? 1/22-1/23 Fred PMPS 382, +4.5 282, +8 221 AMPS 354 Still refusing food. ER?

[Purrberry]

https://www.felinediabetes.com/FDMB...449-5-5-414-refusing-all-food-all-day.258229/

By the grace of God, I was able to get an ondansetron in Fred around 2:30 this morning. (EST)
After that battle, he ran under the bed. He then ate maybe 3/4 Tbsp of kibble, and maybe about 1/4-1/2 more around 6:30 AM. But once again this morning, he won't even look at it.

I will try the battle to get another ondansetron in him this morning, but I think I just got really lucky last night. I just don't know if that amount of food is enough to keep him out of the ER? He did drink a decent amount of water this morning and is not as lethargic. (likely because the Cerenia wore off...that dopes him out). But still so, so nauseous. If I need to get him to the ER, I cannot take him until later this afternoon.

I gave him 2.5 units last night, instead of his 5, and 2 this morning.

 

[Katherine&Ruby]

Hi Kathleen, sounds like you had a night. I am glad to hear that he ate on his own and drank water. I would see how he does this morning before contemplating the ER. Perhaps a regular vet visit might be in order tomorrow though.

 

[Purrberry]

Hi Kathleen, sounds like you had a night.

Oh, indeed it was!

Again, by massive luck, I was able to get an ondansetron in him. Just a few minutes after our wrestling match, he came over to me and asked for a few PureBites! I was shocked but thrilled. He then came upstairs, went to his feeder, and ate a small amount of kibble. The Zofran was literally like 30 min ago, so it can't be from that as of yet. So crossing all fingers!

Perhaps a regular vet visit might be in order tomorrow though.

Yes, I feel like that will likely definitely be in order. As of now, I feel OK about no ER. (anti-jinx!)

 

[Purrberry]

Oh, and for anyone that might be out there who knows....should I give him the Mirataz again today? It certainly didn't seem to do anything yesterday, but I don't know how long it takes to become effective. The Rx says "daily as needed". But I've also read (on a human site) that ondansetron and mirtazapine may have an interaction? I don't want to end up with serotonin syndrome, either!

 

[Katherine&Ruby]

ondansetron and mirtazapine may have an interaction? I don't want to end up with serotonin syndrome, either!

I did give ondansetron and mirtazapine once together and it did not work well, and they are contraindicated. Cerenia and mirtazapine is ok, but ondansetron and mirtazapine is not. Cyproheptadine is safe to give with ondansetron. It's an antihistamine that happens to also stimulate appetite in cats. I find Ruby to be less loopy on cypro. Zyrtec, which is often given to cats with allergies, has the same effect. If you're going to the vet tomorrow, you should ask about cyproheptadine. I like it more than mirtaz.

 

[Purrberry]

Unfortunately, I’d be looking at another pill. :-( if I have one bullet, I think I should probably save it for the ondansetron.

 

[Wendy&Neko]

The Zofran was literally like 30 min ago, so it can't be from that as of yet

Took about 20 minutes for it to work with Neko, so could have been that. Super happy to hear that it's helping.

Since he might have some underlying infection/inflammation (possibly pancreatitis), he's not eating as much, plus you lowered the insulin dose so much, try to be diligent about testing him for ketones.

 

[Wendy&Neko]

@Katherine&Ruby Could you tell me where you found that Mirataz and ondansetron are contraindicated in cats. I have the opposite. The only interaction between the two drugs is that mirtazapine binds tighter to the same nausea receptor, so it could be that the effects of ondansetron are not as strong as would be without mirtazapine.

Katherine - the seritonin syndrome is another myth. Paper about that here. Both mirtazapine and ondsetron are 5-HT3 antagonists.

 

[Purrberry]

the serotonin syndrome is another myth.

Happy to hear this-thank you.

@Wendy&Neko So, if they are not contraindicated, do you think it might be better if I withhold the Mirataz? I think #1 priority is stopping the nausea, as that allows him then to eat. He did eat some kibble on his own from the timer around +5.5, and then again at +7. (I had to be out this afternoon) So I was very relieved to see that, but he's not himself, by a long shot. I am sure he is only eating because I've managed to get the ondansetron in him. His sugar is high as well..I just didn't know what to do without the guarantee of food.

 

[Katherine&Ruby]

@Katherine&Ruby Could you tell me where you found that Mirataz and ondansetron are contraindicated in cats. I have the opposite. The only interaction between the two drugs is that mirtazapine binds tighter to the same nausea receptor, so it could be that the effects of ondansetron are not as strong as would be without mirtazapine.

Katherine - the seritonin syndrome is another myth. Paper about that here. Both mirtazapine and ondsetron are 5-HT3 antagonists.

Could very well be a myth long perpetuated. I was warned of it by other members here last May after Ruby spent time in the ER and I was throwing everything I could at her to get her to eat. This is the site that corroborated the advice: https://www.drugs.com/interactions-check.php?drug_list=1752-0,1640-0.

 

[Wendy&Neko]

I always prioritize nausea meds over appetite stims, as you are thinking too. You don't want to give an appy stim to a nauseous cat. If nothing else it can develop food aversion to that food.

Regarding food and insulin, only part of the insulin's job is to combat the carbs in food. Insulin is needed by other cells in the body. Even cats who cannot have food because they are undergoing anaesthesia, it's suggested they can get a half dose. As long as Neko was eating 2/3 of her meal, I was fine with giving her full dose, and she was running in a lot more greens than Fred is. Full disclosure, I had assist feeding as a tool if I needed it, and I'd often bump her carbs up to 8% to give me a little buffer.

 

[Purrberry]

Absolutely re: aversion. I am paranoid about it, since Fred eats like…two things. And I already feel there is some aversion in place, thanks to me not realizing he had lower grade nausea.

@Wendy&Neko I missed your post above about the ketones. I will keep on top. I have the Nova test strips, and I swear half of them are always defective! It is so frustrating.

I should have given Fred at least 2.5 this AM. He was not eating a thing at that time. But in the good news portion of the post, Fred was much perkier this evening. He even ate just about all of his dinner! As such, I was able to get in his ondansetron in a treat instead of a Sumo match. He’s also drinking much more water today, but I’d like more. But we remain with all fingers crossed.

Now…my debate over what to give him tonight. I feel like I can’t be certain he’ll eat…

 

[Suzanne & Darcy]

Okay … skipping to the bottom of this thread to say that I gave my cat Tabitha (CKD) Zofran and Mirataz together for years without any ill effects. I believe lots of people on Tanya’s support group do the same. It was the transdermal Mirataz. Sometimes the mirt was only every other day because she was sensitive to mirataz and became aggressive with the other cats.

 

[Suzanne & Darcy]

And now… having said the above… I am really worried about dear Fred. I hope this is just a pancreatitis flare up. (I say “just”, of course, knowing they are beastly, but I think he can weather that storm… so I said “just a pancreatitis flare up.”

That is a wordy way of saying that I am worried about Fred so please keep us posted!

 

[Suzanne & Darcy]

@Katherine&Ruby Could you tell me where you found that Mirataz and ondansetron are contraindicated in cats. I have the opposite. The only interaction between the two drugs is that mirtazapine binds tighter to the same nausea receptor, so it could be that the effects of ondansetron are not as strong as would be without mirtazapine.

Katherine - the seritonin syndrome is another myth. Paper about that here. Both mirtazapine and ondsetron are 5-HT3 antagonists.

Am going to read the paper you linked, thanks. I don’t know what is a myth or not, but I have had cats on transdermal Mirataz that have gone absolutely cuckoo! I don’t know if it was seratonin syndrome and never worried about giving it a name, but I have always since been very cautious about starting with a low dose of Mirt to see what each cat can tolerate. One cat of mine decided to beat up every other cat in the household. Another cat became the howling kitty who was so restless he couldn’t calm down until it wore off. All of them did fine once I cut the recommended dose of Mirataz in about half and then gave it perhaps every other day. I read on Tanya’s support group, about a lot of cats having similar problems with “Meowtazapine”. Perhaps it’s not a seratonin thing?

 

[Ashleigh & Ares]

zofran is super fast acting even on humans. its used for chemo patients a lot. ive used it fornausea...works in like 15min or even less sometimes. just FYI.
im going to pray for Fred! hope he eats a decent amount today!