Amodip for dogs?

RE: Amodip for dogs?

Stephen Courtney — Sun, 28 Feb 2016 23:15:45 GMT

ACE inhibitors block Angiotensin I. Semintra blocks angiotensin II, which gets uprated when you use ACE inhibitors, and this uprating can block the effect of the ACE inhibitor ( i think...) they work in different places in the RAAS therefore can be used together with good effect if needed.

I wouldn't routinely consider using semintra and an ACE inhibitor unless i had a poorly responding situation with hypertension and evidence of renal issues as well, such as hyper proteinuria, which is what BOTH these products are supposed to help with. And they do - very well, based on serial urine protein:creatinine measurements. i like semintra in CRD cats with proteinuria as the proteinuria improves, and clients like the liquid formulation. and it drops systemic blood pressure a little more than my usual fortekor does. so there is a systemic effect as well.

I have never had a cat where I was struggling with amlodipine and fortekor, but dogs are different - as has been mentioned, and in a refractory case I'd rather add in telmisartan as well than give massive doses of the ACE inhibitor

A potential side effect of Angiotensin II blockers in humans is profound hypotension - so you do have to be careful, especially with polypharmacy.

RE: Amodip for dogs?

Martin Atkinson — Sun, 28 Feb 2016 21:31:56 GMT

[quote user="Stephen Courtney"]And if that doesn't work, add in semintra.[/quote]

[quote user="Stephen Courtney"] much cheaper than semintra[/quote]So how does this work? I thought the selling point of Semintra was that it works directly on renal hypertension unlike ACEi's which have a systemic effect. It would thus seem odd to use it for a case of systemic hypertension with or without an ACEi. And by extension if it is working systemically as well as intra-renally then there is no justification in its use as in renal hypertension given the additional cost.

RE: Amodip for dogs?

Stephen Courtney — Sat, 27 Feb 2016 21:58:14 GMT

The human amlodipine comes in 5mg and 10mg sizes,almost identical prices according to my somewhat out of date MIMS

I see also from this that our medic colleagues like Angiotensin II blockers including telmisartan among others - trade name Micardis, also made by Boehringer , comes as 20mg, 40mg and 80mg tablets, much cheaper than semintra...could be justified for a large dog, perhaps? I'd want expert guidance from a specialist though, but it seems a pretty safe drug, and probably would be very useful to dogs already on ace inhibitors, as using these uprates the angiotensin II activity anyway.

RE: Amodip for dogs?

Martin Atkinson — Sat, 27 Feb 2016 10:13:18 GMT

[quote user="Michael Woodhouse"]Have things changed? When I was at college we were told that amlodipine of no real practical use in dogs and to use ACEi - so I've never even considered it.[/quote]I have used amlodipine for hypertension in dogs but last year referred a case with a phaechromocytoma to the RVC and they said that it was not much use for hypertension in dogs and ACEi's benazepril in particular were better. Which is the opposite to cats.

In answer to the OP the it is probably no because the dose for dogs is usually much higher and the larger human size tablet may be more suitable than several 5mg tablets.

RE: Amodip for dogs?

Aine Seavers — Thu, 25 Feb 2016 22:45:42 GMT

Any one using Propanolol to address some of the hypertension? It is getting back in favour in human cardiac cases and is used here extensively in old dogs with dementia for their anxiety. In a couple of 300+ BP almost non compos mentis undiagnosed hypothyroid dogs, it was effective in reducing the bp until the thyroxine kicked in, still required some to keep the bp under control after but low doses have stabilised the dogs for some years now. It did make me wonder if some of the myxodema coma dogs in the years before bp measurement had the mental depression from soaring bp as much as any low thyroxine state.

RE: Amodip for dogs?

nikki — Thu, 25 Feb 2016 22:14:55 GMT

I've got a couple of hypertensive dogs on a combination of 0.5mg/kg/day of amlodipine and 4x the normal dose of benazepril plus low dose aspirin on the advice of the RVC medicine department. They're both still hypertensive but considering one started with a BP of 360mmHg and is now down to 240mmHg and the other from 280mmHg to 200mmHg it's at least an improvement and they're both significantly less proteinuric.

RE: Amodip for dogs?

nikki — Thu, 25 Feb 2016 22:13:41 GMT

RE: Amodip for dogs?

Stephen Courtney — Thu, 25 Feb 2016 20:56:17 GMT

[quote user="Michael Woodhouse"]

[quote user="Francisco Gomez"]Should I be using it for dogs before human preparations?[/quote]

Have things changed? When I was at college we were told that amlodipine of no real practical use in dogs and to use ACEi - so I've never even considered it.

Pub med shows it should be useful:

http://www.ncbi.nlm.nih.gov/pubmed/21671942

And yes - cost or convenience are not reasons to ignore the cascade.

[/quote]

Amlodipine is indicated for hypertension in dogs but they often need high doses, and ACE inhibitors are usually also needed. And if that doesn't work, add in semintra. i've had reasonable success ie a 12 year old border collie with hypertension and marked proteinuria becoming normotensive and less proteinuric, and living another 2 years as if nothing was wrong. i doubt she would have done that without treatment.

Alas I thing we need to use amodip in dogs as per cascade, but it is a flavoured tablet, so if we need a non flavoured pill I guess we can argue the odds

RE: Amodip for dogs?

Michael Woodhouse — Thu, 25 Feb 2016 20:07:00 GMT

[quote user="Francisco Gomez"]Should I be using it for dogs before human preparations?[/quote]

Have things changed? When I was at college we were told that amlodipine of no real practical use in dogs and to use ACEi - so I've never even considered it.

Pub med shows it should be useful:

http://www.ncbi.nlm.nih.gov/pubmed/21671942

And yes - cost or convenience are not reasons to ignore the cascade.

RE: Amodip for dogs?

Bob Russell — Thu, 25 Feb 2016 16:40:24 GMT

Cascade says yes but there is no requirement to change an existing patient over unless clinically justified.

If the tablet strength makes it impractical then you should be able to justify continuing to use the human preparation.

Cascade is law but a degree of common sense is still allowed!