Anyone using Varenzin in a 20 year old cat?

[Dyana]

Ginger had a HCT of 27.7 and my vet put her on Varenzin.
She had not been acting normal, and today was the 2nd day I had to give her Mirataz.
She has a short history of seizures or I think my vet said were ATV?s and is now on 1/4 baby aspirin every 3 days.
Today, she seemed to have a seizure where she was on her side and had troubles getting up.

Here are my notes:

Gave 1/4 baby aspirin. aspirin
Gave 0.9 Varenzin at 4:00pm. Start Varenzin - dose for 21 days, stop for 7 days, then test.
Gave 100ml Normosol R before work. Gave 0.9 Varenzin at 4:00pm. Fluids. Did not come out for breakfast, right away. Ate a good breakfast, then went back to bed. Had to get her up to join me for work.
Forgot to give the aspirin,, Gave 0.9 Varenzin at 3:00pm. aspirin. Did not come out for breakfast, had to get her up, Ate a little breakfast and did not sit with me, but went back to bed instead.
Gave 1/4 baby aspirin. Gave 0.9 Varenzin at 3:00pm. Forgot to give B12. Forgot B12. Ate pretty good. Did not sit with me, had to get her from bed to go to work.
Gave 100ml Normosol R before work. Gave 0.9 Varenzin at 2:30pm. Gave .50ml Cyanocobalmin, Gave 1 inch Mirataz at 5:30pm. Fluids and B12. Did not eat breakfast with all her meds, but ate treats throughout the day. Ate well at night.
Gave 0.9 Varenzin at 2:30pm. Ginger's weight was 9lbs 5.5oz on my scale. Ate okay today.
Gave 1/4 aspirin at 12:15pm, Gave 0.9 Varenzin at 5:00pm. Had to get her out of the bedroom at breakfast. Ate okay, but not a lot. Seems more wobbily.
Gave 100ml Normosol R and 1 inch Mirataz before work. Gave 0.9ml Varentin at 5:00pm. Did not come out and did not want breakfast. Ate some food and some treats. Had a seizure like episode in the afternoon (flailing with her front paw to get up, and then screamed), Very wobbily / weak? (can't jump as well),

 

[Bron and Sheba (GA)]

I’m really sorry Ginger is having this problem.
I have no experience with this Dyana but I’ll tag @Suzanne & Darcy as she may have an idea.

 

[Margaret and Pearl (GA)]

Hi Dyana,

Have you had your cat's blood pressure checked? Sounds to me like Ginger may have high blood pressure. High BP causes seizures and seizure-like episodes.

Varenzin is for radical anemia caused by CKD only, and we're talking a decently low HCT. HCT 27.7 is just below the reference range - and Varenzin may or may not work on that. My cat Chessie almost needed to be on Varenzin and I did a lot of research into it at the time (December 2023). Her anemia (HCT 17 and lower) turned out to be from GI issues, but I know a bit about Varenzin. How quickly has her HCT been declining? For CKD, it's usually slow and steady decline. If you've got a quick decline, it may not be from CKD.

Do you have any current bloodwork we can see? I could probably offer more insight if I have that data. And I definitely recommend a blood pressure check if you don't do that with Ginger. Cats with CKD are prone to high blood pressure, and it's easily treated. It can cause some really weird behaviors if left unchecked, and lead to seizures and blindness (for example).

 

[Dyana]

Thank you.
I will try to post her blood work. I don't know how to make it less blurry looking.
She gets blood work every 3 months.
Her last blood pressure was sent to me in an email from her August 29th vet visit
LF 152/107 (125), 128/97 (110), 149, 98 (122)
LR 150/119 (135), 155/100 (123), 132, 99.
My vet also wants to start her on phosphourus binders which I now have but have not yet started. Let me know if there is another way to post blood work.

 

[Dyana]

Ginger was admitted to a hospital today to get IV fluids since they did more blood work and her kidney values were increased. Please pray for her.

 

[Margaret and Pearl (GA)]

Thank you.
I will try to post her blood work. I don't know how to make it less blurry looking.
She gets blood work every 3 months.
Her last blood pressure was sent to me in an email from her August 29th vet visit
LF 152/107 (125), 128/97 (110), 149, 98 (122)
LR 150/119 (135), 155/100 (123), 132, 99.
My vet also wants to start her on phosphourus binders which I now have but have not yet started. Let me know if there is another way to post blood work.
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The hematocrit looks like it is dropping quickly? I can't read the past two dates to the right of your bloodwork. What are those dates of previous bloodwork? The wobbliness Ginger is experiencing could be also due to anemia. If the hematocrit is dropping quickly, then this is likely NOT from CKD but is another source of blood loss. CKD anemia is normally slow going and the cat adjusts really well to it. You also don't know from these bloodwork's whether or not the reticulocytes will start regenerating - sometimes this doesn't start happening until the hematocrit (HCT) is a lot lower than 27. Reticulocyte activity signals that the red blood cells are regenerating, which also would indicate NOT from CKD.

When was Ginger's last ultrasound? I would probably do that while she is in the hospital to get some more possible answers about the anemia. The CREA in her bloodwork (kidneys values) is really not awful. So, if that is escalating now, I would really also consider an infection hypothesis and treat that for sure by hypothesis. If this was me and my cat!

 

[Dyana]

I'm a little too messed up right now, to post her blood work.
It's confusing as Dr. Mark Peterson pays using his account for her blood work every 6 months and I use my vet's account every (in between) every 6 months, so every 3 months she gets blook work (but not always the Hematology).
I just called the vet hospital and she is "resting comfortably, and ate for them.".
Her next blood work is scheduled for 10:00pm, and if I am awake can check back at 11:00pm. I am to take her ThyroTabs to them in the morning and can visit her then. And, I'll bring them her favorite food and treats.
Luckily, I work in an animal friendly envoriment.
The blood work on this account was from March of this year and June of last year.

 

[Dyana]

I think the hospital said her creatinine was 8 something and her bun was 130 and her phosphorus was 14. I'm not sure.
This is her last blood work from August 29th:

 

[Suzanne & Darcy]

I’m so sorry to hear about this!
In the past, my cats have had seizures as a result of high blood pressure. A listed side effect of Varenzin is high blood pressure. Here’s what the felinecrf site says about Varenzin.
Molidustat (Varenzin-CA1)

I have heard from a number of people over the last few years who have been participating in a double blind clinical trial of an anaemia treatment for CKD cats at various centres in the USA. Each cat has been given a treatment for 30 days, with blood tested once a week, and they do not know if their cat is receiving the new treatment or a placebo. From what I have heard, it appears to be a promising new treatment.

I now know this treatment is an HIF-PH inhibitor called molidustat. Elanco US Inc received conditional approval in the USA in May 2023 for molidustat (Varenzin-CA1) for the treatment of non-regenerative anaemia in cats with CKD.

Conditional approval means that the drug is considered safe and is reasonably likely to be effective, and therefore may be prescribed while further safety data are being collected. The conditional approval runs for a year but may be extended each year for an additional four years.

Food and Drug Administrationreports on the approval.

The medication is given once a day for up to 28 days. Possible side effects include vomiting, increased blood pressure and thromboembolism. According to Freedom of information summary application for conditional approval (2023), increases in creatinine and phosphorus levels were also seen, but the increases returned to their initial starting point when the treatment was stopped.

 

[Suzanne & Darcy]

. Had a seizure like episode in the afternoon (flailing with her front paw to get up, and then screamed), Very wobbily / weak? (can't jump as well),

This also is bothering me. What you describe sounds similar to what many people have described on a couple of my groups for cats with heart disease. That could be a sign of a clot (they are not always the saddle thromboses). I don’t know that the HCT at about 27 justifies the use of the Varenzin. If there’s a clotting concern there are better blood thinners for cats these days (Clopidogrel, Xarelto). I see that thromboembolism is a listed side effect as well. Is there a reason why the vet did go with an Erythropoietin Stimulating Agent (which have been used for a much longer time in cats) instead of the Varenzin?

 

[Suzanne & Darcy]

Oh and finally (sorry) are you a member pf the tanyackd support group on groups.io? There has been quite a bot of discussion on Varenzin in the group. I hope your Ginger is going to be okay!

 

[Suzanne & Darcy]

I’m praying for your Ginger to be okay. I’m glad she ate. I would stop the Varenzin. The felinecrf.org site has loads of information on anemia and the causes (which may not be due to lack of erythropoietin especially if the HCT is dropping rapidly as has been pointed out.) Has she ever had a cardiac ultrasound. I noticed her ProBNP was high. Is that why they prescribed aspirin? There are other heart medications that could possibly help her.

 

[Bron and Sheba (GA)]

Sending many healing vines for Ginger.

 

[Dyana]

I noticed her ProBNP was high. Is that why they prescribed aspirin? There are other heart medications that could possibly help her.

I'm going to visit her in a little bit, and will ask again about a cardiologist appointment while she's there.
Both my regular vet and the ER vet said they are not concerned with the proBNP being raised. I want her heart checked anyway.
She is prescribed aspirin because my regular vet said what I thought was seizures is probably mini strokes (a clot getting through).

 

[Dyana]

are you a member pf the tanyackd support group on groups.io? There has been quite a bot of discussion on Varenzin in the group.

I think I was once probably a decade or more ago. Is it an email group?

 

[Suzanne & Darcy]

I think I was once probably a decade or more ago. Is it an email group?

It is the email support group associated with the felinecrf.org website. That site is a wealth of information on chronic kidney disease and actually a lot of other cat health issues (including heart disease in cats that also have CKD and more.)
Aspirin is typically prescribed for cats no more than every 72 hours because of how long it takes them to metabolize it. Is that what you were doing? I would aak for Clopidogrel (usually it’s going to be 1/4 tablet once per day.). This is most likely what the cardiologist would/will prescribe. The Facebook group Cats With Blood Clots is run by a vet called Ten Lives (Facebook name) who has a clinic in England. They advocate the use of Nattokinase for clot prevention and also have many success stories of cats who have recovered from saddle thrombus with Nattokinase. I did think that the paw thing you described sounded like what others on that group have described. My Ginger was on two different blood thinners (Clopidogrel and Xarelto) but most cats with heart disease are prescribed Clopidogrel (Plavix) to start.

 

[Suzanne & Darcy]

How did you find Ginger to be doing?

 

[Dyana]

I just returned from my afternoon visit.

They say she is eating really good, which is good for her, because she is so picky. I was worried because she didn't eat much (anything) but treats on Sunday even after giving her Mirataz, and then on Monday, she didn't eat her breakfast, so at 8:00am instead of calling her regular vet who is off recovering from shoulder surgery, I called Crown Veterinary Specialists who are expensive, but have a good reputation. I must have said 5 times to them, she has to eat.
They said she is not on any appetite stimulants, and they are feeding her Friskies and dry kibble. Each time, I go visit I bring her a can of Fancy Feast and a Delectables Squeeze up.

I asked how she was and they said she is laying in her litter box and their cages are tiny (a couple feet wide). I put her on the floor so she could walk around a little.
She is still walking wobbily, but she often does that when she has been laying for a long time, and then gets better. I don't like that she doesn't get any exercise.
I now have Zobaline and will start that when she comes home because her back legs are wobbily (splayed out) and I swear she must use her front to legs to do all the jumping she does.

She did get to see the board certified cardiologist today for an echocardiogram (I think that's what it's called, I haven't looked at the paperwork yet), and I was told he saw some thickening of the heart wall? and a small cyst on some part. I was told that they could aspirate the cyst but that could cause bleeding. No thanks.
He (or the other vet) said to keep with the 100ml of fluids she is getting subQ every 3 days.

She said to stop the aspirin and it is not good for kidneys and to start the Plavix.

She also said that she is on the fence about giving meds for high blood pressure.
She wants to start them tonight if her blood pressure is 160 or above.
Ginger has alway had good blood pressure at her regular vet, where she goes all the time. I said, what if it's just being here? They say she is spicy and angry there. How do I know if it is just not being hospitalized that her blood pressure is raised, and if she starts the meds, which I guess she will tonight.. and she comes home, how will I know if her blood pressure is too low? I know nothing about blood pressure in humans or cats.

The urine culture did not find any bacteria, but she is sending it out for another type of blood culture that takes 3 days for results.

She said her kidney results are coming down slowly and it is a slow process.
I thought once they are on IV fluids that they go from Stage 4 to Stage 3 or 2, I guess I am wrong or need more patience. I kept asking for her numbers and she gave me a couple but kept saying don't look at the numbers, look at the cat....

Maybe, she will be released tomorrow... She has a vet appointment on Friday for her Solensia, and I can ask my regular vet to check her blood pressure then.

That's all I have for now. I'll go visit her again tomorrow morning, and maybe, maybe, she can come home tomorrow <3

Thanks for your prayers and responses. I appreciate you as I always have.

 

[SmallestSparrow]

Most of this is out of my realm but did the vet have an idea of why her eosinophil count was so high? In the species that walks upright it’s usually either parasites or an allergic reaction to something. I don’t know the significance of it in cats.