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Re: benazepril dangers

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  • r schu
    Courtney and Maggie, Benazepril will limit the amount of fluid and wastes dumped by the kidneys? And the lasix will pull it to dump? I what you are saying is
    Message 1 of 15 , Mar 7, 2013
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      Courtney and Maggie,

      Benazepril will limit the amount of fluid and wastes dumped by the kidneys? And the lasix will pull it to dump?

      I what you are saying is accurate and trust that they are good to be used together. I just can't really make sense of it though.

      Why not just lower the lasix instead of lowering fluid production with benaz then increasing it with lasix?

      Thank you for this addition to my puzzle!

      Purrs to Maggie.

      -Lee and May

      --- On Thu, 3/7/13, tourtaney <tourtney17@...> wrote:

      > Hi Lee and May,
      >
      > Sounds like you've done some research on top of the info
      > from the cardiologist.  I'm going to tell you what I
      > have learned through this process in lay-men's terms.
      >
      > The benazepril will limit the amount of fluids the body will produce and the lasix will remove the excess amount of fluids from the body.  Using the 2 medications together is a good way to balance the fluids and the levels.  If you are treating only with lasix and you have to keep increasing, then you run the risk of reaching deydration faster and that's when you start affecting the kindeys, etc.
      >
      > The way my vet has explained it, in her experience, the
      > longer you can keep your cat stable and balanced the better
      > your chances are of maintaining health.  Once you hit a
      > high level of lasix, you start to reach that level of
      > dehydration, that's when cats are more apt to spiral
      > downward and hard to get back on track.
      >
      > So I think your cardiologist is hoping to find that balance
      > by adding the ace-inhibitor to prevent upping the lasix.
      >
      > 3mg qd of lasix is a pretty low dose and 1.25mg qd of
      > benazepril sounds like a fairly low/average dose based on
      > weight too.  My Maggie weighs 13.4 lbs and can get up
      > to 3.3 mg qd of benazepril but she has been on 2.5 for 3
      > months.
      >
      > I hope some of this helps.
      > Courtney & maggie
    • tourtaney
      Lee & May, Again, this is my lay-man interpretation, but here s my understanding of heart failure: Heart disease or an underlying disease that affects the
      Message 2 of 15 , Mar 7, 2013
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        Lee & May,

        Again, this is my lay-man interpretation, but here's my understanding of heart failure:

        Heart disease or an underlying disease that affects the heart, causes the heart to funtion improperly. When heart is struggling to funtion, the blood builds up. When the blood builds up, the fluids within the blood begin to leak into the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen (ascites). Lasix is used to remove this excess fluid from the lungs/cavities. The benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up.

        Again, this is strictly my general understanding and my description but when I explain to my vet this is my understanding, she says I have it right.

        I'm pretty new to this board, so this was the first post I've read about May. Can you share May's diagnosis and experience with me?

        -Courtney & Maggie

        --- In feline-heart@yahoogroups.com, "tourtaney" <tourtney17@...> wrote:
        >
        > Hi Lee and May,
        >
        > Sounds like you've done some research on top of the info from the cardiologist. I'm going to tell you what I have learned through this process in lay-men's terms.
        >
        > The benazepril will limit the amount of fluids the body will produce and the lasix will remove the excess amount of fluids from the body. Using the 2 medications together is a good way to balance the fluids and the levels. If you are treating only with lasix and you have to keep increasing, then you run the risk of reaching deydration faster and that's when you start affecting the kindeys, etc.
        >
        > The way my vet has explained it, in her experience, the longer you can keep your cat stable and balanced the better your chances are of maintaining health. Once you hit a high level of lasix, you start to reach that level of dehydration, that's when cats are more apt to spiral downward and hard to get back on track.
        >
        > So I think your cardiologist is hoping to find that balance by adding the ace-inhibitor to prevent upping the lasix.
        >
        > 3mg qd of lasix is a pretty low dose and 1.25mg qd of benazepril sounds like a fairly low/average dose based on weight too. My Maggie weighs 13.4 lbs and can get up to 3.3 mg qd of benazepril but she has been on 2.5 for 3 months.
        >
        > I hope some of this helps.
        > Courtney & maggie
        >
      • r schu
        Courtney and Maggie, I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left
        Message 3 of 15 , Mar 7, 2013
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          Courtney and Maggie,

          I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left atrium, which is the ante chamber to the ventricle (ventricle is the ante chamber for the aorta and circulation to the body) fills up, like a traffic jam, with the excess blood the ventricle can't process.

          This build up of pooled blood can coagulate and get clots causing stroke/thrombosis.  (I'm no doctor, and barely understand this).  This is why they take plavix, or anti coagulant, to prevent clots forming in this pooled blood.

          So it makes sense what you say, that the build up can leak into heart or chest cavity or lungs or abdomen.  So lasix removes the built up fluids.

          Hopefully the amount of lasix meets the amount of fluid build up, preventing it from getting into the heart/lungs/abdomen, yes?

          You said: "benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up."  My guess is that this is done via lowering the kidney bp.  But I don't understand how that reduces the amount of fluid?  Unless lower kidney bp means lower kidney function?? which would be very very bad for May.

          The body doesn't create fluid, it all comes in via the mouth, or sub q.  So I'm still confused on exactly how this aspect works.

          If benaz reduces fluids going to the heart and lasix flushes fluid via the kidneys, then how do we know when enough is enough?  Crf cats need fluids to keep up with all the fluids their kidneys are dumping to begin with!  So this sounds like a nightmare for a crf cat.

          I'm not doubting you or your vet, just not really understanding.  I'd like to understand.

          As for May's diagnosis: crf 9/09, creatinine 3.1 then and higher threes til last summer when an infection threw it up.  Vet said to double fluids, which possibly, (combined with pred for kidney mass) threw her into chf.  After temp lasix she was fine, echo said mild hcm, and crea came back down to 3.5! in Feb when I took her in for fainting spells, which started this all over again.

          Once sub q was reduced from 100 daily to 40, crea went up (4.9), but last week down to 4.3 after going to 50cc sub q and 15-20cc oral.

          Her meds are as stated in my original post. I try to minimize meds. I hate putting drugs into her!

          So that is her story and where we are. She's 21.

          Yesterday afternoon she was miserable, seemingly nauseous with standard crf stuff. I gave 5cc oral water and soon after assist fed 14ml food. Heart rate was 168, breathing calm at 27, so ??? is this heart or kidneys? Then...25 minutes later she perks up and eats 20ml on her own! 50 minutes hence I gave her the anti nausea/acid blocker and an hour later she eats again! I didn't give lasix til 830 based on all this other activity.

          Today, same thing, awful feeling...so I fed her a bit at 6, then gave heart meds, an hour later anti nausea/acid and 45 minutes later she perks up and again eats!

          This isn't corelated with either the lasix or the anti nausea/acid???? I'm just happy she comes out of these down times and seems her happy self the rest of the day.

          Sorry this is so long, but at 21, alot of history can build up.

          Why are you here with Maggie? Does she have heart issues?

          -Lee and May
          ================

          Lee & May,

          Again, this is my lay-man interpretation, but here's my understanding of heart
          failure:

          Heart disease or an underlying disease that affects the heart, causes the heart
          to funtion improperly. When heart is struggling to funtion, the blood builds
          up. When the blood builds up, the fluids within the blood begin to leak into
          the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen
          (ascites). Lasix is used to remove this excess fluid from the lungs/cavities.
          The benazepril is used to reduce the amount of fluid the body creates in order
          to prevent it from 'leaking' and building up.

          Again, this is strictly my general understanding and my description but when I
          explain to my vet this is my understanding, she says I have it right.

          I'm pretty new to this board, so this was the first post I've read about May.
          Can you share May's diagnosis and experience with me?

          -Courtney & Maggie
        • Karen Plasket
          Hi, First, I apologize for not trimming the message, but don t think I can in order for this to make any sense. I agree with Courtney in her lay terms...she is
          Message 4 of 15 , Mar 7, 2013
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            Hi,
            First, I apologize for not trimming the message, but don't think I can in order for this to make any sense.
            I agree with Courtney in her lay terms...she is right. I'm not sure I can add anything to make it easier to understand, but the bottom line is Benazepril is used in chronic renal failure to decrease proteinuria. The degree of proteinuria is a direct prognostic indicator of survival. Benazepril appears to decrease this, and thus, increases survival times and slows the progression of disease. ACE inhibitors selectively dilate the efferent artiole of the glomerulus.
            Another increase in survival is the change to a renal prescription diet...these diets reduce the amount of protein, phosphorus, and sodium (all detrimental in normal amounts for a cat in renal failure/compromise).
            Benazepril is also used in heart failure as a vasodilator. Because it decrease blood pressure, studies show that it results in renal vasodilation which causes a decrease in renal filtration pressure and therefore a decrease in renal proteinuria. It also increases renal plasma flow and glomerular filtration rates, which ultimately help compromised kidneys. Some studies show it also increase appetite in cats, which in renal failure can also be a problem.
            Ultimately, a cat with heart disease and renal failure is in a delicate balancing act...you should be very judicious in giving a heart cat any fluids, as you can easily overload the heart. However, the heart trumps the kidneys...treat the heart first, and try to balance out the needs of the kidneys...it's not easy, and no easy answers.
            We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities). I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).
            I hope this helps...let me know if you have any questions...it's late, and by now I am usually brain-tired :-)
            Finally, 21 is an amazing age for a kitty...you are definitely doing something right!
            Karen Plasket, DVM

            -----Original Message-----
            From: r schu <rschu92@...>
            To: feline-heart <feline-heart@yahoogroups.com>; tourtaney <tourtney17@...>
            Sent: Thu, Mar 7, 2013 8:25 pm
            Subject: [FH] Re: benazepril dangers





            Courtney and Maggie,

            I have the same understanding of hcm; left ventricle stops processing as well, due to less elasticity or scar tissue or something, so left atrium, which is the ante chamber to the ventricle (ventricle is the ante chamber for the aorta and circulation to the body) fills up, like a traffic jam, with the excess blood the ventricle can't process.

            This build up of pooled blood can coagulate and get clots causing stroke/thrombosis. (I'm no doctor, and barely understand this). This is why they take plavix, or anti coagulant, to prevent clots forming in this pooled blood.

            So it makes sense what you say, that the build up can leak into heart or chest cavity or lungs or abdomen. So lasix removes the built up fluids.

            Hopefully the amount of lasix meets the amount of fluid build up, preventing it from getting into the heart/lungs/abdomen, yes?

            You said: "benazepril is used to reduce the amount of fluid the body creates in order to prevent it from 'leaking' and building up." My guess is that this is done via lowering the kidney bp. But I don't understand how that reduces the amount of fluid? Unless lower kidney bp means lower kidney function?? which would be very very bad for May.

            The body doesn't create fluid, it all comes in via the mouth, or sub q. So I'm still confused on exactly how this aspect works.

            If benaz reduces fluids going to the heart and lasix flushes fluid via the kidneys, then how do we know when enough is enough? Crf cats need fluids to keep up with all the fluids their kidneys are dumping to begin with! So this sounds like a nightmare for a crf cat.

            I'm not doubting you or your vet, just not really understanding. I'd like to understand.

            As for May's diagnosis: crf 9/09, creatinine 3.1 then and higher threes til last summer when an infection threw it up. Vet said to double fluids, which possibly, (combined with pred for kidney mass) threw her into chf. After temp lasix she was fine, echo said mild hcm, and crea came back down to 3.5! in Feb when I took her in for fainting spells, which started this all over again.

            Once sub q was reduced from 100 daily to 40, crea went up (4.9), but last week down to 4.3 after going to 50cc sub q and 15-20cc oral.

            Her meds are as stated in my original post. I try to minimize meds. I hate putting drugs into her!

            So that is her story and where we are. She's 21.

            Yesterday afternoon she was miserable, seemingly nauseous with standard crf stuff. I gave 5cc oral water and soon after assist fed 14ml food. Heart rate was 168, breathing calm at 27, so ??? is this heart or kidneys? Then...25 minutes later she perks up and eats 20ml on her own! 50 minutes hence I gave her the anti nausea/acid blocker and an hour later she eats again! I didn't give lasix til 830 based on all this other activity.

            Today, same thing, awful feeling...so I fed her a bit at 6, then gave heart meds, an hour later anti nausea/acid and 45 minutes later she perks up and again eats!

            This isn't corelated with either the lasix or the anti nausea/acid???? I'm just happy she comes out of these down times and seems her happy self the rest of the day.

            Sorry this is so long, but at 21, alot of history can build up.

            Why are you here with Maggie? Does she have heart issues?

            -Lee and May
            ================

            Lee & May,

            Again, this is my lay-man interpretation, but here's my understanding of heart
            failure:

            Heart disease or an underlying disease that affects the heart, causes the heart
            to funtion improperly. When heart is struggling to funtion, the blood builds
            up. When the blood builds up, the fluids within the blood begin to leak into
            the chest cavity (plueral effusion) or lungs (plueral edema) or even abdomen
            (ascites). Lasix is used to remove this excess fluid from the lungs/cavities.
            The benazepril is used to reduce the amount of fluid the body creates in order
            to prevent it from 'leaking' and building up.

            Again, this is strictly my general understanding and my description but when I
            explain to my vet this is my understanding, she says I have it right.

            I'm pretty new to this board, so this was the first post I've read about May.
            Can you share May's diagnosis and experience with me?

            -Courtney & Maggie









            [Non-text portions of this message have been removed]
          • tourtaney
            Hi Karen, Thanks for the answer. I read a little bit yesterday about the benefits of benazepril for CRF but I couldn t tackle the answer. I only know a
            Message 5 of 15 , Mar 8, 2013
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              Hi Karen,

              Thanks for the answer. I read a little bit yesterday about the benefits of benazepril for CRF but I couldn't tackle the answer. I only know a little bit about the heart failure. This helps makes sense for both senarios.

              -Courtney & Maggie
            • Mary Sue Rubin
              Hi Karen, Thank you for this explanation. Everything I read helps me get a better understanding of my 18 year old cat s newly diagnosed restrictive-like CM (I
              Message 6 of 15 , Mar 8, 2013
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                Hi Karen,



                Thank you for this explanation. Everything I read helps me get a better
                understanding of my 18 year old cat's newly diagnosed restrictive-like CM (I
                think there were some signs that weren't clear cut) and right sided CHF. One
                thing I might have misunderstood or for which I could benefit from more
                information is the last half of this statement in your post:



                "We typically use lasix to remove excess fluid from the heart and
                lungs...the mechanism of action doesn't really work on abdominal fluid
                build-up (or any fluid build up in body cavities)."



                My cat was prescribed Lasix for ascites. She did not have fluid buildup
                in/around her lungs or heart, however her liver was slightly enlarged and
                had some nodules, which we aren't addressing at this point. Her abdominal
                fluid was gone in fewer than 10 days with the Lasix. (She's also taking
                Vetmedin, benazepril, and aspirin). What am I missing from that statement?



                Thanks,

                Mary Sue



                From: feline-heart@yahoogroups.com [mailto:feline-heart@yahoogroups.com] On
                Behalf Of Karen Plasket
                Sent: Thursday, March 07, 2013 11:41 PM
                To: rschu92@...; feline-heart@yahoogroups.com; tourtney17@...
                Subject: Re: [FH] Re: benazepril dangers



                ...We typically use lasix to remove excess fluid from the heart and
                lungs...the mechanism of action doesn't really work on abdominal fluid
                build-up (or any fluid build up in body cavities). I know it may seem
                counter-productive, but a lot of medications work in synergy (or work better
                when used together).
                Karen Plasket, DVM

                -----Original Message-----
                From: r schu <rschu92@... <mailto:rschu92%40yahoo.com> >
                To: feline-heart <feline-heart@yahoogroups.com
                <mailto:feline-heart%40yahoogroups.com> >; tourtaney <tourtney17@...
                <mailto:tourtney17%40hotmail.com> >
                Sent: Thu, Mar 7, 2013 8:25 pm
                Subject: [FH] Re: benazepril dangers






                [Non-text portions of this message have been removed]
              • Karen Plasket
                Hi Mary Sue, You aren t missing anything :-) Some vets will try Lasix...but, traditionally, it doesn t do a lot of good for fluid build-up in body
                Message 7 of 15 , Mar 8, 2013
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                  Hi Mary Sue,
                  You aren't missing anything :-) Some vets will try Lasix...but, traditionally, it doesn't do a lot of good for fluid build-up in body cavities...the way Lasix works is to remove fluid from tissues. A more accepted method with ascites is to remove the fluid manually (syringe and catheter) which also removes the pressure from abdominal organs. It also depends on the amount of fluid in the abdomen. I'm glad in your case the Lasix worked.
                  Karen Plasket, DVM


                  -----Original Message-----
                  From: Mary Sue Rubin <msrubin@...>
                  To: 'Karen Plasket' <slammerfold@...>; feline-heart <feline-heart@yahoogroups.com>
                  Sent: Fri, Mar 8, 2013 11:37 am
                  Subject: RE: [FH] Re: benazepril dangers



                  Hi Karen,

                  Thank you for this explanation. Everything I read helps me get a better understanding of my 18 year old cat’s newly diagnosed restrictive-like CM (I think there were some signs that weren’t clear cut) and right sided CHF. One thing I might have misunderstood or for which I could benefit from more information is the last half of this statement in your post:

                  “We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities).”

                  My cat was prescribed Lasix for ascites. She did not have fluid buildup in/around her lungs or heart, however her liver was slightly enlarged and had some nodules, which we aren’t addressing at this point. Her abdominal fluid was gone in fewer than 10 days with the Lasix. (She’s also taking Vetmedin, benazepril, and aspirin). What am I missing from that statement?

                  Thanks,
                  Mary Sue


                  From: feline-heart@yahoogroups.com [mailto:feline-heart@yahoogroups.com] On Behalf Of Karen Plasket
                  Sent: Thursday, March 07, 2013 11:41 PM
                  To: rschu92@...; feline-heart@yahoogroups.com; tourtney17@...
                  Subject: Re: [FH] Re: benazepril dangers




                  …….We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities). I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).
                  Karen Plasket, DVM

                  -----Original Message-----
                  From: r schu <rschu92@...>
                  To: feline-heart <feline-heart@yahoogroups.com>; tourtaney <tourtney17@...>
                  Sent: Thu, Mar 7, 2013 8:25 pm
                  Subject: [FH] Re: benazepril dangers








                  [Non-text portions of this message have been removed]
                • r schu
                  Thank you Karen, Thank you very much for this information. Our cardiologist is using it for heart, but I realized that slowly over the last year her urine
                  Message 8 of 15 , Mar 8, 2013
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                    Thank you Karen,

                    Thank you very much for this information.

                    Our cardiologist is using it for heart, but I realized that slowly over the last year her urine protein has gone from none to 1+ and now 2+, though upc is low normal.  So if she doesn't have proteinuria now, she may be heading for it, which would add another benefit to benazepril use.

                    "ACE inhibitors
                    selectively dilate the efferent artiole of the glomerulus." - yes, this is the tight rope walk, too much dilation is bad, not enough is bad, getting it just right is key, yes?



                    As for May's diet, she gets renal kibble and mostly homemade food, (not raw), that I've been making for 12 years and altered for crf.  It has taurine, calcium carb, and most of my crf therapy has been nutrition and supplements (fish oil, methycobalamin, mirilax), and fluids. The food is quite watery, like a thick soup. Only meds are ondans and ranitid.  crf diagnosis 9/09.



                    "Benazepril is also used in heart failure as a vasodilator.  Because
                    it decrease blood pressure, studies show that it results in renal
                    vasodilation which causes a decrease in renal filtration pressure and
                    therefore a decrease in renal proteinuria.
                    It also increases renal
                    plasma flow and glomerular filtration rates, which ultimately help
                    compromised kidneys. "  -----------the crf site that the crf support group uses says ace inhibitors can be dangerous with lasix in kidney cats, per mar vista vet.  But this is the only source saying that.

                    I know this is a delicate balancing act.  May is my one and only and I am doing everything I can to support her desire to keep living with quality of life.  So far, she is keeping on and happy, except for occasional feeling bad spells in the afternoons that don't seem to correlate with anything.

                    I am not going to get a better understanding of this because I'm not a vet! and this is complicated.  What you have said is really helpful!   So after much research, and opinions from a friend vet, yourself, and our cardiologist who I really trust, I gave her the first dose last night, a bit lower than 1/4, and will give 1/4 tonight and going forward.  I assume the cardiologist will want more blood from her little old veins in a week or two, to make sure it still looks good.  (potass and phos are mid range)

                    My only other question is what signs might I see that the benaz is doing harm, other than what one would expect from ailing kidneys; nausea, inappetence, etc?
                    (I assist feed more than half her calories right now, so would be thrilled to see her appetite go up)

                    Thank you.

                    - Lee and Miss May




                    --- On Thu, 3/7/13, Karen Plasket <slammerfold@...> wrote:

                    Hi,

                    First, I apologize for not trimming the message, but don't think I can in order for this to make any sense.

                    I agree with Courtney in her lay terms...she is right.  I'm not sure I can add anything to make it easier to understand, but the bottom line is Benazepril is used in chronic renal failure to decrease proteinuria.  The degree of proteinuria is a direct prognostic indicator of survival.  Benazepril appears to decrease this, and thus, increases survival times and slows the progression of disease.  ACE inhibitors selectively dilate the efferent artiole of the glomerulus.

                    Another increase in survival is the change to a renal prescription diet...these diets reduce the amount of protein, phosphorus, and sodium (all detrimental in normal amounts for a cat in renal failure/compromise).

                    Benazepril is also used in heart failure as a vasodilator.  Because it decrease blood pressure, studies show that it results in renal vasodilation which causes a decrease in renal filtration pressure and therefore a decrease in renal proteinuria.  It also increases renal plasma flow and glomerular filtration rates, which ultimately help compromised kidneys. Some studies show it also increase appetite in cats, which in renal failure can also be a problem.

                    Ultimately, a cat with heart disease and renal failure is in a delicate balancing act...you should be very judicious in giving a heart cat any fluids, as you can easily overload the heart.  However, the heart trumps the kidneys...treat the heart first, and try to balance out the needs of the kidneys...it's not easy, and no easy answers.

                    We typically use lasix to remove excess fluid from the heart and lungs...the mechanism of action doesn't really work on abdominal fluid build-up (or any fluid build up in body cavities).  I know it may seem counter-productive, but a lot of medications work in synergy (or work better when used together).

                    I hope this helps...let me know if you have any questions...it's late, and by now I am usually brain-tired :-)

                    Finally, 21 is an amazing age for a kitty...you are definitely doing something right!

                    #yiv1482415575 #yiv1482415575AOLMsgPart_1_72d2bad8-66df-41fc-a14f-5b6dd35c97a6 td{color:black;}Karen Plasket, DVM















                    [Non-text portions of this message have been removed]
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