Cerenia

Scruffy's not doing very well. I can't talk about it. Anyway, the vet has suggested cerenia. I haven't even touched a syringe since The Puffer went off insulin almost four years ago, so the injectible form of cerenia makes me a little nervous to start with. The vet also said - and I've searched and read for hours in the last two days without finding any mention of this - that it stings significantly. I saw several mentions here about dosages that are smaller than I was told to give, and about some restrictions on how long it can be used. I also saw that cerenia was meant to treat vomiting. Scruffy's problem appears to be more in the area of nausea - lots of lip-licking; He is very rarely throwing up, and when he has in the last few days, it's been foam. Anyway, I came home last night with four 4 mg tablets, ($3 each) and gave Scruffy the first one last night. He seemed mildly interested in food within a couple of hours, but not sufficiently to avoid liver problems in the frighteningly near future. And he was hungry this morning, but all he ate was a few pieces of kitten chow dredged in Fancy Feast. (I have food to give him by kitten bottle warming now.)

I would appreciate any information about cerenia that you guys have, like 1) pros and cons of using the pills or the injectible, 2) how long to allow between giving the medication and when he is most likely to want to eat, 3) did it appear that this medication caused pain when injected, 4) might ondansetron be a better choice, since there's a lack of vomiting and it seems to be aimed at reduction of nausea, and anything else that might be significant in using this stuff. I couldn't find it listed as cerenia or its generic name at any local pharmacy, but the WalMart website, which has a section for "pet meds", didn't seem to be working last night. My vet keeps a very minimal inventory of drugs; I don't know if I'd have to wait for him to order an injectible or what.

 

Hi guys .. no advice from me on any of those meds .. Just get well wishes for Scruffy ..

 

Hi Lynda,

I am sorry to hear Scruffy is not feeling well. I don't have any info on Cerenia or ondansetron, but I asked someone who I know is familiar with it, as well as a couple others. Hopefully they will check in soon.

Hang in there. I know how hard it is when they can't or won't eat. ((((((Lynda))))))

 

If you give the Cerenia injection when it's cold it stings less. Sammy had to take it a few weeks ago, he was licking his lips and swallowing so much air. He was dx with asthma, first time he got this dx was in 2007, same symptoms, licking lips, swallowing air, xrays showing air in his chest and donuts showing the inflammation.

Back then and this time, we did two Cerenia injections about 24 hours apart and also some steroids to help him start eating again. For Sammy I think it was the steroid that helped the most.

 

HI Lynda, I'm sorry I don't have any info on Cerenia. I have used Zofran and Omeprazole (done at a compounding pharmacy) for nausea successfully. I have also tried 1/4 tablet of pepcid but that never seemed to do much with my cats. I sure hope Scruffy feels better soon. Hugs, Jan

 

I used cerenia for Latte and felt it made a world of difference, mainly when she was given the injectible. I believe injectible worked better for her because she had some digestive issues (ibd/lymphoma). I do not think she absorbed the entire 'contents' of the pill when given. The shot did wonders. It was the only medicine I could not for the life of me get my vet to let me take home in the injectible form, so I never administered it and cant tell you if I thought it stung her. It is possible, but Im sure did not last more than a few seconds. Well worth no more vomiting! (I *think* she would have agreed too!)

It is usually used for vomiting not so much just nausea. That does not mean it isnt worth trying. We always used it as a 'last resort'. The dosage, I believe, is half of a dogs. The general rule is 1x/day, no more than 5 days in a row because it has potential to build up in their system. As Latte progressed, we messed around with that schedule and did it a little differently. There is not a generic form of it. As you can see it is pretty expensive. It actually looks like the price has gone down drastically. I think we were paying about $6+ per pill or injection. :sad:

If I remember correctly you want to avoid giving the pill wrapped in a treat or in food. It is most effective if you give it straight, washed down with a little water of course!

It can be used in conjunction with ondansetron and/or pepcid. We used all three at the same time.

I think if you do a search for cerenia in the forums you will see many people have had experience using it.

As for the eating, I do not know what you have tried or what is going on with Scruffy. Im very sorry he is not doing well.
Have you been offered an appetite stimulant along with the anti nausea/vomiting meds? Babyfood, chicken, turkey, food straight from the can vs bowl, spoon feeding, dry, tuna, fortiflora, treats sprinkled over food, yogurt, cottage cheese, etc?

I hope things turn around quickly. I will never forget how stressful it is to have a cat that does not feel well enough to eat.

:YMHUG: to both of you!

 

Hi Lynda - sending healing prayers to Scruffy.

(((hugs)))

 

oh poop. know nothing about question but maybe some fluids may perk the puffer up??

 

Re: Thank you all.

I appreciate all the thoughts and information. I did search here and read a whole bunch of posts from people who used cerenia. (Didn't see any mention about the stinging, though.)

Carolyn - he's really hard to pill - you think I can't use my Pill Pockets? Rats.

Jennifer - Do you mean that this is only for short term use? Is it supposed to make him better that quickly? What if the cause of the nausea is still there, unchanged?

Jan - I guess I'm gonna stop worrying about whether cerenia's the right drug - the lip-licking has totally disappeared, so I'm assuming it's working well enough.

Dian - he's got serious PU/PD going on. Worse than it was in all those years he was diabetic. I'm waiting for the vet to call me, I guess I could ask about fluids. Not that I have ever done it, of course. Poor Scruffy - get terribly sick and then have to depend on me to take care of him....... (

 

Hi, Lynda, I recognize several of the meds mentioned above as the same ones given to my mother when she had severe digestive problems - she stopped eating. Several medical doctors insisted on using pills as opposed to injections, even when available, of course. The doctors associated with medical schools always recommended injections because digestive issues often preclude proper absorption of oral meds. I imagine it must be the same with kitties. That simply makes "gut sense."

Re not eating, I have a cat who adores catknip, will lick the floor to get every last bit of it. I put lots of crushed catnip over a bit of water softened food and she'll eat it even when not eating out of a dish. When sick, she'll eat bits of food off my finger, though not out of a dish - though I imagine you've tried this. With many health hugs for both of you, Sophie

 

Hi Lynda & Scruffy,

Vicky flagged me to come look at your post as I have used Cerenia, Zofrm (ondansetron) and Anzemet (dolasetron), which is in the same drug family as Zofram, with my Harley who has diabetes, pancreatitis and IBD. I see you've already received some great replies so I won't repeat some of what's been already stated.

I've used the injectible Cerenia with my Harley to stop vomiting and as Jennifer said, I refrigerate mine so that it doesn't sting as much when administered. Although vets do tend to prescribe it as an anti-nausea med, the manufacturer only states that Cerenia is intended to stop vomiting. There is some new research coming out which suggests that Cerneia has anti-inflamatory and analgesic effects in addition to the anti-vomiting effects. So I can see why vets turn to it when they think it is a case of GI upset. The injectible form is given once a day and each dose lasts 24-36 hours. It should be discontinued after 4 or 5 days as another poster said because it does build up in the body. After 2 days off, Cerenia can be resumed. I did not find it to be effective at controlling Harley's nausea though. It stopped his vomiting and made him a little sleepy, but he still didn't want to each much. But I don't want to color your experience with mine - if you feel it is working for Scruffy, then use it as directed by your vet.

I have had much better luck with using Zofram (ondansetron) and Anzemet (dolasetron) with Harley and also my Exocrine Pancreatic Insufficiency kitty, Princess, to control nausea. Both ondansetron and Anzemet are human anti-nausea drugs used to treat patients undergoing chemotherapy drugs and are available online or through your local pharmacy. Of the two, ondansetron is the the cheaper and it comes in both 4 mg and 8 mg pills and 4 mg/2ml injectible vials. I get mine from Thriving Pets. If you find the Cerenia alone is not helping Scruffy, then as Carolyn said, you can add in the ondansetron - both drugs can be given together without any side effects. The typical starting dose is 1 mg every 8 or 12 hours. If you are using pills, I suggest getting some gelatin capsules to put them in so Scruffy doesn't taste them. These drugs are very, very bitter and if a kitty associates the bitter taste with something like food (e.g. pill pocket) it could cause a food aversion to that particular item. Just what you don't need - more problems!

I also mentioned Anzemet (dolasetron) which is in the same drug family as Zofram (ondansetron) because that is the drug that works best for my Harley. It comes in pills but they are such a large dose that they'd have to be compounded to get small enough dose for a cat. So it's generally dispensed as an injectible instead. It is super expensive though so if you have to start with an anti-nausea drug I'd recommend the Zofram (ondansetron) first. Anzemet is dosed only once a day and does not need to be discontinued. When I first tried it with Harley, I was desperate - he'd not eaten more than a few bites in 4 days and his one Cerenia shot had long since worn off. I took him to a different vet who agreed to give him a shot of Anzemet. One hour after the Anzemet shot, I opened a 5.5 oz can of Friskies and he ate 1/2 of it right away and ate the other 1/2 a few hours later. This after not eating anything for 4 days. Harley also responded to ondansetron, but not as well (ECID) so we stuck with Anzemet for him. But my EPI kitty, Princess, responds very well to the injectible ondansetron. She hates shots :roll: so I may have to look into the pills instead for her.

I hope this helps you both and that Scruffy is feeling better again soon! It's so hard when they don't want to eat (((((Hugs))))).


Edit1: To fix spelling errors and to spell out EPI
Edit2: To clarify Anzemet and ondansetron usage in paragraph 3, see underline and strikethrough.

 

Spitzer is on both ondansetron (daily) and mirtazapine (every 3 days) to handle his issues with nausea and vomiting, plus appetite.
I wrap the pieces in pill pockets; he eats them readily.

For him, this seems to be working.

 

I am pretty sure this is what the ER gave my Peanut when we took her in when she stopped wanting to eat and we couldn't get her lasix into her. She was never a well mannered kitty at the vet toward then, but she was laying on the towel sprawled a little until that stuff hit her and she went stiff and screamed and was like a feral cat :cry: They scruffed her and tossed her into a corner where she couldn't hurt anyone until the shock wore off and I could coax her into a chair under her blanket. THEN they told me "that shot stings a little."

 

oh, rats, Melanie.....

I have vacillated all day about whether I should call the vet to get the injectible. I have to make up my mind by tomorrow, because he's closed on Fridays. Every crisis we've ever had in the last 7 years with the cats happened on a Friday.....

Wow, what a lot of helpful information, Laura. Thanks to Vickie for hunting you up. I have no idea what experience my vet has with ondansetron or the other one - he has only mentioned cerenia in the last couple of weeks. BJ, I don't know if he'd be willing to even try a mixture of the three drugs, and truthfully, I'm not sure that at this point we even need the anti-emetic stuff; Scruffy's not throwing up.

Sophie - my interest in ondansetron was because my mom has also used it, and it seemed like a miracle drug, at least for a little old lady. Do we know, is there an injectible form of it, and does it hurt the cat?

I have to sit and digest all of this stuff - quickly - because I'm so afraid there won't be time for anything to work.

As Deb would say, grateful hugs to all of you.

 

Re: oh, rats, Melanie.....

Yes, our fur-kids ALWAYS time their emergencies for the holidays or weekends after the vet has closed.

Ironically I was just prescribed ondansetron over the weekend and I can verify that it is an awesome drug! Here I'd been using it for my cats and I had to go to the ER last Friday (everything's fine now) and they hook me up to IVs with ondansetron. :lol: Now I know how it feels to be my Harley.

Yes, ondansetron does come in injectible in 4mg/2ml vials. I buy mine from www.Thrivingpets.com. They are selling a 2 mg/ml, 20 ml vial for $19.95 which is a seriously good deal. If you decide to go with the injectible, the dose is 1 mg every 12 hours so you'd get about 40 shots from that vial assuming there's no waste. I'd suggest refrigerating the dose after drawing it up because it does sting a little. Your vet will have to authorize the online order as it's a prescirption drug. Or they can write you a script to take to your local pharmacy. But you'd want to check with your local pharmacies first to see if they have it in stock or if it's a special order item. They should have the pills in stock already as it's a pretty commonly prescribed human anti-nausea drug.

If you decide to go with the ondanstetron pills instead, your vet will have to write a script. Ask them for the regular 4 mg pills as you'll need to split them into 4ths. The starting dose is 1 mg every 8 to 12 hours. So 1 pill gives you 4 doses. DO NOT let the vet write the script for the 4 mg human sublingual self-dissolving tabs. They work great for us peeps, but they have artificial sweetners in them that are not good for our kitties. Also you don't want the large 8 mg pills because you'd have to cut them into 1/8's which is a royal pain.

If you have trouble getting the ondansetron script from your vet, shoot me a PM.

:YMHUG:

 

Lynda, I just read your post above where you mentioned Scruffy has PU/PD and you mentioned asking your vet about SubQ fluids. If he's not eating or barely eating, and has PU/PD there's a good chance he's also dehydrated and that makes kitties feel like uber crap and is an appetite killer. Asking your vet about SubQ fluids is a great idea.

One technique I've seen on the Yahoo Feline Pancreatitis group - a member who had a cat who objected to the stingy-ness of Anzemet and ondansetron, she got the IV administration set that had an injection port in it. When she gave her kitty fluids, she stopped the line halfway through giving the fluids, injected the ondansetron, and then restarted the fluids. This diluted the drug so there was less stinging and her cat didn't feel anything.

It's a thought if you are worried about giving an injectible medicine that could sting. I don't know if Cerenia is designed to be administered IV. But Anzemet and ondansetron are.

 

Hi Lynda

I'm sorry to hear that Scruffs isn't feeling too hot. You've gotten a lot of good advice, I'm just piping up because I've injected more Cerenia than anyone else For dogs, the dose is large (often 2 mL) and I can get most of it in before the dog reacts. I haven't had that hard of a time with cats. Since many of the cats are getting SQ fluids, I will push the Cerenia in the SQ line and that never gets a reaction. Giving it SQ, there is occasionally a zing at the end (based on the cat's behavior) but I've also given it and the cat doesn't react a bit. The volume is small for smaller cats, and somehow that seems to make a difference IME. I would give it a try at least to see how Scruffy feels about it.

Anzemet (dolasetron) is a great anti-nausea drug; I've used this in my own animal. Mirtazepine is an appetite stimulant with some anti-nausea properties so that's worth a thought as well.

Please let us know how else we can help.

 

Laura I think this is just a slip of the keyboard , I think you mean that they are used for chemotherapy patients. Neither drug is used to treat cancer; they treat the nausea associated with chemotherapy. So Linda don't worry about using these drugs in your kitty, they aren't toxic like chemo is.

 

Dear Lynda, although your questions have already been answered, I'll add that my mom got ondasetron as a slow IV drip and reported no stinging or pain. I'll be thinking of you and Scruffy, Sophie

 

Thank you Jess for pointing that out - that is absolutely what I meant to say and I will edit my original post accordingly. Was typing way too fast. Sorry Lynda, I didn't mean to say these were human chemo drugs but rather anti-emetics used to treat humans undergoing chemotherapy. They are quite safe for our kitties. My Harley has been on Anzemet since late March of 2011 and has shown no ill effects.

 

Thanks, again.

We have an appointment for more bloodwork at 4:30. I want to discuss the cerenia/ondansetron/anzemet issue especially, although at this point, there has been no vomiting at all since Monday.

I appreciate all the information and the kind thoughts. I've spent the entire 8 years I've had this funny little cat keeping him alive from one horrible disease after another; can't give up now.....

 

Hi Lynda,

So glad you are taking Scruffy to the vet today. I just read your latest post on Scruffy's blog and I wish I'd read it sooner. Has your vet run the spec-fPL test? It's the specific feline pancreatic lipase test for pancreatitis. If not, I suggest asking them if they can run it today. The funky lab values you see: elevated ALT and AST, elevated amylase, elevated calcium, elevated neutrophills, could be indicative of a GI inflamation somewhere. The hard part is knowing whether it could be pancreas, liver or intestines. But running the spec-fPL test is a starting point to either rule out or rule in pancreatitis. Unfortunately diabetics tend to have a higher incidence of pancreatitis. (Which comes first, the diabetes or the pancreatitis, is not often clear. Some cats have chronic pancreatitis and then develop diabetes, and others have diabetes and then get pancreatitis.)

If the spec-fPL test comes back positive and Scruffy does have pancreatitis the treatments for it are daily SubQ fluids, pain medicine like buprenex, and anti-nausea medicines like Cerenia/Anzemet/ondansetron until the flare passes.

Will be thinking of you both this afternoon - please keep us posted!

 

Well, thanks for continuing to help here. We just got back from the vet's. It is difficult for me to describe/explain my relationship with him. I've been taking my cats to him for six or seven years. He's a very nice man and has a cat-only practice. The cats actually don't seem to object to him. He's got one technician that I really like. And we have never seemed to be able to connect in conversation, for some reason.

I had requested that he do the pancreatitis testing when I made the appointment this afternoon. He didn't feel that it was necessary, but "if you want it....." said with a wry expression on his face. That said, he is absolutely unwilling to do any other testing until he sees how the result of the second calcium testing comes out, tomorrow morning. And NOT the ionized calcium, which is what I was told would be helpful, at least, to know - just total calcium. He does not believe that there is a thing in the world wrong with Scruffy's kidneys, or his parathyroids or whatever.... He didn't feel anything suspicious around his liver. He did note, however, that Scruffy's snuffly - he's a herpes cat, he's always snuffly. He mentioned the spiky, dull condition of his fur and the newly appearing dandruff, and asked if he'd always been such a poor groomer. (!) When I wanted to discuss the possibility of using one of the other two medications for nausea that you guys have talked about, the conversation deteriorated into the same old thing we've been talking about for years now - we can't resolve our differing opinions about what's regurgitation and what's vomiting, and in his opinion, nausea IS vomiting.... And Scruffy isn't throwing up. Anyway, he didn't think that I even needed to continue the cerenia, no matter the lip-licking that's still occurring, much less think about using something else. He confirmed the weight loss - five or six ounces since last week, and asked me what sort of scale I was using. He said it was good that I have been successful in getting food into The Puffer, and suggested that AD would be a good thing to try. (Yes, I said that I'm not fond of any of Hill's products. But I said okay - if it's so palatable, any port in a storm, right?) He didn't feel that Scruffy was dehydrated, either. Or that there is any indication that he's in pain.

I brought my poor cat home, along with a bag of zeniquin for the herpes snuffliness, two more cerenia pills, and two cans of AD. He immediately peed - in a litter box! - climbed up on his window ledge and licked half-heartedly at a little pile of beef baby food with taurine added .

I was really worked up before we went, but I have now calmed down. I found 8 quarters of mirtazapine in my box of cat stuff, I still have 4 cerenias, and I am resigned,barring major changes, to waiting until the calcium results come back tomorrow morning, and the FPLI stuff shows up whenever.

 

Hi Lynda,

Wow, it sounds like your vet and my former vet might be related. :lol: She was a wonderful person who really loves dogs and cats and is very compassionate. But when it came to talking about treatments, I had the same challenge in conversations. Fortunately we never disagreed about the vomiting versus regurgitation - which you are right by the way. Undigested food that comes right up is regurgitation and vomiting occurs awhile after they eat and the food is mostly half digested. And nausea is not the same as vomiting - that difference is not emphasized enough in vet school and is only just becoming differentiated in the vet literature.

Sounds like you have a good plan to not change anything until the bloodwork comes in. I hope that if Scruffy has anything, it is easily identifiable and treatable.

:YMHUG:

 

Only two things of note today: the vet called this morning and said that his technician had neglected to check the order form of the vial of blood for the second calcium level testing, so nothing was done with it last night. So, whatever the results are, they won't be available until tomorrow.

In the meantime, around 9:00 last night, having futilely tried to find something Scruffy was interested in eating, I gave him one of the quartered mirtazapine pills I found in my stash. And it was a nightmare. Within a half hour, he suddenly jumped up, started meowing frantically, and began what became 14 hours of incredible agitation and distress. For both of us.... He couldn't sit/lay for more than a few minutes. I haven't heard him meow five times in 8 years, he just isn't a talker, and he could hardly go for 30 seconds without meowing last night. All night. He was up and down, walking all over me, following me all over the house...... He did finally settle down long enough to eat - not AD! - a little FF gourmet chicken, and then the pacing started again. He has just now - it's 12:30PM - settled down in a kitty pi beside my computer and fallen asleep. And he ate about 1/3 of his normal amount of FF this morning, to my delight. The vet seemed to think that, because Scruffy actually ate voluntarily, it would be worth using it again. I'm not convinced.

The one positive - having now started moving around and acting more interested in things, he seems better somehow. I'm feeling more hopeful.

 

Oh lynda! I am sorry to hear about your night with scruffy. That is TOUGH!

It might be worth trying again, BUT give 1/8th of a pill. Some cats do have reactions like Scruffy did, and it is not pleasant. I think Linda/Bearman had a very similar experience which she video taped. I do believe you are only suppose to give it every 3 days. So you should probably wait before giving more. Here is a bit of information on it:
http://www.felinecrf.org/persuading_cat_to_eat.htm#mirtazapine

I always used cyproheptadine with Latte because I was afraid of that reaction. Even the cypro would make her a little agitated, so I often just needed to give her a pinhead sized piece of the pill.

I hope you both get some rest and he continues to feel well enough to eat.

 

Oh wow that must have been scary! Poor Scruffy and poor you! I hate to say it but based on Scruffy's reaction to the mirtazapine, I would not suggest using it again, or if you do, perhaps cut that quarter of a pill in half (not easy to do) and give only 1/8 pill for a lower dose.

I'm on the Yahoo Feline Assisted Feeding, IBD, and Pancreatitis groups and have read of other pet parents tell of mirtazapine causing similar yowling+frantic reactions in their kitties. My vet actually calls mirtazapine "meow-zapine." Mirtazapine is linked to a potentially fatal reaction called serotonin syndrome. Some pet parents have used it and reported no ill effects with their kitties, but I never wanted to take the risk with Harley. There is another appetite stimulant available, cyproheptadine, which is an antihistamine which also stimulates appetite. It too can make kitties yowl at high doses though. I use only 1/8 of a pill to get my boy to eat these days.

What a bummer about the bloodwork.

 

bloodwork

Finally got the report early this afternoon, and the vet wanted us to come immediately and learn how to do fluids. (If you think that's an indication the news wasn't good, well, you're right.) The calcium level was significantly elevated from its already-not-good previous level. He made a referral for an ultrasound to be done as soon as possible. With all the awful stuff I've done to this poor cat over the last 8 years, giving fluids was always on the top of my "I don't want to do that" list, but....... As you guys all know, you do what you have to, I guess. No results yet on the fPLI test.

The good news is, yesterday, Scruffy started eating on his own again. Not a lot, but enough that I felt much better about that whole issue, and no lip-licking. Today, I would say he's about 75% normal in the eating area. His fur's still a mess, but generally he seems to be feeling much better. He's still trailing around behind me, meowing piteously, for some reason, but once I sit down and let him sit on my lap, he's calm and happy.

I don't think we'll be doing any more mirtazapine..... Too scary.

Thanks. I feel guilty because I haven't been around FDMB much recently, if at all, but this is the first place I thought of coming to when things started going wrong. People can talk about "internet crazies" and all sorts of negative things about message boards, etc, but when it comes down to it, FDMB is a haven and an encyclopedia and a rescue, all tied up in one. I am grateful beyond what words can say...

 

get your vet to write RX for fluids and get them from walmart. i will give you the code cause I do not think it is a regular routine for them to order them.I also have a good web site for the needles and lines. very reasonable. PM me here of FB if interested. giving fluids is not a bog deal. was giving to cal every day but have cut down to 2 or 3x a week now