TECHNIQUE

Oral Medication of Elephants  (Disease Investigation & Management - Treatment and Care)

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Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords  
Description The oral route is a basic method of giving medication to animals. It has several advantages over parenteral medication routes in not requiring any invasive procedure, nor does the product being given need to be sterile. However, not all medications are suitable for oral administration. Some medications may be broken down in the GIT before they are absorbed into the bloodstream and thus have no effect. Other drugs are not absorbed effectively from the GIT; lack of absorption may not be a problem if local treatment within the GIT is intended, for example with activated charcoal or bismuth type drugs).
  • Elephants are monogastric, therefore medications given orally are unlikely to be broken down by microbial degradation before being absorbed from the GIT. (P64.1.w2)
  • However, the elephant's stomach is very large; the large volume of ingesta present might dilute and bind drugs which are given orally. (J375.1.w1)

Oral medication of an elephant requires the elephant's cooperation; swallowing must take place voluntarily. (J375.1.w1)

In feed or in water:

If possible, administration in food or water is the simplest means of oral medication. (J375.1.w1)
  • Tasteless medications may be added to water. (B212.w15)
  • Oral medications are usually given in foods, particularly favorite or highly flavoured foods. (W580.Aug2005.w1)
  • Liquid medications may be soaked into bread and then given to the elephant. (B212.w15)
  • Liquid medications may be mixed with syrup, salt, jaggary or tamarind. (P64.1.w2)
  • Tablets may be embedded in bread or in a banana (P64.1.w2) or inside a plantain. B388.3.w3
  • Note: liquid medications cannot practically be injected into the substance of a banana. (V.w5)
  • Note: elephants have a highly developed olfactory sense and may reject food items which smell wrong. (P64.1.w2)
    • Plain food items may be given immediately before and after the items containing the medication. (P64.1.w2)
    • The food should be as normal as possible in appearance, smell and taste. (J375.1.w1)
  • It may be possible for a good trainer to habituate an elephant to eat medicated food, over time. (J375.1.w1)

Placing or tossing medication into the mouth:

  • With a tractable elephant it may be possible to get it to open its mouth and place or toss the medication in within a ball of food or a plantain leaf. (J375.1.w1, W580.Aug2005.w1)
  • Tossing is safer than reaching into the mouth: there is a risk of a hand being crushed if the elephant reacts suddenly to an unpleasant taste or a sudden movement. (W580.Aug2005.w1)
  • The trainer needs to know the preferences of the individual elephant to present the medication in a form the elephant is willing to take. (J375.1.w1)
  • Note: If the medication tastes unpleasant, the elephant may not be willing to open its mouth for repeated dosing. (W580.Aug2005.w1)
    • This method works only while the elephant is willing to open its mouth and swallow the medication. (J375.1.w1)
    • The tongue is large and sensitive and can be used to eject unwanted items. (J375.1.w1)

Training for oral medication:

  • It may be advantageous to periodically hand-feed elephants with food items suitable for administration of medication, such as bread or small packets of edible material filled with treats. Similar packets can then be given containing oral medications. (B212.w15)
  • Giving a variety of placebo tablets of different textures and flavours may be used to desensitise the elephant to oral medications. (J375.1.w1)
  • It has been suggested that elephants may learn to take oral medications as an alternative to injection: a handler offers the oral medication; if this is refused then a veterinarian immediately administers the injected medication. The elephant learns to take the oral medication as a preferable alternative. (B23.77.w12)

Gag/ bite block:

  • A gag or bite block may be used to administer oral medications: (B212.w15)
    • Thoroughly restrain the elephant. (B212.w15)
    • Insert a wooden gag, about 2.5 ft long, 6 ins across and 2 ins thick, with a hole in the centre at least four inches in diameter (to allow an arm to be passed through) and secure this in place with rope. (B212.w15)
    • Pass an arm containing the solid medication into the mouth, past the tongue (taking care that the arm is not forced by the tongue into the cheek teeth, and to the back of the mouth; the elephant will then swallow. (B212.w15)
    • Liquid medications may also be administered through the gag. (B212.w15)

    or, preferably, train the elephant to take the bite block: (W580.Aug2005.w1)

    • Use a pleasant liquid for training, such as sugar water, in a large catheter-tip syringe; (W580.Aug2005.w1)
    • Train the elephant to take the bite block and allow it to remain in place until removed by the operator; (W580.Aug2005.w1)
      • If possible, train the elephant to accept the gag over several weeks, so that the experience of medication is not a negative or traumatic one, or even train young elephants to accept a bite block well before any treatment is necessary. (J375.1.w1)
    • With the bite block in place, place the nozzle of the syringe through the block, over the tongue and towards the centre of the mouth (away from the teeth); (W580.Aug2005.w1)
    • Slowly give the liquid; (W580.Aug2005.w1)
    • Leave the block in place for a short time to ensure the liquid has gone down, then remove it; (W580.Aug2005.w1)
    • Have the elephant "trunk up" so they cannot use the trunk to suck the liquid back out and spit it out; (W580.Aug2005.w1)
    • Walk the elephant around with the trunk up, to encourage swallowing; (W580.Aug2005.w1)
    • Note: If the elephant gets used to the taste of the liquid it may be possible to give medication in this manner without using the bite block, i.e. with the elephant opening its mouth willingly. (W580.Aug2005.w1)
    • Note: Elephants may spit the medication out some time, even several hours, after it has been given. (J375.1.w1)

    (W580.Aug2005.w1)

Stomach tube:

  • It may be possible to give medications via stomach tube as follows. (B10.49.w21, B23.77.w12)
    • Restrain a handleable elephant. (B10.49.w21)
    • Place a gag or bite block in the mouth, between the molars. (B10.49.w21, J375.1.w1) (or a speculum may be used). (B23.77.w12)
    • Introduce the stomach tube dorsally into the mouth over the tongue and dorsal to the larynx into the pharyngeal pouch. (B10.49.w21, B23.77.w12, J375.1.w1)
    • Probe gently, as required, until the sphincter at the posterior of the pharyngeal pouch relaxes sufficiently to allow the tube to pass. (B10.49.w21, B23.77.w12, J375.1.w1)
    • Check carefully that the tube is in the oesophagus and stomach, not the trachea, before administering anything down the tube. (B10.49.w21, B23.77.w12) 
      • The tube should be at least to the mid-oesophagus before medication is administered. (J375.1.w1)
Appropriate Use (?)
  • For administration of oral medication preparations.
  • Antibiotics which are usually accepted by elephants when given orally include trimethoprim-sulphamethoxazole, sulfadimethoxine/ormetoprim (Primor, Pfizer Animal Health) (see: Sulphonamides) and enrofloxacin (Baytril, Bayer). (B23.77.w12)
  • If phenylbutazone is required long term then oral medication may be preferable to injection. J196.72.w1
Notes
  • Care must be taken to ensure that personnel working nearby are aware that a hands-on procedure is being carried out. Both personnel directly involved with the procedure, and those working nearby, need to ensure that movements and noise (from telephones, bleepers, shutting doors, heavy machinery etc.) that might disturb the elephant, both inside and outside the elephant area, are minimized during the procedure. This includes activities at nearby enclosures that might be audible to the elephant and could startle it. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • Tasteless medications are simple to administer. (B10.49.w21)
  • It may be possible to disguise unpalatable medications using flavoured treats such as molasses, fruits or fruit juices. (B10.49.w21)
  • Flavours which may be used to mask bitter drugs include chocolate and mint. (W580.Aug2005.w1)
  • It may be necessary to use ready-flavoured drugs designed for human palatability. (B10.49.w21)
  • If penicillins are to be given, the addition of probenecid is recommended to delay renal excretion of the penicillin, thereby allowing therapeutic blood concentrations to be reached with a lower dose of penicillin. (B10.49.w21)
  • Elephants are more likely to accept medications from their handler than from a veterinarian or other stranger. (B23.77.w12, J375.1.w1, W580.Aug2005.w1)
  • Development of formulations which are inoffensive in flavour and can be milled into feed in sufficiently high concentration would be advantageous. (J375.1.w1)
Complications/ Limitations / Risk
  • Elephants are very large, heavy and strong, highly intelligent, can move surprisingly quickly and can be highly strung at times: 
    • Depending on the management system (free contact / no contact / protected contact), and the character and training of the individual elephant, it may be necessary to carry out any hands-on procedure with the elephant under sedation and/or in an elephant restraint device.
    • There is always some risk to personnel involved when carrying out hands-on procedures on a conscious elephant.
    • There is always some risk to the elephant when sedation is used, especially if full anesthesia is required.

    (V.w6, V.w72, V.w84, V.w86, V.w88)

  • Elephants appear to detect tastes very well; (W580.Aug2005.w1) Elephants may refuse to swallow medicines which taste unpleasant or unusual. (B212.w15, J375.1.w1, W580.Aug2005.w1)
    • Medicated foods may be rejected for long periods. (J375.1.w1)
  • Elephants have shown the ability to separate out medication from food despite thorough mixing. (J375.1.w1)
  • Care must be taken since some additives may affect drug function. (B10.49.w21)
  • Care must be taken if a medication is to be frozen with or cooked with foods, that this will not change the drug's stability or chemical properties. (W580.Aug2005.w1)
Equipment / Chemicals required and Suppliers

Suggested foods for delivering oral medication include: 

  • Chocolate

  • Molasses

  • Donuts

  • Mint flavour

  • Bread

  • Ice cream

  • Coke

  • Jaggary

  • Jello (US), i.e. jelly (UK)

  • Bananas

  • Fruit juice

  • Pineapple (cut a window in the fruit, place the medication inside, replace the plug of fruit)

  • Plantains (place pills inside)

  • Boiled rice

  • Salt

  • Small papayas

  • Syrup

  • Honey 

  • Popsicles

  • Sweetened rice balls

  • Tamarind

  • A mixture of rolled oats, bran and molasses, forming balls (used successfully to administer tablets of enrofloxacin). (J13.66.w1)

  • A gruel of pellets, rolled oats, rice bran and water (used successfully to administer tablets of enrofloxacin). (J13.66.w1)

(B212.w15, B214.3.7.w3, B388.3.w3, J13.66.w1, P64.1.w2, W580.Aug2005.w1)

Expertise level / Ease of Use
  • Expertise and experience of the elephant handler(s) are critical when carrying out hands-on procedures on a conscious elephant. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • Only personnel experienced with elephants should be involved with procedures involving placing a hand or arm into an elephant's mouth.
Cost/ Availability
  • No expensive or difficult to obtain equipment required.
Legal and Ethical Considerations
  • When working with elephants it is important always to remember that their size and weight means that they can injure people easily, whether intentionally or unintentionally. The potential risks to all personnel involved must be considered before any hands-on procedure is initiated, and remembered during the procedure. It is critical that all personnel are highly trained and understand their respective roles and responsibilities during the procedure, that one person has overall command responsibility, and that no unnecessary people are present within the contact area. (V.w6, V.w72, V.w84, V.w86, V.w88)
  • The safety of both veterinarians and animal care staff involved in the procedure must be considered.
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Susan K. Mikota DVM (V.w72)
References B10.49.w21, B23.77.w12, B212.w15, B214.3.7.w3, B388.3.w3, J13.66.w1, J375.1.w1, P64.1.w2, V.w5, V.w6, V.w72, V.w84, V.w86, V.w88, W580.Aug2005.w1

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