Pancreatitis flare. Appetite stimulants: mirtazapine, cyproheptadine, or Entyce?

Question about appetite stimulants. Lucy, all 17 years and 9.5 pounds of her, is having a pancreatitis flare-up. Minor symptoms started about a week ago but she started really not looking too good 5 days ago which is when we started breaking out all the meds. She has had multiple bouts over the years and all have ended up in the ER for multiple days, most recent being 10 just about a year ago which was insanely expensive and we are really trying to avoid getting there again.

This time, we feel a lot more equipped to try to head it off at home or hope to anyway. She had a vet appt 4 days ago and we have been touching base daily. Her eating is definitely nowhere near optimal but not totally uninterested/zero at this point. We are keeping close track of her BG.

Her current meds:
- 2mg Ondansetron 3x daily (more aggressive approach rather than 2x as this does seem to help her)
- 8mg Cerenia 1x daily
- 100mL fluids 1x daily
- unfortunately, no pain meds. Vet does not have bupe in house and her internal medicine appt. is not until almost a week from now. Vet prescribed Gabapentin but it sounds like that won't work for pancreatitis (however, someone please correct me if I am wrong with this one as I do not want her to be in pain).
- ~2mg of mirtazapine daily (1/4 of a 7.5mg tablet)

Question is: I am not sure how well mirtazapine actually works for her and the serotonin syndrome concerns me. Vet prescribed both 1mg of cyproheptadine every 12 - 24 hours and .3mL of Entyce every 24 hours to see which one works better. Does anyone have experience with either of these?

 

Can you get Mirataz from the vet? It's a version of mirtazapine that you put in the ear and is slower acting, way less chance of getting side effects. We've had people here give cypro before, so that's also an option. I've given both Mirataz and cypro. The idea of putting something in their ear instead getting a pill down is appealing. I'd personally stay away from Entyce (called Elura for cats). It can raise blood sugar, so not recommended for diabetic pets. I've seen a few people here give it, with not a strong endorsement for it.

 

You can give ondansetron from 0.5mg up to 1mg/kg every 6 to 8 hours, less will not be effective as an anti nausea as I learned the hard way during Aida’s recent acute pancreatitis. For Lucy weighting 9.5 pounds, you could try 2.5mg x3 ondansetron, and if she’s still nauseated, you can up it to 5mg x3 and even x4 daily. There is no point of giving appetite stimulant as long as there is nausea.
The Cerenia / maropitant dose that is effective as an anti vomiting is 1mg to 2mg/kg once daily, so what you’re giving should be ok.

My vet didn’t “believe” in giving anti nausea and anti vomiting, she went with the rationale of “letting Nature do its job” and “she’ll eat when she’s ready for it” which means that I would have lost her.

And of course, we didn’t get any anti-pain medication. I gave her gabapentin and it did help her. You can give it twice a day, I don’t remember if 3 times is also safe.

You have a good plan, wishing you lots of patience and hugs!

 

Yes! I actually have an opened tube of Mirataz from ~6 months ago. The vet said it 'should' be discarded after 30 days but that it's probably fine, just less effective. The trouble I run into with Mirataz is that I have such a tough time getting her BGs with it on her ear, even though it's applied to the inside. It makes the blood drop sort of 'spread' on the fur and makes her ear more slippery/difficult to work with.

Thanks for the note on Entyce, I think I will save that as a very last resort. I am going to try the cypro this morning. I gave her a mirtazapine pill just about exactly 24 hours ago and am curious if I can give her the cypro now or if I need to wait since I have read that cypro cancels out the effects from the mirtazapine. The only comment I found on the boards is that we would have to wait 72 hours until after the mirtazapine otherwise the cypro won't work. Does anyone know if that is accurate or have experience with giving both close together?

 

Thank you for this! The initial advice I got from the vet was 1mg of the ondansetron every 12 hours which did pretty much nothing for her so I increased it after researching the boards a bit and viola! Good to know it sounds like even upping it a bit more can be an option if needed.

I am sorry to hear about Aida's recent bout and it adds so much to the stress when you are struggling with your vet!

Lucy seems to be feeling a bit better today woot so fingers crossed it continues.

 

Gabapentin would not be a good choice of pain med for pancreatitis. Gabapentin is effective for nerve based pain which does not include pancreatitis. Cats tend to do better on buprenorphine.

I'm not sure if anyone had linked our Primer on Pancreatitis. It may be helpful.