10/21 - Fitzel - AMPS-253/+4-133/PMPS-224

[Shai and The Pirate Fitz (GA)]

Pirate Fitzel's Condo Cove

Recap of last couple days:

10/19 - AMPS-304
+2.75-260
+10-225
PMPS-220

10/20 - AMPS-132
+2- 106
+7-199
PMPS-233

I gave Fitz an appy pill yesterday and she was so agitated. It's the Mirtazapine 15mg tablet - 1/4 pill. She was meowing and meowing and so unsettled. Moving around and not settling any place. Today, it's like she's exhausted. Has anyone had this issue with an appy pill? She needs something for her appy as it's not very good, but I'm not going to give this again. I intend to let the vet know and see if there's something else.

Otherwise, as you can see, her numbers are hideous. Just all over the map. I think we're still dealing with the vetty visit. I'm also wondering if the Lantus vial is coming to the end of it's effectiveness. It's the same one we started with back on June 28, so that might be a factor.

I want to say congrats to all who are doing so well, and those on OTJ trials. Healing vines to all in need and a special heartfelt thank you to everyone who expressed their concern and love to The Pirate and me. My eyesight and issues with same are keeping me off line mostly. I'm having a hard time reading what has been written and hoping I'm not making mistakes in my responses. Never was much of a touch typist. :sad:

Shai

 

[rhiannon and shadow (GA)]

Re: 10/21 - Fitzel - AMPS-253/+4-133

Appy vines for Fitzel.
It does sound like a reaction to the medicine. I found this for you.
try pushing Ctrl + to make the font bigger so you can see it.

Mirtazapine:
In recent years a drug called Mirtazapine (trade name is Remeron in the USA and Zispin in the UK) has become increasingly popular as an appetite stimulant for CKD cats. Mirtazapine is actually an anti-depressant but in small doses it can cause an increase in appetite. It may also have anti-emetic (anti-vomiting) properties.



Mirtazapine must be used with caution in anyone with renal problems. It should also be used with caution in cats with hyperthyroidism or liver problems.



A commonly used dose in CKD cats is ⅛ to ¼ of a 15 mg tablet every 3 days. However, a recently completed study at Colorado State University, The pharmacokinetics of mirtazapine in cats with chronic kidney disease and in age-matched control cats (2011) Quimby JM, Gustafson DL & Lunn KF Journal of Veterinary Internal Medicine 25(5) pp985-9, found that the half life of the drug (the time it takes to leave the body after taking it) is shorter than originally thought. The Veterinary Teaching Hospital at Colorado State University therefore considers it safe to give mirtazapine every other day, but always start with ⅛ of a 15mg tablet. It usually takes effect pretty quickly, within a few hours, though it works more quickly for some cats. If you wish to participate in further mirtazapine studies at Colorado State University, see below.



As a tetracyclic anti-depressant, mirtazapine may cause an increase in blood pressure and heart rate. It may increase cholesterol levels. Like cyproheptadine, it may make some cats restless, agitated and vocal (to such an extent in some cases that it is known on Tanya's CRF Support Group as meowzapine), although around 50% of human patients on mirtazapine feel sleepy.



Most people I have heard from have not had problems with mirtazapine, but I have heard from a couple of people whose cats were on treatment for hyperthyroidism who did not seem to do well on mirtazapine. This is probably because methimazole, a commonly used medication for hyperthyroidism, reduces levels of a liver enzyme called CYP2D6 which helps to clear mirtazapine from the body. The University of Maryland Medical Center (click on Drug Interactions) has some information about this. If your cat is on methimazole and you want to use mirtazapine, I would talk to your vet about using a reduced dose of mirtazapine.



A few years ago I heard from a lady whose CKD cat had an extremely severe reaction to mirtazapine, and since the medication takes a long time to clear from the cat's body, her cat's reaction lasted for around three days. A poison centre was unable to offer any suggestions, so she just had to wait for the drug to work its way out of her cat's system. I have since learnt that when cats react badly to mirtazapine, it is often because their bodies are creating too much of a hormone called serotonin. Mirtazapine is supposed to stop serotonin being bound to receptors in nerve cells, but this may cause too much serotonin to accumulate in the cat's brain instead, which leads to a condition called serotonin syndrome. Symptoms of serotonin syndrome include a fast heart rate, hypertension (including dilated pupils), excessive vocalisation (meowing loudly or howling), being "spaced out", walking strangely, stumbling, pacing up and down, breathing problems such as panting or breathing very fast, and agitation. Although this reaction is not common, I have since heard from several other people whose cat experienced it, so be aware of the possibility, and be sure to start with a really small dose. Mar Vista Vet mentions that the risk of serotonin syndrome is higher if you are using a painkiller called tramadol at the same time.



The antidote for serotonin syndrome caused by mirtazapine is actually another drug commonly used as an appetite stimulant in cats, cyproheptadine. Treatment of the serotonin syndrome with cyproheptadine (1998) Graudins A, Stearman A & Chan B The Journal of Emergency Medicine 16(4) pp615-9 explains more about this. One possible dose would be 2mg given twice within the first 24 hours, followed by 1 mg given twice daily for the next 48 hours; but do not give this without your vet's knowledge and approval. I would recommend actually taking your cat to the vet if you think s/he is suffering from serotonin syndrome because other treatments such as IV fluids may also be necessary.



Mirtazapine does seem to work pretty well as an appetite stimulant in cats but for most cats I think I would try cyproheptadine first. If you do opt to use it with your vet's blessing, please be sure to monitor blood pressure.



The US National Library of Medicine explains more about serotonin syndrome.

Veterinary Partner has information about the use of mirtazapine in cats. It mentions that it may help with nausea as well as appetite.

Net Doctor has some information about the use of mirtazapine in humans.

Medicine Net also has information about the use of mirtazapine in humans.

 

[Shai and The Pirate Fitz (GA)]

@Rhiannon- thank you for your post. That's exactly what Fitz was doing. All that meowing and agitation. She's better today and tonight. At least now I know. I really appreciate you finding that and posting it.

Her PMPS number is awful. My poor pirate. When are you going to come back into consistent blue/green territory?

Thank you also for the suggestion about enlarging the print. I wish that was my issue. I have corneal damage and can't quite focus things up close anymore. Makes reading and typing like trying to solidify a single image out of a prism.

Judith's reading off the numbers from tests and filling syringes. I'm giving the shots and the pain meds and of course the treats. cat_pet_icon

Shai