Mirtazapine (Axit) question

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sarahtee

sarahtee

Member Since 2015
Hi,

(Short history - we had two sibling kitties, Max and Milly, both diagnosed with IBS last year. Max developed diabetes after a month of Prednisolone and while we were able to get that under control, she had further complications, and was PTS last December).

Max's civvie Milly has been on a low dose (2.5mg per day) of Prednisolone for over 12 months. She has not developed diabeties, but still has IBS symptoms. Her weight has been declining over the past 6 months, and the vet has prescribed Mirtazapine (Axit in Australia) @ 1/4 of a 15mg pill every 3 days.

I bought a pill cutter and have been giving her 1/8 of a pill every 4 days. She becomes very vocal, and quite hungry within about 20 mins of being pilled. It is having the affect of stimulating her appetite, which is great, but because of the change in behaviour (almost an agitated state) I'm not sure if it's the best option?

Are there alternatives to Mirtazapine, which I can discuss with our vet?

TIA for reading and for your advice :)
 
Mirtazapine reacts that way in a lot of cats....We call it Meowzapine around here because of it's tendency to make kitties very vocal

The other option is Cyproheptadine....and it can be given twice a day as needed (and usually only takes 1/4 pill or less to work)
 
Chris & China said:
Mirtazapine reacts that way in a lot of cats....We call it Meowzapine around here because of it's tendency to make kitties very vocal

The other option is Cyproheptadine....and it can be given twice a day as needed (and usually only takes 1/4 pill or less to work)
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Thanks, Chris - appreciate your advice. Meowzapine is right! I'll ask about Cyproheptadine next appointment.
 
Hi Sarah,

I posted the following on another recent thread; you might find it helpful:

it might be worth your discussing with your vet the use of an appetite stimulant. Cyproheptadine is fairly gentle in action and usually a very small dose (1/8 of a 4mg tablet or less for a 10lb cat) can provide just enough support to get a cat more interested in food and also to eat a bigger portion at a sitting. The appetite stimulating effect typically lasts about 8-12 hours, possibly a bit longer. You can dose 3x per day so you can fine tune the med support to the cat's needs. Things to check with the vet are liver function and also blood pressure (it's an antihistamine so may have a vasoconstricting effect). The other appetite stimulant commonly used in cats is mirtazapine. An antidepressant med, it can have an excessively strong appetite stimulating effect, even a small dose can make a cat crazed with hunger (not pretty) and the appetite stimulating effect typically lasts for 2-3 days so it's less controllable. Mirtazapine also carries the risk of inducing serotonin syndrome which can be potentially life-threatening (antidote is cyproheptadine, BTW). The risk of serotonin syndrome may be increased by interactions with other drugs, especially anything that affects serotonin levels. It can interact with buprenorphine (bad case on here a few months ago).​

For information, I recently purchased a blood pressure monitor for Saoirse. Saoirse has early stage CKD and her blood pressure has been raised recently. As I mentioned above, antihistamines can cause vasoconstriction. Saoirse has been having problems with eating recently and I had to give her a dose of cyproheptadine today because she has eaten so little and the last thing she needs is to start accumulating fat in her liver. I checked her BP before and after giving the dose. There was a significant rise in her blood pressure on a dose of 1/8 of a 4g tablet (now a major problem for us). I was able to give her her blood pressure medication and it brought her back down thankfully but it's still a worry. I suggest therefore that you ask your vet to check Milly's blood pressure as part of the discussion on cyproheptadine. (Note: it may be elevated by vet stress but better to have some visibility of her status than no idea at all.) I have no idea of whether mirtazapine may affect blood pressure but I suggest you discuss that with your vet, too, if Milly's blood pressure turns out to be of concern as s/he may be able to offer a solution which will look after her blood pressure and her appetite problems.

For information, Saoirse had a very bad reaction to mirtazapine; her pupils were like dinner plates, she became vocal, agitated, absolutely crazed with hunger - and aggressive. She was like a different cat - and not in a good way. I would be very, very reluctant to give it to her again, not least of all because I've been prescribed mirtazapine myself and I also had a very bad reaction to it. Due to my PTSD, I've been prescribed a lot of psych meds over the years and mirtazapine was one of the worst in terms of side effects; it is a very strong medication. BP problems aside, Saoirse did much better on cyproheptadine. I hope that cyproheptadine will be suitable for Milly and that it will help her to get her appetite back; it's a great deal gentler in its action. Note that too high a dose can cause sedation and depressed mood; a little goes a long way.


Mogs

ETA:

Useful links on cyproheptadine and mirtazapine from marvistavet.com:

Cyproheptadine

Mirtazapine

NB: The alert about liver issues and cyproheptadine was posted by an FDMB member who had problems with same. I don't have any specifics, just passing on the caveat. The marvistavet.com entry for mirtazapine carries a specific warning about reducing the dose in patients with liver issues.

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Thanks Mogs @Critter Mom - liver function may be an issue, so that may be why we were offered mirtazapine. I don't think Milly has ever had her blood pressure checked - they've been very low maintenance kitties up until last year.
Thanks for all that info - much appreciated.
 
sarahtee said:
liver function may be an issue, so that may be why we were offered mirtazapine.
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I've found that some vets over here aren't familiar with cyproheptadine.

On liver issues, I added that as a flag because a member here reported that cypro was a problem in his cat because of same but I've not had to deal with such a problem so I can't give any specifics; I just think it wise to pass on reported concerns to other members so that they might check things out better with their vets. Definitely explore it with your vet. I just checked online at marvistavet.com to see whether they might have more info on why it might be contraindicated for liver patients but they don't make any mention of it. However, they do advise that it's contraindicated in patients with a predisposition to glaucoma as it may elevate pressure in the eye. Here's the link:

http://www.marvistavet.com/cyproheptadine.pml

I also checked their mirtazapine page and it does have a caveat about its use in patients with liver issues:

h ttp://www.marvistavet.com/cyproheptadine.pml

http://www.marvistavet.com/mirtazapine.pml

From the article at the above link:

Patients with liver or kidney disease should receive a reduced dose of mirtazapine or a reduction in the dosing schedule
Click to expand...


Mogs
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Bron and Sheba said:
Can't help with the medication but just wanted to say hi! Sorry you are having trouble with Milly. Looks like you have some good advice.
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Hi Bron! Yes, Milly is unfortunately not doing too well, which is why we are trying the Axit. We have the option of increasing the Prednisolone dosage, but I'm fairly wary of doing that after Max developed diabetes on the higher dose. We want Milly to be comfortable and have a reasonable quality of life, but it's a difficult balance (at least, at the moment).
 
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