Nikko just dxd with CKD pepcid ac question

[Vicki and Jerry]

My cat Nikko Male 13 years old was just dxd with CKD today and I am trying to gain knowledge on the disease and see what the possible treatments are. He is not eating so I am assist feeding him now. I am using the Royal Canin Recovery RS with added water and I add some high calorie paste. He also is constipated and I am giving him 1/4 t Miralax twice a day. Vet did not feel any mass in his intestines. He is drinking water ok and urinating as usual. The vet prescribed Mirtazapine 1/4 tablet every 72 hours to stimulate his appetite. I have not given him this yet. Might want to investigate it a little more before I do. I am giving sub fluids. 35 ml of sodium chloride in am and 35 ml of Veterinary Lactated Ringers Injection at pm.
Nikko has a brother Jerry that is a diabetic and I give him insulin shots twice a day and test his BG at home. So with all of this I am busy with these guys.
Any suggestions are so welcome!
Thank you

 

[Critter Mom]

Hi Vicki,

I'm sorry to hear about Nikko's Dx but the good news is that there are many, many things you can do to help a CKD kitty. The go-to site on the web for all things feline CKD is the well-researched and well-respected Tanya's Site. There is a veritable mountain of information there to get through but it's an absolute goldmine of a resource for CKD and all manner of related cat health issues.

Nausea and inappetence are very common issues with CKD cats so to kick you off on Tanya's Site here are two links to pages which will hopefully be very helpful to you straight away:

Nausea, Vomiting and Stomach Acid - guide to symptoms and treatments

Slippery Elm Bark Information

Persuading Your Cat to Eat

It's important to watch for signs of nausea because you need to address that alongside appetite stimulation.

As mentioned on the Nausea page there are two meds commonly used for appetite stimulation in cats: cyproheptadine (an antihistamine) and mirtazapine (an antidepressant). The former is gentler in action but too high a dose can cause drowsiness and low mood. The latter doesn't need to be dosed as often but it can leave a cat absolutely crazed with hunger for a while after administration (humans too - I can vouch for that). Mirtazapine can induce serotonin syndrome (potentially life-threatening so be aware of symptoms - antidote is cyproheptadine).

Cerenia and ondansetron are both used to treat nausea in cats. Cerenia may kick in a bit faster and may be of more help when vomiting is an issue but FWIW in Saoirse's case I've found that ondansetron to have far superior anti-nausea effect (takes about 3 doses to kick in properly for her). Cerenia benefits don't seem to be as long-lasting as ondansetron's for her.

There is a support group associated with Tanya's Site. The link is in the left-hand column on the home page. There are some very kind, knowledgeable and friendly people in the group. They find it helpful if you can get hold of Nikki's labwork and upload it for review (details on the support group site).

One of the simplest and quickest things you can do to try to help with a queasy tum day-to-day is to raise Nikki's food and water bowls.

There's also a Yahoo CRF support group:

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

For all things feline constipation:

www.felineconstipation.org

There's also info on constipation at Tanya's Site.

Hope some of the above helps to give you a kick start on the learning curve.


Mogs
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[Vicki and Jerry]

Hi Vicki,

I'm sorry to hear about Nikko's Dx but the good news is that there are many, many things you can do to help a CKD kitty. The go-to site on the web for all things feline CKD is the well-researched and well-respected Tanya's Site. There is a veritable mountain of information there to get through but it's an absolute goldmine of a resource for CKD and all manner of related cat health issues.

Nausea and inappetence are very common issues with CKD cats so to kick you off on Tanya's Site here are two links to pages which will hopefully be very helpful to you straight away:

Nausea, Vomiting and Stomach Acid - guide to symptoms and treatments

Slippery Elm Bark Information

Persuading Your Cat to Eat

It's important to watch for signs of nausea because you need to address that alongside appetite stimulation.

As mentioned on the Nausea page there are two meds commonly used for appetite stimulation in cats: cyproheptadine (an antihistamine) and mirtazapine (an antidepressant). The former is gentler in action but too high a dose can cause drowsiness and low mood. The latter doesn't need to be dosed as often but it can leave a cat absolutely crazed with hunger for a while after administration (humans too - I can vouch for that). Mirtazapine can induce serotonin syndrome (potentially life-threatening so be aware of symptoms - antidote is cyproheptadine).

Cerenia and ondansetron are both used to treat nausea in cats. Cerenia may kick in a bit faster and may be of more help when vomiting is an issue but FWIW in Saoirse's case I've found that ondansetron to have far superior anti-nausea effect (takes about 3 doses to kick in properly for her). Cerenia benefits don't seem to be as long-lasting as ondansetron's for her.

There is a support group associated with Tanya's Site. The link is in the left-hand column on the home page. There are some very kind, knowledgeable and friendly people in the group. They find it helpful if you can get hold of Nikki's labwork and upload it for review (details on the support group site).

One of the simplest and quickest things you can do to try to help with a queasy tum day-to-day is to raise Nikki's food and water bowls.

There's also a Yahoo CRF support group:

https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info

For all things feline constipation:

www.felineconstipation.org

There's also info on constipation at Tanya's Site.

Hope some of the above helps to give you a kick start on the learning curve.ya's


Mogs
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Thank you so much for all this information!! Lots of great info. I def will have a learning curve on this as I did on FD. ( Still learning)
As of now he is not nauseated but refuses to eat. Vet did give me mirtazapine but I have not given it to him yet. I need more info on this before I do. Nikko is also constipated but vet did not feel much stool when he examined him. I do not have all the print out of today's vet visit but I will get it tomorrow. I have joined the Tanya's site now but there again its format is a little different so I need to learn that too.

 

[Critter Mom]

There are several members here with CKD kitties. Keep an eye on the threads on this forum for information, too. I'm picking up a lot from the posts I've read here (and I'm very grateful!).


Mogs
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[Vicki and Jerry]

There are several members here with CKD kitties. Keep an eye on the threads on this forum for information, too. I'm picking up a lot from the posts I've read here (and I'm very grateful!).


Mogs
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Yes I will! Just kind of heartbroken for my little guy now but everyone on here are so helpful and that helps so much!!

 

[Anitafrnhamer]

On Tanya's site be sure to check out the information on blood tests and what they mean. If you have not already done so, get copies of all test results. I found it helpful to set up a spreadsheet to track changes over time. If you join the CRF group, we find it helpful to have blood test results to fully assess and offer advice.

Could I ask why your vet has advised the use of two different types of fluid?

 

[Critter Mom]

Yes I will! Just kind of heartbroken for my little guy now but everyone on here are so helpful and that helps so much!!

The Dx is a bit of a broadside, alright. (And anticipatory grief is the pits.)

I found wading through Tanya's Site quite tough going emotionally but as I started following relevant recommendations for Saoirse and then saw her blood work show fairly good stability over time things got a bit less fraught.


Mogs
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[jayla-n-Drevon]

Hi Vicki,
Your doing great !!
My Rico was DX at age 11 (he in not FD) he has been getting SQ fluids for 6 years and he is doing great -he is now 17. He gets ordanestrom/cerenia/and pepcid.... he was not a good eater until we started these anti nausea meds... (as needed)
We started with 100-150 every day for a week then re evaluated. As the disease progressed we then went from a few times a week ....fast forward to now we give about every other day.

AD is easy to syringe and high calorie ...might be something to ask your vet.

The fluids should help as they will flush the toxins out and appy should increase....
Now my FD kitty is getting SQ as well and values are being kept in tact

 

[Vicki and Jerry]

On Tanya's site be sure to check out the information on blood tests and what they mean. If you have not already done so, get copies of all test results. I found it helpful to set up a spreadsheet to track changes over time. If you join the CRF group, we find it helpful to have blood test results to fully assess and offer advice.

Could I ask why your vet has advised the use of two different types of fluid?

I do not have a copy of the test results. Thought I would get them today but I will be going back on Monday or Tuesday and have a follow up test done and then I can get the info.
I have no idea as to why the tow different types of fluids. They did seem to make him feel better and he had a bowel movement this morning!! YEAH!! It was not runny and had good constancy except for one section that was pretty hard. I see this as a plus!

 

[Vicki and Jerry]

Hi Vicki,
Your doing great !!
My Rico was DX at age 11 (he in not FD) he has been getting SQ fluids for 6 years and he is doing great -he is now 17. He gets ordanestrom/cerenia/and pepcid.... he was not a good eater until we started these anti nausea meds... (as needed)
We started with 100-150 every day for a week then re evaluated. As the disease progressed we then went from a few times a week ....fast forward to now we give about every other day.

AD is easy to syringe and high calorie ...might be something to ask your vet.

The fluids should help as they will flush the toxins out and appy should increase....
Now my FD kitty is getting SQ as well and values are being kept in tact

Wow thats great for Rico!!
Do you give all three ordanestrom/cerenia/and pepcid together every other day? Nikko is not vomiting but now I know he still could be nauseated so maybe one or all three of these I should check into with the vet? He id not mention any of these.

Vet gave me mirtazapine for appetite but I have not given him any yet. Kind of concerned on that one for what I have read.
Vet said 1/4 tablet every 72 hours but after reading more I would give 1/8 tablet every 72 hours when I decided to give it to him

I feed Nikko Royal Canin Recovery RS with the sryinge. But is this one good for CKD kitties?
You mentioned AD is this the one you use? http://www.petsmart.com/dog/canned-food/hill-s-prescription-diet-a-d-canine-
and would it be a better choice for a CKD kitty?

 

[jayla-n-Drevon]

Wow thats great for Rico!!
Do you give all three ordanestrom/cerenia/and pepcid together every other day? Nikko is not vomiting but now I know he still could be nauseated so maybe one or all three of these I should check into with the vet? He id not mention any of these.

Vet gave me mirtazapine for appetite but I have not given him any yet. Kind of concerned on that one for what I have read.
Vet said 1/4 tablet every 72 hours but after reading more I would give 1/8 tablet every 72 hours when I decided to give it to him

I feed Nikko Royal Canin Recovery RS with the sryinge. But is this one good for CKD kitties?
You mentioned AD is this the one you use? http://www.petsmart.com/dog/canned-food/hill-s-prescription-diet-a-d-canine-
and would it be a better choice for a CKD kitty?

I do not give all at the same time and I would ask your vet about giving the nausea meds prior to the appetite stimulate as he may eat if the nausea goes away. Who wants to eat if they want to puke

On the days he gets fluids he gets a shot of cerenia (in the fluid bubble as it stings and if given in the fluid it does not sting-I also freeze the needle for fluids and cerenia) Sometimes he will get 2mg of ord. as well if needed later in the day or a few times if I can tell he is "off"--

He gets 2.5 mg of pecid (I put it in a capsule as it tastes really bad) at night and not always every night but most nights. Acid blocker can block other meds so this is best to give before bed.

As far as food-
Conventional vets will tell you low protein with CKD --the vets I work with are holistic and more progressive and believe it is the quality of the protein not just "protein" -that being said AD is not the best source BUT it is organ meat and it is easy to syringe and it is high calorie so I always have it on hand if needed. Sometimes we have to bite the bullet. Rico has maintained a good weight and if you see his BW you would not know he was CKD as the fluids keep his kidneys functioning.
AD is also pretty low carb about 11-12 %
I do not know about RC food-

 

[jayla-n-Drevon]

On a regular basis Rico eats NV Pride and FF --really anything he wants
Sometimes he does well on ID too--this is higher carb but like I said at 17 he gets what he wants and keeps down

 

[Vicki and Jerry]

Looked up Royal Canin Recovery RS and its 1.32% phosphorus 52.37% protein calories 31.50 for 1 oz.
So guess not the best for Nikko even if it is easy to syringe. Maybe I need to check into
Royal Canin Veterinary Diet Renal LP Modified (pâté) phosphorus 0.47 protein 32.75 calories 0.30

 

[jayla-n-Drevon]

Looked up Royal Canin Recovery RS and its 1.32% phosphorus 52.37% protein calories 31.50 for 1 oz.
So guess not the best for Nikko even if it is easy to syringe. Maybe I need to check into
Royal Canin Veterinary Diet Renal LP Modified (pâté) phosphorus 0.47 protein 32.75 calories 0.30

Depending how finicky he is many people make a home made diet-
Rico will have nothing to do with it--I have tried raw over and over but to no avail....
If you post with a" ? Home made CKD diet " I am sure many people can offer what they feed--from the vets I consult with raw is the best but that being said there is a specific way to avoid what you don't want. I am pretty sure Wendy make her own food for Niko.

 

[Critter Mom]

Looked up Royal Canin Recovery RS and its 1.32% phosphorus 52.37% protein calories 31.50 for 1 oz.
So guess not the best for Nikko even if it is easy to syringe. Maybe I need to check into
Royal Canin Veterinary Diet Renal LP Modified (pâté) phosphorus 0.47 protein 32.75 calories 0.30

I suggest that you ask about diet recommendations when you're posting the lab results to the CKD support groups. Depending on the labs and the CKD stage there may be better options than the veterinary Rx diets for Nikko.


Mogs
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[Anitafrnhamer]

[QUOTE="Vicki and Jerry, post: 1630552, member: 13688\
I have no idea as to why the tow different types of fluids. QUOTE]

LRS is the fluid of choice. Sodium, Normosol, and Plasmalyte are used when there are complicating factors like high Ionized Calcium or heart disease is present. Tanya's site is down right now, but if you get the chance it would be a good idea to familiarize yourself with each of the fluids so you can ask your vet about it.

 

[Vicki and Jerry]

On Tanya site I read to give 1/4 tablet of Pepcid ac. for an acid reducer . Nikko is not vomiting and the only thing that he acts different is he does not want to eat. I have the appetite stimulant mirtazapine but I have not given it to him yet. Thought the acid reducer might be less harsh. I was going to do the 1/4 tablet every other day which is the recommenced starting dose from Tanya's site. But I gave it to him crushed up in water and he immediately threw it up.
So how is this best administered since the taste must be awful!!

 

[Marje and Gracie]

Vicki

I'm sorry to hear about Nikko's diagnosis. I would try and get him off the Recovery as it is way too high in P. Any food that you can make into a good slurry that is lower in P but higher in calories would be good for now. I'm generally not a fan of the Renal diets but if you need to syringe feed, they can be helpful because of their consistency.

I've had three CKD cats and one with PKD which presents as CKD. Tanyas is literally my Bible for treating CKD and it's what kept my CKD cats healthy and stable for so very long.

If he does not seem to have an acid tummy, I would not jump into using Pepcid. I feel anti-acids are really overused because we and our cats need acid in our tummies to help us digest the food so our intestines can absorb it. It's best to control nausea with cerenia and ondansetron and as others have said, you can give them both as they address it from different modalities.

If Nikko starts to get an acid tummy, he will either vomit clear or foamy liquid or hunch over like his tummy hurts. I used two holistic methods to address this. One is to feed small meals more often and to use slippery elm syrup. Both worked very well for my CKD cats and I only occasionally used Pepcid AC when those things failed to work. Some cats might eventually require a dose or even two a day of Pepcid but I'd try to address it with other means at first.

 

[Vicki and Jerry]

Vicki

I'm sorry to hear about Nikko's diagnosis. I would try and get him off the Recovery as it is way too high in P. Any food that you can make into a good slurry that is lower in P but higher in calories would be good for now. I'm generally not a fan of the Renal diets but if you need to syringe feed, they can be helpful because of their consistency.

I've had three CKD cats and one with PKD which presents as CKD. Tanyas is literally my Bible for treating CKD and it's what kept my CKD cats healthy and stable for so very long.

If he does not seem to have an acid tummy, I would not jump into using Pepcid. I feel anti-acids are really overused because we and our cats need acid in our tummies to help us digest the food so our intestines can absorb it. It's best to control nausea with cerenia and ondansetron and as others have said, you can give them both as they address it from different modalities.

If Nikko starts to get an acid tummy, he will either vomit clear or foamy liquid or hunch over like his tummy hurts. I used two holistic methods to address this. One is to feed small meals more often and to use slippery elm syrup. Both worked very well for my CKD cats and I only occasionally used Pepcid AC when those things failed to work. Some cats might eventually require a dose or even two a day of Pepcid but I'd try to address it with other means at first.

Thanks Marge for your response. Your always right here when I need you and I thank you for that. I switched the recovery and Nikko is on Royal Canine renal rp right now. Its 5% p. He likes it but I still need to syringe feed and the constancy does work well for that. I do not think Nikko has a acid tummy right now. Has no symptoms of that. The only symptom I see is that he is not interested in food. So that is why I thought maybe did need something to make him feel like he could eat on his own again. I do give him Miralax for the constipation ( that is why I took him to the vet for) and he is now doing ok with that. He does have a bladder infection and is on clavamox antibiotic. I do feed Nikko four meals a day now. Also is this the slippery elm sryup ? http://www.amazon.com/SLIPPERY-ELM-PETS-RELIABLE-REMEDIES/dp/B00TOQRSVU/?tag=felinediabetesfdmb-20
Vet gave me mirtazapine for appetite but I have not given him any yet but maybe that is the better choice to get his appetite back?

 

[Marje and Gracie]

Thanks Marge for your response. Your always right here when I need you and I thank you for that. I switched the recovery and Nikko is on Royal Canine renal rp right now. Its 5% p. He likes it but I still need to syringe feed and the constancy does work well for that. I do not think Nikko has a acid tummy right now. Has no symptoms of that. The only symptom I see is that he is not interested in food. So that is why I thought maybe did need something to make him feel like he could eat on his own again. I do give him Miralax for the constipation ( that is why I took him to the vet for) and he is now doing ok with that. He does have a bladder infection and is on clavamox antibiotic. I do feed Nikko four meals a day now. Also is this the slippery elm sryup ? http://www.amazon.com/SLIPPERY-ELM-PETS-RELIABLE-REMEDIES/dp/B00TOQRSVU/ref=sr_1_1?ie=UTF8&qid=1458669008&sr=8-1&keywords=slippery elm for cats
Vet gave me mirtazapine for appetite but I have not given him any yet but maybe that is the better choice to get his appetite back?

The clavamox can definitely cause inappetance. Absolutely. I'm glad you changed his diet. I have found one of the things that greatly helps towards longevity and QOL with CKD is keeping the serum phosphorus level as close to 4-4.5 as you can and staying ahead of anemia.

I prefer cyproheptadine over mirtazapine for an appetite stimulant...I'm not sure why vets always want to give mirtz but it can only be given once every three days and it always made my cats super hyper. The cypro can be given daily and you can try just a tiny sliver to see if it helps without making him hyper. If it doesn't, you can give a little more. A lot of times, they aren't interested in food because they feel nauseous and that's where the ondansetron and cerenia can help and you might not need an appy stimulant. ECID.

The slippery elm syrup is for acid tummy or intestinal upsets but not for inappetance. I just buy a tiny bit of pure powder at my local health food store. It's loose powder and you want to be sure it's the higher quality...ask the clerk. I always keep a tiny bit on hand around here in case anyone has any soft stools but it's also good for constipation in some cats. I'd just buy a couple tbsp to start to make sure he will like it. You can mix 1/4 tsp of powder with a tsp or more of water to make it a liquid .....and it will become thicker as you stir it. You just want a consistency that makes it easy to syringe. You can give it a few times a day but must separate it from oral meds by two hours. Here is more info on how to make and use slippery elm syrup.

 

[Vicki and Jerry]

The clavamox can definitely cause inappetance. Absolutely. I'm glad you changed his diet. I have found one of the things that greatly helps towards longevity and QOL with CKD is keeping the serum phosphorus level as close to 4-4.5 as you can and staying ahead of anemia.

I prefer cyproheptadine over mirtazapine for an appetite stimulant...I'm not sure why vets always want to give mirtz but it can only be given once every three days and it always made my cats super hyper. The cypro can be given daily and you can try just a tiny sliver to see if it helps without making him hyper. If it doesn't, you can give a little more. A lot of times, they aren't interested in food because they feel nauseous and that's where the ondansetron and cerenia can help and you might not need an appy stimulant. ECID.

The slippery elm syrup is for acid tummy or intestinal upsets but not for inappetance. I just buy a tiny bit of pure powder at my local health food store. It's loose powder and you want to be sure it's the higher quality...ask the clerk. I always keep a tiny bit on hand around here in case anyone has any soft stools but it's also good for constipation in some cats. I'd just buy a couple tbsp to start to make sure he will like it. You can mix 1/4 tsp of powder with a tsp or more of water to make it a liquid .....and it will become thicker as you stir it. You just want a consistency that makes it easy to syringe. You can give it a few times a day but must separate it from oral meds by two hours. Here is more info on how to make and use slippery elm syrup.

Great info. Would you use both the ondansetron and cerenia?

 

[Larry and Kitties]

Would you use both the ondansetron and cerenia?

Yes they can and are frequently used together.

 

[Marje and Gracie]

Great info. Would you use both the ondansetron and cerenia?

Yes...I used them together because they address nausea from different modalities.

Cerenia can be given once a day. Most vets will say ondansetron twice a day but the IM specialist who posts in the small cell lymphoma group says it can be dosed three times a day. I found for Gracie, twice a day worked just fine.

 

[Critter Mom]

the IM specialist who posts in the small cell lymphoma group says it can be dosed three times a day.

Very interesting nugget of information, Marje.

What dose did you use for Gracie? (Hate talking about loved ones in past tense - need to send you a .)


Mogs
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[Marje and Gracie]

Very interesting nugget of information, Marje.

What dose did you use for Gracie? (Hate talking about loved ones in past tense - need to send you a .)


Mogs
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It’s ok, Mogs. I appreciate the hug. It doesn’t matter because I still cry every day either way.

1 mg ondansetron twice a day and 4 mg cerenia once a day. I wouldn’t have increased the ondansetron to three times a day without talking to my vet.

 

[Critter Mom]

It’s ok, Mogs. I appreciate the hug. It doesn’t matter because I still cry every day either way.

Sending more .

I cried every single day for the best part of two years after losing Saoirse's brother, Amadán. Then six days out of seven, then ... ... ...

After about seven years I finally achieved a sort of numbness. I've had to lock all my memories of him into a little room in my heart that I dare not open ...

1 mg ondansetron twice a day ... I wouldn’t have increased the ondansetron to three times a day without talking to my vet.

Thanks for the supplemenary info, Marje. I found that 1mg BID doesn't quite cut it for Saoirse. With vet approval she is on a 2mg BID dose and she seems to do much better on it. (Weight 4.5kg.)


Mogs
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[Marje and Gracie]

Sending more .

I cried every single day for the best part of two years after losing Saoirse's brother, Amadán. Then six days out of seven, then ... ... ...

After about seven years I finally achieved a sort of numbness. I've had to lock all my memories of him into a little room in my heart that I dare not open ...


Thanks for the supplemenary info, Marje. I found that 1mg BID doesn't quite cut it for Saoirse. With vet approval she is on a 2mg BID dose and she seems to do much better on it.


Mogs
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Aah Mogs....I'm so very sorry about Amadan.

I think if that is the dose that helps Saoirse and the vet is on board, then that's fine. I think I read that the IM specialist thought it could be dosed three times a day at higher than 1 mg but, again, for anyone else reading....please don't do that without conferring with your vet because of other potential drug interactions.

 

[Critter Mom]

... other potential drug interactions.

For general reader information, there is a major drug interaction between ondansetron and Tramadol.


Mogs
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[Vicki and Jerry]

Talked with Vet and he is ordering the cyproheptadine in tablet form and the cernia in the tablet form. He could not find the
ondansetron in his book of meds so guess I will try the cernia alone and hope it helps .
I was thinking about ordering the slippery elm in the liquid from Amazon http://www.amazon.com/SLIPPERY-ELM-...8669008&sr=8-1&keywords=slippery elm for cats Would it be the same as the powder? We don't have any health stores in town that would carry it and thought amazon ships in one day.

Its always so hard to lose our sweet furbabies, they are family...
One of my favorite quotes is “Don’t cry because it’s over, Smile because it happened.”

 

[Critter Mom]

He could not find the ondansetron in his book of meds

Ask him to look up Zofran. It's the branded version of ondansetron. For info, Zofran is insanely expensive in the UK. Generic ondansetron is one tenth the price so it might be worth checking with local pharmacies to see how much they charge for the generic if possible.

BTW if he's worried that it might not be a suitable med for a cat, it might be worth letting him know that IDEXX recommend ondansetron in their Feline Pancreatitis Treatment Guidelines.


Mogs
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[Vicki and Jerry]

Ask him to look up Zofran. It's the branded version of ondansetron. For info, Zofran is insanely expensive in the UK. Generic ondansetron is one tenth the price so it might be worth checking with local pharmacies to see how much they charge for the generic if possible.

BTW if he's worried that it might not be a suitable med for a cat, it might be worth letting him know that IDEXX recommend ondansetron in their Feline Pancreatitis Treatment Guidelines.


Mogs
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Ok so I would ask for the Zofran or the generic ondansetron. Not sure if he could find the generic of that since he could not find the onsdansetron listed. Just a little confused why he could not find it. If he can do the Zofran do you know the dose for a 8.6 lb cat?
It look like Zofran is for
Chemotherapy-Induced Nausea and Vomiting so pretty potent stuff I would guess.

Also what about Vitamin B complex for the CKD?
Sorry all the questions.

 

[Critter Mom]

If he can find the information on dosing by looking up Zofran you're halfway there. I think it would be a good idea to get some idea of the price of the medication because the price difference is huge in the UK (30 Zofran about £100, 30 generic ondansetron less than £10) and the pricing might be similarly structured in the US.

If you look on the nausea page at Tanya's Site you'll find more info about ondansetron. Your vet will need to set the dose. (If the link to Tanya's Site doesn't work at first, try again later - sometimes you get glitches accessing the site.) You'll also find information on B-complex supplementation at Tanya's Site (somewhere in the treatments pages IIRC).


Mogs
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[manxcat419]

On Tanya site I read to give 1/4 tablet of Pepcid ac. for an acid reducer . Nikko is not vomiting and the only thing that he acts different is he does not want to eat. I have the appetite stimulant mirtazapine but I have not given it to him yet. Thought the acid reducer might be less harsh. I was going to do the 1/4 tablet every other day which is the recommenced starting dose from Tanya's site. But I gave it to him crushed up in water and he immediately threw it up.
So how is this best administered since the taste must be awful!!

I just pop the 1/4 pill into Rosa's mouth and wash it down with a little water (or sometimes with her Liqui-vite - just something to make sure it doesn't stick in her throat and come back up). What I would say is that, with hindsight, I would be inclined to give the Pepcid AC even if you don't think acid is too much of a problem right now especially with more than one cat in the house where you may not be able to tell which one has vomited overnight. I didn't do that with Rosa and finished up having to put her on Sucralfate (expensive, tastes bad and needs to be given 2 hours after food and other meds and one hour before which can cause scheduling nightmares) for 6 weeks for a suspected GI bleed because we apparently didn't get control of the acid from the moment it started. If I was doing this over, I'd have given her the Pepcid from the day she was diagnosed and with any luck avoided the need for Sucralfate altogether.

 

[Vicki and Jerry]

The clavamox can definitely cause inappetance. Absolutely. I'm glad you changed his diet. I have found one of the things that greatly helps towards longevity and QOL with CKD is keeping the serum phosphorus level as close to 4-4.5 as you can and staying ahead of anemia.

I prefer cyproheptadine over mirtazapine for an appetite stimulant...I'm not sure why vets always want to give mirtz but it can only be given once every three days and it always made my cats super hyper. The cypro can be given daily and you can try just a tiny sliver to see if it helps without making him hyper. If it doesn't, you can give a little more. A lot of times, they aren't interested in food because they feel nauseous and that's where the ondansetron and cerenia can help and you might not need an appy stimulant. ECID.

The slippery elm syrup is for acid tummy or intestinal upsets but not for inappetance. I just buy a tiny bit of pure powder at my local health food store. It's loose powder and you want to be sure it's the higher quality...ask the clerk. I always keep a tiny bit on hand around here in case anyone has any soft stools but it's also good for constipation in some cats. I'd just buy a couple tbsp to start to make sure he will like it. You can mix 1/4 tsp of powder with a tsp or more of water to make it a liquid .....and it will become thicker as you stir it. You just want a consistency that makes it easy to syringe. You can give it a few times a day but must separate it from oral meds by two hours. Here is more info on how to make and use slippery elm syrup.

Vet prescribed ondansetron for nausea 2mg 2x's a day but only as needed if he is vomiting. I was thinking it was more helpful to give a little every day to help with the nausea feeling even if he is not vomiting.
Appetite stimulant he prescibed cyproheptadine in the liquid form and marked give .1 ml as needed . There again I thought a smaller amount would do good to give every day. I have given him the 1/8th pill of mirtazapine and he did well on it but he had more appetite the first day I gave it and then after that it did not seem to make much of a difference in the rest of the 72 hours. Just wondering Marje what you think? TIA

PS I am giving him the slippery Elm Sryup 1/8 t twice a day and wait two hours before I give him the clavamox.

 

[Marje and Gracie]

Vet prescribed ondansetron for nausea 2mg 2x's a day but only as needed if he is vomiting. I was thinking it was more helpful to give a little every day to help with the nausea feeling even if he is not vomiting.
Appetite stimulant he prescibed cyproheptadine in the liquid form and marked give .1 ml as needed . There again I thought a smaller amount would do good to give every day. I have given him the 1/8th pill of mirtazapine and he did well on it but he had more appetite the first day I gave it and then after that it did not seem to make much of a difference in the rest of the 72 hours. Just wondering Marje what you think? TIA

PS I am giving him the slippery Elm Sryup 1/8 t twice a day and wait two hours before I give him the clavamox.

Ondansetron is really better suited for nausea. I'd start low....1 mg twice a day and see how he does. Did you discuss with your vet using the cerenia as well ...usually 4 mg once a day.

I've never given cypro in liquid form so just be sure it doesn't have any sugar in it. You might see if the ondansetron and cerenia help enough that he eats on his own and, if not, you've got the cypro.

The very reason I am not crazy about mirtz is if it wears off, it's supposed to be given every three days so seems he would then have nothing to help him. That's why I like a bit of cypro better if they need it.

I hope the slippery elm helps him!

 

[Critter Mom]

I agree with Marje about the cypro: it's gentler in action, you've got better control over how much and how often the appetite needs to be stimulated, and also it doesn't carry the risk of inducing serotonin syndrome. (Note: it can affect mood and too large a dose may cause low mood and mild sedation.)


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