Giving oral meds a nightmare, I need help!!!

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Noah & me (GA)

Noah & me (GA)

Member Since 2016
Noah needs a lot of teeth extracted but that can't happen because he, like his 3 brothers and Mom and Dad, has cardiomyopathy. And his heart is so enlarged it's pushed through the sac so he has only a 10% chance of making it through the surgery. Cardiomyopathy "Broken Heart Syndrome" took his whole family away before the age of 8 so my wife and I have decided to just manage his oral pain and let him go. Cardiomyopathy is one of those things that goes undiagnosed and then one day their heart just gives up. So..... Noah handles the injections and the metering no problem but for his pain I have to give him Buprenorphine twice daily. It can only be administered orally. It's 30 times more powerful than morphine so I cannot just stop. A cat going through withdrawal without knowing what's going on would be cruel. He hates the taste so much he runs and hides if he knows what's coming. I'm now on our third taste variant, triple fish, but nothing works. I've had cats for 40 years and I've never seen anything like this.
DOES ANYONE HAVE A BETTER IDEA?
 
I'm so sorry about Noah's heart...

I don't know enough about pain management practices to know whether this is at all feasible, but when my impossible-to-pill cat needed pain meds for a week, my vet prescribed a fentanyl patch. I don't know if that would even be possible for a longer time period, or if it would even be effective for dental pain, but it might be something to ask your vet about. It's not something that can be applied at home, for a variety of reasons, so it would require vet visits at least every week, possibly more frequently, to swap out patches.
 
I used bupre for Smokey. It wasn't flavored. Started at 0.1 ml. It was such a tiny amount of liquid. I just squirted into the cheek. The vet gave me TB syringes (without needles) to use. They were thin and small. Smokey didn't seem to mind. It was in him before he knew he got it. I would stand behind him and just squirted into the corner of his mouth. He was never a problem giving meds to as long as they were liquid. Pills I had trouble with. He fought to hard and I was afraid I would knock his teeth out, they were so bad. As like you, he was cardiac and needed full mouth extraction but because of age vets wouldn't do it.
 
If it's the liquid he's objecting to, I use gabapentin compounded into 10 mg gelcaps for Regan, who has similar issues...desperately needs teeth removed, but she has an intermittent arrhythmia that makes anesthesia too risky. Depending on how long he's been on the bup, you might not have too much of an issue with withdrawal. I had dreadful problems getting bup into Rosa after her surgery - for some reason, even though it wasn't flavored, it was something she really, really objected to...yet she wasn't too difficult to pill generally. She came off it after a week, but there was no withdrawal that I noticed, even though she'd been on 0.25 ml bup and had also been on IV fentanyl for 48 hours following the surgery.
 
What freaked me out about the fentanyl patch. I had the lowest dose possible, 12.5 micrograms. If I had worn the patch as directed it would take 9.13 YEARS to absorb just 1 gram! That is why there is a "Fentanyl Crisis". I can't imagine what the security and containment would look like for the lab that makes this stuff. Of course we have a cat that loves to chew on plastic and when I took the patch out of the wrapper I had no idea it was so small and it landed somewhere on the kitchen floor! I locked all the cats in a room until I found the patch. I've done that math 100 times, it's no joke.
 
Larry, do you know if the injectable Buprenorphine is subcutaneous? You guys have just made my day so much better!
 
Losing track of the patch/having one of the cats chew on it and getting a megadose was a huge fear of mine when we used it. The amounts are much smaller in a cat-sized patch, of course-- but it's still enough to kill them if they ingest a whole week's worth at a time. If there's an alternative in the form of liquid bupe, it might be worth going that route just for the peace of mind...
 
For general info:

Care is needed when reducing buprenorphine dose/ceasing treatment: it can trigger surges in blood pressure.


Mogs
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Critter Mom said:
Care is needed when reducing buprenorphine dose/ceasing treatment: it can trigger surges in blood pressure.
Click to expand...
I didn't know that, Mogs. Thank you for the heads-up. With Rosa we were told to 'just stop it' at the end of the week - I had no idea how dangerous that could be!
 
manxcat419 said:
I had no idea how dangerous that could be!
Click to expand...
I think it was what triggered the eye haemmorhage. :(

Our vet didn't know about this potential issue either, April, but there's a wealth of reports online from humans who have experienced hypertension upon cessation of treatment with buprenorphine.

In Saoirse's case it was the only recent change. She was doing really well on the pancreatitis side of things and it was just after finishing her taper off the bupe that the problem hit. My baby ... :(


Mogs
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That makes me wonder about Rosa too, Mogs. She'd been doing so well for the first week after her surgery...it was around day 9, soon after we stopped the bup, that things started going wrong for her too. We didn't link the 2 at the time because it appeared to be something different...but now that's making me think maybe that contributed too. :(
 
I had a cat with CHF and a congenital deformity that should have killed him as a kitten but somehow he lived undiagnosed until he was 12. He was on 6 meds 4 times a day and I would hide them in enough wet food to cover them and wipe them into the back of his throat then kiss his forehead while gently rubbing his throat and he had no choice to swallow them. It worked wonderfully every time. He was a pro by the time kidney failure set in from the water pills then we had to put him down.
If it's not a pill I'm not sure how to help. The sub-q injection might be the way to go as long as it doesn't sting!
 
Dupe comes in a
N under the tongue pill or a patch(Butrans) the smallest size for humans might need to be cut down for a cat. They were really good for pan, but my copay was expensive. Things might havechanged. I would
talk to my vet.
 
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