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Mirtazapine & Ondansetron taken together

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Teresa & Buddy, Aug 11, 2019.

  1. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Jan 2, 2017
    Has s anyone given this before. Buddy has been taking Ondansetron prescribed by a previous doctor, he was not eating so I gave him Mirtazapine and they are not to be taken together. Help!
     
    Last edited by a moderator: Aug 11, 2019
    Reason for edit: Removed 911 as suggestions have been offered and after hour vets contacted. Feel free to put it back up again if necessary!
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Teresa --

    I just ran these meds through a drug interaction checker and at least in humans, they do not interact. Where did you find the info on their not being taken together. (Depressed cancer patients who are receiving chemo and are nauseated and losing weight are often prescribed both.)
     
    Jill & Alex (GA) likes this.
  3. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I looked under drug interaction action checker for cats, I called a 24 h vet in another town and they told me not to give any more and they would be glad to see him, but I am not up to driving by myself out of town tonight.
     
  4. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I have given Miratzapine and Ondanstron together. Where did you read that they interact?
     
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  5. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    On drug interaction for cats. Buddy has been taking Ondansetron prescribed by a previous vet, he has been sick and would not eat so I gave him the Miratzapine prescribed by his vet. He started acting funny and I know Ondansetron is weird. It said the 2 should not be taken together. How did your cat act.
     
  6. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Has he ever gotten miratzapine alone? It is notorious for causing some weird behaviors (hence the nickname, "meowzapine").
     
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  7. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Yes, he has and he got the meows.
     
  8. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Please provide the link.
     
  9. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    How much/what dose of miratzapine did you give?
     
  10. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I don't have a link. I looked under drug interactions for cats and Mitrazapine.
     
  11. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I did not notice any behavior differnences. He had been a bit off altogether, but I attributed that to his almost dying from a kidney infection. He's doing much better now. What was Buddy doing that you noticed?
     
  12. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I think Ondansteron is pretty safe, I think it's the Miratzapine that causes behavioral differences.
     
  13. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    He has been taking Ondansetron prescribed by a previous vet and he would not eat so I gave him 1/2 -15 mg mirtazapine. He started acting weird, not just the MEOWS, but hiding, his eyes bugging out and just not his self.
     
  14. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Hiding, eyes bugging out and just acting strange. They are not to be taken together.
     
  15. Sean & Rufus

    Sean & Rufus Well-Known Member

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    1/2 of 15mg seems like a large dose. I only gave 1/4 of a tablet and I had heard that even a 1/4 of a tablet was double the dose that is needed for cats.
     
  16. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    On the top of your Chrome or Google webpage, there will be a "history" of sites you have looked at today. Click on it and scroll down for the page you checked.
     
  17. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  18. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Here's the thing, Teresa... there's no way anyone can tell you if this is an emergency or not. In the interest of safety, going to the vet tonight is the most responsible suggestion any of us can make.


    ETA: add to the above --- there could also be something else going on with Buddy that we're not aware of...
     
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  19. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    There is no one but my 97 year old Mother who lives with me and she is sick. I have called a 24 hr vet in another town who told me they if he started throwing up, diarrhea and a few other things to bring him in. He seems to be acting better, I thought if someone else had used both they would have an idea. He will not get anything else until in the morning.
     
  20. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    That is what was prescribed by his doctor, it is to be taken every 3 days. Maybe your pill was a larger mg.
     
  21. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I've used both and not had a problem with them individually or together. Many cats do seem to have more of a reaction to mirtazapine since there is a component to the medication which is activating (hence the meowzapine name).
     
  22. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    (((Hugs)))
    I'm glad you spoke to another vet. It sounds like you have a plan in place.
    I hope you have an uneventful evening...
     
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  23. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Bud
    Thank you, I hope so too. Buddy has been really sick and in the hospital twice for several days in the last 2 or 3 weeks. His pancreatitis was so bad, that he had Peritonitis. I have been sooo worried about him, I love him a lot.
     
  24. Sandi & Whisper

    Sandi & Whisper Well-Known Member

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    I agree, we just can't know if this is an emergency or not.

    I have given them together without issue, however that was with mirtazapine compounded into 1.88mg capsules.

    If you have to call the vet again, I'd be sure to stress to them the high dose of mirtazapine, because I am more suspicious of that. DO NOT consider this next part as recommended advice, but do you know if you have any cyproheptadine at home (it is also an appetite stimulant)? I'm asking because it can help reverse a mirtazapine overdose, but DO NOT GIVE IT WITHOUT DIRECTION FROM A VET. PLEASE. But I would go ahead now and see if you have any available, and make the vet aware of that if so, if symptoms are such that you need to call the vet back and/or head that way.
     
  25. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I have 1/4 of a Cyproheptadine, that is why I was giving the Mirtazapine. My new vet uses only Mirtazapine and cerenia, not ondansetron. I called the local hospital and they said ondansetron stayed in your system 10 hrs and the 10 hrs is past. I have some Mirtazapine from my old vet and the mg are the same as my new vet. I did not know that cypro would reverse mirtazapine. I also have Loratadine 10 mg (spelling) for myself.
     
  26. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    How is Buddy doing today?
     
  27. Sandi & Whisper

    Sandi & Whisper Well-Known Member

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    I was just thinking the same, Nan :p

    Teresa, I've been looking all around today and can find nothing that recommends a 7.5mg dose of mirtazapine for any size cat at any frequency. Everything that I see acknowledges a 3.75mg dose (1/4 of 15mg), but also says that 1.88mg (1/8 of 15mg) is still effective but with fewer side effects. This particular article gives the frequency of 1.88mg dosing as every 24 hours for young, healthy cats, and every 48 hours for older/liver/kidney cats. Especially with what happened last night, I really urge you to press your vet for cyproheptadine, or compounded 1.88mg mirtazapine capsules (since it is almost impossible to split a pill into eighths) or transdermal mirtazapine. Personally if I were you, I would lean towards crypo instead.

    Here's the article that I recommend you read: https://www.americanveterinarian.com/news/wvc-2017-mirtazapine-for-appetite-stimulation-in-cats

    But here is the summary:
    "In conclusion, mirtazapine works as an appetite stimulant in cats. Current dosing recommendations for mirtazapine in young, healthy cats is 1.88 mg/day. In older cats and those with chronic kidney or liver disease, 1.88 mg can be given every 48 hours. This dose, while effective, results in fewer undesirable side effects than the traditional 3.75-mg dose."
     
  28. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I took Buddy to see his vet today, just to be on the safe side and he is doing fine. The vet said to not give him any more mirtazapine for a while. I did call the office of his former vet to see if they will sell us some cyproheptadine (this is what he has always taken) This vet also prescribes Mirtazapine 15 mg take 1/2 pill every 3 days.
     
  29. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I guess 7.5 over 3 days would b 2.5 mg a day.
     
  30. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    But if that 7.5mg is given as a single dose-- I don't know, that just seems like a lot, especially for something like mirtz. I'm glad the vet says to hold off for a while.

    Glad Buddy is doing well!
     
  31. TSP

    TSP Member

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    May 30, 2019
    Hi. I'm going to attach some links. My T was prescribed the human/pill form of Mirtazapine years ago the way it was traditionally, take 3.75mg (1/4 tablet every 72 hours). He had no issues. Fast forward years later & we gave him the same dose, 1/4 tablet & he was agitated, pupils dilated, meowing etc.. Turns out there have since been studies to show that a lesser dose-1.88-was just as effective but much fewer side effects & metabolized better by cats. Additional studies showed that part of the issue may have been the initial studies were done in healthy cats.

    https://www.americanveterinarian.com/news/wvc-2017-mirtazapine-for-appetite-stimulation-in-cats

    In 2018, a newer version of Mirtazapine was created & FDA approved specifically for cats. It's called MIRATAZ. Its a transdermal ointment & therefore easier to get a smaller dose. It is the first & only FDA approved drug specifically for felines for the management of weight loss. Dose indication is a 1.5 inch ribbon applied to the inside of the ear (equivalent to 2mgs):

    https://kindredbio.com/mirataz/mech...MI4KzW3db_4wIVk1qGCh0lxAXhEAAYASAAEgIGvPD_BwE

    I would still be careful & speak to your vet & then if you try Mirataz, watch for any issues as your cat may have an issue with the drug no matter what formulation or dose. Most likely, & hopefully, it was the dose vs the drug :)
     
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  32. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I m having problems getting him to eat, if he was not diabetic I would not worry about it, but when you need to go somewhere I can't leave unless I know he has ate. I have phoned his former vet's refill line and asked for cypro. I will not give the mirtz, unless something changes. That is the 2ndtime he has taken mirtz.
     
  33. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    The dose might have been a problem, but Ondansetron is also a problem. Ondansetron is not to be taken with a lot of things, including
    Mirtazapine. The 1st time Buddy took the Mirtazapine he was very meowy, but not this time. I am not planning on giving him any soon.
     
  34. TSP

    TSP Member

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    May 30, 2019
    Thats helpful to know about the Ondansetron. I've only used Cerenia so I'm unfamiliar with Ondansetron. Its good info to know so I appreciate you sharing your experience & info!
     
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  35. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I picked up 10 Cyproheptadine today from Buddy's former vet, we may start seeing her every now and then. The problem is, she only is in a few days a week and I need to be able to get my cat's seen more often. Wonder how much 1.88 mg would be of a 12mg Mirtz.
     
  36. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    I have not had a chance to reply, but I had no idea about the dose of mirtazapine being so high, especially since this came from 2 vets. If Buddy ever has mirtazapine he will get 1/8 of a 15mg pill. I also saw somewhere that you could use the cyproheptadine to reverse the mirtazapine like you said. Thank you, for the needed info, Sorry it took me so long to reply.
     
  37. TSP

    TSP Member

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    May 30, 2019
    I would definitely ask for the transdermal gel, Mirataz, vs the pill. Nice & smooth delivery & no issues with getting the right dose. You wear a rubber glove, measure a ribbon (theres guidance on box) & then rub it into the pinna of the cats ear.
     
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  38. Sandi & Whisper

    Sandi & Whisper Well-Known Member

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    I am glad you followed up. That was my exact concern, that you heard that from two vets, where you can now see that an even lesser dose than what you gave was being warned about for side effects.

    I also did search more about a mirtazapine/ondansetron interaction, and the only thing I saw was for humans. I'm not saying it isn't possible in cats, but since this post is going to "live forever", I just wanted to note again here that I couldn't confirm it and I suspect the mirtazapine overdose instead.

    How is Buddy doing?
     
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  39. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Buddy is not feeling very well tonight, he has a serious problem with pancreatitis and that is why I was giving him mirtazapine, but we now have some cypro. Tomorrow is a new day and I am hoping things will look up. I appreciate all the info.
     
  40. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Sounds good.
     
  41. TSP

    TSP Member

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    May 30, 2019
    Hope Buddy is doing better. We've been handling a flare over here as well. The Mirataz has been helpful with no crazy side effects. We went back to Prednisolone & after 2 days of 2.5mgs, he's been eating, he is off the Cerenia as of this morning, won't need the Mirataz again & is back up & about like his normal self. Once he's 100% for a few days, we will most likely go back to every other day Pred & maybe in the future we will try reducing the Pred dose again, but for now leave him as is---stable & without the need for any other drugs. Even his BGs didn't go significantly higher with the Pred on board. We did decide to give the Pred in the evening when he tends to run lower (also eats less evening hours vs morning) & thats working out. Thoughts with you & Buddy!! Hope he is turning the corner soon!
     

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