? Giving pain meds( bupe) for pancreatitis

Smoky has been feeling sick and looks like he is miserable all the time. The prozinc is working well to reduce his BG and bring him down to much lower numbers.
I can't tell if he is just nauseous or is in pain. He is hiding a lot and doesn't want to be touched. How can I tell if he is having a flare up from his pancreatitis or is just sick from the FD. His vet just prescribed bupe for him to be given orally and Denamarin, a liver supplement,which he has taken before.

The vet said I can give the bupe to him every 12 hours and gave me a 5 day supply. I gave him that after his surgery for a urinary blockage on an as needed basis.
Anyone have any ideas about this?

 

Saoirse hid when Caninsulin disagreed with her and when her pancreatitis symptoms were worse. That Smoky doesn't want to be touched sounds more like a pain-related issue (but obviously I can only speculate on this). Smoky's BGs are in a fairly good range so it's not hyperglycaemia making him feel unwell.

ETA - Sometimes I would give Saoirse bupe twice a day (after the benazepril made her pancreatitis symptoms worse) - sublingually. (Note: I found it could suppress her appetite a little and also it was slightly constipating.)

Questions:

Did the vet examine Smoky today and did he order a Spec fPL? Was Smoky's abdomen tense at all? Did Smoky have any pain in the back? (Pain from the pancreas may radiate to the back.)

Does Smoky sit in a tense-looking 'meatloaf' position (especially after eating)?

Does Smoky hide more after eating?

Is Smoky pooping normally or is there any chance he might be constipated?

How well is Smoky eating at the moment and is he showing any symptoms of nausea?

Is Smoky's hydration OK?


Mogs
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The vet didn't examine smoky today. She just gave me denamarin and bupe to give him. She said to give the bupe every 12 hours with enough for 5 days. He just had a spec fpl done recently.
He sits in a meatloaf position at times, especially after meals. He tends to hide after meals a lot. He drinks a normal amount of water and his appetite was fairly good until yesterday morning.
He poops several times a day but stools are formed but soft and light brown in color. I gave him some cerenia last night and going to give him some denamarin tonight.

 

Thanks for the reminder, Lisa. (I'm not feeling very well and I couldn't remember what was discussed before. )

If something has triggered a flare (and, based on my experience, all the clinical signs you describe do sound like it's a flare) then his Spec fPL markers may now be higher.

Be sure to keep up the anti-nausea treatment; the last thing you need is to have Smoky inappetent. Also keep an eye on his fluid intake and add a little water to his food to help keep him hydrated.

I've been advised by vets that stress from pain during a flare can make things worse, and that effective pain management can reduce the stress as well as the pain and potentially shorten the duration of the flare.

With the pain relief and anti-nausea meds on board it may help Smoky to eat better. When you give the bupe you should be able to judge its efficacy by any reduction in hiding behaviour/'meatloafing'.

If he hasn't improved much by tomorrow I'd suggest you ask the vet if she can give Smoky a physical exam and also ask for a dose of B12 (can be really helpful). Also make sure you'll have enough anti-nausea meds to keep you covered throughout the weekend (and possibly some cyproheptadine for appetite stimulation - a good precautionary addition to the medicine chest of a pancreatitis kitty).

I really hope he feels better soon. (((Smoky)))


Mogs
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I can't give him the bupe until tomorrow morning, vet said to give it to him same time morning and night, 12 hours apart.
The vet told me to give 1/4 tab of cerenia every three days. Is it safe to give it to him more than that? I have to look on the box to see the dosage instructions. I can give him the denamarin tonight. I'm nervous about giving him bupe while I'm at work and can't observe him. I do add water to his food and have Cipro for appetite.
Get some rest Mogs and hope you feel better soon.

 

You can't get Cerenia tablets for cats over here. I've primarily used ondansetron for nausea. However, here's a post by Marje with info on Cerenia and ondansetron dosing which might be helpful to you (and, needless to say, check it out with your vet):

http://www.felinediabetes.com/FDMB/...ast-yesterday-help.166040/page-3#post-1796242

That's a feeling I can very much relate to, Lisa.

What weight is Smoky and what dose is the bupe? (I'm assuming it's via oral syringe that you're giving it.)

Thanks for the good wishes.




Mogs
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Smoky is 8 lbs 10 oz
Bupe is 0.3 mg/mL
Dose is 0.14 ml every 12 hours.

 

Hi Lisa,

Just checking in to see how Smoky's doing today. Did you give him the bupe and is it helping him? (Hoping it is.)

For info, the dose he's on is about the same pound for pound as Saoirse's.


Mogs
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I haven't given him the bupe yet. I wanted to give it to him when I was home to watch him this evening. I gave him the cerenia and denamarin and he seems to be a little better. I thought the vet was giving me bupe in an as needed basis.
The instructions the vet gave me was every 12 hours for five days.

 

I'm glad that the Cerenia and Denamarin have helped a bit. Let us know how Smoky gets on with the bupe; I hope that'll help him, too.

(((Smoky)))


Mogs
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Lisa, pancreatitis is quite painful. You do want to give it so Smoky is comfortable.

My Smokey got 0.1 every 8 hrs to start. He was 16 lbs. Once the pain was under control we were able to decrease amount, it did take a few weeks though.

 

Buprenorphine can be given more frequently than every 12 hours. My civie cat Monet was getting it every 6-8 hours to help with his pain from his oral cancer.

 

My Smoky is half that weight, only about 8 and a half lbs. The vet gave me 0.3 mg/ mL and said to give 0.14 mL every 12 hours which is enough for five days. I'm concerned that may be too much of a concentrated dose for his weight. What do you think? I had planned on giving it to him at 7 am and 7 pm eastern standard time zone. The dose is in a pre-filled syringe already.

 

The dosage range for Buprenorphine is very extended. Your dose is consistent what has been prescribed for my cats

 

Thank you. That helps me out with my concerns.

 

My Smokey had the same concentration (0.3mg/ ml). I would start tonight and observe him. See how he acts. My Smokey was meat loading and hiding. He pretty much slept the first 24 hrs. After that he was more alert, not meatloaf ing, not hiding. I worked at the time, my Smokey was okay with it so I didn't worry. Try it tonight. If you see him acting to spaced out you can give slightly less. But he does need the relief. Think of it like a migraine, the pain will get worse without the medicine.

 

One other question, should bupe be given before the cats eats or afterwards?

 

If it works, ask you vet to call in a script so you always have it ready as soon as he needs it.

 

It would be hard to give him less, it is premeasured in the syringe. How would I do that in that case? If he sleeps that long I would think it wld be harder to test and then feed?

 

I had to time it around his other meds. He ate every 3 hrs so it didn't matter.

At first Smokey was prefilled. After that my vet called in a script to a compounding pharmacy. They mailed a 30 ml bottle. So it was easy to adjust the dose.

 

I would ask the vets to preload to a dose of 0.20 so that I'd have stronger doses available but most of the time I would express a little of the preparation from the syringe before administering the smallest effective dose to match Saoirse's needs at that time. It helps to draw the syringe plunger back a good bit and then moving it back and forth a little so that it moved smoothly before expressing the unwanted amount. (Note: Med sensitivity was an issue with Saoirse.)


Mogs
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The vet gave me 1 mL syringe, how can I tell where 0.14 mL is on it?

 

The syringes my vet dispenses the bupe in have graduation marks so I was able to measure any dose adjustments.


Mogs
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I don't know if I'm comfortable giving him the bupe w/o knowing where the 0.14 mark is on the syringe.

 

Can you take a picture if syringe? The ones I had were marked 0.1, 0.2 etc.

You said they were prefilled.

 

The vet was gone when I picked up the bupe and the vet tech was showing me how to dose while syringes were still in the bag.

 

Sorry was checking smoky BG. I can take a pic

 

They are pre-filled so don't know why vet tech was showing me where to measure

 

Make sure of the dose in it before giving.

 

You can see the 0.1 on the syringe. How many lines between the 0.1 and 0.2? You can measure what you need easily.

 

Not that great of a pic.

 

So I just count 14 lines from 0.1
I can see the liquid in syringe,it's sitting right at 0.4 line on syringe.

 

14 lines back from 0.0; 4 lines back from 0.1.

 

In this picture you see a longer line between the .1 and .2. That would be .15. It looks like there are 4 smaller lines between .1 and .15 If so they would be .11, .12, .13 etc.

 

Maybe I will have to run by vets office in the morning and have them show me on syringe just where the 0.14 mark is. They shld have done that yesterday.

 

Oh I see it now. Thanks Mogs

 

You can just give 0.1 ml. That is clearly marked and a little less than 0.14. But he will get some and that's important.

 

Yep you are right about the lines. I get it now.
Thank you @Woodsywife

 

Teasel's bupe syringe is the same as yours. Mine weren't prefilled though. I was given a dropper bottle with a small amount of bupe solution in it. It's a controlled substance so I think that's the reason it's sometimes dispensed in prefilled syringes.

 

I think it depends where you get it from. My ER would only give prefilled syringes and only enough for 3 days. When I asked for a script, they told me small quantities couldn't be dispensed. My regular vet gave me a small amount (they have large quantity bottles for in house use). Then he called in a script to compounding so I got 30 ml bottle with refills.

 

I depressed the plunger down to the 0.14 mark and bupe went from 0.0 to 0.14 mark so syringe actually only had that amount in it. Oh well, at least now I learned how to measure it out if I need to for future use. My vet only gave me 10 syringes so enough for five days with 12 hour dosing.

 

To me the image shows the plunger pulled back to the 5.5 or 5.4 marking. For the minimum-volume syringes shown in the image (the tapered tip that goes into the part of the syringe where the needle attaches when fully depressed) you measure where the tapered part of the plunger intercepts with the barrel part of the plunger.

 

I posted in this forum under "Tips for giving bupronephrine" about my vet getting me Bupe in a topical ointment. Noah wouldn't tolerate the oral and injections a no-go in Canada.

 

The bupe I have for Smoky is given orally, don't think I mentioned that.

 

How's Smoky doing today, Lisa?




Mogs
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He seems a little better, always seems to feel worse at night. His appetite is coming back so that's a good thing.

 

That is good news about the appetite, Lisa.

Sending healing thoughts and scritches for Smoky.




Mogs
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Nice to hear appy is coming back.

 

BTW any reduction in crouching/hiding since starting the bupe?


Mogs
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Not too much yet but he only had one dose so far. If I take smoky in bedroom with me and put him on the bed he stays in there with me

 

For any of you are using BUPE for dental issues and/or cat hated it orally. My vet gave me Transdermal syringes. Total turnaround! In my case I got 1ml syringes, preloaded. It's the consistency of toothpaste. You plunge the amount needed on the backside of the little tiny spoon provided, it won't drip off, and smear it on the inside of his ear. No pawing at the ear, no irritation. My vet said getting the subcutaneous syringes in Canada would trigger an F16 flyby. Hope that helps someone.

 

@Noah & me where's the link for topical? Plz and ty

 

Try:
http://www.diamondbackdrugs.com/transdermal-gel-for-cats/

 

Ty

 

Sorry, took a few days off. No link, the syringes were made at a local compounding pharmacy at the request of my vet. I can tell you the strength later but your vet would determine that.

 

Phoebes, this is the thread I started about Noah's dental problems and how he ended up on transdermal BUPE. Hope that's of some help.
http://www.felinediabetes.com/FDMB/threads/buprenorphine-bupe-transdermal-upate.172777/#post-1894071

 

I just talked to the vets office, they are going to try and get it ordered from a local Apothecary for her ear. Yay!!

 

Check the spoons that come with it. Mine had a very rough spot on them where they were snapped off a mold, sloppy manufacturing.

 

That's another good point. I was told I could adjust the dose accordingly and apply more frequently as long as I was very aware of the math. Thanks Deb & Wink.