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RE: [FH] Alternatives to Atenolol?

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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 1 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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    • 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 2 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 3 of 5 , Oct 1, 2003
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          --- 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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