Kusha, my 12-year Tonk, newly diagnosed diabetic, has not been eating properly. In fact, that was his initial symptom. It was taking me hours to get him to finish a meal. Since the weekend, he's been worse and stopped eating more or less completely yesterday. Didn't give him any insulin this morning because he wouldn't eat. Took him to the vet today to check on his hydration and the vet gave him mirtazapine as an appetite stimulant. Got home and checked it online and was aghast when I discovered that he'd given a 15mg dose when the recommendations I read were for 1/8 to 1/4 of a 15mg tab! Kusha started yowling, looking woozy, and wandering restlessly within an hour or so. Called the vet and asked him if he had prescribed that dose before and he said it was perfectly safe and that some cats would act like they'd had three martinis. Kusha is calmer now but the drug stays in the system up to 72 hours so I am terrified that he's going to have some kind of reaction or that it will have some irreversible effect on him. I read one story about a cat that died after taking it. Has anyone had any experience with it at the dosage Kusha got? Would appreciate advice/warnings about what to look for/reassurance.
mirtazapine
- Thread starter LilaKusha
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bookw0rm
Very Active Member
No experience with that dose, but Cass reacted that way on 1/4 pill. It cleared up a day ir so later. He did start eating but we didn't use any more.
Did the vet check for ketones? That can cause them to stop eating & can be a major problem. Also check for a uti or other infection.
Did the vet check for ketones? That can cause them to stop eating & can be a major problem. Also check for a uti or other infection.
Dyana
Very Active Member
I'm not an expert, but I have been around awhile. Normally, we give 1/4 tablet of a 15mg pill every 72 hours.
I have used Mirtazapine on a few occasions. Mostly, I carry it for when traveling and my cat doesn't want to eat in a strange place, or when he is on antibiotics and becomes inappetant. I usually have Cyproheptadine (which happens to be another appetite stimulant that you can use instead of Mirtz), on hand as the antidote for Serotonin syndrome.
Only one time did my cat display what I thought was restlessness and a tremor or two, and I was worried. After about 15 minutes, it passed. Attached is the information on Mirtazapine. Have you checked your cat for ketones?
It is very important that you check your cat for ketones, if he is diabetic and not eating.
Link to Mirtazapine information
Side Effects
The most common side effect of this medication is drowsiness.
Mirtazapine decreases cortisol secretion by the adrenal glands but has not actually panned out as a treatment for Cushing's syndrome, where excess adrenal steroids are produced by the adrenal glands.
Serotonin syndrome is a potential side effect should brain levels of serotonin get too high but this syndrome generally requires a combination of serotonin-increasing medications. Elevated heart rate, tremors/shivering, dilated pupils, difficulty breathing, elevated body temperature, or high blood pressure can all be signs of serotonin syndrome. Animals with serotonin syndrome sometimes demonstrate general hyperactivity. If there is any question that serotonin syndrome is occurring, cyproheptadine can be used as an antidote.
I have used Mirtazapine on a few occasions. Mostly, I carry it for when traveling and my cat doesn't want to eat in a strange place, or when he is on antibiotics and becomes inappetant. I usually have Cyproheptadine (which happens to be another appetite stimulant that you can use instead of Mirtz), on hand as the antidote for Serotonin syndrome.
Only one time did my cat display what I thought was restlessness and a tremor or two, and I was worried. After about 15 minutes, it passed. Attached is the information on Mirtazapine. Have you checked your cat for ketones?
It is very important that you check your cat for ketones, if he is diabetic and not eating.
Link to Mirtazapine information
Side Effects
The most common side effect of this medication is drowsiness.
Mirtazapine decreases cortisol secretion by the adrenal glands but has not actually panned out as a treatment for Cushing's syndrome, where excess adrenal steroids are produced by the adrenal glands.
Serotonin syndrome is a potential side effect should brain levels of serotonin get too high but this syndrome generally requires a combination of serotonin-increasing medications. Elevated heart rate, tremors/shivering, dilated pupils, difficulty breathing, elevated body temperature, or high blood pressure can all be signs of serotonin syndrome. Animals with serotonin syndrome sometimes demonstrate general hyperactivity. If there is any question that serotonin syndrome is occurring, cyproheptadine can be used as an antidote.
Dyana
Very Active Member
You can buy ketone test strips at any pharmacy, and if you don't already have them, I would go out and buy some now.
They are about $10 or so for a box, and you can buy them in the diabetic supplies area of the pharmacy. Some pharmacies keep them behind the counter and some have them out on the shelves.
They are about $10 or so for a box, and you can buy them in the diabetic supplies area of the pharmacy. Some pharmacies keep them behind the counter and some have them out on the shelves.
Lisa and Merlyn (GA)
Very Active Member
http://www.marvistavet.com/html/body_mirtazapine.html
Please print this for your vet. I cant believe your vet rxed 4X the dose for cats.. its liver and kidney toxic so cats with those issues should have even LESS.
The correct dose is given to cats 2x a week because it takes so long to be processed out of the body by the liver/kidneys.
Please print this for your vet. I cant believe your vet rxed 4X the dose for cats.. its liver and kidney toxic so cats with those issues should have even LESS.
The correct dose is given to cats 2x a week because it takes so long to be processed out of the body by the liver/kidneys.
Thanks for the responses. We're six hours into it and so far so good. Kusha is calmer and has eaten a little. I'm still scared because there are many hours before it will be out of his system - will be a long night, hopefully without a trip to the emergency room. Am worried about liver and kidney damage. His urine was checked for ketones yesterday - none present.
Kusha had no problems during the night - no bad reaction, and he ate frequently, so at least the appetite stimulant part of it worked. He really won't let us test his bg - he fights like crazy, so we don't know how much insulin to give him. He's very strong and he whips his head around so that the blood smears before we can get it to the meter. His last few numbers show a drop: 9/20 pm 232 (gave 1 unit), 9/21 am 108, 147 two hours later on retest (none, because he wasn't eating), couldn't get blood out of him last night (he ate, so we gave half a unit) or this morning (none yet). He has since eaten so there's no point in trying to test again, right?
dian and wheezer
Very Active Member
if you can get the blood on your finger, you can test it from there. glad all went well through the night
Kusha seems to be OK today (46 hours in). On advice from an online vet, I took him in for sub-q fluids yesterday to try to flush the drug out of his system sooner. Also had his liver and kidney values checked - mild elevation of one liver value, but apparently nothing of concern. He is at least eating somewhat but is refusing his raw food.Gave him FancyFeast to start with just to get him to eat something but have switched him to Evo. Managed to test his bg all by myself this morning!
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