Budenoside qs

[Laura and Quincy]

When I take my cat in for his next vet appt, I plan to discuss the pros and cons of starting him on budenoside for his IBD and small cell GI lymphoma. I know some people have been very pleased with its effectiveness for IBD (e.g., Cassandra of "Cassandra and Sasha" fame), but also that it's very powerful and the more inflammation that's present, the more drug absorption there is. I was wondering what the standard dose is, what side effects people have observed, and whether they've used the enteric or non-enteric coating kind. Just want to find out as much as I can before going in.

Any thoughts on questions to ask the vet are appreciated too. I'm pretty sure he's more interested in trying this rather than starting Quincy back up on prednisone, and I'm inclined to be more interested in pred alternatives too.

 

[Larry and Kitties]

The standard dose for cats is 1 mg sid. It is a human drug that is only available in 3 mg capsules. On name for the human capsules is Entocort EC. I talked to my pharmacist about getting the 3 mg capsules so I could divide them up a\to 1 mg and put them in capsules. However, he could not get them. I did find places to get the capsules for Canada but gave up. I get them from a compounding pharmacy. Mu guess is the the compounding pharmacy divides up the 3 mg capsules.

I have not really noticed any side effects..

 

[Laura and Quincy]

Thanks! I already use a good compounding pharmacy for Quincy's leukeran (chlorambucil), so I could likely use them for this drug too. I think some order online from Wedgewood Pharmacy too (?)

 

[Cassandra and Sasha]

I think some order online from Wedgewood Pharmacy too (?)

That's where I get Sasha's from. They make a tiny tab of it, which is really easy to use.

Side effects - Have seen a little bit of skin changes, but nothing too drastic. She has developed some blackhead type things on her stomach (shaved from her last u/s, so they are noticeable). She's had a couple of hematomas from insulin shots recently, and I am unsure if they are related or not. In the years prior to the Budesonide she never had one, despite daily insulin injections/antiemetics/B12/Adequan/etc, but she is getting older and may be more prone to them because of that. Water intake increased initially but then tapered off and is now back to normal. Very nice appetite increase. Stool now smells like fertilizer (as though you walked into a garden department of a home store) - this is a welcome change from how her stool used to smell. I have to attribute it to the Budesonide, as it started right after she began taking it.

but also that it's very powerful and the more inflammation that's present, the more drug absorption there is.

Once the inflammation begins to subside, so should the absorption. I went through a period of having to increase Sasha's insulin initially and then decrease rapidly recently, which I assume was the drug first being absorbed heavily and now that she is healing it is absorbed less.

ETA: We give 1mg SID, but I do believe that Joanna and Bix is using an increased dose now (Bix has been using it for awhile).

 

[Joanna & Bix (GA)]

Yep, that's us!

I have been happy with it and not noticed side effects. It started working pretty quickly for him - comparable to Pred - and was a good fix to the severe nausea he was having. He hasn't had a lot of pooper problems, so I can't vouch for it on that front, but it has worked great for him & stomach issues.

Bix started on 1mg SID and after a year or so started having a return of some nausea problems. I have gradually increased the dose when that has happened, as it has periodically. He is now on about 1mg BID. I switched to BID a while back in case it was affecting BGs (don't know) and also because I was often seeing nausea towards the end of the SID cycle. I found switching to BID allowed me to keep the same total 24 hr dose, rather than raising it again as an SID dose. (BID is off label, I just tried it and it has worked well.) I've tried a few times to reduce the dose (in theory one can do that) with a return of nausea in a couple days. :sad:

I get it from a compounding pharmacy too. His is a liquid, with chicken flavor. I'm not sure if that diminishes the effectiveness by not having the protected capsule.

For what it's worth (anecdotal anti-Pred story), Bix started on Budesonide a few years ago with a vet I was seeing temporarily while traveling and who was excited about it. He did great, but when I switched to a new vet who wasn't as familiar with it, like an idiot (FD unaware at the time) I agreed to switch him to Pred. After one year on that, guess what, diabetes. Bean has been kicking herself ever since. :-x So then it was back to Budesonide (the new vet in the meantime having researched it).

 

[Laura and Quincy]

Joanna,

Thanks for sharing your experience. When you swtiched from SID to BID, the total for the day was still 1 mg, right? Wasn't sure if you meant you doubled the dose, or just split it into two .50 doses. I remember my vet having me give Quincy prednisone BID in spite of my requests to do that SID because he mentioned SID being harder on the body / related more to diabetes problems.

 

[Joanna & Bix (GA)]

He had gradually needed some dose increases from the initial 1mg SID. By the time I switched to BID he was getting around 1.75mg SID, so now he gets something like 0.9mg BID. So yes I split the dose in half for BID. I don't know why Budesonide is typically only dosed SID - I have seen Pred both ways, and generally (I had another cat on it years ago) with higher doses the vet wanted it split out BID, but SID if it was just a low dose when he was doing well. I've never seen Budesonide recommended for BID though. I did find one study that mentioned it, that gave me the courage to try it nailbite_smile , but I don't still have the link.

 

[Jess & Earl]

Cassandra

Hi Cassandra

She's had a couple of hematomas from insulin shots recently, and I am unsure if they are related or not. In the years prior to the Budesonide she never had one, despite daily insulin injections/antiemetics/B12/Adequan/etc, but she is getting older and may be more prone to them because of that.

Is she really getting hematomas (blood blisters)? That is very concerning, if so. Even if they are bruises, and not hematomas, I would take her in for a workup. She is not on any new medication? She should get a full blood panel including coagulation profile (this requires citrated blood), and a urinalysis would be worthwhile too. Until the blood comes back normal, she should not have a cystocentesis or jugular venipuncture (make sure you remind them).

PS Sorry for threadjack.

 

[Cassandra and Sasha]

Re: Cassandra

Is she really getting hematomas (blood blisters)? That is very concerning, if so. Even if they are bruises, and not hematomas, I would take her in for a workup. She is not on any new medication? She should get a full blood panel including coagulation profile (this requires citrated blood), and a urinalysis would be worthwhile too. Until the blood comes back normal, she should not have a cystocentesis or jugular venipuncture (make sure you remind them).

Hey Jess,

I'm using the word hematoma when I probably shouldn't be....they are not fluid/blood filled or raised, just very large bruises. She's had two of them since starting the Budesonide, both from insulin shots (she gets other injections as well). In the two years since we started insulin she has never gotten one that I have seen, and for most of that time she was also getting many antiemetic injections, B12 shots, Adequan, fluids, etc. in addition to her insulin.

She does have full blood panels (CBC, SuperChem, Thyroid - plus sometimes other add on tests) run every 2 months now. I was having labs run every month, but since her clinical signs have resolved for the most part from her IBD and her lab values have been stable in other areas, we have backed off a little bit. She also usually has a urinalysis run every 2-3 months, and just had her last along with the last blood panels in December. In addition, a BP check is normally run about every 3 months at my request. All has been relative normal/stable for a kitty her age - coming up on 18. Her labs are in my signature if you would like to take a look and see if anything catches your eye.

I did let our vet know of both bruises, and she did see the last one. Since it was not raised, hardened, or fluid/blood filled, vettybean said that as long as the blood reabsorbed in a reasonable amount of time (she said 7 to 10 days was not uncommon), then she wasn't too concerned about it. Sasha is supposed to have new blood run on Wednesday of this week, and if you think a coagulation profile is a good idea then I'll add one in.

It is never easy to get a jugular draw on Sasha for all of the labs that are run. Apparently her jugular will flow for a short while and then stop, at which point they switch to her back leg. I don't know if this is common or has something to do with Sasha's age or the skill of the phlebotomist? We go to a large animal hospital and I find it hard to believe that no one there can do a blood draw well, including our own vet, but maybe?

The majority of her urinalysis samples have been cysto, except for some ones run last year where we were really just looking at the USG but I had them run in-house testing on it too.

I have a theory about the bruises - tell me if I am far off base with this. In the last few months, we have been giving Adequan injections every 2-3 weeks rather than once/month. As Adequan is related to Heparin, is it possible that this dosing schedule is just too much for her and is thinning her blood too much?

Final note - on the last bruise formation, I was actually able to see a drop of blood from the nicked capillary when I withdrew the insulin syringe. The first time I did not see that, or perhaps did not notice it. The second one was larger and darker than the first.

Sorry for throwing all of this info at you. Thank you for addressing it, and please do just let me know if you think I should do anything further about it. Our vet knows how OCD I am when it comes to exams and blood/urine workups, so asking her to add another one on wouldn't make her bat an eye. ;-)

My apologies for the hijack, Laura!

 

[Jess & Earl]

Re: Cassandra

Hi Cassandra

I will post again tonight as I have to leave for work soon. Off the top of my head, I'd say that steroids, too, can cause platelet abnormalities. As far as the Adequan as a heparin analog, IIRC, it would cause a reduction in platelets rather than platelet dysfunction (so you'd see a difference in the CBC) but I could have that mixed up. I'll look it up later. The short answer is yes, if I were you, I'd check a coag profile because why not? And avoid jugular venipuncture tomorrow.
Jess