8/6 Max AMPS 410 +4 249 +6 105 +7 87 +10 82 PMPS 143 +2 188 +3 140 +4 54 +4.5 63 +5 91

Hello again. I am sure you are all over this, because I know you, Lori... you check things out :-) but I'm attaching information from Tanya's site on using Cerenia and Amlodipine together. The best thing to do it check with your vet. They've got the experience to know if they've ever seen problems in using both together. Helen mentions possible giving them 12 hours apart. And, of course, Ondansetron is an option (although a potentially constipating one.) This also mentions using caution with other calcium channel blockers used in conjunction with Amlodipine (because Amlodipine is a calcium channel blocker) such as cyproheptadine (appetite stimulant.) Also antacids which do the same (not Pepcid though, which seems to be fine). It's very interesting how it mentions glucosamine driving up blood sugar and blood pressure in HUMANS (so who knows about cats, but interesting.) Here goes.

Amlodipine: Interactions with Other Medications
The European Medicines Agency says (clause 4.8 on page 9) that "Cerenia should not be used concomitantly with Ca-channel antagonists as maropitant has affinity to Ca-channels." The University of Zürich Institute for Veterinary Pharmacology and Toxicologyalso mentions this (in German). In principle this means that amlodipine should not be used with maropitant (Cerenia), a treatment used for nausea and vomiting. 'Concomitantly' has a rather vague medical meaning in that it means during the same time period, but in this context I don't know exactly what time period the EMA is referring to, i.e. do they mean at the same time or on the same day? Both of these medications tend to be given once daily, so they have a relatively long effect. Maybe giving them both on the same day but 12 hours apart (i.e. one in the morning and one in the evening) would probably be acceptable, but check with your vet or pharmacist.

If you are using Fosrenol, a lanthanum carbonate-based phosphorus binder, in 2011 the US Food and Drug Administration issued a Safety Labeling Change which states "There have been reports of serious cases of gastrointestinal obstruction, ileus, and fecal impaction reported in association with lanthanum, some requiring surgery or hospitalization. Risk factors for gastrointestinal obstruction identified from post-marketing reports include alteration in gastrointestinal anatomy (e.g., history of gastrointestinal surgery, colon cancer) hypomotility disorders (e.g., constipation, ileus, diabetes) and concomitant medications (e.g., calcium channel blockers). Some cases were reported in patients with no history of gastrointestinal disease." Since amlodipine is a calcium channel blocker, I would check with your vet before using both fosrenol and amlodipine.

Cimetidine (Tagamet) (used to control gastric hyperacidity) may increase the effects of amlodipine (thereby possibly reducing blood pressure too far), so it would probably be safer to use another histamine H2 antagonist such as ranitidine (Zantac 75) or famotidine (Pepcid AC) instead.

Plumb's Veterinary Drug Handbook mentions that cyproheptadine, an appetite stimulant commonly used in CKD cats, may also have calcium channel blocking effects and cause low blood pressure. In theory this means there is a risk that cyproheptadine in combination with amlodipine could reduce blood pressure too far. It is probably safer not to use these two drugs together, but in practice many people seem to use both medications without any problems. Be guided by your vet.

Early research indicated that glucosamine (used to treat arthritis) might cause elevated blood sugar and elevated blood pressure in humans. Glucosamine sulfate (2016) US National Library of Medicine discusses glucosamine sulfate. It says (with regard to humans) "Glucosamine appears to be safe for most people with diabetes, but blood sugar should be monitored closely. Early research suggests that glucosamine sulfate can increase insulin levels. This might cause blood pressure to increase. However, more reliable research suggests that glucosamine sulfate does not increase blood pressure. To be cautious, if you take glucosamine sulfate and have high blood pressure, monitor your blood pressure closely."
 
Suzanne & Darcy said:
I'm attaching information from Tanya's site on using Cerenia and Amlodipine together.
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Hello Suzanne, thanks for posting. I did read that yesterday, that's why I asked the question about taking Cerenia and Amlodipine together. Max also takes the Ondansetron twice a day. I was giving the Cerenia at night in addition to that because of the anti-inflammatory aspects of it. Max is very prone to bouts of pancreatitis. The slightest thing sets it off. I had left a message for my vet and she was out when I called. She called back later saying his labs were pretty good for him and that she doesn't see any drug interactions between Cerenia and amlodipine, nor any of his other meds. I gave him the Cerenia last night, but this morning he has been acting strange, hiding in the girls' princess tent in the playroom, went to the litter box and tried to have a BM there, but dashed out and did it on the floor. Just before that I heard him coughing, so I gave him a puff of Albuterol. He seems better now. He just has been sleeping so much since he started the amlodipine and I also mentioned that to the vet. She said lethargy was a side effect as I suspected. I think I'm going to hold off on giving him anymore Cerenia for now anyway. I don't know if all of what happened this morning was coincidental or if it was related to that. I was concerned about it though when I read about it. I have a difficult time trusting vets or even doctors for that matter. I am not saying I know it all, because that's far from the truth. I will say "I don't know, but I will check into that" if a patient ever asked me a question that I did not know the answer to and I always checked drug interactions before prescribing medications to patients. There are a lot of vets and doctors who don't admit to not knowing out there (believe me, I know) and that's why I have a problem trusting them sometimes. I don't think there are many vets at all experienced in diabetes, nor a cat like Max with so many complex issues. I am not experienced in taking care of sick animals and I don't know half of what you know, or Wendy and some of the others. That's why I rely on you guys to educate me. I trust you all here because I have a sense that you know what you are talking about because of your experience, unlike some vets I've seen. Everything that I have learned about Max since he was diagnosed was from here…everything. I need all the education I can get when it comes to cats, specifically Max. I don't want anyone to ever hesitate telling me something, or educating me on something because I'm a medical professional. This is certainly not my thing. I was OB/GYN. I can tell you anything about high risk obsetrics, and gyn problems, but that's my limit, unless it's something minor.....Anyway the vet said to try to keep him on the Amlodipine for a few more days to see if he settles down and if not she would try something else. I just don't know. I'm way out of my league right now, but I'm trying my best. I hope he will be alright without the Cerenia for now, but I'm afraid to give it to him again. He doesn't take a phosphorus binder yet. He doesn't use an antacid, cyproheptadine, nor glucosamine either. I decided to wait on that. She didn't mention what his phosphorus level was, but I have a call in to get his lab reports emailed to me. Sorry for rambling, I do that when I'm anxious. Worried about my boy this morning. Bottom line after all of that, I don't know that I completely trust the vet on everything.
 
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Max & Lori said:
Thank you so much @Suzanne & Darcy for checking up on Max and helping me too. Max seems better now than earlier. :)
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I’m happy he’s perked up! I checked back to see. A lot of new meds do take time to adjust to - as I am certain you know from experience in the medical field. I haven’t had problems with cats and Amlodipine in the past (and gave Cerenia) but every cat’s situation and responses are unique. I do recall now that you mentioned it, it did take a few days to adjust. It’s right to be cautious. Just as long as the two together did not make his blood pressure drop too low - it would be okay to give. But unless you can monitor his BP, you will not know.
 
It could be nothing more than a combination of fatigue/stress from vet visits, high morning BG, new med and asthma acting up (what am I saying “nothing more” but you know what I mean) … we don’t really know which factor or combination of factors made him seem “off” this morning… plus… he’s a cat! They can be hard to figure out!
 
Suzanne & Darcy said:
I’m happy he’s perked up! I checked back to see. A lot of new meds do take time to adjust to - as I am certain you know from experience in the medical field. I haven’t had problems with cats and Amlodipine in the past (and gave Cerenia) but every cat’s situation and responses are unique. I do recall now that you mentioned it, it did take a few days to adjust. It’s right to be cautious. Just as long as the two together did not make his blood pressure drop too low - it would be okay to give. But unless you can monitor his BP, you will not know.
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That’s right! I’m glad to know that you’ve given the two before. It might just be coincidental that all of that happened this morning. I want to check his pressure myself. That cuff is supposed to come today, but lately USPS is slow, so we will see. He made it to green. I was just getting ready to post. He’s 87. He still keeps going into that little tent in the playroom. I think that’s his new spot, but I have to crawl inside of there to get to him when I need to check his BG though, he won’t come out by himself. My husband laughed at me. If that ain’t something…the stuff this cat makes me do. He’s definitely got me wrapped since he was diagnosed…and he knows it.
 
Suzanne & Darcy said:
It could be nothing more than a combination of fatigue/stress from vet visits, high morning BG, new med and asthma acting up (what am I saying “nothing more” but you know what I mean) … we don’t really know which factor or combination of factors made him seem “off” this morning… plus… he’s a cat! They can be hard to figure out!
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Exactly.:cat:
 
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