LafeberVet

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Administration of Medication in Reptiles

Date: August 17, 2011; updated with video and photographs September 18, 2013
By: Christal Pollock, DVM, DABVP (Avian Practice)
Reviewed by: M. Scott Echols, DVM, DABVP (Avian Practice) and Natalie Antinoff, DVM, DABVP (Avian
Practice)
Keywords: cloaca, injection, intracoelomic, intramuscular, intraosseous, intravenous, parenteral,
subcutaneous
Categories: Lizard,  Reptiles & Amphibians,  Snake,  Turtles & Tortoises,  Resources & Education 

Medication in reptiles
Reptile owners are routinely instructed on oral or intramuscular (IM) drug
administration techniques for outpatient care. In many instances and in many species,
parenteral injections are preferred over the oral route. Injectable medications can be
delivered IM, subcutaneously (SQ), intracoelomically (IC), intravenously (IV), or
intraosseously (IO). Before beginning drug administration, ensure the patient is well
hydrated and maintained at its preferred optimum temperature zone.

Intramuscular route: Video

Intramuscular injections are the most common parenteral route for drug administration
in reptiles.
 IM Injections in reptiles 9-13-13
Video narrated and produced by M. Scott Echols, DVM, DABVP (Avian Practice)

Injection site

Historically the tail and rear limbs have been avoided because of the presence of a
renal portal system. Research has shown that a first pass effect may not occur as
previously assumed (Beck 1995, Holz 1997, Holz 2002). Nevertheless we still do not
know if injections in the caudal half of the body are appropriate with all medications or
in all (or even most) species. Therefore most clinicians still inject medications into the
cranial half of the body (Fig. 1).

Figure 1. Intramuscular injections are traditionally made into

the cranial half of the reptile body. Click on image to enlarge.

Specific sites for IM injection will vary (Box 1). In lizards, injections are made into the
most muscular part of the upper arm or forearm. Take care to avoid the cranial surface
of the limb to minimize the risk of radial nerve damage (Fig. 2). The forelimbs are also
used in chelonians (Fig. 3). The only muscle group available for intramuscular injection
in snakes is the epaxial musculature (Fig 4).

Box 1. Intramuscular injection sites in reptiles

Chelonian Upper arm (deltoid or triceps), forearm (biceps)
Lizard Forelimb
Snake Epaxials in cranial half of body
 Figure 2. Intramuscular injections are made into the most
muscular part of the upper arm or forearm in. Click on image
to enlarge.

Figure 3. Intramuscular injections are made into the

forelimbs in chelonians. Click on image to enlarge.
 Figure 4. Palpation of epaxial musculature in a snake. Click
on image to enlarge.

Whenever possible, avoid IM injections in small species like geckos. When injecting
medication into the forelimb, avoid the cranial surface to minimize the risk of radial
nerve damage.
Technique

Insert the needle between scales in squamates (lizards and snakes). After inserting
the needle, apply negative pressure as you would in any animal to prevent inadvertent
injection into a blood vessel. If multiple injections are required, be sure to alternate
sites to minimize inflammation and improve patient compliance.
The medication prescribed will vary with the species, the clinical problem, culture
results (if using antibiotics), and the planned duration of treatment, however keep in
mind that the manufacturer recommends enrofloxacin (Baytril®, Bayer Animal Health)
be administered via injection only once due to its alkaline pH. Repeated IM injections
of enrofloxacin can cause muscle necrosis. This necrosis is typically only recognized
at necropsy but is undoubtedly painful. In rare cases, repeated injections can also lead
to skin depigmentation and sloughing (Fig. 5) (Mitchell 2006).
 Figure 5. In rare instances, repeated intramuscular injections
can lead to skin depigmentation. Click on image to enlarge.

Home care instructions

Instruct owners to alternate injection sites (as described above) and to return needles
for proper disposal.

Subcutaneous route
Reptiles have a relatively small subcutaneous space with limited vascularity making
absorption of fluids or medication variable (Mitchell 2006). There is no need to tent the
skin in reptiles (Box 2). Insert the needle parallel to the body wall in between the
scales. Advance more than half of the needle’s length to reduce the risk of fluid
leakage.

Box 2. Subcutaneous injection sites in reptiles

Chelonian Axillary and inguinal space
Lizard Lateral body wall, inguinal space
Snake Lateral body wall
Some turtles also have a thin strip of skin at the junction of the plastron (or lower shell)
and bridge (or where the upper and lower shells connect). This area may be used for
injection of small volumes even when the chelonian is withdrawn into its shell (Sykes
2006).

Intracoelomic route

The intracoelomic route is a not a common site for administration of medications.

1. Position squamates in dorsal recumbency and chelonians in lateral
recumbency.
2. Clean the area with alcohol or another topical disinfectant.
3. To prevent injection of fluids or drugs into the lungs and air sacs, insert the
needle into the caudal third of the coelom in chelonians and lizards or the
caudal one-fourth in snakes. Avoid the ventral midline in lizards to prevent
laceration of the ventral abdominal vein.
4. Insert the needle at the junction between the lateral scales and ventral belly
scutes in snakes. In chelonians, insert the needle where skin folds attach to the
bridge.
5. Advance the needle parallel to the body wall.
. Always aspirate the needle before injecting to make sure the needle did not
enter the respiratory tract.

Intraosseous route
Intraosseous (IO) injections are typically used for fluid administration in reptiles,
however anything that may be injected intravenously may also be injected IO.
Intraosseous catheter use is typically limited to lizards. The proximal tibia is typically
used, however the distal femur is an alternate site.

Intravenous route
Intravenous injections are the preferred route for drug administration in the septic
reptile (Mitchell 2006). Intravenous catheters often require cut down, however only
sites that do not require a surgical incision are listed below (Box 3).

Box 3. Intravenous injection sites in reptiles

Chelonian Right jugular vein
Lizard Tail vein, ventral abdominal vein
Snake Tail vein

Oral route
Oral drug administration can be challenging in reptiles due to the sharp teeth of some
species like large monitors and the difficulty in opening the chelonian mouth. Research
also suggests the reptile gastrointestinal tract may be quiescent between meals,
making oral drug administration of dubious value in a large, fasting reptile.
Among reptiles, oral drug delivery is most frequently used in lizards. One “easy”
method is to hide medication in food items. Inject drug into prey items such as a
mouse or mealworm, or place fruit-flavored medication on top of herbivore diets. Limit
the amount fed to ensure the full dose is consumed, and monitor food intake carefully.
Oral medications may also be delivered by syringe or tube. Some lizards may simply
lick at flavored compounded medications offered via syringe. A feeding tube may also
be passed as described below:
Equipment needed:

Something to create a gap in the oral cavity so that the speculum and/or tube may
be introduced: plastic card (i.e. credit card) or exposed x-ray film. A cotton-tipped
applicator and some speculums (see below) will also serve to open the mouth in
snakes.
Mouth speculum: rubber spatula, rubber coated infant spoon, hemostat of
appropriate size padded with tape or elastic bandage material, metal avian
speculum, small nylon bone, plastic-coated paper clip, syringe case with the closed
end removed, tape roll
Water-soluble lubricant
Metal ball-tipped gavage tube or rubber feeding tube

Technique

1. Pre-measure the tube from the mouth to the reptile’s midpoint, the approximate
location of the stomach.
2. Lubricate the tube with the water-soluble lubricant or water.
3. Open the mouth, taking care not to injure the teeth or beak.

Option 1) To manually open the mouth in some lizards and snakes, hold the lower jaw
with your fingers and apply steady downward pressure.
Option 2) In some lizards, such as iguanas or bearded dragons (Pogona vitticeps),
gently pulling down on the dewlap can also open the mouth (Fig. 6). Perform this
maneuver gently because excess force can damage the hyoid apparatus, and even
permanently curve the lower lip in patients with metabolic bone disease (Sykes 2006).
 Figure 6. In some individuals, the green iguana’s (Iguana
iguana) dewlap can be gently pulled down to open the mouth.
Click on image to enlarge.

Option 3) Use a plastic card (or similar item) and speculum to open the mouth as
needed.
Caution: Despite the evident strength of many turtles or tortoises, use careful
technique as opposed to brute strength to open the mouth. Aggressive manipulation
can injure the cervical spine or the cutting edges (or tomia) of the beak. If frequent
tubings are indicated in chelonians, place an esophagostomy tube instead.
Identify the glottis at the base of tongue.
Bypass the glottis, gently passing the tube into the stomach.

Cloacal route
The cloaca allows extensive resorption of fluids and other materials, and cloacal
administration of some medications like fenbendazole has been described in
chelonians (Innis 1995). Unfortunately this same physiology can create a dangerous
osmotic gradient to occur with the use of soap or dioctyl sodium sulfosuccinate so
avoid these products in reptiles (Sykes 2006).