Bexacat/Senvelgo

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FrancesG50

FrancesG50

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I've done the best "homework" on this question, but I cannot find an answer and the vet is closed until Monday, December 30. If you start a cat on Senvelgo, can you switch to Bexacat? Bexacat was not even an option mentioned by my vet, but looking at things I think it might be a better choice. I know that after a cat uses insulin, it is not possible to switch to the other treatments, but I can find no information on the subject. Anyone had any experience with switching? Thanks.
 
Here is your first post for continuity.
https://www.felinediabetes.com/FDMB/threads/new-here-with-a-question-about-senvelgo.296945/
I can see Sienne gave you the information we have on the new oral medications for feline diabetes.
I have no idea of the oral treatments can be swapped around.
But do be careful. There have been some less than good outcomes with this new treatment.
Are you testing every day for ketones in the urine?
If not I would recommend you do. You will need some Ketostix from a pharmacy and collect a urine sample from your kitty. There should be no ketones. If there are tell this vet immediately.
 
Bron and Sheba (GA) said:
Here is your first post for continuity.
https://www.felinediabetes.com/FDMB/threads/new-here-with-a-question-about-senvelgo.296945/
I can see Sienne gave you the information we have on the new oral medications for feline diabetes.
I have no idea of the oral treatments can be swapped around.
But do be careful. There have been some less than good outcomes with this new treatment.
Are you testing every day for ketones in the urine?
If not I would recommend you do. You will need some Ketostix from a pharmacy and collect a urine sample from your kitty. There should be no ketones. If there are tell this vet immediately.
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Thanks. The vet will be checking for ketones on a regular basis. But if I feel the need to do so, I will collect and test regularly. I appreciate your help.
 
FrancesG50 said:
Thanks. The vet will be checking for ketones on a regular basis. But if I feel the need to do so, I will collect and test regularly. I appreciate your help.
Click to expand...
Please don’t leave that up to the vet. One of the problems with these oral medications is they can cause ketones to form quite quickly. If it were my cat I would be checking for ketones daily at the moment.
 
FrancesG50 said:
I've done the best "homework" on this question, but I cannot find an answer and the vet is closed until Monday, December 30. If you start a cat on Senvelgo, can you switch to Bexacat?
Click to expand...
Hi, Senvelgo and Bexacat are both the same type of drug, SGLT2 inhibitors, so in principle they do the same job.
However, one of the advantages of Senvelgo seems to be that it is a liquid medication, and therefore the dose can be adapted/reduced if necessary. And, as I understand it, that's not possible with Bexacat.

For some cats the recommended starting dose has been found to be too high, and needs to be reduced in order to avoid hypo. And some cats on Senvelgo and Bexacat will go into diabetic remission, and may need their dose reduced as their needs for the medication decrease.

It's helpful to try to learn to test blood glucose, as with cats on insulin. That would enable you to see how low your cat's blood glucose is dropping on the Bexacat.

And I second Bron's advice to be checking urine for ketones. Ketones can be an increased risk with these meds. A cat on these meds needs to be producing enough insulin of its own in order to enable normal glucose metabolism, sufficient for the body's basic needs. If it can't do that, then there's greater likelihood of ketones being produced.

Eliz
 
I agree with what the others noted. In theory, you should be able to switch. I've not seen any journal articles addressing the question, though. Keep in mind that the approval of the SGLT2 drugs for cats is relatively recent and the research with humans doesn't truly apply. A few ideas about getting information come to mind.
  • Your vet may have a colleague who can answer the question or your vet may subscribe to an online forum (e.g., VIN) where someone may be knowledgeable about these drugs.
  • The Feline Health Center at Cornell University College of Veterinary Medicine has a consultation service.
  • If there's a veterinary college near you, it's likely they have a pharmacy. One of the pharmacists there may be able to answer your question. Or, your vet can call. The pharmacists may be more likely to reply to a vet versus a caregiver.
 
In theory you can switch but can I ask why you want to switch?

there are two advantages for senvelgo over Bexacat that I can see: its size dosed (methos was on Bexacat but I worried that maybe he didn’t need an entire tablet and there’s no dosing besides one dose for all). And cost: I’m told the bottle of liquid is good for quite a while, and its size dosed so you can get a lot of doses from a bottle especially if your cat is smaller. Bexacat cost me WAY MORE every month than insulin. WAY MORE. But Methos wasn’t good about liquid and because of his tumor (not my convenience ) I didn’t want to be increasing his stress which could trigger tumor growth. But you should be able to switch

my vet insisted on home blood testing for ketones (and spot glucose testing) to be on Bexacat. I wouldn’t even consider not testing my cat at home for ketones. If you read the package insert for either drug you will see that many cats in the original study died. The only reason I had Methos on Bexa was I knew his diabetes (due to his tumor) would not respond to insulin. Otherwise it would not have been worth the risk. But everyone has different lives and reasons for what they do.

I hope you reconsider your decision about home testing for ketones. Testing urine at home is very cheap. Testing blood is easy. Pros and cons to each but you should consider doing one or the other. I also hope you are closely monitoring a full chemistry panel to include pancreatic enzymes, electrolytes and BUN/creatinine as well as liver function. These are the areas the cats who got really sick or died in the studies had problems. Because we checked Methos often we caught the damage to his pancreas early but six months later he hasn’t returned to normal.

re timing: a few minutes one way or the other shouldn’t hurt but otherwise you do need to keep on schedule—because you don’t want to give a dose too soon after a previous dose. You should ask your vet but for me, if it were my cat and I’d somehow given a dose an hour or two late I’d very slowly inch the dose back to the correct time over as many days as it took to inch back slowly

edit: way more was about $100 a month for Bexacat; I think this is comparable to a bottle of senvelgo except a bottle may last longer than a month. Glargine by comparison is $75 for 10ml which lasts many here 3 months or more.
 
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FrancesG50 said:
Thanks for the advice. Every bit helps.
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I understand that you don’t plan on testing and I apologize for telling you that you should without clearly explaining why. I know you’ve got a lot going on so it probably feels like something that takes time you don’t have.

I’m not a vet, I’m an MD- I wouldn’t have my cat on Bexa without testing because I understand how the drug works. Maybe you don’t. You can still choose not to test of course but let me explain how this drug works and why DKA is a risk. So you can make a more informed decision

normally your cat makes insulin in the pancreas and it lets her body take up the glucose from what she eats and use it in her cells. For this example we have a stream (her blood stream) with rubber ducks floating in it (glucose). There’s a narrow area where some ducks are held back and then shunted back to the start of the stream (in the kidney), while others float away (get peed out in urine). You have a net (insulin) to pull the ducks out (use the insulin). Too many ducks=disbetes.

SGLT2 drugs open the floodgate—the ducks are no longer recirculated (glucose not sent from kidney back to blood stream) but instead they all start to race downstream (get peed out). You can still grab the ducks (utilize glucose) with your net but need to be quick about it. If your net is damaged (cat makes less insulin) or worse you don’t have a net (cat can’t make insulin) then the cat isn’t getting any glucose from the food she eats. She will start to break down protein and fat in her own body as a last ditch effort to stay alive. The process she uses produces ketones snd makes her blood acidic and the resultant state is Diabetic Ketoscidosis (DKA) which can make her very sick and often leads to death. It can progress rapidly, and in cats on an SGLT2 their glucose tests are often normal (because they peed away any excess glucose ) rather than elevated as you normally see in diabetics (so can be misdiagnosed). If your kitty is vomiting or won’t eat in the middle of the night on a Saturday you’ll be glad to be able to test for ketones. I checked regularly just so I’d know at the very earliest stages—so hopefully my cat wouldn’t end up for days in the hospital, or worse.

it’s most important to be testing for the first few months but also anytime kitty acts sick. If kitty is sick on a Friday night it can’t wait until Monday for the vet to check. If it’s DKA it will be way too late. So being able to test saves worry and long waits in a pet ER for someone to test her. You can test urine (variety of ways to collect it) or blood (with a meter and pricking her ear). I chose blood because I didn’t want to have to wait until he peed to have an answer. Many others choose urine. Either way just takes minutes to do.

I hope things become less stressful for you
 
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