7/6 Max AMPS 113 +3 220 +7 112 +10 103 PMPS 100 +2 40,45,53 +3 63 +4 71 +5 121 +6 189

I’ve read somewhere that Mirataz cannot be used with Ondansetron, so is there another appetite stimulant that can be used on a cat who takes Ondansetron and Cerenia daily? I’m having an extremely difficult time getting Max to eat. He did eat a little Friskies pate and some baked chicken but I am trying to monitor the phosphorus content in his food because of proteinuria and possible early kidney disease. He has become very picky all of a sudden with his usual Weruva food, EZ mix, and Instinct foods. This boy is driving me crazy. He’s otherwise doing great. Running up the stairs, jumping on furniture, doing things I haven’t seen him do in over a year. It’s just the food pickiness. I’ve got a call in to his vet to ask for recommendations but wanted to know what I could ask for specifically. Anyone is welcome to comment, but I will tag those of you who usually share good advice for us. Thank you! @Wendy&Neko @tiffmaxee @FrostD @Suzanne & Darcy
 
I used cyproheptadine as my appetite stimulant and found it worked better for my cats. It’s what was used before mirt existed. Just a sliver worked for Max and it can be given twice a day. Tiffany was given 1/4 a 4mg but never thought to try less back then. You need an RX as it’s a human medication. I’ve also had luck with 1/4 a 10mg Zyrtec allergy pill.

When Max got picky it was pancreatitis starting.
 
You can use Miritaz and Ondansetron together. Done it myself. Just give the ondansetron about 30 minutes ahead of the Miritaz.
 
Wendy&Neko said:
You can use Miritaz and Ondansetron together. Done it myself. Just give the ondansetron about 30 minutes ahead of the Miritaz.
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Oh okay! Thanks Wendy. I know he’s not going to eat as much as he did when his BG was much higher or when the growth hormone was so abundant in his system, but for a cat his size (19 pounds) I’m having to try so many things to get him to eat. He tries to bury the food on the floor like he’s used the litter box lol. I don’t understand it. He’s always been a good eater even before he was diabetic. It makes me wonder if something else is going on but he acts like he feels fine. Any ideas come to mind?
 
tiffmaxee said:
I used cyproheptadine as my appetite stimulant and found it worked better for my cats. It’s what was used before mirt existed. Just a sliver worked for Max and it can be given twice a day. Tiffany was given 1/4 a 4mg but never thought to try less back then. You need an RX as it’s a human medication. I’ve also had luck with 1/4 a 10mg Zyrtec allergy pill.

When Max got picky it was pancreatitis starting.
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I’m guessing that’s probably the issue. He seems to keep that problem. He doesn’t act nauseous or vomiting though, just picky.
 
Max & Lori said:
I’ve read somewhere that Mirataz cannot be used with Ondansetron, so is there another appetite stimulant that can be used on a cat who takes Ondansetron and Cerenia daily? I’m having an extremely difficult time getting Max to eat. He did eat a little Friskies pate and some baked chicken but I am trying to monitor the phosphorus content in his food because of proteinuria and possible early kidney disease. He has become very picky all of a sudden with his usual Weruva food, EZ mix, and Instinct foods. This boy is driving me crazy. He’s otherwise doing great. Running up the stairs, jumping on furniture, doing things I haven’t seen him do in over a year. It’s just the food pickiness. I’ve got a call in to his vet to ask for recommendations but wanted to know what I could ask for specifically. Anyone is welcome to comment, but I will tag those of you who usually share good advice for us. Thank you! @Wendy&Neko @tiffmaxee @FrostD @Suzanne & Darcy
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All I can say is that I have used both Mirataz and Ondansetron at the same time (same days) in my CKD cats. Where did you read that they should not be used together? Can you find that anywhere? I'd like to read it. Since my vet prescribed both the Mirataz and the Ondansetron, I would be surprised if they aren't supposed to be used together. Also, tons of people on the tanyackd support group (the support group of felinecrf.org) use Mirataz and Ondansetron (and Cerenia, too) all at the same time.
 
OBTW, I have used cyproheptadine as well. Sometimes I have alternated between that an Mirataz in my cats. Also, I can say that in some cats the Mirt works better, in others the cypro works better.

There is also another appetite stimulant called Entyce. I personally have never used it yet (thank heaven I've not had to.)
 
Suzanne & Darcy said:
All I can say is that I have used both Mirataz and Ondansetron at the same time (same days) in my CKD cats. Where did you read that they should not be used together? Can you find that anywhere? I'd like to read it. Since my vet prescribed both the Mirataz and the Ondansetron, I would be surprised if they aren't supposed to be used together. Also, tons of people on the tanyackd support group (the support group of felinecrf.org) use Mirataz and Ondansetron (and Cerenia, too) all at the same time.
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I may be mistaken on these two meds as I cannot find where I read that but I remember it mentioning serotonin syndrome. I’ve wanted to use those together before, but didn’t because of what I read. Like I said, maybe I’m not remembering the right thing. Good to know I can use both.
 
Max & Lori said:
serotonin syndrome.
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Overuse of Mirataz can definitely cause serotonin syndrome. That's why I only ever gave my cats half the recommended dose every other day. But every cat is different. Some cats can tolerate it every day. Ondansetron does selectively inhibit serotonin receptors. Here's what the felinecrf.org site has to say about it:

"There is some debate as to whether ondansetron causes serotonin syndrome. The US Food and Drug Administration states that it may, though it says that "The majority of reports of serotonin syndrome related to 5-HT3 receptor antagonist use occurred in a post-anesthesia care unit or an infusion center." It also says that serotonin syndrome is more common when given at the same time as medications such as mirtazapine (used in CKD cats as an appetite stimulant). Drugs also mentions that using ondansetron and mirtazapine together may increase the risk. However, Can 5-HT3 antagonists really contribute to serotonin toxicity? A call for clarity and pharmacological law and order (2014) Rojas-Fernandez CH Drugs - Real World Outcomes 1(1) pp 3–5 disputes that ondansetron causes serotonin syndrome. Discuss with your vet whether to give both medications, and if you do so, give them at least two hours apart"
 
Okay, thanks for that Suzanne. When my vet calls me back, I will see what she tells me. It makes me feel better to know that some others of you have used them together. Max is a full time job. Seems like I never retired from work lol. Thank you!
 
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Well everyone else had you covered, but I always used both (just spaced out to not stimulate the appetite of a nauseous cat).

Agree with Elise, both times Mr Kitty got weird/picky it was pancreatitis. But another time it was something more serious. Max also has IBD so that may be affecting things, CKD too. When were his last labs? I think someone else mentioned similar troubles when the CKD progressed.

Bottom line, the usual! Just keep an eye on him.
 
Thanks Melissa. I’m kind of thinking pancreatitis again. Seems like that’s a constant thing. I had no choice and gave him higher carb food and syrup a couple of days ago to bring him up from dropping in the 40’s. It took quite a bit…that may have aggravated it since it was a change from his usual diet. He doesn’t seem nauseous though. He ate that friskie’s pate like he loved it. I hope it’s not his kidneys. He’s scheduled for labs 7/22. He gets labs every 3 months.
 
Entice is the dog version, Elura is the cat version. It is contraindicated for cats with acromegaly. It stimulates excess growth hormone production, one thing Max does not need!

When I get back to my computer I will try to post the link to the bit about serotonin syndrome in cats on ondansetron not being true. Also, current Miritaz dosing is way less than what was traditionally used in pill format, so less risk there too. Plus Miritaz is absorbed more slowly.
 
Just FYI Max’s vet just called me back and said he can use Mirataz with his Ondansetron. I’d already used it after checking with y’all so thanks a bunch. He ate a good dinner and has been very playful, so I’m not sure what his deal is with his food. Thanks again!
 
I just checked Max and he is 40! That’s a human meter. I rechecked on alpha track pet meter and got 61. I have just given him some karo syrup (2 ccs) in his regular LC food. He is acting okay. What in the world?!?
 
No worries about too much syrup this early in the cycle. Please update the spreadsheet.

I rather suspect he's in a "active SRT" mode and a number of those tumour cells have died out. Depending how this cycle goes, might be worth a 1.0 unit reduction. Note for lurkers, this is only for Max who looks like he's in a downhill portion of the post SRT roller coaster.
 
We are having a really bad storm and my internet keeps going out in case I disappear. I don’t have good cellular service where I live. Rechecking him now.
 
Whew! Will he eat a little LC or MC now. Not much, don't overfill. So maybe a couple tsps. And test again in 30.

If you can, please update the subject line to show he's above 50 and remove the 911.
 
Let's see where he is 30 after than last test. You'll need to keep testing for a couple hours after last syrup to make sure he doesn't wobble back down.
 
Wendy&Neko said:
How about sticking to LC now, to make sure those numbers aren't influenced by carbs.
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Okay he hasn’t eaten since that last MC. He’s asleep in his bed. Just recheck on an hour okay, or wait 2 hours since that last MC? I probably can’t go to sleep anyway so I will be up for a while. Thank you Wendy.
 
So was that 71 @3.5? You can mark the spreadsheet as 65;71@+3.5. I'd start with a recheck in an hour and see where to go from there.
 
Now he is 121. That’s 1 hour and 15 mins since that 71 and when he ate the MC, so +5. I guess all the syrup and carbs have caught up with him. I should reduce by 1 unit tomorrow right? That was quite a lot of syrup and I also think we have some pancreatitis going on so not sure how his tummy will be tomorrow. But then again he may bounce. What do you think?
 
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"Normally" you'd do a 0.5 unit reduction. But with a post SRT cat sometimes you have to break a few reduction rules. This was also only 4 cycles after a BCS. He went from 9.0 to 8.5 units in 5 cycles, now 5 cycles to the next reduction. I think what size reduction you do depends a lot on you. How much you can monitor the next few days, how you think he's doing. As for bouncing, look how long he bounced last time - a few hours maybe?
 
Wendy&Neko said:
How much you can monitor the next few days, how you think he's doing. As for bouncing, look how long he bounced last time - a few hours maybe?
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I see what you mean. I’m pretty good at making time to monitor him, most of the time anyway. I’m concerned about his tummy too though. I will go with the 1 unit reduction and see how he does. Is that what you would do? I can always go up if I need to right? It’s been 2 hours since the carbs now and he has already shot up to 189. Good grief, was that a bounce already??? I guess I can go to bed now. He will probably be on the moon in the morning unless it’s another short bounce. This is really tricky, but I’m so glad he’s making some progress. Thanks again for sticking with us!
 
Thanks for this link. It’s kind of sad that false information gets out there that may inhibit someone from getting or taking an RX they really need. Good to know.
 
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