New 'libeo' tablets

RE: New 'libeo' tablets

Anthony Todd — Wed, 16 Dec 2015 16:30:03 GMT

[quote user="David Mills"]

It is the writers curse that the intelligence of their readers cannot be guaranteed

[/quote]

Oh, I dunno, I can understand Katie Price, and her daughter's a sweetie.

RE: New 'libeo' tablets

David Mills — Wed, 16 Dec 2015 15:49:34 GMT

[quote user="Virginia Campbell"]Less than good because of the very high dropout from the study, or not impressive enough results vs placebo?[/quote]

Very weak inclusion criteria mainly. Many of the dogs were unlikely to have been anywhere near CHF. The commentary on it sets it out quite nicely if you have access to JVIM.

[quote user="Martin Atkinson"]be interested to know how many of those were on thiamazole or methimazole for concurrent treatment of hyperthyroidism which we know do cause ulcerative facial dermatitis.[/quote]

None. It was an experimental colony of Maine Coons with HCM.

RE: New 'libeo' tablets

Martin Atkinson — Wed, 16 Dec 2015 15:41:47 GMT

[quote user="David Mills"] a large number of cats suffered severe ulcerative facial dermatitis[/quote]I would be interested to know how many of those were on thiamazole or methimazole for concurrent treatment of hyperthyroidism which we know do cause ulcerative facial dermatitis.

RE: New 'libeo' tablets

Virginia Campbell — Wed, 16 Dec 2015 15:31:37 GMT

Thanks for those links David. Good to know about this:[quote user="David Mills"] ulcerative facial dermatitis)[/quote] as a risk if I did decide to try it off licence in cats - I'd always thought of spironolactone as a fairly benign thing.

[quote user="David Mills"]Its use in dogs, while commonplace, does not have much evidence to support it. The 'original' study (by CEVA) is, erm, less than good[/quote]

Less than good because of the very high dropout from the study, or not impressive enough results vs placebo?

RE: New 'libeo' tablets

Mark Hedberg — Wed, 16 Dec 2015 15:12:29 GMT

I'm loving pimobendan in cats; kept my mom's cat going WAY beyond the average prognosis!

RE: New 'libeo' tablets

David Mills — Wed, 16 Dec 2015 12:33:05 GMT

[quote user="Martin Atkinson"]You really are assuming your readers are stupid David. [/quote]

I'm only going off the evidence earlier in this thread...

RE: New 'libeo' tablets

Martin Atkinson — Wed, 16 Dec 2015 12:31:53 GMT

[quote user="David Mills"] it is referred to as a "piss poor diuretic" (geddit?) [/quote]You really are assuming your readers are stupid David.

But more sensibly, I do agree that the evidence for the significance/prevention of cardiac fibrosis is spurious.

RE: New 'libeo' tablets

Kate Richardson — Wed, 16 Dec 2015 10:18:28 GMT

[quote user="David Mills"] Its diuretic effects are generally quite weak - it is referred to as a "piss poor diuretic" (geddit?) so I certainly wouldn't rely on it for oedema resolution.[/quote]

That is my understanding as well, but I have found it very useful in addition to frusemide when I am reluctant to increase the frusemide dose but need additional diuresis.

[quote user="Martin Atkinson"]but I've never known a problem with potassium in animals on diuretics. It is a theoretical rather than practical problem extrapolated from human medicine IMO.[/quote]

Not in my experience. Usually cats that are predisposed to hypokalaemia in the first place, but I have seen it in other cats, usually picked up before the hypokalaemia is causing a problem, hence why I look at electrolytes frequently in cats

RE: New 'libeo' tablets

David Mills — Wed, 16 Dec 2015 09:29:44 GMT

[quote user="Virginia Campbell"]I assume for the diuretic but potassium-sparing effect in those that are dodgy of kidney and/or prone to inappetance....but I'm also interested in using with HCM cats with some degree of fibrosis, given that I've heard encouraging mutterings about the anti-fibrotic effects of spironolactone in mitral valve disease dogs and also chronic active hepatitis (don't know of any proper studies on spironolactone in HCM/MVD/chronic active hepatitis though)[/quote]

There has been some work in cats, which showed no significant anti-fibrotic effects over 4 months (and a large number of cats suffered severe ulcerative facial dermatitis):

http://www.ncbi.nlm.nih.gov/pubmed/18346145

Its use in dogs, while commonplace, does not have much evidence to support it. The 'original' study (by CEVA) is, erm, less than good:

http://www.ncbi.nlm.nih.gov/pubmed/20102506

Commentary here:

http://www.ncbi.nlm.nih.gov/pubmed/21054535

And another study here showing no benefit:

http://www.ncbi.nlm.nih.gov/pubmed/20950346

Its use in humans came about because of the RALES study in the late 90s which was stopped early due to a large benefit in the treatment group. Recent re-analysis has shown that those who benefited were mostly on digoxin concurrently.

Whilst theoretically and experimentally it has anti-fibrotic effects, I don't think we have enough evidence to say this happens in vivo or is beneficial to survival.

I don't use it other than in cases of refractory oedema or problems with potassium. It doesn't help that its more expensive than pimobendan. Its diuretic effects are generally quite weak - it is referred to as a "piss poor diuretic" (geddit?) so I certainly wouldn't rely on it for oedema resolution.

RE: New 'libeo' tablets

Martin Atkinson — Wed, 16 Dec 2015 09:22:33 GMT

[quote user="Virginia Campbell"]I assume for the diuretic but potassium-sparing effect in those that are dodgy of kidney and/or prone to inappetance....but I'm also interested in using with HCM cats with some degree of fibrosis. Anyone using Cardalis in cats?[/quote]I had a cat with dilative cardiomyopathy that was maxed out on frusemide so I gave it spironolactone as well as a diuretic but I've never known a problem with potassium in animals on diuretics. It is a theoretical rather than practical problem extrapolated from human medicine IMO. I also thought about the anti-fibrotic effect so that was in my consideration. And yes, I switched the ACEi to Cardalis once we did this. Although I am cynical that this is just another of the drugs formulated to take advantage of the back door of the cascade it does at least have the advantage of being a combination medication.

RE: New 'libeo' tablets

Virginia Campbell — Tue, 15 Dec 2015 22:10:50 GMT

[quote user="Kate Richardson"]spionolactone is helpful.[/quote]

I assume for the diuretic but potassium-sparing effect in those that are dodgy of kidney and/or prone to inappetance....but I'm also interested in using with HCM cats with some degree of fibrosis, given that I've heard encouraging mutterings about the anti-fibrotic effects of spironolactone in mitral valve disease dogs and also chronic active hepatitis (don't know of any proper studies on spironolactone in HCM/MVD/chronic active hepatitis though)

Anyone using Cardalis in cats?

RE: New 'libeo' tablets

David Mills — Tue, 15 Dec 2015 18:36:02 GMT

It is the writers curse that the intelligence of their readers cannot be guaranteed

RE: New 'libeo' tablets

Martin Atkinson — Tue, 15 Dec 2015 18:34:36 GMT

[quote user="David Mills"]Sorry if it was too complicated for you.[/quote]I know they begin with the same letter but there is a difference between confusing and complicated.

Anyway it seems they jumped out of the frying pan into the fire getting you to write articles rather than me!

RE: New 'libeo' tablets

David Mills — Tue, 15 Dec 2015 18:31:33 GMT

[quote user="Martin Atkinson"]I know I read it and grudgingly admit that it was quite interesting if not a little ambiguous and contradictory so the conclusion you have highlighted above was not clear.[/quote]

Sorry if it was too complicated for you.

RE: New 'libeo' tablets

Martin Atkinson — Tue, 15 Dec 2015 18:24:24 GMT

[quote user="David Mills"]I wrote a VT article in September[/quote]I know I read it and grudgingly admit that it was quite interesting if not a little ambiguous and contradictory so the conclusion you have highlighted above was not clear.

RE: New 'libeo' tablets

David Mills — Tue, 15 Dec 2015 16:52:19 GMT

I wrote a VT article in September (I think) about recent advances in feline cardiology (they've changed their website so I can't link it up). From an evidence perspective, pimobendan has the greatest evidence base and has shown improved survival vs other treatments across most cardiomyopathies. Half life appears longer in cats (12-18h) than dogs (4-6h) meaning it can be given q24h (normally use 1.25mg/cat/day).

RE: New 'libeo' tablets

Martin Atkinson — Tue, 15 Dec 2015 14:30:37 GMT

[quote user="Kate Richardson"]I don't use Hypercard for my cardiac cats, but would consider an ace inhibitor instead; diuretics are the main stay of treatment in cats although I believe pimobendan is proving very useful in some cases as well.[/quote]Many years ago I started using an ACEi until Dannielle Gunne-Moore told me to use diltiazem in cats until I leaned that it was no more indicated than an ACEi so I'm now back to using benazepril +/- frusemide if indicated. As the condition progresses I will go onto pimobendan then spirolactone all with low dose aspirin.

My own cat is on Nelio with low dose Aspirin, he doesn't have an effusion or cough so no diuretic at present. I diagnosed him on a grade 3/6 murmur, cardiomegaly on X-ray and a NT-proBNP of >1000! And before anyone says: no I'm not going to refer him for echo!

RE: New 'libeo' tablets

Kate Richardson — Tue, 15 Dec 2015 11:25:38 GMT

If you're struggling to get the Hypercard in Gillian Mostyn then I would try her without it- the frusemide is probably more important anyway. Depending on dose, keep an eye on kidneys and potassium levels, often combing with spionolactone is helpful. But in cats I tend to go for minimal numbers of tablets if at all possible! I don't use Hypercard for my cardiac cats, but would consider an ace inhibitor instead; diuretics are the main stay of treatment in cats although I believe pimobendan is proving very useful in some cases as well.

RE: New 'libeo' tablets

Gillian Mostyn — Tue, 15 Dec 2015 10:19:18 GMT

Hang on Martin...she wasn't that bad!!

RE: New 'libeo' tablets

Martin Atkinson — Tue, 15 Dec 2015 09:02:19 GMT

[quote user="Gillian Mostyn"]Embarrassingly have to admit that I managed to not notice my cat's problem to the point of significant dyspnoea![/quote]FIFO! Now you can sympathise with those owners who claim that their end-stage dyspnoic cats have only been like it since last night and their sarcopenic/cachectic cats have only been off their food for 2 days!!!!!

RE: New 'libeo' tablets

Mark Hedberg — Tue, 15 Dec 2015 08:59:55 GMT

[quote user="Gillian Mostyn"]

[quote user="John Flynn"]and no better reviewer than a vet who's giving it to their own cat in my mind[/quote]

Embarrassingly have to admit that I managed to not notice my cat's problem to the point of significant dyspnoea! (I was casually watching her when I noticed she was rocking gently....and then noticed it was in time with her breathing...oops!)

She had very significant pleural effusion and ascites and radiographs showed could 'just' be HCM (amongst other differentials, obviously). I'm afraid it was a case of 'well I'll try some meds but if no improvement then bye bye Maisie' (she is 17) but she is a new cat now! Although, now the ascites has resolved, I have noticed how skinny she's become...

[/quote]

My mother's cat lasted 3 years on pimobendan and diuretics; if the hypercard is a pain, the chewable vetmedin, while pricier, was something this grumpy old madam (the cat, not my mother) would happily take.

RE: New 'libeo' tablets

Gillian Mostyn — Mon, 14 Dec 2015 21:00:51 GMT

Lol... Yes.

RE: New 'libeo' tablets

Kate Richardson — Mon, 14 Dec 2015 20:59:41 GMT

Have you checked her T4?

RE: New 'libeo' tablets

Gillian Mostyn — Mon, 14 Dec 2015 20:45:34 GMT

[quote user="John Flynn"]and no better reviewer than a vet who's giving it to their own cat in my mind[/quote]

RE: New 'libeo' tablets

John Flynn — Mon, 14 Dec 2015 20:27:49 GMT

Thanks Gillian - always good to learn about new options and no better reviewer than a vet who's giving it to their own cat in my mind

Had to google the hypercard so there's no end to what I don't know about cat medicines these days it seems! (still not sure when I'd use it, but at least I know it exists now which is a start :-) )