5/15 Asia AMPS 345 Cerenia Info/Cerenia doesn’t work, read here

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Stacy & Asia

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http://www.felinediabetes.com/FDMB/threads/5-13-asia-amps-171-aha-an-important-observation.195515/

Asia is doing really well. There is one thing I gained from the vet visit fail on Saturday is that she needed and can have more pain meds than I was giving her. Currently she is getting 1.5mL bupe every 7 hours. I tried for every 8 and it was too long, every 6 was too close, so 7 it is. :rolleyes: We are about past post vet freak out numbers and hopefully that combined with no pain might bring her numbers back down a bit.

She is not in pain and that makes me happy. She spent a good amount of time playing with her bird toy last night and even chub run chased it down the hall a bit. Have to run out for several appointments this morning so hopefully she behaves.

PSA for the day on Cerenia:

So I noticed a trend on here that some people weren’t having much luck with Cerenia and ondansetron was being suggested as working better/working differently/used in conjunction with Cerenia to provide nausea relief. No doubt some cats respond better to one than the other or perhaps even need both, but I found some interesting info on how Cerenia is dosed and wanted to make it available because Cerenia works for 24 hours and ondansetron needs to be given multiple times a day. Which only means if Cerenia can work for your cat, it last a lot longer and is probably less expensive for needing to be given less frequently.

The first time Asia got Cerenia was at the vet’s office and it was an injection. It was a miracle for her, she wasn’t eating well and it was a game changer. I was sent home with a compounded liquid form. When the shot wore off and I gave the oral version, it did absolutely nothing. Asia stopped eating again. I wish I still had the bottle to see what the mg/mL was, but I threw it out long ago. I’ve been giving the sub-q injectable version ever since and we are both happier about that!

I came across some (outdated) info that Cerenia (maropitant) should be dosed 1mg/kg period. That info is still out there and likely some vets still unknowingly prescribe 1mg/kg regardless of oral or sub-q delivery. Then I found some info on the Merck Veterinary Manual and Plumb’s (like the PDR for veterinary drugs) and they both say the oral dose (PO) is essentially double the sub-q (SC) one. Thought that could explain (for some cases) why Cerenia wasn’t working for some cats.

From Plumb’s:

In cats, bioavailability is approximately 50% (PO) and 91% (SC). Protein plasma binding is high (99%). Maropitant displays linear kinetics when administered SC within the 0.25 – 3 mg/kg dose range. There appears to be an age-related effect on pharmacokinetics, as kittens (16 weeks of age) appear to have a faster clearance of maropitant than adults. Terminal elimination half-life is approximately 15 hours. Feline-related isoforms of CYP1A and CYP3A enzymes are involved in the hepatic biotransformation of maropitant in cats. Less than 1% of a dose is excreted unchanged in urine or feces.4,5"

From Merck Veterinary Manual:

A new class of antiemetic that appears to work at both the vomiting center and the CRTZ is the NK-1 receptor antagonist maropitant (1 mg/kg SC, once daily for up to 5 days; 2 mg/kg PO, once daily for up to 5 days; 8 mg/kg PO, once daily for up to 2 days for motion sickness). Maropitant was first introduced as a prophylactic for animals with cancer undergoing chemotherapy. Its use has been extended to effectively stop acute vomiting secondary to a wide variety of causes and for the treatment of motion sickness. The administration of maropitant includes a “washout” period (5 days on/2 days off for vomiting; 2 days on/3 days off for motion sickness). Mild, transient discomfort following SC injection may occur in some animals. The dose for cats has not yet been established but seems to be approximately one-half of the dose for dogs.

Even the Merck info seems to already be out of date as a cat dose had not yet been established and it doesn’t seem to be half the dose as is for dogs, but instead based on weight and growth stage/age. And Merck still lists 5 days as the maximum length of time for use. But they acknowledge the dosing is different depending on method of delivery.

So if you think Cerenia just doesn’t work for your cat, check your prescription bottle for the pill form and if it isn’t 2mg/kg or very close to, it likely isn’t a therapeutic dose for your cat and maybe have a discussion with your vet about it too so you can make the next cat’s life easier.
 
It's good to hear Asia was playing some last night and is not in pain. That is interesting on the Cerenia. Thanks for sharing. Sending prayers for Asia.
 
Wow re the cerenia and it explains a lot. Had same kinds of experiences with the differences in effect between the injectable and oral (pill). Thank you!
Vines for Asia feeling better❤️
 
That is interesting on the Cerenia. Jones has been on a 1/4 tab forever and it does the job I need it to for the most part. Though he has been on it for almost a year and a half now. There are days I think he needs a bigger dose but he does well on it.

So that would be 16mg tab = 4 mg which when he was at his lowest weight was 1mg/kg.


Happy to hear that Asia is feeling good.
 
She did mention that the injectable stings a decent amount.
It does which is why I opted for Anzemet with Doodles back in the day. It's way more expensive and you hear little about using it. Other than that I have little to no experience with nausea meds in my cats.

I'm glad Miss Asia is feeling good and playing with her toys! This is most important :bighug::bighug::bighug:
 
Question: Are vets willing to prescribe Cerenia in injectible form as needed?

I don’t see why not, it depends on your vet. Before Asia had diabetes I was prescribed injectable B12 to give her, in pre-loaded syringes. I’m sure they could give you pre-loaded Cerenia for something acute. I bought a bottle since I was giving it daily for a long time. It is supposed to sting and does not need to be refrigerated but they told me to keep it in the fridge so it stings less.

Oddly, it doesn’t seem to sting Asia at all, or if it does, she doesn’t react. It’s a lot more than Lantus, by comparison she would have about 50 units of Cerenia (no sting) compared to 1 unit of Lantus which stung her. Either she’s a weirdo or it depends on the cat if/what stings them. :rolleyes:
 
ASIA JUMPED ON THE COUCH! :woot::)

She hasn’t done that in many, many months! I thought she may never do it again since she got a little rounder than she used to be. :rolleyes: She has cat stairs too, so she just decided for whatever reason to jump up there instead. So happy for her! Adequan? Must be.
This is SOOOOO cool! I have a bottle of Adequan for civvie Noah but have been hesitant to start it because of his other issues he's been having. I know it works great...it helped Trixie and Mario so much, but I've been so nervous about getting Noah going on it. Asia jumping on the couch, though, has got me motivated! Yay Asia!!!
Question: Are vets willing to prescribe Cerenia in injectible form as needed?
My vet was willing to prescribe injectable Cerenia because she knew I knew how to do SubQ shots - however, it is cost-prohibitive to use regularly. At least at my vet, the injectable is something like $49 or $59 per shot! I know others have gotten it cheaper than that, but it was still too expensive to use regularly. (I have to say, though, I never did ask about getting a whole bottle of Cerenia...)
 
This is SOOOOO cool! I have a bottle of Adequan for civvie Noah but have been hesitant to start it because of his other issues he's been having. I know it works great...it helped Trixie and Mario so much, but I've been so nervous about getting Noah going on it. Asia jumping on the couch, though, has got me motivated! Yay Asia!!!

My vet was willing to prescribe injectable Cerenia because she knew I knew how to do SubQ shots - however, it is cost-prohibitive to use regularly. At least at my vet, the injectable is something like $49 or $59 per shot! I know others have gotten it cheaper than that, but it was still too expensive to use regularly. (I have to say, though, I never did ask about getting a whole bottle of Cerenia...)

If this chubster can do it, Noah can too! :joyful:

The 20mL Cerenia bottle for me is $157 usd...and that’s a NYC price which is often double of what it would be elsewhere. If they charge $50 a shot, it would be much more economical to get the whole bottle even if for acute/occasional use. My bottle expires in 7/20 so it will last a good long time. Onda was brand name Zofran, I had that when I had HG with my pregnancies, there was no generic at the time and I needed it 3 times a day, I want to say it was $30 a pill or something crazy like that. My insurance would only pay for 15 a month. It was a rough time financially for us because of that! :facepalm:
 
If this chubster can do it, Noah can too! :joyful:

The 20mL Cerenia bottle for me is $157 usd...and that’s a NYC price which is often double of what it would be elsewhere. If they charge $50 a shot, it would be much more economical to get the whole bottle even if for acute/occasional use. My bottle expires in 7/20 so it will last a good long time. Onda was brand name Zofran, I had that when I had HG with my pregnancies, there was no generic at the time and I needed it 3 times a day, I want to say it was $30 a pill or something crazy like that. My insurance would only pay for 15 a month. It was a rough time financially for us because of that! :facepalm:
Wow....$30 a pill! I got some Zofran for Trix when she had her first big p-titis flare; it was $7 a pill and I thought that was bad! Worse than that, the vial of ondansetron was something like $19 - but it had to be ordered (and I did order it) whereas I could get the pills immediately.

I'll keep in mind about ordering a bottle of Cerenia next time (which I hope never happens, of course!). However, does that expiration date mean before the seal is punctured, or after? Technically, Lantus has a 1 year expiration date, but that drops to 28 days once the seal is punctured.
 
However, does that expiration date mean before the seal is punctured, or after? Technically, Lantus has a 1 year expiration date, but that drops to 28 days once the seal is punctured.

I’m sure the package insert says whatever time after first puncture, but I asked the vet about it and they said they use it until it’s gone. It probably has a lot of preservatives and if it’s in the refrigerator, hopefully not so many baddies can get in there. At the price you have to pay per shot though, you would start saving money even if you only used it four times!
 
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I’m sure the package insert says whatever time after first puncture, but I asked the vet about it and they said they use it until it’s gone. It probably has a lot of preservatives and if it’s in the refrigerator, hopefully not so many baddies can get in there. At the price you have to pay per shot though, you would start saving money even if you only used it for times!
Good to know - thanks!
 
I have shared before on other condos but will post it again here. Best pricing I have found for Cerenia tablets is here

https://www.kvsupply.com/item/cerenia-tablets-4-pack/496933/

They will call your vet for authorization so if your vet will let you use online pharmacy they are very easy to deal with. I usually get minimum of 2 boxes of the 24mg (6mg per 1/4 pill). Cost per box $12.99. They do charge a minimal shipping fee ($5?). You place your order and when checking out there is a place to enter your vet info. After I place the order I send my vet an email with KV Supply info and order confirmation # and ask them to approve (as a heads up). Orders are received within a week of the vet approving.

Thriving pets has Ondan. I have not ordered any from them. I was given a bunch from a member here but compared to some prices y'all have posted their pricing looks good.

http://www.thrivingpets.com/index.php/ondansetron-zofran.html
 
Hey Stacey! I missed your condo yesterday and am glad to see that Asia is pain free and jumped up on the couch. :woot: Good information on your thread about pain meds. I think I will keep this in my file. :bighug:
 
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