Advice Needed: How to Administer a Dose of Gabapentin

Hi all,

Lúnasa, my civvie, is due at the vets in the morning for a blood draw and (hopefully) a cysto.

The Noodle is a tad difficult (ahem!) at the vets and she has had to be sedated in the past for blood draws, etc. The vet hopes that giving her gabapentin prior to the visit will calm her enough to allow the procedures to take place without the need for sedation.

My problem: the gapapentin capsule is really big. Can any of you give me any tips on how to administer this med, please? She's not allowed to eat anything and she's only allowed 15ml of fluid with which to wash it down. Wondering whether it could be mixed into the fluids but I don't know whether it tastes bad. It's really difficult to get her to accept fluids via syringe. (I have the scars to prove it... )

Any ideas?


Mogs
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I used to open the capsule and mix it with extra-yummy food. Amber never seemed to mind (and she was much easier to deal with at the vet, too-- sometimes, they didn't even need to use the giant oven mitts to handle her!). I have heard that gaba is bitter, though, so Amber may not be typical.

 

Gabapentin tastes terrible. I just administer the human 100mg gabapentin (they should be #3 gelcaps) with a pill popper. I tried hiding the capsule in a pill pocked but that did not work. If I opened the capsule and mixed it with either food or the pill pocket it would not be eaten.

 

Hi Mogs - Good luck with the gaba! Have you seen this article - https://fearfreepets.com/study-gabapentin-reduces-stress-cats-veterinary-visits/

I just started using it for Jax (also historically sedated for vet visits...his chart notes say "feisty kitty" ) - at his dental consult last month (so no blood draw), they were able to examine him with only minimal hissing and teeth showing We did 100mg the night before and another 100mg two hours before his visit. I opened the capsule and mixed it with a little food and water - tbh, he was suspicious but since it was the only food option, he ate it ...not sure how it is in liquid...FWIW, Jax is going in for his actual dental surgery tomorrow and he was okayed by his doctor for 2 teaspoons of food to get the gaba in him.

Also, my vet gave us extra pills incase he didn't eat it and I needed to try pilling. Gaba is pretty cheap here in the US.

And, you may know this, but keep an eye on Lunasa as a side affect is ataxia. I keep Jax in a room with nothing to jump on.

Paws crossed it works for her

 

Mogs, we use this method with Duke when he has his twice daily milk thistle tablet plus when he used to have his Synoquin and they were big capsules.
We took him of the Synoquin because of the glucosomine in it.

Good luck

 

Sorry I can’t really help, Mogs, don’t know about the capsules but my vet gives me tiny little pills of gabapentin, 25mg each, that I manage to hide into treats before get visits... I use the Natures Menu treats which are quite soft so you can mould it around the pill. Maybe ask for that next time?
Good luck at the vet, let us know how it goes,

 

Ta for the vid, Tee. That's the same method I use and it works really well for us, but all of the Noodle's other med doses are tiny. I'm scared of the capsule getting stuck ... (Heaven forbid!). It's good to know that you've had success using this method with larger lumps of medical goodness. Makes me a little less frit.




Mogs
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I've got a pair of those somewhere. I bought them in anticipation of her being really difficult to pill but, anti-jinx, she pleasantly surprised me in that direction - well, most of the time. I have had the odd occasion where she managed to hook her claws into my cuticles. (Ow.)

That's what I feared. She doesn't even like slippery elm, so I reckon mixing the capsule with fluids is going to be a non-starter.

I've only got the one capsule so no chance for a take 2 either.


Mogs
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Hi Susanne,

I reckon the Noodle's notes probably read 'psychotic cow'.

Thank you for the link and the tip about ataxia. I'll put up the kitty penthouse ready for the quare one's return home.

You did well. It was all I could do to negotiate our vet up from 10ml to 15ml of fluid to help get the capsule down. It's a worry because I suspect that Lúnasa has an issue with acid reflux and I want to protect her little oesophagus. (((Noodle)))

Sending lots of positive vibes for Jax's dental.

(((Jax)))




Mogs
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Hi Diana,

That's actually a massive help, Diana. It's good to know that there is an alternative to the jumbo capsule. I'll be sure to ask our vets about the small pills for the future: they'd be a much more straightforward option for the Noodle, and therefore much less of a worry for her bewildered mammy.


Mogs
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Yes do ask Mogs. They’re pretty little pink pills, very girly

 

You could try rubbing a little butter on the capsule first Mogs to make it a little slippery and easier for her to swallow.
I have just measured the Synoquin capsules and they are 22mm x 8.5mm, so pretty big and Duke had no problem swallowing them.

 

I hate pink. I don't do girly.




Mogs
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Horse pills!


Mogs
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Haha why did I think you’d say that...

 

You know me far too well, Diana. (I'm not sure if that's a good thing...)




Mogs
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Going to try this. I just hope I get it into the cat rather than torpedo it across the kitchen.


Mogs
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Love you Mogs!

 

Right back atcha, Diana.




Mogs
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I used to get the regular100mg capsules, open them, and split them up into smaller capsules. I’d wrap it in a pill pocket and Minnie would eat it up. I hope you managed. For the future, there’s also a liquid form you can get compounded. It may be easier than the capsules for ya!

good luck!!!

 

Thanks for the tip about the liquid formulation, Ale. I hope I manage to administer the jumbo capsule OK in the morning.


Mogs
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Lol.

 

It's down! Very nearly wasn't...

To paraphrase Ol' Blue Eyes:

♫ I did it sideways... ♫


Mogs
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Knew you had it in you Mogs! Or should I say, knew you would get it in the Noodle
Good luck today xx

 

Yay atta girls!!!

And now you have options for next time. The liquid version may be your best bet.

 

How long does it normally take for the side effects of the dose to wear off? Quite worried at the moment. Dose was administered over 10 hours ago and the Noodle still can't walk properly.


Mogs
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What was the dose Mogs? With the 4 x 25mg tablets I find the effect wears off after about six hours.

 

It was a 100mg capsule.


Mogs
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How severe were the side effects, Diana? Lúnasa's looked like a cat with severe neuropathy most of the day. Her hind legs are still weak.


Mogs
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Amber used to get pretty zonked out for the rest of the day from 100mg (can't say about apparent neuropathy because, uh, she never did move much), but was fine the next day. She was a big cat, though, over 16lbs. How big is Lúnasa?

If you're concerned about what you're seeing, I'd definitely call the vet to discuss.

 

My Sapphire was really just a bit groggy and wobbly for a few hours until the med wore off almost imperceptibly, really. Maybe the effects vary depending on the weight of the cat? Saff is fairly big. I’m sure you’ll find the effects wear off in the next few hours... let is know.

 

She's currently 9.7lb | 4.4kg (just a smidge under her ideal weight).

Ahead of you, Nan. Called the vets (again) and they told me it could take up to 24 hours for her to return to normal. Earlier today they told me she would be fine in a couple of hours. When she's had the regular injected sedative in the past she's fully recovered by about 3pm. Right now she's so groggy I can't feed her (unsafe to do so), can't give her her BP med. She's had real difficulty trying to use the litter box.

If they'd told me in the first instance that gabapentin could affect the Noodle like this I would never have given it to her. She has been a complete mess all day. It was pitched to me as a gentler and shorter-acting alternative to the injected sedative.

I am not a happy camper.


Mogs
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Sorry to hear this Mogs. I guess we all - all living things - metabolise things in a different way. I also wonder if in this case it’s due to no food being on board when it was given - might have meant it hit harder? Just a thought.

 

Or it might mean that a lower dose is appropriate for her. I wouldn't necessarily give up on the gaba as an alternative to full-on sedation, assuming it worked as hoped for the appointment. I worry about sedation, too...

Hoping she bounces back soon .

 

Instructions from the vet:

- No food after midnight.
- Administer gabapentin capsule 1 hour prior to appointment time.
- At a push, give a maximum of 15ml oral fluids to wash down the capsule. Absolutely no food.

I fed Lúnasa just before midnight so that her fast would be as short as possible.

At one stage today, Lúnasa looked like she might be having a CKD crash. When I took her up to the bathroom to use the facilities she crawled into a corner and looked worse than this:






Mogs
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So sorry for your worry, Mogs. Obvs I’m no vet but I’ve not been told to give gaba on an empty stomach before... only guessing that that could be part of the issue. All paws crossed that your little baby will shake off her side effects soon ...

 

Your poor little girl.... I hope she comes out of it soon...

 

I just had a gander at the gabapentin listing at marvistavet.com. From the listing:

Gabapentin is removed from the body via the kidneys. If it is to be used in a patient with kidney insufficiency the dose will need to be modified or another product should be selected.​

Not a whisper about this from the vet. Lúnasa has IRIS stage III renal insufficiency.

Note to self: Must always do own research. (Shame on me: I really do know better. )


Mogs
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gah! I didn't know that either...

 

Vets.... grrrr... even the best ones don’t get everything right

 

The Noodle needed to be fasted prior to the blood draw, Diana, hence the dose admin on an empty tum.


Mogs
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Also, according to the marvistavet.com listing, gabapetin can give rise to false positives for urine protein. My cat has CKD. Her blood and urine tests today were specifically to check her CKD status, and urine protein is an ever so slightly important value. I don't know how much of the drug might have found its way into her urine in the space of 2 hours but now there'll be a a question mark over the validity of her urine protein result.


Mogs
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Are you going to challenge the vet about this Mogs?

 

I will discuss it with the vet. It's possible he may be able to give me additional information as to how likely it is that the test result may have been adversely affected. If not, the issue's flagged for the next time.

The quare one's pupils are still like dinner plates, and her little body still feels leaden when I pick her up.


Mogs
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Poor baby. Has she eaten anything?

 

I can't feed her until she's more with it, Diana. Try to feed her any sooner and there's a risk of choking.


Mogs
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Ok yes sure. Really hope she’ll come out of this soon.

 

Just as another data point...

My Becca's pre-vet mood adjustment routine is 50mg of gabapentin, half the capsule, sprinkled over food two hours before the appointment. This leaves her mellow but not zorked out.

When she recently had to go in for fasting labs, the vet said it would be OK to give her just enough food to get the gabapentin down. To be on the safe side, I decided to tough it out and skip the gaba. I only bled for ten or fifteen minutes.

 

How are things today, Mogs?

 

How is she Mogs?

 

@Critter Mom, hope she's doing a bit better now...

 

Hello people,

Thank you so much for your messages. Greatly appreciated.

Good news:

The Noodle's hind legs are working better now and she has been able to eat a few uber-mini feeds. (Poor créatuir got sick last night because her stomach had been empty for so long - really acidic vomitus. )

Bad news:

She's still not great. Her pupils aren't back to normal, she's barely moved all day. She's been sleeping on the sofa but it's not a normal sleep, if you get my drift. There's a muted quality to her, her face looks different - expression has a somewhat absent look to it - and she's eerily quiet. Her blood pressure has been doing strange things too.

It's over 33 hours since the gabapentin dose was administered! By way of comparison, when she was sedated at the vets in the past, she might be slightly wobbly on her legs on return home but the absolute maximum time for her to return to full normal mobility would be 8 hours after administration of the sedative. She'd be a bit loved up with the world for the rest of the evening (a nice side effect!) but she was fully compos mentis and able to eat and drink OK. The following day you'd never know she'd had the meds.

(((Lúnasa)))




Mogs
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Hi Tom,

Thank you for posting the above. Becca's reaction to the gabapentin is what my vet indicated I should expect in Lúnasa. Given that she's at the zorked stage 34 hours after dose admin she must have been near catatonic when the vet was doing the blood draw and cysto. Based on her response, I think the dose prescribed was way too high for her.

Solidarity! I feel your pain.


Mogs
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Oh poor baby... I’m sure you’ll be discussing this with your vet, Mogs, it has not been a good couple of days for both of you. I hope to see a report very soon that things are back to normal.

 

Oh, the poor thing! It sure does sound like, at a minimum, the dose was way too much for her. Seems also like things snowballed in part because she was unable to eat for so long after that dose zonked her out so thoroughly. Maybe that wouldn't happen on a lower dose, or maybe it's just a bad fit for her kidneys, period.

Hope she continues to improve, poor little girl...

 

Aaaaaand we're back in the room.

Her nibs has just decided to make a liar of me. She's awake and moving around a little but pupils continue to be abnormally dilated somewhat, she's still spacey and seems confused: she just complained that her litter box wasn't in the bathroom. (It's in the kitty penthouse at the moment. Normally she'd go straight to wherever the litter box happened to be at a given time.) Nathelees, phew! I'll take it.

(((The Noodle)))


Mogs
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@JaxBenji -

Hi Susanne,

How did Jax's dental go?


Mogs
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Aww Mogs, I just caught up on your experience with the gaba maybe a smaller dose next time? so sorry all the angst...I hope Lúnasa is okay FWIW, the 25mg tabs are more expensive BUT I have had success pouring the 100mg tab into a small dish and dividing it apprx in half (I'll give Jax 50mg for long car rides to our beach condo). Just a thought.

You are so sweet checking on Jax. His dental went well - 2 extracted (his upper third molars). He was over drugged though so I can relate with you there...made me upset to see him SO drugged . Technically, I think they dosed to his weight but of course every cat metabolizes things differently. Alas, here we are and he's on the mend now (36+ hours post surgery). I still haven't given more pain meds (perhaps tomorrow if I think he needs them...I have gaba for the weekend which will hopefully be enough). He's eating on his own now though not quite his zealous self but loads better than yesterday - I skipped insulin last night because I wasn't confident he'd eat...he was SO out of it.

Hugs to you and Lúnasa

 

Hey Mogs,
I’ve been following along and hope things improve soon. I have to say the reaction to the gaba gives me pause — I doubt I’d personally use it again at any dose.

Does Lunasa have any heart issues? Does she receive subQ fluids for her kidney impairment? I’m wondering if maybe a bit of subQ would help flush the system a bit faster, though of course only if not contraindicated.

I’m glad she’s eating some. As for her BP, what type of wonkiness is happening? Do you test that at home?

 

How is she today Mogs?
I hope she's feeling better now.

 

Hiya,

The perk-up was short-lived last night. About quarter of an hour or so after I posted the last update the Noodler retreated to the sofa and sank back into an exhausted sleep again. Later in the evening she went up to one of her hidey places and looked a bit depressed - and still somewhat spacey. Thankfully, this morning - 48 hours after administration of the gabapentin dose - she finally seemed more like herself. Her pupils are finally back to normal but she's been a bit hissy and aggressive a couple of times today. She got her first dose of bupe in nearly three days this morning and thankfully she's eating better since (needs it to help with GI discomfort), although she did get uncharacteristically hyperactive for about 30 minutes this afternoon. She's definitely more with it and has been much more active and alert today. It's very good to hear her trilling and chatting again. Certainly a big improvement on where she's been for the last two days. (((Lúnasa)))

Thank you all for supporting the two of us. I appreciate it so much.




Mogs
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What a relief, Mogs... been worried for you both.

 

Hi JL,

Lúnasa doesn't get sub-qs (our vets aren't fans of them) but thankfully I can normally manage her hydration quite well with oral fluids. In addition to what she takes in from her food and her water bowl, she gets 80-120mls of oral fluids per day (highly diluted cat soup), with which she gets her B vitamin and D-mannose supplements.

I am inclined to agree with you that a greater fluid intake might have helped flush the drug out of her system a bit better but she was in such a bad state on the day of the blood draw that I was only able to give her a very small amount of oral fluids and couldn't give her food for fear she might choke. I don't think that helped matters in terms of flushing both the drug and any toxins present from her system. As I mentioned above, at one stage on Thursday afternoon she did resemble what Helen from Tanya's Site describes in her section on cats in uraemic crisis. If that had persisted for any amount of time I'd have brought her straight back to the vets for fluids.

I managed to get more fluids into her yesterday, plus some food (about 40-50% of daily requirement) but it was gastro support kibble - easier on the gut while I couldn't give her any bupe but not a great help for flushing the system.

Re heart issues, Lúnasa has hypertrophic cardiomyopathy (developed secondary to hyperthyroidism in early 2017). Thus far, her resting respiration rate has remained good (15-20 breaths/min). When she last had scans, etc., apart from the thickening of the left ventricular wall, there was no sign of any other physical abnormalities. She does get intermittent short coughing bouts but it's eating that triggers them, not activity or drinking her soup - unless she eats and drinks too much at the one time. The current hypothesis is that acid reflux may be the trigger, or possibly asthma. Situation is being closely monitored.

I have an oscillometric meter and I monitor her BP daily at home. It has proved very necessary because I need the data to manage the dosing of her amlodipine, and it has been a real eye-opener how different meds and supplements can affect pressure levels. Sometimes the amlodipine takes her too low and I have to adjust the dose every few days. She had one episode of syncope on benazepril last year and I do not want to go there again. If she runs low, I decrease the dose, and when she gets higher again I increase. Rinse 'n' repeat. Not unlike managing an insulin depot.

Normally the readings taken in each session fall in a consistent range, diastolic blood pressure tracks upward and downward movements in systolic BP, and the curves on the meter display are a good height. When I was trying to take Lúnasa's BP/HR readings with the gabapentin in her system, the pressure readings were really erratic (not due to movement), diastolic pressure was significantly lower than it should have been a few times, plus the curves on the display were all over the place - and much reduced in height when I did manage to get reliable reading series. Cuff placement was fine, so that wasn't the cause. Also, despite 2 skipped doses, her SBP stayed solidly at 150 +/- 2 points while the gabapentin was affecting her. Under normal circumstances, if she'd skipped 2 doses of amlodipine her BP would have been well into the severely hypertensive range (>180), so the gabapentin was definitely doing something. Her resting heart rate did not seem to be similarly affected.

The Noodle's SBP was up to 168 early this afternoon and the readings late last night and this morning were much steadier. That plus the improvements in the Noodle's clinical signs from this morning seem to point to the gabapentin being cleared from her system.

We are of the same mind. This may cause an issue down the road with the vet if Lúnasa's arthritis becomes a problem. My enquiry a short while back about potentially treating with Adequan got shot down and the vet proposed treatment with gabapentin. After this episode? I think not.


Mogs
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That's brilliant news Mogs, i'm glad she's feeling better now and eating and chatting.

 

Quite.

Lúnasa's purpose in life is to enjoy the sound of her own voice.

(((Noodle)))




Mogs
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Mogs, you’re a marvel. I hope you’ve been looking after yourself during this testing little episode...

 

Now that the Noodle seems to be over the worst and I'm back to DEFCON 3 (my idea of 'normal') the elevated stress levels of the last couple of days are really hitting home. I'm completely banjaxed. I need to go and get heavily involved with my duvet.


Mogs
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Hi Susanne,

Thanks for the Jax update. I'm glad to hear he's safely through his dental. They always make me nervous - even when they're for someone else's cat! I'm sorry they over-egged the anaesthesia. It really is both disturbing and distressing to see them out of it like that. I hope the soreness in Jax' mouth subsides really quickly.




Mogs
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Here's an FYI for anyone following this thread.

I noted in an earlier post that the marvistavet.com Pharmacy Center listing for gabapentin contained a caveat about false positive results in urine protein tests for patients receiving gabapentin. Here is further information on this matter from Plumb's Veterinary Drug Handbook 6th edition:

Laboratory Considerations
There are reports of gabapentin causing false-positive urinary protein readings on Ames N-Multistix SG dipstick tests. The use of a sulfosalicylic acid precipitation test to determine presence of urine protein is recommended for patients receiving gabapentin.​

Mogs
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@Douglas_my ginger cat - Anna, fyi in case this is of interest