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RE: [FH] Alternatives to Atenolol?

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  • Susan
    ... Never discontinue beta-blockade suddenly. From the Plumb Handbook of Veterinaty Drugs: Contraindications/Precautions/Reproductive Safety Atenolol is
    Message 1 of 5 , Oct 1, 2003
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      --- Jennifer Trendler <jennifert@...>
      wrote:
      > I would recommend taking him off.

      Never discontinue beta-blockade suddenly.

      From the Plumb Handbook of Veterinaty Drugs:

      Contraindications/Precautions/Reproductive Safety

      Atenolol is contraindicated in patients with overt
      heart failure, hypersensitivity to this class of
      agents, greater than first degree heart block, or
      sinus bradycardia. Non-specific beta-blockers are
      generally contraindicated in patients with CHF unless
      secondary to a tachyarrhythmia responsive to
      beta-blocker therapy.

      (NOTE: based on human CHF trials this is no longer
      true. See below for complete reference.)

      They are also relatively
      contraindicated in patients with bronchospastic lung
      disease.

      Atenolol should be used cautiously in patients with
      significant renal insufficiency. It should also be
      used cautiously in patients with sinus node
      dysfunction.

      Atenolol (at high dosages) can mask the symptoms
      associated with hypoglycemia. It can also cause
      hypoglycemia or hyperglycemia and, therefore, should
      be used cautiously in labile diabetic patients.

      Atenolol can mask the symptoms associated with
      thyrotoxicosis, but it may be used clinically to treat
      the symptoms associated with this
      condition.

      Adverse Effects/Warnings

      It is reported that adverse effects most commonly
      occur in geriatric animals or those that have acute
      decompensating heart disease. Adverse effects
      considered to be clinically relevant include:
      bradycardia, lethargy and depression, impaired AV
      conduction, CHF or worsening of heart failure,
      hypotension, hypoglycemia, and bronchoconstriction
      (less so with beta1 specific drugs like
      atenolol). Syncope and diarrhea have also been
      reported in canine patients with beta blockers.
      Lethargy and hypotension may be noted
      within 1 hour of administration.

      Exacerbation of symptoms have been reported following
      abrupt cessation of beta-blockers in humans. It is
      recommended to withdraw therapy gradually in patients
      who have been receiving the drug chronically.

      From:
      Management of Feline Cardiomyopathies
      http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2991

      "Neurohormonal activation plays an important role in
      heart failure. Thus, disruption of neurohormonal
      activation represents therapeutic rationale for using
      ACE inhibitors. The RAS plays a prominent role in
      human HCM patients by influencing or regulating the
      expression of myocardial hypertrophy. Inhibition of
      RAS has a beneficial effect on extracellular
      remodeling in CHF, and ACE inhibitors reduce
      ventricular remodeling by blocking the tropic effects
      of angiotensin II on myocytes. There is also survival
      value provided by early use of ACE inhibitors in acute
      human myocardial infarction. Many clinicians combine
      an ACE inhibitor (usually enalapril) with furosemide,
      with or without a beta-blocker or diltiazem,
      particularly with recurrent heart failure. Enalapril
      (0.25-0.5 mg/kg q24h PO) and benazepril (0.25-0.5
      mg/kg q24h PO) are clinically well tolerated. Optimal
      timing for ACE inhibitor therapy and the effects of
      these agents on morbidity and mortality in feline
      cardiomyopathy is undetermined."


      From a question I asked on the vetlearning.com forum:

      I asked the following question on the bulletin board
      on vetlearn.com:

      is there a downside to atenolol?
      my question:
      I have read Kittleson, Fox, Fuentes, Bonagura and
      Nelson and I realize there is no proof that there is
      any advantage to medicating asymptomatic HCM felines,
      however my vet does believe in doing so based on his
      own personal experience. Clinically I believe I have
      seen a difference and certain ultrasound paramaters
      are improved. However according to Plumb's Handbook of
      Veterinary Drugs, CHF is listed as an adverse effect.
      Is this more likely referring to propanol rather than
      atenolol?

      Re:
      Submitted Thursday July 10, 2003 - 8:19:31pm by Alex,
      DVM
      Reply
      I've not seen any cases of CHF that I felt were due
      to atenolol. The referance may have been to propanolol
      since it is a non-selective beta-blocker.

      Susan (Rudy is on 12.5 mg atenolol for 1 year now)

      >
      > My cat has been taking 6.25 mg of Atenolol for 2
      > weeks, and is doing
      > horribly on it. I feel like I'm giving him chemo
      > for how sick it
      > makes him. Prior to being diagnosed with HCM, his
      > symptoms were
      > continuing weight loss and poor appetite. The drug
      > completely cuts
      > out his appetite, he has lost another pound, down to
      > 8 pounds, from
      > 12, and even though the cardiologist told me I could
      > cut the medicine
      > to every other day if it affected his appetite, it's
      > taking longer
      > than 2 days for him to start eating again.
      >
      > Does this sound "normal" to you? For the past day,
      > he's holding his
      > body very rigid, not purring, and almost in a
      > catatonic state. Won't
      > eat, drink, anything.

      >
      > Should I approach my vet about some other drug, or
      > should we plod
      > ahead on this one? I feel like he's better off
      > without it, come what
      > may. It's unbearable to see him this sick.
      >
      > Thanks for any advice.
      > Lisa
      >
      >

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    • Jennifer Trendler
      Well - don t know what to say. I saw Chase the way he was - and was told to take him off completely and suddenly. It worked and now he s fine. ... From: Susan
      Message 2 of 5 , Oct 1, 2003
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        Well - don't know what to say. I saw Chase the way he was - and was told to
        take him off completely and suddenly.

        It worked and now he's fine.

        -----Original Message-----
        From: Susan [mailto:somnamblst@...]
        Sent: Wednesday, October 01, 2003 6:48 AM
        To: Jennifer Trendler; 'pugsleykall'
        Cc: 'feline-heart@yahoogroups.com'
        Subject: RE: [FH] Alternatives to Atenolol?



        --- Jennifer Trendler <jennifert@...>
        wrote:
        > I would recommend taking him off.

        Never discontinue beta-blockade suddenly.

        From the Plumb Handbook of Veterinaty Drugs:

        Contraindications/Precautions/Reproductive Safety

        Atenolol is contraindicated in patients with overt
        heart failure, hypersensitivity to this class of
        agents, greater than first degree heart block, or
        sinus bradycardia. Non-specific beta-blockers are
        generally contraindicated in patients with CHF unless
        secondary to a tachyarrhythmia responsive to
        beta-blocker therapy.

        (NOTE: based on human CHF trials this is no longer
        true. See below for complete reference.)

        They are also relatively
        contraindicated in patients with bronchospastic lung
        disease.

        Atenolol should be used cautiously in patients with
        significant renal insufficiency. It should also be
        used cautiously in patients with sinus node
        dysfunction.

        Atenolol (at high dosages) can mask the symptoms
        associated with hypoglycemia. It can also cause
        hypoglycemia or hyperglycemia and, therefore, should
        be used cautiously in labile diabetic patients.

        Atenolol can mask the symptoms associated with
        thyrotoxicosis, but it may be used clinically to treat
        the symptoms associated with this
        condition.

        Adverse Effects/Warnings

        It is reported that adverse effects most commonly
        occur in geriatric animals or those that have acute decompensating heart
        disease. Adverse effects considered to be clinically relevant include:
        bradycardia, lethargy and depression, impaired AV
        conduction, CHF or worsening of heart failure,
        hypotension, hypoglycemia, and bronchoconstriction
        (less so with beta1 specific drugs like
        atenolol). Syncope and diarrhea have also been
        reported in canine patients with beta blockers.
        Lethargy and hypotension may be noted
        within 1 hour of administration.

        Exacerbation of symptoms have been reported following
        abrupt cessation of beta-blockers in humans. It is
        recommended to withdraw therapy gradually in patients
        who have been receiving the drug chronically.

        From:
        Management of Feline Cardiomyopathies
        http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMOSU2002&PID=2991

        "Neurohormonal activation plays an important role in
        heart failure. Thus, disruption of neurohormonal
        activation represents therapeutic rationale for using
        ACE inhibitors. The RAS plays a prominent role in
        human HCM patients by influencing or regulating the
        expression of myocardial hypertrophy. Inhibition of
        RAS has a beneficial effect on extracellular
        remodeling in CHF, and ACE inhibitors reduce
        ventricular remodeling by blocking the tropic effects
        of angiotensin II on myocytes. There is also survival
        value provided by early use of ACE inhibitors in acute
        human myocardial infarction. Many clinicians combine
        an ACE inhibitor (usually enalapril) with furosemide,
        with or without a beta-blocker or diltiazem,
        particularly with recurrent heart failure. Enalapril
        (0.25-0.5 mg/kg q24h PO) and benazepril (0.25-0.5
        mg/kg q24h PO) are clinically well tolerated. Optimal
        timing for ACE inhibitor therapy and the effects of
        these agents on morbidity and mortality in feline cardiomyopathy is
        undetermined."


        From a question I asked on the vetlearning.com forum:

        I asked the following question on the bulletin board
        on vetlearn.com:

        is there a downside to atenolol?
        my question:
        I have read Kittleson, Fox, Fuentes, Bonagura and
        Nelson and I realize there is no proof that there is
        any advantage to medicating asymptomatic HCM felines,
        however my vet does believe in doing so based on his
        own personal experience. Clinically I believe I have
        seen a difference and certain ultrasound paramaters
        are improved. However according to Plumb's Handbook of Veterinary Drugs, CHF
        is listed as an adverse effect. Is this more likely referring to propanol
        rather than atenolol?

        Re:
        Submitted Thursday July 10, 2003 - 8:19:31pm by Alex,
        DVM
        Reply
        I've not seen any cases of CHF that I felt were due
        to atenolol. The referance may have been to propanolol
        since it is a non-selective beta-blocker.

        Susan (Rudy is on 12.5 mg atenolol for 1 year now)

        >
        > My cat has been taking 6.25 mg of Atenolol for 2
        > weeks, and is doing
        > horribly on it. I feel like I'm giving him chemo
        > for how sick it
        > makes him. Prior to being diagnosed with HCM, his
        > symptoms were
        > continuing weight loss and poor appetite. The drug
        > completely cuts
        > out his appetite, he has lost another pound, down to
        > 8 pounds, from
        > 12, and even though the cardiologist told me I could
        > cut the medicine
        > to every other day if it affected his appetite, it's
        > taking longer
        > than 2 days for him to start eating again.
        >
        > Does this sound "normal" to you? For the past day,
        > he's holding his
        > body very rigid, not purring, and almost in a
        > catatonic state. Won't
        > eat, drink, anything.

        >
        > Should I approach my vet about some other drug, or
        > should we plod
        > ahead on this one? I feel like he's better off
        > without it, come what
        > may. It's unbearable to see him this sick.
        >
        > Thanks for any advice.
        > Lisa
        >
        >

        __________________________________
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        The New Yahoo! Shopping - with improved product search
        http://shopping.yahoo.com
      • brinkett
        The key point is that you were told by the vet to take him off. The original poster should consult with her vet and/or cardiologist and follow their
        Message 3 of 5 , Oct 1, 2003
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          The key point is that you were told by the vet to take him off. The
          original poster should consult with her vet and/or cardiologist and
          follow their recommendations.

          This is a great place to share experiences and knowledge, but one
          thing we shouldn't do is tell someone to change their cat's
          medication regimen. This should only be done in consultation with
          their vet. The best we can do is relate our experiences with a
          medication, which I think is extremely helpful, and then suggest
          that the person consult with their vet about the medications that
          their cat is on if they are having concerns or doubts about it.

          Hopefully your post about your experience with atenolol will prompt
          the original poster to speak to her vet about whether atenolol is
          making her cat ill. However, she should not discontinue the
          atenolol or make any other changes to her cat's medication unless
          instructed to do so by her vet.

          --- In feline-heart@yahoogroups.com, Jennifer Trendler
          <jennifert@n...> wrote:
          > Well - don't know what to say. I saw Chase the way he was - and
          was told to
          > take him off completely and suddenly.
          >
          > It worked and now he's fine.
          >
        • Susan
          ... I agree. We need to realize that HCM is just a catchall term for an extremely variable disease. I posted the info from Plumb s Book of Veterinary Drugs
          Message 4 of 5 , Oct 1, 2003
          • 0 Attachment
            --- brinkett <scrubbrush@...> wrote:
            > The key point is that you were told by the vet to
            > take him off. The
            > original poster should consult with her vet and/or
            > cardiologist and
            > follow their recommendations.
            >


            I agree. We need to realize that HCM is just a
            catchall term for an extremely variable disease. I
            posted the info from Plumb's Book of Veterinary Drugs
            because not every symptom being attributed to
            beta-blockade is necessarily a result of
            beta-blockade. Sometimes things that we think are
            related are simply a coincidence. Anorexia and
            lethargy are symptoms of the disease and may have more
            to do with decompensation. No one here is in a
            position to recommend any mode of treatment or
            discontinuation of treatment. If you think your vet
            may be wrong seek out another board certified ACVIM
            veternarian. And always report any new symptoms to
            your vet cardiologist or internist. JMHO.

            Susan

            =====
            Rudy: Male DSH brown tabby, feral mom, diagnosed 09-2002 at 19 months of age with idiopathic HCM: grade 2 murmur, hyperkinetic heart, borderline normal thickening, considered asymptomatic, 12.5 mg Atenolol 1x day, 1/2 baby aspirin 2x week administered via pilling

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