Cerenia vs Ondansetron for pancreatitis

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Howiesmom

Howiesmom

Active Member
Hello!
There has been a good thread about anti nausea meds for pancreatitis lately, but I don’t want to poach the thread so am starting a new one with my questions.

Howie was diagnosed in Feb with pancreatitis. My vet put him on a week of cerenia and mirataz which helped. Now he has been taking breaks while eating (breakfast is the worst) and I can’t tell if he’s not feeling good or if this is just a new patttern. He eats his supper pretty good, so I’m just confused on what’s going on with him. I have one more box of cerenia, but it is $28.99 from my vet….so NOT cheap. I read that some people give their cats cerenia/Ondansetron every day even if they seem to be feeling OK. I’ve been wondering this for the past couple of weeks but the cost of cerenia would be too much to do this. Is there a difference in effectiveness with Ondansetron vs cerenia? How much does it cost folks who use it? Howie is 13.3lbs.

He has his senior check-up on Fri so would love to go to that appt armed with info from all the experts on here! Friday is also Howie’s 3 year GOTCHA DAY with me. I can’t believe it’s been 3 years already…we’ve been through a lot!
 
I have the ondansetron orally disintegrating tablets (I'm not great at pilling but can clamp her mouth shut until it's dissolved). Minnie gets 1/2 pill as needed i.e. when she walks away from food when she's been presented with a buffet. The prescription says 1/2 pill every 12 to 24hr but I think you can go up to every 8h (?) someone will certainly correct me. Ondansetron is my go-to over cerenia.

I got a box of 30 x 4mg pills from Costco for $15 (can't remember if that was with Good Rx or just the Costco pricing). Sorry I can't answer about a difference in effectiveness, I just know they work differently and you can give both. Cerenia is a bit cheaper online or Costco ($20 for 4) than the vet.

And Howie, stop being a breakfast pest!! Good luck with your Friday appointment and celebrating the gotcha today. You've really had a journey, I just looked at your s/s....27u. I can't believe how fast you run through the pens. He is a lucky boy.
 
The two anti-nausea medications work differently and can be taken together. I wonder if Howie gets a bit of acid tummy overnight? What time is when he last eats at night vs during the day? You could try leaving some food out for him before you go to bed (or set up a timed feeder) and see if that helps.
 
Liz & Minnie said:
I have the ondansetron orally disintegrating tablets (I'm not great at pilling but can clamp her mouth shut until it's dissolved). Minnie gets 1/2 pill as needed i.e. when she walks away from food when she's been presented with a buffet. The prescription says 1/2 pill every 12 to 24hr but I think you can go up to every 8h (?) someone will certainly correct me. Ondansetron is my go-to over cerenia.

I got a box of 30 x 4mg pills from Costco for $15 (can't remember if that was with Good Rx or just the Costco pricing). Sorry I can't answer about a difference in effectiveness, I just know they work differently and you can give both. Cerenia is a bit cheaper online or Costco ($20 for 4) than the vet.

And Howie, stop being a breakfast pest!! Good luck with your Friday appointment and celebrating the gotcha today. You've really had a journey, I just looked at your s/s....27u. I can't believe how fast you run through the pens. He is a lucky boy.
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Thank you for all this information on your experience! I will certainly ask my vet about differences in effectiveness between the 2 meds. Yes, a breakfast pest he is!! I have a rescue kittie in a closed off room waiting to go to a sanctuary in April-May. Howie knows she is in there and gets quite jealous if I don't dote 1000% of my time to him!! I take care of her while he eats which I know he doesn't like. But I also don't have an hour to spend each meal time taking care of them separately!
 
Sienne and Gabby (GA) said:
The two anti-nausea medications work differently and can be taken together. I wonder if Howie gets a bit of acid tummy overnight? What time is when he last eats at night vs during the day? You could try leaving some food out for him before you go to bed (or set up a timed feeder) and see if that helps.
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He does have an auto-feeder that he gets mini meals with in the day and overnight (10:30pm, 2:30am, 5:30am). He gets fed around 7:20am/pm. I'm just hoping that the Ondansetron will work as well as the Cerenia. I saw that the Chewy pharmacy has them for something like $.20 a pill (but not sure on the dosage of them). I'm sure my critter sitter I have lined up next week will be real thrilled to start giving him oral meds. Her cat takes pills like a champ. Howie fights me with the pill wand! At least he has no teeth so can't do any finger damage!
 
Getting blank gel caps may help. I will stuff as many pills as possible in a gel cap when I need to give meds. Capsuline is one place that stocks pet-sized gel caps.
 
Howiesmom said:
He does have an auto-feeder that he gets mini meals with in the day and overnight (10:30pm, 2:30am, 5:30am). He gets fed around 7:20am/pm. I'm just hoping that the Ondansetron will work as well as the Cerenia. I saw that the Chewy pharmacy has them for something like $.20 a pill (but not sure on the dosage of them). I'm sure my critter sitter I have lined up next week will be real thrilled to start giving him oral meds. Her cat takes pills like a champ. Howie fights me with the pill wand! At least he has no teeth so can't do any finger damage!
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That's why the orally disintegrating ondansetron work for me (from a human pharmacy - the vet didn't even know they were an option but wrote the Rx). They have a slight strawberry flavor which she doesn't like, but I don't have to worry about her swallowing the pill as long as I can hold her mouth shut until it dissolves/she swallows.
 
I used ondansetron and it worked well. Max got it 2x a day whenever his appetite started to be off. It can be given every 8 hours and I have read sone give it even 4 times a day but not sure if that’s recommended. If I caught it early he didn’t need an appetite stimulant. I used cyproheptadine which was so much cheaper than mirtaz and no side effects plus he could get it twice a day if needed.
 
Cerenia is better if you have vomiting, ondansetron I find generally better for nausea. They do work on different nausea receptors. Neko was taking both and if I cut back, appetite tanked pretty quickly. Cerenia is once a day, ondansetron you can give 3-4 times a day. Both also come in injectible, but stinging can be an issue. My current vet has given me compounded maropitant (what Cerenia is) that I can use on the ears. So much easier to give!

Table 9 is this document gives the dosing, and does mention ondansetron can be given every 6 hours. (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease Some vets underdose, Neko's did. So good to have the dosing in mind for Howie before you talk to the vet about it. For his weight, it's 12mg of Çerenia oral once a day and 3-6 mg of ondansetron 3-4 times a day. It comes in 4mg pills.
 
Wendy&Neko said:
Cerenia is better if you have vomiting, ondansetron I find generally better for nausea. They do work on different nausea receptors. Neko was taking both and if I cut back, appetite tanked pretty quickly. Cerenia is once a day, ondansetron you can give 3-4 times a day. Both also come in injectible, but stinging can be an issue. My current vet has given me compounded maropitant (what Cerenia is) that I can use on the ears. So much easier to give!

Table 9 is this document gives the dosing, and does mention ondansetron can be given every 6 hours. (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease Some vets underdose, Neko's did. So good to have the dosing in mind for Howie before you talk to the vet about it. For his weight, it's 12mg of Çerenia oral once a day and 3-6 mg of ondansetron 3-4 times a day. It comes in 4mg pills.
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Thanks, Wendy! I got a script for Onsansetron from the vet today to try. I was hoping he would write me out a script but instead just uploaded one in their online pharmacy that is expensive.

Side question…there was a thought that perhaps he’s got some acid reflux going on. He gets fed around 7:15am/pm and mini meals every 12 hours at 10:30 (+3), 12:30 (+5), and 2:30 (+7). Since he is not a good breakfast eater right now, it was suggested I spread his mini meals out in his feeder to 10:30 (+3), 1:00 (+5.5), and 4:30 (+9.5). His nadir is normally between +9 - +11. Is it bad (or not suggested) to give him a mini meal so close to his nadir? I know he shouldn’t get fed 2 hrs before shot time. I honestly have no idea why I settled on the original times
 
Feeding around +9 is fine if that's around his nadir. Neko got a small snack then too. Actually, feeding at the low point of the cycle is fine and can help him from going too low.
 
Wendy&Neko said:
Feeding around +9 is fine if that's around his nadir. Neko got a small snack then too. Actually, feeding at the low point of the cycle is fine and can help him from going too low.
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Thank you so much for a quick response! I’m leaving tomorrow for a work trip through Thursday so my poor critter sitter gets to deal with some of this. If you’re still online, can you verify if you think doing a decrease for the sitter down to 24 units is appropriate or if I should drop to something else? He’s been at 27 units for a long time. In normal Howie fashion, he is usually pretty stable for 4 cycles while I’m gone and then takes a nosedive. She can only come at mealtimes but does test him.
 
Can I ask you what the symptoms are for pancreatitis? My cat has been vomiting every other day (3 times total) since starting him on 0.5 of lantus. I am wondering if this could be the reason

I am very nervous to take him to the vet again because not sure if I can afford another expensive test
 
Catrina said:
Can I ask you what the symptoms are for pancreatitis? My cat has been vomiting every other day (3 times total) since starting him on 0.5 of lantus. I am wondering if this could be the reason

I am very nervous to take him to the vet again because not sure if I can afford another expensive test
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For Howie, he really slowed down on eating, would walk away from food frequently, and vomiting. He also was very cranky when you tried to pick him up. Cats don’t indicate they’re in pain. You could call your vet to see if you could get your cat some Cerenia for anti-nausea if you see any pattern with the vomiting. If eating becomes an issue, I would definitely get a pancreatitis screening.
 
Howiesmom said:
For Howie, he really slowed down on eating, would walk away from food frequently, and vomiting. He also was very cranky when you tried to pick him up. Cats don’t indicate they’re in pain. You could call your vet to see if you could get your cat some Cerenia for anti-nausea if you see any pattern with the vomiting. If eating becomes an issue, I would definitely get a pancreatitis screening.
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is that expensive?

my cat has been vomiting every other night (only at night) since starting him on insulin (im on day 6) but still has an appetite and eating frequently and is his normal happy cuddly self
 
Catrina said:
is that expensive?

my cat has been vomiting every other night (only at night) since starting him on insulin (im on day 6) but still has an appetite and eating frequently and is his normal happy cuddly self
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I would ask for some cerenia. You get 4 tablets in a box that will give you 8 days of coverage (1/2 pill a day)
 
Wendy&Neko said:
Cerenia is better if you have vomiting, ondansetron I find generally better for nausea. They do work on different nausea receptors. Neko was taking both and if I cut back, appetite tanked pretty quickly. Cerenia is once a day, ondansetron you can give 3-4 times a day. Both also come in injectible, but stinging can be an issue. My current vet has given me compounded maropitant (what Cerenia is) that I can use on the ears. So much easier to give!

Table 9 is this document gives the dosing, and does mention ondansetron can be given every 6 hours. (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease Some vets underdose, Neko's did. So good to have the dosing in mind for Howie before you talk to the vet about it. For his weight, it's 12mg of Çerenia oral once a day and 3-6 mg of ondansetron 3-4 times a day. It comes in 4mg pills.
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Hi Wendy, I’m trying to make sure I understand this dosing you mentioned a couple weeks ago as he is having a flare-up. Since he is about 13.3 pounds, you mentioned he would get 3-6mg 3-4 times a day. Since these are 4mg pills, does that actually mean he would get a whole pill 3-4 times/day? Or would he get 1/2 pills? He is currently getting 1/2 pill 2-3 times/day. Thanks! Just want to make sure I don’t overdose him!
 
Max did well with dosing every 12 hours. Every cat is different but also at first dosing every 12 hours was suggested. Id start with 3 or 4 mg and see if enough. Max actually did well on 2 mg and he was a big boy, 14-16 pounds throughout his life.
 
Yes, you can give him a whole pill 4 times a day if he needs it. Actually 1.5 pills if needed. Like Elise said, start with the smaller amount and see how he does on it. If it's not enough, increase, either timing and or quantity. You might need more during a pancreatitis (or IBD) flare.
 
Wendy&Neko said:
Yes, you can give him a whole pill 4 times a day if he needs it. Actually 1.5 pills if needed. Like Elise said, start with the smaller amount and see how he does on it. If it's not enough, increase, either timing and or quantity. You might need more during a pancreatitis (or IBD) flare.
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Thank you for that clarification! Also, do you happen to know if Ondansatron raises BGs? Even before I noticed a flare-up this week, his BGs have been a little haywire (high for him) in the 200s. I've been tempering it with Novolin R, but am not sure if that will have to be a common practice from now on or not (??) I certainly don't want to keep doing a Levemir increase! Thanks again for everything!!!
 
Howiesmom said:
do you happen to know if Ondansatron raises BGs?
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It can cause constipation, which can raise BG's, but not cause higher numbers by itself. Just watch and add Miralax or whatever you use to counter that if needed.

As for higher numbers, I'd get some spot checks at night around nadir to see if bouncing is causing the higher numbers.
 
His numbers may be higher due to him having a pancreatitis flare up right now. My boy has chronic pancreatitis & when he has a flare up his numbers are higher.
 
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