? Pancreatitis medications questions

[Autumn'sMom]

My cat, Autumn, has recently fallen out of remission after almost 2 years OTJ.
She is currently hospitalized (due to nausea, vomiting, and refusal to eat - but luckily no ketones so far), being treated for suspected pancreatitis. Having spent a lot of time reading here over the last 2+ years, I know that many here have lots of experience dealing with this condition. So, I have questions
(I apologize for how long this is - I tried my best to make it easier to read).

It seems that the key to treating pancreatitis is to recognize a flare asap, and deal with the pain and nausea/vomiting to keep the cat eating/hydrated until the flare subsides? The drugs I see mentioned most often seem to be cerenia, ondansetron (zofram), and buprenorphine (buprenex)? Also, some people seem to give sub-q fluids at home as well?

Since it seems that pancreatitis is often chronic, do you keep a supply of the necessary medications on hand, or do you get them as needed?

If I will be keeping a supply on hand, I'd like to buy what I can online (supplier suggestions welcome!) , rather than directly from my vet (who seems to always charge higher prices). I have begun looking around online, but I figure I can get some great real world experience answers here. I have searched (and read) many of the past pancreatitis threads from these forums (and gotten lots of great info). I know that ECID, but I appreciate any starting points you can give me.

Cerenia - comes in tablet form? I see that it comes in different strengths. How big are the tablets? Can the tablets be easily cut? What is the approximate dose?

Ondansetron - comes in tablet and (compounded) liquid form? Formulation preference? (I know the human dissolvable kind are a no-no) How big are the tablets? Can the tablets be easily cut? What is the approximate dose? Some quick reading indicates the pills have a limited shelf life?

buprenorphine - since this is a narcotic, I am assuming I will need to get directly from the vet? (I have gotten/used in the past from vet after cat dentals).

sub-q fluids - I think that these, too have a limited shelf life?

If you have gotten this far, thanks so much
Any/all advice or words of wisdom are extremely welcome.

 

[Diane Tyler's Mom GA]

My cat, Autumn, has recently fallen out of remission after almost 2 years OTJ.
She is currently hospitalized (due to nausea, vomiting, and refusal to eat - but luckily no ketones so far), being treated for suspected pancreatitis. Having spent a lot of time reading here over the last 2+ years, I know that many here have lots of experience dealing with this condition. So, I have questions
(I apologize for how long this is - I tried my best to make it easier to read).

It seems that the key to treating pancreatitis is to recognize a flare asap, and deal with the pain and nausea/vomiting to keep the cat eating/hydrated until the flare subsides? The drugs I see mentioned most often seem to be cerenia, ondansetron (zofram), and buprenorphine (buprenex)? Also, some people seem to give sub-q fluids at home as well?

Since it seems that pancreatitis is often chronic, do you keep a supply of the necessary medications on hand, or do you get them as needed?

If I will be keeping a supply on hand, I'd like to buy what I can online (supplier suggestions welcome!) , rather than directly from my vet (who seems to always charge higher prices). I have begun looking around online, but I figure I can get some great real world experience answers here. I have searched (and read) many of the past pancreatitis threads from these forums (and gotten lots of great info). I know that ECID, but I appreciate any starting points you can give me.

Cerenia - comes in tablet form? I see that it comes in different strengths. How big are the tablets? Can the tablets be easily cut? What is the approximate dose?

Ondansetron - comes in tablet and (compounded) liquid form? Formulation preference? (I know the human dissolvable kind are a no-no) How big are the tablets? Can the tablets be easily cut? What is the approximate dose? Some quick reading indicates the pills have a limited shelf life?

buprenorphine - since this is a narcotic, I am assuming I will need to get directly from the vet? (I have gotten/used in the past from vet after cat dentals).

sub-q fluids - I think that these, too have a limited shelf life?

If you have gotten this far, thanks so much
Any/all advice or words of wisdom are extremely welcome.

Hi Diane, sorry to hear about Autumn, I can only reply about the cerenia tablets. My other cat that doesn't have diabetes takes cerenia because he has kidney disease and if he doesn't take it every day he vomits. If you buy them on line your vet would have to send them a prescription for them. They come 4 tablets to a box. As far as I know one box of 4 comes in 16 mg each. The other box of 4 tablets are 24 mgs. For my cat I buy the 24 mgs and cut them in half, so he gets 12 mgs once daily . I give it to him at 6:00 pm every day. I tried buying the 16 mgs and cutting them in half which was 8 mgs per day but he started to vomit again. So my vet said to stick with the 24 mgs and cut then in half. When I tried to cut them with a pill cutter they sort of shattered, they were not even, so I decided to break them in half with my fingers, they do have a line on them and breaking them with my fingers came out good. I guess it would be up to your vet what dosage she would want to try on your kitty first. I used to pay 25.00 a box for them until I asked my vet to give me a break on them. She did and now I pay 16.00 a box.

 

[Autumn'sMom]

Hi Diane, sorry to hear about Autumn, I can only reply about the cerenia tablets. My other cat that doesn't have diabetes takes cerenia because he has kidney disease and if he doesn't take it every day he vomits. If you buy them on line your vet would have to send them a prescription for them. They come 4 tablets to a box. As far as I know one box of 4 comes in 16 mg each. The other box of 4 tablets are 24 mgs. For my cat I buy the 24 mgs and cut them in half, so he gets 12 mgs once daily . I give it to him at 6:00 pm every day. I tried buying the 16 mgs and cutting them in half which was 8 mgs per day but he started to vomit again. So my vet said to stick with the 24 mgs and cut then in half. When I tried to cut them with a pill cutter they sort of shattered, they were not even, so I decided to break them in half with my fingers, they do have a line on them and breaking them with my fingers came out good. I guess it would be up to your vet what dosage she would want to try on your kitty first. I used to pay 25.00 a box for them until I asked my vet to give me a break on them. She did and now I pay 16.00 a box.

Thanks so much, Diane. (I hardly ever run into anyone else with the same name - feels like I'm talking to myself lol)

I will definitely work with my vet about exactly which drugs, dosages, etc.
Mostly I'm looking for practical knowledge (like yours) about the feasibility of saving a bit of money possibly buying larger dose pills and cutting, and just a general idea of how long quantities of drugs might last (Since I don't have any frame of reference with these drugs at all).

Years ago, I had a cat with hyperthyroid, and over time I got very good at mixing/matching/cutting different dosage pills to get just what he needed at the best possible price for me.

 

[Autumn'sMom]

Just a bit more info about Autumn and her recent history:

5/28/19 - noticed (over ~1 month) that she had been generally been paying more attention to water, and (over ~1 week) actually saw her drinking some, so tested her BG (was 235).
Since she had been in remission so long (BG ~50-80), I got complacent and stopped testing her several months ago (which I won't do again, if I am fortunate enough to get her into remission a second time). Prior to original dx, she lived by the water dish, but once in remission ignored the water dish - so new attention to water was a big red flag for me).

6/4/19 - took her to regular vet for full bloodwork panel, new insulin prescription, and to schedule a dental; she received rabies vaccine and distemper booster as well; filled insulin scrip, started lantus with PM dose

6/6/19 - vomited once overnight; appetite was off, but managed to convince her to eat at least half of her normal amount (and this is a cat that loves to eat); thought that maybe she was feeling a bit "down" from vaccinations

6/7/19 - vomited again overnight, and at least twice during the day; refused to eat anything; called regular vet, had no openings; referred to emergency vet who found slightly elevated temperature, no urine ketones; gave sub-q fluids and cerenia injection and took urine sample for analysis; given option to immediately hospitalize, but decided (with vet's approval) to try her at home overnight and see if maybe would start eating on her own; if not, bring back in AM for hospitalization

6/8/19 - still not eating, and now acting slightly painful, so admitted at emergency vet; they performed ultrasound, everything looked normal, but she was showing significant sensitivity in pancreatic area of abdomen; currently treating for suspected pancreatitis; will stay at least overnight.

Her blood panel came back fairly normal (slightly elevated ALT [20 -100 normal, hers 104], elevated eosinophils [2 - 12% normal, hers 16%], and elevated PrecisionPSL [8 - 26 normal, hers 39]). I filled in all values on "labs" tab of SS.
Was told today that her initial urinalysis results are normal, waiting to see what (if anything) is able to be cultured.

 

[Diane Tyler's Mom GA]

Just a bit more info about Autumn and her recent history:

5/28/19 - noticed (over ~1 month) that she had been generally been paying more attention to water, and (over ~1 week) actually saw her drinking some, so tested her BG (was 235).
Since she had been in remission so long (BG ~50-80), I got complacent and stopped testing her several months ago (which I won't do again, if I am fortunate enough to get her into remission a second time). Prior to original dx, she lived by the water dish, but once in remission ignored the water dish - so new attention to water was a big red flag for me).

6/4/19 - took her to regular vet for full bloodwork panel, new insulin prescription, and to schedule a dental; she received rabies vaccine and distemper booster as well; filled insulin scrip, started lantus with PM dose

6/6/19 - vomited once overnight; appetite was off, but managed to convince her to eat at least half of her normal amount (and this is a cat that loves to eat); thought that maybe she was feeling a bit "down" from vaccinations

6/7/19 - vomited again overnight, and at least twice during the day; refused to eat anything; called regular vet, had no openings; referred to emergency vet who found slightly elevated temperature, no urine ketones; gave sub-q fluids and cerenia injection and took urine sample for analysis; given option to immediately hospitalize, but decided (with vet's approval) to try her at home overnight and see if maybe would start eating on her own; if not, bring back in AM for hospitalization

6/8/19 - still not eating, and now acting slightly painful, so admitted at emergency vet; they performed ultrasound, everything looked normal, but she was showing significant sensitivity in pancreatic area of abdomen; currently treating for suspected pancreatitis; will stay at least overnight.

Her blood panel came back fairly normal (slightly elevated ALT [20 -100 normal, hers 104], elevated eosinophils [2 - 12% normal, hers 16%], and elevated PrecisionPSL [8 - 26 normal, hers 39]). I filled in all values on "labs" tab of SS.
Was told today that her initial urinalysis results are normal, waiting to see what (if anything) is able to be cultured.

Hi Diane, my cats cerenia pills last 8 days, I cut the 24 mg pills in half. It depends on what mgs your vet suggests to try. I did try giving 6 mg and 8 mg at one time and it didn't work. I'm sorry I don't know anything about pancreatitis. Please keep me informed on how Autumn is doing

 

[Bron and Sheba (GA)]

The zofran needs a script and I think you will need to get that from a pharmacy. We do here in Australia they are little 4 mg wafers and the usual dose is 2 mg 8 hours if necessary. Just pop the wafer ( with dry hands) onto the tongue.
With subQ fluids you would need to get the ok from your vet first. And find out what type of fluids and amount as well. If your cat has any heart issue you would need to definitely get vet clearance on that.
The bupe you would need a vet script as well.
Best to have them all on hand at home to use as soon as flare appears.

 

[Autumn'sMom]

Thanks so much for all of the replies, I really appreciate it!

The vet called to update me this evening. She has IV fluids, cerenia, zofram and bupe on board, but not willing to eat yet. Said they keep offering food, she sniffs it like she's interested, but won't actually eat it. On the plus side, the nurses had her out of her cage this afternoon, and they seemed to think she was feeling more comfortable physically. My next update (barring anything unforeseen) will be in the AM, so maybe she'll have eaten something by then.

It's so strange to not have her here. She was born in my house to a stray (not feral) mother who had wandered into our feral colony. She just turned 11, and she's never spent a night away from me in her life until now. Luckily, my civvy cat, Archie, seems to be sticking closer to me than usual, which helps somewhat.