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Cat terminally ill

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  • Derek Amer
    About 3 weeks ago our 13 year-old female persian cat stopped eating and became very quiet and sluggish. She has never been ill in her life so we paid several
    Message 1 of 20 , Jul 3, 2008
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      About 3 weeks ago our 13 year-old female persian cat stopped eating
      and became very quiet and sluggish. She has never been ill in her
      life so we paid several visits to the vet but they were unable to
      definitively diagnose her condition but said it was probably cancer
      and there was nothing they could do without opening her up. During
      this time she started to get bloated with fluid accumulating in her
      abdomen and we knew something serious was going on. We didn't think
      she would survive surgery so we sought a second opinion.
      We took Gigi to a very experienced farmers' vet about 20 miles away
      and he took an x-ray and did a scan. Sadly he said she had an
      enlarged heart and fluid in her lungs. He dismissed cancer as the
      cause and said she had Congestive Heart Disease and would probably
      only last a few weeks. The only medication he could prescribe was
      Furosemide to disperse the fluid in her abdomen but we had tried that
      on her with the previous vet and it made her vomit violently and she
      became very distressed and disoriented, so we couldn't give her that
      again. Instead the new vet gave her a steroid injection which has got
      her eating and drinking again but the fluid is causing her
      discomfort. Does anybody know of a milder diuretic than Furosemide or
      any other treatment that may help make her final weeks more
      comfortable? Thanks in advance.
    • Carol
      Hi Derek, You could try a smaller dose of Lasix? If you don t want to do that, you can try spironolactone. It s also used quite a lot for our heart kitties.
      Message 2 of 20 , Jul 3, 2008
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        Hi Derek,

        You could try a smaller dose of Lasix? If you don't want to do that,
        you can try spironolactone. It's also used quite a lot for our heart
        kitties. There is also Hydrochlorothiazide, or abbreviated as HCTZ,
        also a diuretic.

        Another thing I've done is given herbs and other supplements.
        Dandelion leaf extract is a diuretic too. The bioflavanoid, Rutin,
        can help eliminate fluid accumulated in the lungs. I don't know the
        doses for these two things. You would need to talk to a holistic vet.
        A regular vet probably wouldn't know how to use them. You can find a
        holistic vet from this site - http://www.holisticvetlist.com/ and many
        of them, if you can't find one in your area, will do phone consults.

        As far as there only being weeks for your cat...I think it all depends
        on how he responds to the medication. My cat, Sweetie, lived for
        almost a year with her congestive heart failure. There's no way they
        can say "only a week" or whatever, because it all depends no how the
        cat responds or doesn't respond to the meds.

        Hang in there,
        Carol and Snowball and the gang
      • nala nala
        I agree with the others, that there are other diuretics to try. However, I just wanted to let you know that in general, cats with heart disease should NOT be
        Message 3 of 20 , Jul 4, 2008
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          I agree with the others, that there are other diuretics to try.
          However, I just wanted to let you know that in general, cats with
          heart disease should NOT be given steroids. There have been a few
          studies about steroids administration leading to heart failure in cats.
          For more information I have included a few article abstracts below.

          Here is some pertinent info from the abstract:

          "Cats are reported to be remarkably resistant
          to the adverse effects of exogenous corticosteroids.
          However, antecedent corticosteroid
          administration has been noted in cats with
          congestive heart failure (CHF) due to hypertrophic
          cardiomyopathy. Consequently, a
          study was conducted to describe the clinical
          and laboratory findings and outcomes in 12
          cats diagnosed with CHF following corticosteroid
          administration. Methylprednisolone
          acetate was the most common corticosteroid
          administered. Time from initial corticosteroid
          administration to diagnosis of CHF
          ranged from 1 to 19 days."

          My cat's first cardiology report noted the following for my
          cat diagnosed with mild HCM:

          "Patient will likely be sensitive to steroids,
          especially depo-medrol, and IV fluid administration.
          If anesthetized, KETAMINE and ATROPINE should be
          avoided."

          Intern J Appl Res Vet Med • Vol. 2, No. 3, 2004

          Corticosteroid-Associated
          Congestive Heart Failure in 12 Cats
          Stephanie A. Smith, DVM, MS, DACVIM (Internal
          Medicine)a
          Anthony H. Tobias, BVSc, PhD, DACVIM (Cardiology)
          Deborah M. Fine, DVM, MS, DACVIM (Cardiology)b
          Kristin A. Jacob, DVM, DACVIM (Cardiology)
          Trasida Ployngam, DVM

          KEY WORDS: Methylprednisolone
          acetate, triamcinolone acetonide, prednisolone,
          betamethasone diproprionate, dexamethasone
          sodium phosphate,
          corticosteroid, congestive heart failure
          ABSTRACT
          Cats are reported to be remarkably resistant
          to the adverse effects of exogenous corticosteroids.
          However, antecedent corticosteroid
          administration has been noted in cats with
          congestive heart failure (CHF) due to hypertrophic
          cardiomyopathy. Consequently, a
          study was conducted to describe the clinical
          and laboratory findings and outcomes in 12
          cats diagnosed with CHF following corticosteroid
          administration. Methylprednisolone
          acetate was the most common corticosteroid
          administered. Time from initial corticosteroid
          administration to diagnosis of CHF
          ranged from 1 to 19 days. Mean respiratory
          rate was elevated, mean heart rate was relatively
          low for cats with CHF, and mean
          body temperature was subnormal. Systolic
          blood pressure and total serum thyroxine
          concentration were normal or below normal.
          Vertebral-heart size on thoracic radiographs
          was increased. Mean interventricular septum
          thickness in diastole, mean left ventricular
          posterior wall thickness in diastole, and
          mean left atrial dimension at end-systole
          were above the reference range. Five cats
          died or were euthanized because of CHF.
          Seven cats recovered and were long-term
          survivors. Repeat echocardiograms disclosed
          partial or complete resolution of the
          M-mode abnormalities in these cases. All
          cardiac medications were eventually discontinued,
          and there was no recurrence of CHF.
          It was concluded that the 12 cats in this
          study suffered from a unique form of CHF
          associated with corticosteroid administration.
          Consequently, CHF should be listed as
          a potential adverse effect of corticosteroid
          administration in cats.

          This second article explores how steriods
          can effect the cat heart (I do not have
          the whole article)

          Am J Vet Res. 2006 Apr;67(4):583-7. Links
          Hemodynamic effects of methylprednisolone acetate
          administration in cats.

          Ployngam T, Tobias AH, Smith SA, Torres SM, Ross SJ.
          Department of Veterinary Clinical Sciences, College of
          Veterinary Medicine, University of Minnesota, 1365
          Gortner Ave, Saint Paul, MN 55108, USA.
          OBJECTIVE: To investigate the mechanisms by which
          corticosteroid administration may predispose cats to
          congestive heart failure (CHF). ANIMALS: 12 cats
          receiving methylprednisolone acetate (MPA) for the
          treatment of dermatologic disorders. PROCEDURE: The
          study was conducted as a repeated-measures design.
          Various baseline variables were measured, after which
          MPA (5 mg/kg, IM) was administered. The same variables
          were then measured at 3 to 6 days and at 16 to 24 days
          after MPA administration. Evaluations included
          physical examination, systolic blood pressure
          measurement, hematologic analysis, serum biochemical
          analysis, thoracic radiography, echocardiography, and
          total body water and plasma volume determination.
          RESULTS: MPA resulted in a substantial increase in
          serum glucose concentration at 3 to 6 days after
          administration. Concurrently, RBC count, Hct, and
          hemoglobin concentration as well as serum
          concentrations of the major extracellular
          electrolytes, sodium and chloride, decreased. Plasma
          volume increased by 13.4% (> 40% in 3 cats), whereas
          total body water and body weight slightly decreased.
          All variables returned to baseline by 16 to 24 days
          after MPA administration. CONCLUSIONS AND CLINICAL
          RELEVANCE: These data suggest that MPA administration
          in cats causes plasma volume expansion as a result of
          an intra to extracellular fluid shift secondary to
          glucocorticoid-mediated extracellular hyperglycemia.
          This mechanism is analogous to the plasma volume
          expansion that accompanies uncontrolled diabetes
          mellitus in humans. Any cardiovascular disorders that
          impair the normal compensatory mechanisms for
          increased plasma volume may predispose cats to CHF
          following MPA administration.

          Best,

          Nala (not back, just visiting)
        • Kristi
          Steroids and cats with heart problems are NOT a good mix. Sally was diagnosed with HCM at the age of 2. She is now 13.5 and was just diagnosed with GI
          Message 4 of 20 , Jul 4, 2008
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            Steroids and cats with heart problems are NOT a good mix. Sally was
            diagnosed with HCM at the age of 2. She is now 13.5 and was just
            diagnosed with GI Lymphoma. She was prescibed Prednisolone as a part
            of her chemo and after just 4 doses, I had to rush her to the
            emergency vet with pulmonary edema/CHF. As a result, she was put on
            Lasix. 3 weeks later, we tried her on Methylprednisolone because her
            IM vet thought she'd be able to tolerate it better than the Pred.
            Not only did it cause CHF again, but it took much longer for her
            heart rate and breathing to return to normal. Her HCM is considered
            moderate (she has a grade III murmur) and she has lived with it her
            whole life. She has been on Diltiazem since she was 2 and in
            addition now takes Lasix and Enalapril. Her HCM has never been a
            problem until her lymphoma diagnosis. If your cat is not already
            seeing a cardiologist or IM specialist, you should find one and take
            her in as soon as you can. My regular vet handles Sally's day to day
            care, but he defers to her IM vet when it comes to both her lymphoma
            and her HCM.

            Good luck!

            Kristi & Sally Maria
          • Derek Amer
            Our dilemma with the steroids is if she didn t have the shots she wouldn t eat and we all know the eventual consequences of that. She has now been prescribed
            Message 5 of 20 , Jul 5, 2008
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              Our dilemma with the steroids is if she didn't have the shots she
              wouldn't eat and we all know the eventual consequences of that. She
              has now been prescribed Fortekor and Spironolactone but she hasn't
              perked up. We are very concerned about the build up of fluid in her
              chest and lower abdomen, it looks like she's swallowed a football and
              it has slowed her down to a crawl, it's very upsetting! The vet said
              he would have to sedate her to drain the fluid and it would almost
              certainly return very quickly. Does anybody have any advice on the
              draining or anything else as we are now desperate?



              --- In feline-heart@yahoogroups.com, "Kristi" <sonotspoiled@...>
              wrote:
              >
              > Steroids and cats with heart problems are NOT a good mix. Sally
              was
              > diagnosed with HCM at the age of 2. She is now 13.5 and was just
              > diagnosed with GI Lymphoma. She was prescibed Prednisolone as a
              part
              > of her chemo and after just 4 doses, I had to rush her to the
              > emergency vet with pulmonary edema/CHF. As a result, she was put
              on
              > Lasix. 3 weeks later, we tried her on Methylprednisolone because
              her
              > IM vet thought she'd be able to tolerate it better than the Pred.
              > Not only did it cause CHF again, but it took much longer for her
              > heart rate and breathing to return to normal. Her HCM is
              considered
              > moderate (she has a grade III murmur) and she has lived with it her
              > whole life. She has been on Diltiazem since she was 2 and in
              > addition now takes Lasix and Enalapril. Her HCM has never been a
              > problem until her lymphoma diagnosis. If your cat is not already
              > seeing a cardiologist or IM specialist, you should find one and
              take
              > her in as soon as you can. My regular vet handles Sally's day to
              day
              > care, but he defers to her IM vet when it comes to both her
              lymphoma
              > and her HCM.
              >
              > Good luck!
              >
              > Kristi & Sally Maria
              >
            • Carol
              Our angel Chris had HCM and CHF for a year. He was diagnosed in Sept. 2006. Chris was 16, and last summer (2007) he threw a clot and lost the use of one of
              Message 6 of 20 , Jul 5, 2008
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                Our angel Chris had HCM and CHF for a year. He was diagnosed in Sept.
                2006. Chris was 16, and last summer (2007) he threw a clot and lost
                the use of one of his rear legs and was diagnosed with pretty bad
                kidney failure, which we were told was from all the many months on the
                Lasix. The vets said he wouldn't make it, never get the use of his leg
                back again, there was nothing they could do but keep draining his
                fluid off.

                Chris had been going in for fluid draining every 3 weeks, sometimes
                every 2 weeks, from Sept. 2006 to June 2007 when he threw his clot,
                and was on Lasix all that time too. Right after the clot, that's when
                I posted here to this wonderful group of people. They told me about
                giving him supplements (CoQ10, DMG, taurine, nattokinase), and we
                started him on all 4 of those. Within about 3 weeks he was able to
                get almost total use back in his rear leg, which he was dragging
                around. And I do believe that the supplements helped his heart get
                stronger and work better, because for the last 4 months of his life,
                he only had to go to the vet to have his lungs drained once.

                Now I know every cat is different and how they respond to things can
                be completely different for each cat, but I would go ahead and start
                her on the supplements and see how she does on them. With Chris, we
                just mixed them in a tiny bit of his food to make sure he got it all.
                Many times we syringe fed him, which he didn't mind.

                Probably the most important of the supplements is the CoQ10. I've read
                in a lot of my researching things, that they do give it to humans who
                are in congestive heart failure.

                I think it would be worth a try to see if she'll perk up no the
                supplements. We saw a big change in Chris after he was on the
                supplements for about 4 days.

                When they did drain fluid on Chris, sometimes they sedated him,
                sometimes not. Most of the time they sedate them a little just to keep
                them quiet and calm.

                Here's a list of the common supplements.

                ~~taurine 250mg/day. Make sure it's plain free form taurine without
                any added vitamins. Some taurine has vit. B6 added.

                ~~L-carnitine 250mg/day

                ~~CoQ10 30 to 60mg/day (CoQ10 in the liquid gel cap form that has a
                tiny bit of vitamin E in it is said to absorb better than straight
                CoQ10 powder). Here are some of the brands that are liquid gels.
                Country Life, CoQ10 Maxi-Sorb, 30 mg
                Doctor's Best, Best CoQ10, 30 mg
                Jarrow Formulas, Q-absorb Co-Q10, 30 mg
                Twin Labs, Twinsorb CoQ10 50 mg

                ~~DMG/dimethylglycine 125mg/day (it comes in foil wrapped sublinqual
                tablets that you can cut in half and give half twice a day, but make
                sure you wrap up the unused half well or it being exposed to light
                and air will make it melt). I use Country Life brand, but there are
                many others.

                ~~a supplement called Cardio Strength by VetriScience (Cardio S in
                the UK) has some of the above, so if you use this one, don't give as
                much of the others separately.

                ~~Nattokinase 50 to 72mg/day (Nattokinase is an enzyme that helps
                prevent and/or disolve clots. The difference between Natto and
                something like Heparin that is the medication often prescribed for
                clots, is that the Natto actually "digests" the clot, where the
                Heparin just breaks it up. You don't give Natto at the same time as
                any other blood thinner type drug (aspirin or heparin), since they
                all have the same actions as blood thinners. There are many
                brands...this is the one that we used: NattoZyme by Nutricology
                http://www.organic-pharmacy.com/Nutricology/Nattozyme.htm

                Hang in there. By the way, what is your kitty's name?

                hugs and healing light,
                Carol and Snowball and the gang


                --- In feline-heart@yahoogroups.com, "Derek Amer" <derek.amer@...>
                wrote:

                She has now been prescribed Fortekor and Spironolactone but she hasn't
                perked up. We are very concerned about the build up of fluid in her
                chest and lower abdomen, it looks like she's swallowed a football and
                it has slowed her down to a crawl, it's very upsetting! The vet said
                he would have to sedate her to drain the fluid and it would almost
                certainly return very quickly. Does anybody have any advice on the
                draining or anything else as we are now desperate?
              • Carol R.
                hi Derek, All the supplements can be put in the food. I ve do it that way with our Snowball. I can t give her pills either. The CoQ10, taurine, l-carnitine
                Message 7 of 20 , Jul 6, 2008
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                  hi Derek,

                  All the supplements can be put in the food. I've do it that way with our Snowball. I can't give her pills either. The CoQ10, taurine, l-carnitine and DMG are pretty much tasteless (I've actually tasted all of them...I always taste things before I give them to the kitties). I don't know about the Cardio Strength (Cardio S). I haven't used that, but some of the folks on the group have and maybe they can tell you about that one. I think it's a capsule and you can empty it in the food.

                  The CoQ10 in the liquid gels, you can just poke them with a pin and squeeze out the contents into the food. That's what I do and some of the other folks do too. What you can do is just put the CoQ10 in just a tiny bit of food, maybe a half a teaspoon, so you're sure she'll eat it all. Will she eat tuna? Sometimes I put unsalted tuna water on top of the food so Snowball will be more inticed to eat it. Clam juice works too if you can get the unsalted kind.

                  The DMG comes in individual foil wraps. It's a tiny pill. I cut it with a razor blade, put the unused half back in the foil and wrap it up really good and put that in the refrigerator. It's very light and air sensitive and will melt if it's not wrapped up good. I melt the one half in a tiny bit, about .7 cc of water and suck it back up into a 1cc syringe and either I just squirt it in Snowball's mouth or I squirt it in the food. Lately I've been putting it in the food, because Snowball tends to throw up when I give her pills.

                  I hope Gigi is doing better today. We'll hold good thoughts and send lots of healing light.

                  hugs,
                  Carol and Snowball and the gang
                  >> Thanks for this Carol. We would certainly be interested in the CoQ10 but we are in the UK and I'm not sure what form it takes. Our cat is named Gigi and she doesn't do tablets very well,it's a real struggle. If there were a form that we could add to her food that would be better although she's not eating very well. Please let us know if any of the supplements you have mentioned can be added to food. Thanks again.>>

                  [Non-text portions of this message have been removed]
                • nala nala
                  ... I understand. Getting the kitty to eat is important. It is also important to keep an eye on Gigi because of the steroid treatment, especially for a cat
                  Message 8 of 20 , Jul 6, 2008
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                    > Thanks everybody for your concern. Our dilemma is that Gigi
                    > was not
                    > eating and had already been diagnosed with CHF when the
                    > first steroid
                    > injection was administered (dexamethasone). This
                    > immediately
                    > stimulated her appetite and she is now eating and drinking
                    > almost
                    > normally.

                    I understand. Getting the kitty to eat is important. It
                    is also important to keep an eye on Gigi because of the
                    steroid treatment, especially for a cat already in CHF. Many
                    general practitioner vets seem to be unaware, or have forgotten
                    about the possible complications of steroid treatment in the
                    context of heart failure. The steroid injection could certainly
                    be leading to further fluid retention.

                    Some cats respond well with cyproheptadine as an appetite
                    stimulant, although some veterinary drug manuals suggest
                    that cypro is also contraindicated in heart disease. My
                    cat's cardiologist OK'd it for my particular cat, but it
                    was not very effective and there were undesired side effects.

                    Some vets are now also prescribing mirtazapine (an antidepressant)
                    as an appetite stimulant. It is given every 3 days or so. I am not personally familiar with this drug or possible effects on the heart.

                    I would mention that some cats in heart failure will stop
                    eating until the fluid starts to clear up with diuretic treatment.
                    Additionally, many vets will remove fluid in the abdomen with
                    a syringe, followed by diuretics. Also if the fluid is in the lung cavity, again the fluid is removed by a "chest tap" followed by diuretics. Fluid within the lungs is treated with diuretics.

                    Sometimes other problems will also affect the heart - for example
                    there can be heart changes with kidney disease (persians are prone
                    to polycystic kidney disease) or hyperthyroidism. When the scan
                    was done, what kind of scan was it? An abdominal ultrasound? Were
                    the kidneys normal? Was any blood work done?

                    You might consider joining the yahoo feline-assisted feeding
                    group in the event that Gigi's eating issues recur.
                    http://pets.groups.yahoo.com/group/Feline-Assisted-Feeding


                    >As far as the diuretic is concerned we are now
                    > giving her
                    > Spironolactone, as recommended by members of the group, as
                    > well as
                    > Fortekor

                    As you likely know, Fortekor (benazepril) is an ACE inhibitor
                    and not a diuretic. An additional diuretic that might
                    be useful in the future is HTCZ (hydrochlorothiazide). Spironolactone
                    alone is actually a very weak diuretic.

                    > Another
                    > setback is our
                    > pet insurance expired last month, unbeknown to us, as we
                    > were in the
                    > middle of home reloction 250 miles away and the
                    > consequential
                    > upheaval. This means we are having to fund vets fees from
                    > our own
                    > savings and we cannot afford specialist treatment.

                    I am sorry to read this, I can understand. When my cat
                    needed help I was jobless and I had to spend my own savings
                    to care for her as I never purchased pet insurance. There are
                    posts in the archives that mention some options for those with
                    financial difficulty.

                    The
                    > upshot is
                    > without the steroids it seems she would starve to death and
                    > obviously
                    > that is not an option.

                    Again, consider joining the FAF group for possible feeding options.

                    I will keep you and your Gigi in my thoughts.

                    Nala
                    >
                  • Carol
                    We were giving Mirtazapine to Snowball, but we stopped it because of the side effects and she had a bad interaction with her Tapazole and the Mirtazapine.
                    Message 9 of 20 , Jul 6, 2008
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                      We were giving Mirtazapine to Snowball, but we stopped it because of
                      the side effects and she had a bad interaction with her Tapazole and
                      the Mirtazapine.

                      Mirtazapine has the same side effects as Cyproheptadine as far as
                      increased heart rate and respiration. In addition to that, you
                      shouldn't use Mirtazapine if you're also giving Tapazole/Methimazole
                      for hyperthyroid. Methimazole inhibits an enzyme (CYP2D6) that
                      clears Mirtazipine from the liver. Since the enzyme becomes inactive
                      Mirtazapine can't be cleared and continues to build up in the body
                      and making it much stronger.

                      Our experience with Mirtazapine was that it wasn't worth dealing
                      with the side effects. It didn't work that well for Snowball. Since
                      you can only give it every 3 days (it takes that long to clear out
                      of the body), she'd be okay maybe for the first day and then the
                      whole next two days miserable and nauseated because the good effects
                      didn't last long enough. In the end, we stopped it because of the
                      interaction with her Tapazole. One day she collapsed having a
                      seizure and that's when I found out about not using it with
                      Tazapole. I knew it had to be given cautiously and at much lower
                      doses for cats with kidney failure, but I didn't know about the
                      Tapazole/Mirtazapine warnings.

                      I'm looking up some links that have more info about it. I'll post
                      those separately when I find them.

                      hugs,
                      Carol and Snowball and the gang

                      >>
                      Some vets are now also prescribing mirtazapine (an antidepressant)
                      as an appetite stimulant. It is given every 3 days or so. I am not
                      personally familiar with this drug or possible effects on the heart.
                      >>
                    • Carol
                      Here is the other info about the Mirtazapine. This is from my hyperT group and the author gave me permission to post it here for us. Carol and Snowball and the
                      Message 10 of 20 , Jul 6, 2008
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                        Here is the other info about the Mirtazapine. This is from my hyperT
                        group and the author gave me permission to post it here for us.

                        Carol and Snowball and the gang



                        >>
                        Here is a merck write up on methimazole:
                        http://www.merck.com/mmpe/lexicomp/methimazole.html
                        "CYP2D6 substrates: Methimazole may increase the levels/effects of
                        CYP2D6 substrates." .i.e., it is inhibits CYP2D6, and here is the
                        confirmation: "Inhibits CYP [...] 2D6 (moderate)"

                        Here is a Merck write up on mirtazapine:
                        http://www.merck.com/mmpe/print/lexicomp/mirtazapine.html
                        "Substrate of CYP [...] 2D6 (major)," and further
                        "CYP2D6 inhibitors: May increase the levels/effects of
                        mirtazapine."

                        And yet further: "Hepatic impairment: Use with caution in patients
                        with hepatic impairment. • Renal impairment: Use with caution in
                        patients with renal impairment." if used with methimazole these two
                        cautions are essentially out the window.

                        Mirtazapine carries a warning on the manufacturer's label to "Use
                        caution if you have a history of urinary difficulties, glaucoma,
                        heart disease, liver disease, epilepsy, or hyperthyroidism." And on
                        top of everything else, there were never any studies done on
                        mirtazapine in cats.
                        >>
                      • nala_zq
                        thanks for this info Carol. Nala
                        Message 11 of 20 , Jul 13, 2008
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                          thanks for this info Carol.

                          Nala
                          --- In feline-heart@yahoogroups.com, "Carol" <carolroars@...> wrote:
                          >
                          > We were giving Mirtazapine to Snowball, but we stopped it because of
                          > the side effects and she had a bad interaction with her Tapazole and
                          > the Mirtazapine.
                          >
                          > Mirtazapine has the same side effects as Cyproheptadine as far as
                          > increased heart rate and respiration. In addition to that, you
                          > shouldn't use Mirtazapine if you're also giving Tapazole/Methimazole
                          > for hyperthyroid. Methimazole inhibits an enzyme (CYP2D6) that
                          > clears Mirtazipine from the liver. Since the enzyme becomes inactive
                          > Mirtazapine can't be cleared and continues to build up in the body
                          > and making it much stronger.
                          >
                          > Our experience with Mirtazapine was that it wasn't worth dealing
                          > with the side effects. It didn't work that well for Snowball. Since
                          > you can only give it every 3 days (it takes that long to clear out
                          > of the body), she'd be okay maybe for the first day and then the
                          > whole next two days miserable and nauseated because the good effects
                          > didn't last long enough. In the end, we stopped it because of the
                          > interaction with her Tapazole. One day she collapsed having a
                          > seizure and that's when I found out about not using it with
                          > Tazapole. I knew it had to be given cautiously and at much lower
                          > doses for cats with kidney failure, but I didn't know about the
                          > Tapazole/Mirtazapine warnings.
                          >
                          > I'm looking up some links that have more info about it. I'll post
                          > those separately when I find them.
                          >
                          > hugs,
                          > Carol and Snowball and the gang
                          >
                          > >>
                          > Some vets are now also prescribing mirtazapine (an antidepressant)
                          > as an appetite stimulant. It is given every 3 days or so. I am not
                          > personally familiar with this drug or possible effects on the heart.
                          > >>
                          >
                        • jamander33
                          Hi all, we are hard at work trying to treat Griffin s IBD and elevated liver ALT and possible pancreatitis. He has had the fpli which was negative, but I am
                          Message 12 of 20 , Jan 3, 2009
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                            Hi all, we are hard at work trying to treat Griffin's IBD and elevated
                            liver ALT and possible pancreatitis. He has had the fpli which was
                            negative, but I am fairly sure there is some inflammation. His appetite
                            has been off for weeks now and we have definitely come to the
                            conclusion that he is nauseous. Reglan did nothing but make him weird,
                            so with the help of the folks at feline pancreatitis, assist feed and
                            IBD, we discovered zofran. It has been wonderful! However, our vet
                            wants to try mirtazapine due to the fact that it only has to be given
                            once every 72 hours (Griffin is hard to pill). She says it has some
                            great appetite stimulant properties as well as anti-nausea. That
                            sounds, in theory, great! We are just concerned about the use of it
                            with his heart disease. I asked the other groups about adverse
                            reactions and experiences in general with using it. Now, I want to see
                            what you all think. Is it considered safe to use with heart disease?
                            Griffin's heart disease is still considered mild. He is on 1/4th pepcid
                            10 mg once a day and 1/2 usual dose of sucralfate for stomach
                            protection. He is currently not on heart meds because of intolerance.
                            Thank you for any help and suggestions. Amanda and Griffin
                          • Carol
                            hi Amanda, The reason the Mirtazapine is only given every 72 hours is that it has a long half life and it takes that long for it to clear out of the liver. I
                            Message 13 of 20 , Jan 3, 2009
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                              hi Amanda,

                              The reason the Mirtazapine is only given every 72 hours is that it
                              has a long half life and it takes that long for it to clear out of
                              the liver.

                              I would not give Mirtazapine. It still causes elevated heart rate,
                              and since it clears very slowly out of the liver... not good for a
                              cat with elevated liver enzymes.

                              And also, you CAN'T give Mirtazapine if your giving hyperthyroid
                              medication (Tapazole/Methimazole). The Tapazole inhibits the enzyme
                              necessary to clear the Mirtazapine out of the liver. Since it
                              doesn't clear properly, it keep storing in the liver and causes
                              toxic effects like seizures. That's what happened to Snowball. She
                              had a huge seizure from it, after that no more for her!

                              And it doesn't work that great anyway. At least it didn't with
                              Snowball. It would work for the first day and then she's be
                              miserable for the next two till she could have another dose, and the
                              longer she took it, the less it worked. From March to June when she
                              had her seizure, so for 4 months she was on it and it only really
                              worked well the first two times she took it, after that she got
                              maybe half a day of the first day of it keeping her nausea at bay
                              and giving her an appetite.

                              After her seizure we stopped it immediately. A couple of months
                              later after we let her liver clear out, we started her back on
                              Cyproheptadine, only 1/8 a tablet a day and it works for her. The
                              normal dose is 1/4 tablet, but she doesn't need that much. Yes, the
                              Cyproheptadine also elevates heart rate, but not as bad as the
                              Mirtazapine did.

                              Now I'm only speaking from our experience with it, but for us, I'd
                              NEVER use that stuff again. It's not worth the risk... and it
                              doesn't work that great.

                              hugs,
                              Carol and Snowball and the gang


                              --- In feline-heart@yahoogroups.com, "jamander33" <justinamanda@...>
                              wrote:

                              However, our vet wants to try mirtazapine due to the fact that it
                              only has to be given once every 72 hours (Griffin is hard to pill).
                              She says it has some great appetite stimulant properties as well as
                              anti-nausea. That sounds, in theory, great!
                            • Jean
                              Hi Amanda, I didn t know some of what Carol mentioned, and it sounds like there may be reason to at least consult with Griffin s cardiologist since you may be
                              Message 14 of 20 , Jan 8, 2009
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                                Hi Amanda,

                                I didn't know some of what Carol mentioned, and it sounds like there may be
                                reason to at least consult with Griffin's cardiologist since you may be
                                using it regularly. I used it once for Patches as a last-ditch effort (he
                                was incredibly sick from his heart meds, his ALT was way off but recovering
                                after stopping the heart meds, and while he'd stopped throwing up thanks to
                                reglan and pepcid, he wasn't eating and his little body was shutting down) -
                                my primary vet and cardiologist talked, and we only gave him 1/8 of a pill
                                instead of the normal 1/4. It worked *fast*, and he continued eating fine
                                after he started again. I can't say if it lasted for three days, because he
                                was only frantically eating the first night, but regardless it got his
                                appetite system "rebooted," which was our goal. I don't know if the
                                increased heart rate side effect that Carol mentioned was deemed an
                                acceptable short-term risk because we were otherwise clearly at the end of
                                the road, or if the 1/8 dose was considered low enough to make it an
                                acceptable trade-off. (It didn't affect his ALT, based on bloodwork from
                                before and after - it continued to recover - but again, it was only one low
                                dose.)

                                Since then we've used it twice (as directed by the vet, at the 1/4 pill
                                dose) for my mom's cat, who's always had appetite issues and doesn't like
                                wet food, period. (We've tried several, and have him on the one he seemed
                                least objectionable to, but he has a history of complete urinary tract
                                obstruction and we never catch him drinking water, so the wet food isn't too
                                negotiable.) The vet suggested mirtazapine short-term to help bulk him up a
                                bit. His personality is definitely affected (meowing like crazy, unsettled
                                for the first night, etc), and it works great as a stimulant for the first
                                12 hours. Then we don't notice much difference in appetite. We're planning
                                on trying something else short-term due to its limited effectiveness and his
                                short-term personality transplant, but just for whatever it's worth. Didn't
                                notice any personality changes in Patches, the heart kitty, though he was
                                extremely sick the only time he got it.

                                Is Griffin any easier to syringe than pill? The vet okayed crushing up the
                                mirtazapine and syringing with a little water (Patches is a rough pill too,
                                and the last thing I wanted to do was stress him out while he was so sick,
                                but he takes liquids very well). That might be worth asking about for the
                                zofran, if that would make it easier for him to continue with what's
                                currently working for him.

                                Jean


                                [Non-text portions of this message have been removed]
                              • lilloise52
                                Hi, My Tigg is 11 years old. My vet has prescribed Mirtazapine to boost her appetite hence her eating, she s lost a lot of weight already... Her creatinine was
                                Message 15 of 20 , Mar 29, 2013
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                                  Hi,

                                  My Tigg is 11 years old. My vet has prescribed Mirtazapine to boost her appetite hence her eating, she's lost a lot of weight already...

                                  Her creatinine was over 8 at diagnosis and her BUN 79... She also has HCM, diagnosed at age 5, so no IV hydration or SubQs, vet is adamant. I first had her on Famotidine for stomach acid, not sure that ever worked, and there's a scenario where the med can actually increase the loss of appetite, so I asked about an appetite stimulant, hence the Mirtazapine, 1/4 of a tablet every 72 hours. Tigg has lost a lot of weight (18lbs in October, but she's a big cat, part Main Coon) down to 14.5 at CKD diagnosis and probably less now.

                                  Has anyone actually used both the Famotidine and Mirtazapine at the same time, or how to tackle stomach acid (not nausea per se)? Tigg is very sweet but not a lap cat, I've tried a syringe but the stress involved is counter productive, working on "finger feeding", some appetite would make all the difference and would lower her numbers also.

                                  Thanks for any thought or suggestions, I'm new to this forum and trying to digest all the information on Tanya's website...
                                • Carol
                                  hi, We used Mirtazapine and Famotidine at the same time. What we found though, was that the Mirtazapine didn t really work all that well after the first day.
                                  Message 16 of 20 , Mar 30, 2013
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                                    hi,

                                    We used Mirtazapine and Famotidine at the same time. What we found though, was that the Mirtazapine didn't really work all that well after the first day. You can't give it any sooner than every 3 days, because it takes that long for it to clear out of the liver.

                                    Is Tigg hyperthyroid and on Tapazole/Methimazole? If she is, then you should not use Mirtazapine. The Tapazole inhibits the enzyme necessary to clear the Mirtazapine out of the liver, so it doesn't clear and accumulates and creates a toxicity, which in turn, causes seizures. This happened to our angel Snowball. No one told us about the interaction between the Mirtazapine and thyroid meds. Snowball was on the Mirtazapine for a couple months and one day had this really bad seizure. I found out later through some research and reading on the hyperthyroid group, about the drug interaction. Snowball recovered, and we never used the Mirtazapine again.

                                    What we do use is Cyproheptadine for appetite stimulant and Zofran (Ondansetron) for anti-nausea.. those are much safer and we think work better.

                                    If Tigg's Creatinine is 8 and BUN 79, that's really high! Our Misty has heart and kidney problems too, and we give her smaller amounts of subQ's twice a day so as not to put her heart in trouble. If you divide up two smaller amounts, say 50ml twice a day, then the heart handles it better. Yes, we're taking a chance... tempting congestive heart failure, but Misty's kidneys are pretty bad, so we try to balance it with what the heart needs.

                                    Carol
















                                    -----Original Message-----
                                    From: lilloise52 <mlawebb@...>
                                    To: feline-heart <feline-heart@yahoogroups.com>
                                    Sent: Fri, Mar 29, 2013 9:05 pm
                                    Subject: [FH] Mirtazapine





                                    Hi,

                                    My Tigg is 11 years old. My vet has prescribed Mirtazapine to boost her appetite hence her eating, she's lost a lot of weight already...

                                    Her creatinine was over 8 at diagnosis and her BUN 79... She also has HCM, diagnosed at age 5, so no IV hydration or SubQs, vet is adamant. I first had her on Famotidine for stomach acid, not sure that ever worked, and there's a scenario where the med can actually increase the loss of appetite, so I asked about an appetite stimulant, hence the Mirtazapine, 1/4 of a tablet every 72 hours. Tigg has lost a lot of weight (18lbs in October, but she's a big cat, part Main Coon) down to 14.5 at CKD diagnosis and probably less now.

                                    Has anyone actually used both the Famotidine and Mirtazapine at the same time, or how to tackle stomach acid (not nausea per se)? Tigg is very sweet but not a lap cat, I've tried a syringe but the stress involved is counter productive, working on "finger feeding", some appetite would make all the difference and would lower her numbers also.

                                    Thanks for any thought or suggestions, I'm new to this forum and trying to digest all the information on Tanya's website...











                                    [Non-text portions of this message have been removed]
                                  • catchat21498
                                    Anyone use this medication? Our vet said it is ok to use this for Sophie. New recommendations.... 1/8 tablet 15 mg everyday I know it was 1/4 tablet every 3
                                    Message 17 of 20 , Apr 8 2:05 PM
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                                      Anyone use this medication? Our vet said it is ok to use this for Sophie.

                                      New recommendations....

                                      1/8 tablet 15 mg  everyday

                                      I know it was 1/4 tablet every 3 days.


                                      The cardiologist was not aware of this dosing.


                                      Thanks,

                                      Chris

                                    • Carol
                                      hi Chris, I used it on my angel Snowball, with not great results. It seemed to work for a day, but then for the next two days, not much at all. You can only
                                      Message 18 of 20 , Apr 8 2:58 PM
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                                        hi Chris,

                                        I used it on my angel Snowball, with not great results.  It seemed to work for a day, but then for the next two days, not much at all.  You can only give it every 3 days, because it takes that long for the liver to clear it out of the system. I would NOT give this medication every day!  

                                        The other thing, is if you are giving thyroid medication (Methimazole/Tapazole) you should NOT give Mirtazapine. The thyroid meds inhibit the enzyme in the liver necessary to clear it out of the body, and what happens is that you get liver toxicity because the drug keeps accumulating in the body and the cat can have seizures.  This is what happened to my angel Snowball.  She was on it for about a month, one day had a horrible grand mal seizure that almost killed her.  I never used it on any of my cats ever after that.

                                        Carol and angel Misty




                                        -----Original Message-----
                                        Anyone use this medication? Our vet said it is ok to use this for Sophie.
                                        New recommendations....
                                        1/8 tablet 15 mg  everyday
                                        I know it was 1/4 tablet every 3 days.

                                      • Yahoo
                                        Here is a link to a study by Quimby on Mirtazapine which the new dosing is based on if anyone is interested.
                                        Message 19 of 20 , Apr 8 3:04 PM
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                                          Here is a link to a study by Quimby on Mirtazapine which the new dosing is based on if anyone is interested.


                                          I also want to add I gave Millie 1/8 every other day which reduced side effects significantly but didn't help much with appetite. 


                                          Sent from my iPhone

                                          On Apr 8, 2015, at 4:05 PM, "catchat21498@... [feline-heart]" <feline-heart-noreply@yahoogroups.com> wrote:

                                           

                                          Anyone use this medication? Our vet said it is ok to use this for Sophie.

                                          New recommendations....

                                          1/8 tablet 15 mg  everyday

                                          I know it was 1/4 tablet every 3 days.


                                          The cardiologist was not aware of this dosing.


                                          Thanks,

                                          Chris

                                        • J. R.
                                          Hi. Just a thought, if Mirtazapine is contraindicated as mentioned below, there is another appetite enhancer called cyproheptadine. It is antihistamine based
                                          Message 20 of 20 , Apr 8 3:26 PM
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                                            Hi.
                                            Just a thought, if Mirtazapine is contraindicated as mentioned below, there is another appetite enhancer called cyproheptadine. It is antihistamine based rather than anti depressant (mirtazapine is anti depressant based).

                                            It might be worth asking your specialist about that if there is a concern.
                                            I would not give any medication or supplement without clearing it first with the specialist due to contraindications or additive/blocking capabilities.\

                                            We do use a very small amount of the compounded mirtazapine with our HCM kitty on occasions to up her appetite...but we're not talking about much or often.

                                            -JR & Crew



                                            On Wednesday, April 8, 2015 3:04 PM, "Yahoo lkaras@... [feline-heart]" <feline-heart-noreply@yahoogroups.com> wrote:


                                             

                                            Here is a link to a study by Quimby on Mirtazapine which the new dosing is based on if anyone is interested.


                                            I also want to add I gave Millie 1/8 every other day which reduced side effects significantly but didn't help much with appetite. 


                                            Sent from my iPhone

                                            On Apr 8, 2015, at 4:05 PM, "catchat21498@... [feline-heart]" <feline-heart-noreply@yahoogroups.com> wrote:

                                             
                                            Anyone use this medication? Our vet said it is ok to use this for Sophie.
                                            New recommendations....
                                            1/8 tablet 15 mg  everyday
                                            I know it was 1/4 tablet every 3 days.

                                            The cardiologist was not aware of this dosing.

                                            Thanks,
                                            Chris


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