Re: 2/13 Latte AMPS~394
Hey m'dear - saw your question about pain meds in your condo yesterday, and did a little digging... so here's a little food for thought ... oh, and, remember to ask if there are any drug interactions w/ all her other meds.
(been working waaay too long and gonna get some sleep now... @-)
Latte, pleeeeez soak up some more of that insulin and slide back into the blue..... pleeezzz
Is it time for "R"? Is "R" affordable? Does your vet know what "R" is and how to use it safely?
OK... some info on pain meds.... I'll catch up with you girls later....
Knowing Latte's sensitivities, I'd stay away from tramadol. If her pain is from arthritis or neuropathy, gabapentin would be an option to ask about. I don't know if would help w/ pancreatitis pain.
If in doubt, I personally would ask about using buprenorphine (Buprenex) - its considered one of the safer meds for cats, and effective for mild-moderate chronic pain, with few side effects and minimal sedation; it is used for pancreatitis pain; but I don't know how effective it is for arthritis... is Latte takiing Cosequin?
(BTW I've used bupe for all my cats over the years and never had one become inappetant)
The drops are tasteless and well tolerated by cats. According to the VASG, at the high end of dosing, a single dose can last up to 12 hrs.
http://www.vasg.org/chronic_pain_management.htm
"A ceiling effect on analgesia exists with partial agonists, making them less useful for severe pain. Buprenorphine is interesting in that increasing the dose prolongs the duration of analgesia, while the degree of pain relief remains essentially unchanged. Doses of 30 ug/kg (0.030 mg/kg) will provide ~ 8-10 hours of analgesia, and 40 ug/kg (0.040 mg/kg) may produce as much as 12 hours of pain control. The onset of action is fairly slow (~ 30 minutes when given IV, 60 minutes IM, transmucosal or transdermal)."
*Important point* Buprenex is dispensed as an oral liquid for transmucosal absorption - the drops must be placed inside the cheek pouch, NOT on the tongue. It loses its effectiveness if swallowed. This is due to the "first-pass effect" which removes from 85% - 95% of the drug when absorbed from the GI tract. In contrast, transmucosal buprenex has the same bioavailability as IM administration.
http://www.vasg.org/newer_options_for_c ... ment_2.htm
The VASG also has info on other meds; I posted a brief summary on tramadol, gabapentin, and a few others; and Dr Lisa cautions about Tramadol here:
http://www.felinediabetes.com/FDMB/view ... 647#p13647
Apparently, gabapentin and tramadol have not been studied for their adverse effects in cats, but a gabapentin study is underway at UC Davis under a 2008 Winn Foundation grant:
http://www.winnfelinehealth.org/Pages/W ... _final.pdf
Several of the CRF list members have had good results w/ gabapentin. Laura has used it for Seth (21 y/o, crf, hyperT, high BP, arthritis) for over a year. She also felt it improved his appetite.
http://groups.yahoo.com/group/feline-cr ... sage/46858 Her experience:
"Our vet has given my 21 year old Seth gabapentin (neurontin) mixed in Val syrup, and it is amazing how that works. Gabapentin is a human drug for epilepsy, that has shown remarkable success in treating neuropathic pain. It's currently being studied in the US for treatment of the pain of shingles.
Our vet compounds this for us, and it 50mg/ml gabapentin, crushed and mixed into 10cc Val syrup. The doseage is 0.2 ml by mouth, once a day. Maybe your vet will be willing to try this? It really has been wonderful for Seth - he even ventures upstairs from time to time. Hasn't done that in over a year, until lately.
Seth was diagnosed with CRF 2 years ago, and also has high blood pressure, hyperthyroidism and arthritis. He's doing great on the gabapentin, with no side effects or interactions with his other meds."
Nancy on the CRF list posted some notes on pain meds from a lecture at the Penn Vet Confc last March; here's a few excerpts for quick refc - questions to check out w/ vet:
http://pets.groups.yahoo.com/group/feli ... sage/39271
http://pets.groups.yahoo.com/group/feli ... sage/39278
GABAPENTIN: 5-10mg/kgq12h. Anticonvulsant; Neuropathic pain analgesic. May be useful in dogs and cats as adjunctive therapy for refractory or complex partial seizures or the treatment of pain. "Appears to be efffective in chronic pain in cats where an increase in sensitivity has occurred (allodynia), or where the pain appears to be excessive in comparison to the lesion present (hyperalgesia)." Caution in patients with diminished renal function (consider reducing dosage). Sedation and weight gain most likely side effects. Signs to monitor your cat for include ataxia, lethargy, bradycardia, depression and dilated pupils; In dogs, don't use with xylitol (causes rise of insulin and hypoglycemia as a result); has a short half life & fast clearance, so pills given 3x/day. Decrease dose slowly to avoid rebound pain; don't stop cold turkey.
(My vet has recommended gabapentin for my cats (arthritis)... I would be less inclined to try Tramadol...)
TRAMADOL: 1-2mg/kg once to twice daily; Has not been evaluated for toxicity in cats and not used extensively; Neurological side effects more readily seen in the cat compared to the dog, dosing should be started at the low end. Metabolism is slow in the cat; may see "Opioid" like side effects." May be useful in conjuction w/ NSAIDS. Can be partially reversed by naloxone. Very limited information is available on adverse effects in cats. Cautions for animals subject to seizures or drugs that lower the seizure threshold (phenothiazine, like acepromazine); cautions in geriatric, debilitated patients, cats w/ impaired renal or hepatic function. Dysphoria, mydriasis have been noted. Potential for CNS (central nervous system) effects--sedation, agitation (paradoxical) anxiety, tremor, dizziness or GI upset (anorexia, vomiting, constipation, diarrhea). Overdose "opioid effects" produce respiratory depression, lethargy, coma, seizure, cardiac arrest, death.
BUPRENORPHINE: 0.02mg/kgsublingual -under tongue-q8h. "Feedback from owners indicates that after 2-3 days at this dose, anorexia develops. Smaller doses may be more appropriate for "long term" administration especially in combination with other drugs." Opiate partial agonist . Good analgesic for mild to moderate pain in small animals. May cause respiratory depression, decrease in blood pressure and cardiac rate. Can be reversed with naloxone. Check drug interactions. (I used in several of my cats, but not for any length of time.)
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Carolyn, I hope her numbers come down this weekend... really glad there's no ketones lurking...
Big hugs -
Deb, angel Evie, and the boys
