elimination half-life was 3.0 hours, and the apparent volume of distribution was 0.58 L/kg.
Valberg S, Essén-Gustavsson B, Lindholm A, Persson S.The skeletal muscle metabolism of horses with a wide range of cardiocirculatory capacities was studied during a standardised near-maximal exercise test in relation to muscle fibre composition. Although the same amount of work was performed by all horses the amount of triglycerides and glycogen utilised and lactate accumulated differed widely. Both blood and muscle lactate accumulation were positively related to the amount of glycogen utilised. These factors were in turn positively associated with the percentage of Type IIB fibres and consequently negatively associated with the percentage of Ty...
MacHarg MA, Bottoms GD, Carter GK, Johnson MA.Adrenocortical function was assessed in horses given multiple IM doses of dexamethasone to determine the duration of adrenocortical suppression and insufficiency caused by 2 commonly used dosages of dexamethasone (0.044 and 0.088 mg/kg of body weight). Dexamethasone was administered at 5-day intervals for a total of 6 injections. Daily blood samples were collected. The plasma was frozen and later assayed for cortisol. An ACTH response test was determined 2 days before the first injection of dexamethasone and again 8 days after the last dexamethasone injection. Maximum suppression of plasma cor...
Carter GK, Martens RJ, Brown SA, Martin MT.Pharmacokinetic values of sodium amoxicillin (22 mg/kg of body weight) in foals were determined after a single IM injection in 6 Quarter Horse foals at 3, 10, and 30 days of age. Serum amoxicillin concentrations were measured serially over a 24-hour period. The absorption of amoxicillin was rapid and followed a 1st-order elimination. Mean peak serum concentrations occurred 30 minutes after the injection in foals at all ages and were 17.31 +/- 9.59 micrograms/ml when the foals were 3 days old, 23.28 +/- 9.86 micrograms/ml when the foals were 10 days old, and 21.35 +/- 6.39 micrograms/ml when th...
Carli S, Sonzogni O, Villa R, Bignazzi R, Montesissa C.The pharmacokinetic profile of a sulphamonomethoxine-trimethoprim (SMM-TMP) combination was investigated in five horses. The combination was administered intravenously, intramuscularly and orally at a constant dose of 20 mg SMM plus 4 mg TMP kg-1 bodyweight. Following intravenous administration both drugs dispersed rapidly with distribution half-lives of about 12 minutes for SMM and about 18 minutes for TMP. Elimination half-lives for intravenous, intramuscular and oral administration were closely similar, indicating that elimination was independent of administration route. Bioavailability of ...
Credille BC, Giguère S, Berghaus LJ, Burton AJ, Sturgill TL, Grover GS, Donecker JM, Brown SA.The objectives of this study were to determine the plasma and pulmonary disposition of ceftiofur crystalline free acid (CCFA) in weanling foals and to compare the plasma pharmacokinetic profile of weanling foals to that of adult horses. A single dose of CCFA was administered intramuscularly to six weanling foals and six adult horses at a dose of 6.6 mg/kg of body weight. Concentrations of desfuroylceftiofur acetamide (DCA) were determined in the plasma of all animals, and in pulmonary epithelial lining fluid (PELF) and bronchoalveolar lavage (BAL) cells of foals. After intramuscular (IM) admin...
Younkin JT, Santschi EM, Kukanich B, Lubbers BV, Warner M.Penicillin is administered intravenously (IV) or intramuscularly (IM) to horses for the prevention and treatment of infections, and both routes have disadvantages. To minimize these shortcomings, a 24-hr hybrid administration protocol (HPP) was developed. Our objective was to determine penicillin plasma concentrations in horses administered via HPP. Venous blood was collected from seven healthy horses administered IV potassium penicillin G at 0 and 6 hr and IM procaine penicillin G at 12 hr. Blood was collected at 2-hr intervals from 0 to 20 hr and at 24 hr. Plasma penicillin concentration...
Landuyt J, Delbeke FT, Debackere M.The plasma concentrations of phenylbutazone (PBZ) and its major metabolites, oxyphenbutazone (OPBZ) and gamma-OH-phenylbutazone (OHPBZ) were determined for up to 72 h in six horses, following intravenous (i.v.) and intramuscular (i.m.) administration of 4 g phenylbutazone, 20 ml Phenylarthrite Ventoquinol (Vetoquinol Spécialités Pharmaceutiques Vétérinaires, Magny-Vernois, 70200 Lure, France). After i.v. dosing the plasma disposition was best described by a two-compartment open model. The hydroxylated metabolites OPBZ and OHPBZ were present in detectable concentrations for 72 h and 48 h, r...
Orsini JA, Park MI, Spencer PA.Concentrations of amikacin in endometrial tissue and plasma were studied in mares in estrus after intrauterine infusion of 1.0 or 2.0 g once a day for 3 consecutive d, and after 9.7 or 14.5 mg/kg body weight (BW) had been injected intramuscularly once a day for 3 consecutive d to determine concentrations of amikacin sulfate in plasma and endometrial tissues, and whether parenteral administration provides any advantages over intramuscular infusion. No amikacin was detected in serum at the 1.0 g dose. At the infusion dose of 2.0 g once a day, very low levels of serum amikacin were detected at 1 ...
Reed RA, Knych HK, Barletta M, Sakai DM, Ruch MM, Smyth CA, Ryan CA.To compare the pharmacokinetics and pharmacodynamics of hydromorphone in horses after intravenous (IV) and intramuscular (IM) administration. Methods: Randomized, masked, crossover design. Methods: A total of six adult horses weighing [mean ± standard deviation (SD))] 447 ± 61 kg. Methods: Horses were administered three treatments with a 7 day washout. Treatments were hydromorphone 0.04 mg kg IV with saline administered IM (H-IV), hydromorphone 0.04 mg kg IM with saline IV (H-IM), or saline IV and IM (P). Blood was collected for hydromorphone plasma concentration at multiple time points for ...
Ebner L, O O, Simon B, Lizarraga I, Smith J, Cox S.The pharmacokinetics of butorphanol after intravenous (IVB) and intramuscular (IMB) administration in donkeys were determined in this preliminary study. Healthy male gelded donkeys ( = 5), aged 6-12 years old, were administered 0.1 mg/kg butorphanol IV or IM in a randomized, crossover design. Blood samples were obtained at predetermined intervals for 24 h (IVB) and 48 h (IMB) after administration. Plasma butorphanol concentrations were determined by high performance liquid chromatography and pharmacokinetic parameters were calculated. Following IVB administration, mean (± SE) apparent volume ...
Loy J, Cawley A, Sornalingam K, Scrivener CJ, Keledjian J, Noble GK.Altrenogest is a synthetic progestin that suppresses reproductive behaviours and assists pregnancy maintenance in female horses. Two formulations are available, a 'weekly' intramuscular injection and a daily oral formulation. Altrenogest administration has returned positive swabs for steroids; consequently, using injectable altrenogest in racing mares is prohibited. Oral administration may be permitted in race mares if there is one clear day between dosing and racing. The only pharmacokinetic data available were generated from geldings. Therefore, to assist veterinarians and analysts in determ...
Mascarenhas C, Castro D, Lascola KM, Hofmeister E, Clark-Price SC.To assess the effect of two different doses of intramuscular atipamezole on head height (HH) in horses after sedation with detomidine. Methods: Randomized, blinded, triple crossover study. Methods: Eight healthy adult horses. Methods: Baseline HH was measured before detomidine (40 μg kg) was injected intravenously. HH was measured at 10 and 20 minutes after injection. Then, saline, atipamezole 60 μg kg (AT60) or 120 μg kg (AT120) was injected intramuscularly. HH measurements were repeated at 10 minutes intervals for 100 minutes. HH data were analyzed with a linear mixed model. Significance ...
Delbeke FT, Debackere M.It is well known that nikethamide (N,N-diethylnicotinamide, CoramineR) is metabolized very rapidly to nicotinamide. Hence, there is difficulty in proving that nikethamide has been used as a doping substance because nicotinamide is a normal physiological metabolite in the organism as well as a vitamin preparation. However, an intermediate metabolite (N-ethylnicotinamide) was found by us in the urine of horses treated with CoramineR. This was characterized by gas chromatography/mass spectrometry, and synthesized and identified as being N-ethylnicotinamide. The excretion and metabolism of niketha...
Trsan J, Nottle BF, Pusterla N.This study was designed to determine the effect of PPG and/or flunixin meglumine on SAA response when used at clinical dosing regimens in healthy adult horses. Six healthy adult horses were enrolled in a crossover study design including one control and three treatment groups: no treatment (control); PPG alone (intramuscularly q12h for 72h); flunixin meglumine alone (intravenously q24h for 72h); and PPG (intramuscularly q12h for 72h) and flunixin meglumine (intravenously q24h for 72h). Whole blood was collected at 0, 24, 48, 72, 96 and 120 hours post-initial drug administration to measure SAA u...
Wagenaar G.A description is given of three cases in which horses died very shortly after being given an intramuscular injection of iron dextran. The use of iron dextran in the case of horses is inadvisable.
Brown MP, Gronwall RR, Martinez DS, Beal C.Six healthy pony foals, from 2 to 11 days of age, were given a single IM injection of amikacin sulfate (250 mg/ml) at a dosage rate of 7 mg/kg of body weight. Serum amikacin concentrations were measured serially over a 24-hour period. The mean peak serum concentration was 14.7 micrograms/ml at 0.5 hour. The elimination rate constant for amikacin was 0.24/hour, the elimination half-life was 3.0 hours, and the apparent volume of distribution was 0.58 L/kg.
Boyd JS.A radio-opaque marker was injected intramuscularly at different levels and with needles of different lengths into the cervical musculature of a series of ponies and horses which were under profound anaesthesia prior to euthanasia. Subsequently the necks were sectioned and radiographed to determine the fate of the injected material. The results indicated that care was necessary in the selection of the level for injection in order to prevent deposition of material on to the periosteal surface of the cervical vertebrae or on to the ligamentum nuchae and fascial sheaths. The muscle mass over the t...
Firth EC, Whittem T, Nouws JF.Six adult ponies were injected in the same intramuscular site with kanamycin sulphate (10 mg/kg). Two hours later, arthrocenteses of the right metacarpophalangeal, radio-carpal, intercarpal, tibio-tarsal and metatarsophalangeal joints were performed within 3 minutes. Arthrocenteses of the same joints on the left side were conducted 5 hours later. When expressed as a percentage of plasma drug concentration, differences in synovial fluid drug concentration between the joints sampled at 2 and 5 hours after injection were not detected.
Edwards DJ, Love DN, Raus J, Baggott JD.Neomycin was administered intramuscularly to four normal adult horses at a dose rate of 10 mg/kg bodyweight every 12 h for 10 days (21 doses). The pharmacokinetic behaviour of neomycin with multiple dosing was characterised and a range of blood chemical and urinary parameters examined for evidence of nephrotoxicity. There was evidence of physical renal tubular injury (enzymuria and cylindriuria) within four days of neomycin administration but this subsided following cessation of treatment. No significant functional nephrotoxicity was detected. More severe nephrotoxicity might be expected in il...