pancreatitis: slightly different treatment

per cleo's oncologist vet, "for possible low grade, fulminating, pancreatitis the treatment recommendations are SQ fluids, prednisone, metoclopramide, pain management (buprinex), and potentially vitamin B injections."

i've been giving injectable famotadine in lieu of the metoclopramide, as do many people here with pancreatitis kitties. does it really matter or would metoclopramide (reglan) work better?

 

http://www.idexx.com/pubwebresources/pd ... rticle.pdf
p11, Twedt: "Metoclopramide is a dopamine antagonist and inhibits vomiting by blocking the CNS dopamine receptors in the chemoreceptor trigger zone (CRTZ). It is probably not a very good antiemetic in cats because they are reported to have few CNS dopamine receptors in the CRTZ. Side effects can also occur at high doses as it causes CNS excitement from dopamine antagonism."

http://www.nxtbook.com/nxtbooks/advanst ... tartid=MV2
see page MV8, discussions by Twedt, Williams and Simpson. (i haven't copied/pasted for copyright reasons).

 

Tanya's CRF site also has a section on Reglan. Note the warning against chronic use.

http://www.felinecrf.org/treatments.htm ... omach_acid

Bear has taken it. He did well on it for some time, but then developed the side effect of agitation, and had to stop taking it.

 

Hi Chris

They are not given for the same reason. Reglan is an anti-nausea medication and Pepcid is an acid reducer. THe use of Pepcid in cats who are not eating is to help prevent/get rid of the 'sour stomach' that seems to develop in cats that don't eat. Cats who miss a meal for any reason will sometimes get caught in this "stomach empty--feels bad so doesn't eat--stomach stays empty--feels worse" kind of thing. That is why SQ fluids and Pepcid can often "cure" a brief period of anorexia.

Metoclopramide is increasingly falling to the wayside for at-home use in cats because it doesn't last that long. Its best use is in-hospital, when added to continuous IV fluids.

Reglan can also be used to help cats with gastric motility problems -- it encourages the movement of food from the stomach through the small intestine.

FWIW, I tried oral Reglan once with Earl when he was feeling nauseous and then spent the next two hours pulling my hair out as he stumbled around the bedroom, frantically pawing at everything. Some lucky cats have an unfortunate reaction and become manic when given the drug. IT was a nightmare.

 

jess, guessing i phrased it incorrectly.
my impression was that we normally give subQ fluids, pepcid, and bupe for pancreatitis. hadn't heard metoclopramide mentioned for it before the onco vet told me.

cleo gets pepcid because she has gas in her intestines. (determined because of xray -- i've never heard her expel it.) but we first got it because of CP (chronic pancreatitis)
as i guess U know, she also gets an antiemetic because of nausea/vomiting from her lymphoma: we switch between cerenia, ondansetron, and anzemet for that.

as we on fdmb often suggest pepcid for pancreatitis kitties, my main question was whether we should be suggesting reglan instead as the onco vet indicated. [warnings about tardive dyskinesia scare the heck outta me, tho i don't know if it's as common with kitties] from what you're saying, i'm guessing your answer is no to this and i should speak with the vet about reglan's side effects/problems for kitties.

 

Ah. No I wouldn't think so. Relgan is a short acting, weak anti-emetic and it does have those unfortunate side effects in a small amount of cats. Pepcid is a better all-round choice.

 

oops -- edited my question before noticing you'd answered!

 

stanley marks-- my fav p-titis guy -- does not like reglan for cats w/ p-titis. ( or seem to think much about reglan at all ) he much prefers. ondasetron or anzement.
which, btw, I have always mentioned in my posts about p-titis on this board.
zoran, scherk and the rest of the usual p-titis vets also prefer ondansetron or anzemet.
pepcid can be used in conjunction w/ these meds, and as jess mentions is targeting a different aspect of stomach upset. For some kitties w/ very mild symptoms, I have found that pepcid often does the trick.

there is a nice round table discussion on the idexx fpli test page on treatment which includes a discussion on the use of antiemetics as well as the use of pepcid . I recommend this read.
sorry my link is on my mac that is in the shop. but you can find it easily.

Both Winnie and Wolfie had adverse response to reglan. Winnie took it for a long time when she was on chemo --- there was nothing else available at that time. Later when given it , it cause her to be extremely restless. Wolf had an immediate neg reaction to reglan when first given and became aggitated and aggressive on it.