Should I administer an anti-emetic after inducing emesis?

RE: Should I administer an anti-emetic after inducing emesis?

mariette asselbergs — Fri, 17 Jul 2015 16:02:24 GMT

[quote user="Michael Woodhouse"]

Anyone dropping the apomorphine into the eye and irrigating afterwards? Never tried it but apparently stops any residual vomiting/nausea from the dog.

Last dog I had to make sick was my own and I was at home having had a few beers. Gave her xylazine and then reversed with atipamezole. Works a treat. Mustard did nothing.

[/quote]

Works a treat in cats but not in dogs and if you THEN decide to give apomorphine that doesn't work because the receptors are occupied bny the xylazine, plus you have a drowsy dog. At least that happened to me when I used it because I couldn't find the apomorphine initially.

Mariette

RE: Should I administer an anti-emetic after inducing emesis?

Charlotte Marshall — Tue, 14 Jul 2015 23:33:50 GMT

I don't give an anti emetic. I give the apomorphine subcutaneously and it normally works within 5 minutes. I use the dose from the ssmall animal formulary not the one in the box. It has always worked for me. I rang the company when they brought it out and asked why they recommended such a high dose. They reckon that if you use the lower dose 5 -10 % of animals won't vomit. I worry that if I use their dose I may need to give maropitant (increasing the cost even more) and it might sedate the dog.

RE: Should I administer an anti-emetic after inducing emesis?

Lucy Fleming — Mon, 13 Jul 2015 17:45:11 GMT

I've given maropitant once after inducing emesis, but more for the owner's sake than the dog's! Nausea after apomorphine appears to wear off pretty quickly so especially given how painful Cerenia can be on injection I don't usually bother. My first practice we had the little tablets to go in the conjunctival sac which you could then rinse out again - theoretically anyway as I don't think I ever successfully managed it.

Interestingly, I once heard of a dog that ate something it shouldn't have (I forget what) after a cerenia injection, and apparently maropitant trumps apomorphine as emesis was unsuccessful. (Anecdote alert, I can't remember who I heard this from!)

RE: Should I administer an anti-emetic after inducing emesis?

Stephen Courtney — Mon, 13 Jul 2015 13:04:23 GMT

[quote user="Andrew Kent"]

I was taught to use acepromazine to reverse apomorphine, which makes a lot of sense as apomorphine primarily works through dopamine receptors and phenothiazines are dopamine antagonists.

So once they had vomited up what I wanted I would give a low dose of ACP and it seemed to work well.

Andy

[/quote]

Perhaps because the apomorphine was wearing off anyway? I'm with Martin - never give anti emetics, and the dogs seem fine in a short time. If I gave them anything I can see how i might believe it was effective though, as it is a short acting medication.

I would worry about giving ACP as it would cause sedation and somnolence and that might obscure further signs of toxicity, also I find clients like to phone at 3am to tell me their dog is 'still sleepy'.....

RE: Should I administer an anti-emetic after inducing emesis?

Andrew Kent — Mon, 13 Jul 2015 12:43:26 GMT

I was taught to use acepromazine to reverse apomorphine, which makes a lot of sense as apomorphine primarily works through dopamine receptors and phenothiazines are dopamine antagonists.

So once they had vomited up what I wanted I would give a low dose of ACP and it seemed to work well.

Andy

RE: Should I administer an anti-emetic after inducing emesis?

Bob Russell — Mon, 13 Jul 2015 12:18:49 GMT

I start with a very low dose of apomorphine, i/v. Even lowest recommended doses seem to work well. Vomiting rarely continues for more than a few minutes so anti-emetic not required.

RE: Should I administer an anti-emetic after inducing emesis?

Michael Woodhouse — Mon, 13 Jul 2015 12:08:27 GMT

[quote user="Hannah Wynne Richards"]Taxi?[/quote]

Not where I live. Plan B was get assistant (who was on duty) to bring apomorphine to my house. It didn't come to that because the xylazine worked a treat.

RE: Should I administer an anti-emetic after inducing emesis?

Hannah Wynne Richards — Mon, 13 Jul 2015 12:07:06 GMT

Taxi?

Wynne

RE: Should I administer an anti-emetic after inducing emesis?

Michael Woodhouse — Mon, 13 Jul 2015 12:04:46 GMT

[quote user="Martin Atkinson"]The effect of xylazine is too unpredictable and IME causes vomiting in less than 50% of dogs [/quote]

If I was fit to drive I'd have gone to the surgery and given the dog some apomorphine, as it was I have xylazine in the car.

I would say I found it generally worked well (much better than the other alpha 2's - I never use it for sedation in dogs, other than on home PTS's that need sedating - for the same reason it is all I carry in the car).

RE: Should I administer an anti-emetic after inducing emesis?

Dagmar Steele — Mon, 13 Jul 2015 10:32:29 GMT

In these cases I use apomorphine i.v. which causes immediate emesis. The effect wears off after less than ten minutes, no need to give any anti-emetics IMO. I didn't have great success by dropping it into the eye, had to repeat it in some cases and effect seems to last longer. i.m. works as well, but not as fast as i.v.

RE: Should I administer an anti-emetic after inducing emesis?

Martin Atkinson — Mon, 13 Jul 2015 09:57:57 GMT

[quote user="Michael Woodhouse"]Last dog I had to make sick was my own and I was at home having had a few beers. Gave her xylazine and then reversed with atipamezole. Works a treat. Mustard did nothing.[/quote]The effect of xylazine is too unpredictable and IME causes vomiting in less than 50% of dogs albeit more successful in cats 90% of which will vomit. Washing soda is the most effective general purpose stuff but few people have that at home these days.

In answer to the OP I would not give Cerenia post apomorphine. The effect of the apomorphine IME has been immediate and temporary so anti-emesis has not been necessary

RE: Should I administer an anti-emetic after inducing emesis?

Michael Woodhouse — Mon, 13 Jul 2015 00:43:11 GMT

Anyone dropping the apomorphine into the eye and irrigating afterwards? Never tried it but apparently stops any residual vomiting/nausea from the dog.

Last dog I had to make sick was my own and I was at home having had a few beers. Gave her xylazine and then reversed with atipamezole. Works a treat. Mustard did nothing.

RE: Should I administer an anti-emetic after inducing emesis?

Noweia — Mon, 13 Jul 2015 00:19:21 GMT

When it looks like it's not going to vomit more I'll give Cerenia, I hate feeling nauseous myself so seek to stop it as soon as possible in my patients.

RE: Should I administer an anti-emetic after inducing emesis?

Sara Ramsey — Sun, 12 Jul 2015 23:14:18 GMT

I don't tend to give anti-emetics though I would if the vomiting seemed to be protracted (more than 20-30 mins) and they were dry retching or nauseous. As far I recall, most of the times I've used apo-morphine (and I use the BSAVA formulary low dose, not the apometic Data sheet dose), the patients have been discharged if appropriate) after about 40 minutes.