Metronidazole for cats

RE: Metronidazole for cats

bevs2251 — Thu, 15 Nov 2018 05:14:45 GMT

Yes. Years ago, had one cat develop neurological signs when he had a second course - he had been on a 7 day course of metronidazole 10mg/kg bid and clavulox for a cat bite abscess. Some time later, I put him on Stomorgyl (metronidazole/spiramicin combo) 10mg 1/2 tablet daily for gingivitis/halitosis. It was during this course that he developed the neurotoxicity. He saw a neurologist who confirmed the diagnosis. Resolved once off the drugs. Only case I've seen in a cat in 30+ years. Have had many cats on it long-term for IBD etc. Probably an idiosyncratic reaction.

Have seen it a couple of times in dogs too (usually small dogs, eg maltese), at regular dose of 10-20 mg/kg bid, but generally those were on it long-term (for gingivostomatitis/IBD issues).

Something to just keep in mind. Appears to be quite a rare reaction. I use Metronidazole a lot - one of my favourite M drugs (methadone/meloxicam etc).

RE: Metronidazole for cats

Richard Carter — Mon, 12 Nov 2018 12:35:16 GMT

use it in preference to clav/amox for GI conditions (at the lower 8-10mg/kg) - not seen issue. In days of flagyl, cats would froth after admin but then have you ever tasted flagyl??

RE: Metronidazole for cats

Silvia Maldonado — Mon, 12 Nov 2018 11:28:18 GMT

I personally am a bit worry with using metronidazole in cats. Has anyone got adverse reaction to oral treatment? if so, how much was the dose?

RE: Metronidazole for cats

Thomas Johnson — Mon, 12 Nov 2018 11:08:29 GMT

[quote user="Michael Woodhouse"]I'd agree with you if everything was referenced with good evidence. As it currently stands there are a few screaming anomalies (10mg/kg paracetamol feels very convenient). I'm very happy using the Metrobactin at licenced dose rates (sometimes for longer periods of time) and it seems safe and anecdotally more effective. I suspect we were actually underdosing.[/quote]

I spoke to one of the veterinary advisors at Dechra about the recommended dose shortly after Metrobactin came out. The story I was told was that the regulating authorities wouldn't let them apply for a license with more than one recommended dose, i.e. different doses for different conditions, they had to make the application with one dose that would treat everything it was licensed to treat. This meant they had to go with the 25mg/kg dose for giardia, even though a lower dose will kill bacteria.

RE: Metronidazole for cats

Rob Loxley — Sun, 11 Nov 2018 21:08:29 GMT

[quote user="Michael Woodhouse"]I'm very happy using the Metrobactin at licenced dose rates (sometimes for longer periods of time) and it seems safe[/quote]

But you will find case reports of metronidazole toxicity with these higher dose rates for extended periods

RE: Metronidazole for cats

Michael Woodhouse — Sun, 11 Nov 2018 18:12:35 GMT

[quote user="Martin Atkinson"]It will be a great shame if that is now its mandate. I've always thought the greatest benefit of the BSAVA formulary was the anecdotal evidence for treating off label with generics and human drugs - indications and dose rates. It is of little advantage if it just paraphrases veterinary drug companies data sheets.[/quote]

I'd agree with you if everything was referenced with good evidence. As it currently stands there are a few screaming anomalies (10mg/kg paracetamol feels very convenient). I'm very happy using the Metrobactin at licenced dose rates (sometimes for longer periods of time) and it seems safe and anecdotally more effective. I suspect we were actually underdosing.

RE: Metronidazole for cats

Charlotte Marshall — Sun, 11 Nov 2018 16:49:22 GMT

There was a thread about metrobactin dosage on samsoc a while ago. The consensus seemed to be that virtually everyone was using the old dose of 10-15 mg/kg bid. Some people had seen neurotoxicity at 50 mg/kg per day as on the data sheet but I think it had been used for longer than the 5-7 days.

RE: Metronidazole for cats

Emily Rainbow — Sun, 11 Nov 2018 14:38:50 GMT

Myself and my colleagues in my current and previous locum practices have continued using 10mg/kg BID, although I’ll happily round up to around 15mg/kg if necessary to split the tablets sensibly.

RE: Metronidazole for cats

Martin Atkinson — Sun, 11 Nov 2018 09:43:08 GMT

[quote user="robloxley"]I assume the formulary just follows the datasheet dose where there is now one.[/quote]It will be a great shame if that is now its mandate. I've always thought the greatest benefit of the BSAVA formulary was the anecdotal evidence for treating off label with generics and human drugs - indications and dose rates. It is of little advantage if it just paraphrases veterinary drug companies data sheets.

RE: Metronidazole for cats

Rob Loxley — Sat, 10 Nov 2018 17:55:39 GMT

[quote user="Martin Atkinson"]Earlier in this thread we've discussed that Dechra's recommended dose rate is 50 mg/kg daily divided was rather high. So I took the trouble to look at the dose in BSAVA formulary which in the previous edition was 8-10 mg/kg bid which justified keeping the generic sizes but is now 25 mg bid or 50 mg sid in the latest edition - why the sudden change?[/quote]

I assume the formulary just follows the datasheet dose where there is now one. But be aware this dose is the higher end of the previous accepted dose range, and is what you need to kill giardia (though my understanding is fenbendazole is more effective) which it is licensed for.
But also be aware the licensed dose is for 5-7 days, if using longerterm (e.g. 'antibiotic responsive diarrhoea) at that dose then you will see cases with neurological side effects

RE: Metronidazole for cats

Gillian Mostyn — Sat, 10 Nov 2018 13:57:56 GMT

I've been wondering the same. I thought our recent grad had overdosed a small dog until I checked the recent formulary!

RE: Metronidazole for cats

Anthony Todd — Sat, 10 Nov 2018 13:43:25 GMT

Surely obtaining a product licence for Metrobactin would have required statutory, thus exhaustive, documented toxicity trials for each licensed species??

RE: Metronidazole for cats

Martin Atkinson — Sat, 10 Nov 2018 13:24:27 GMT

Bump!

I have finally got round to buying Metrobactin and in the light of a locum dispensing some old stock 50 mg and 25 mg metronidazole tablets to a cat this week was agonising over the dose rate. Earlier in this thread we've discussed that Dechra's recommended dose rate is 50 mg/kg daily divided was rather high. So I took the trouble to look at the dose in BSAVA formulary which in the previous edition was 8-10 mg/kg bid which justified keeping the generic sizes but is now 25 mg bid or 50 mg sid in the latest edition - why the sudden change? This obviously makes dispensing Metrobactin easier.

RE: Metronidazole for cats

nikki — Wed, 10 Aug 2016 18:36:11 GMT

I didn't comment on that aspect. Just answered the original question. Have always used 10mg/kg personally. [quote user="robloxley"]

[quote user="nikki"] It is licensed at a dose of 50mg/kg/day[/quote]

Does this mean that is the right/sensible dose to give it at? Especially in cats??

[/quote]

RE: Metronidazole for cats

Martin Atkinson — Wed, 10 Aug 2016 16:58:28 GMT

Recommended dose for cats is 8-10mg/kg. If you're not comfortable giving a higher dose in order to use the licenced product then you are totally legally as well as morally justified in using the 25mg/50mg tablets from Summit.

RE: Metronidazole for cats

Rob Loxley — Tue, 09 Aug 2016 22:22:51 GMT

[quote user="nikki"] It is licensed at a dose of 50mg/kg/day[/quote]

Does this mean that is the right/sensible dose to give it at? Especially in cats??

RE: Metronidazole for cats

Eilidh Corr — Tue, 09 Aug 2016 22:16:38 GMT

I'm uncomfortable with that high a dose, licensed or not.

RE: Metronidazole for cats

Rob Loxley — Tue, 09 Aug 2016 22:10:50 GMT

[quote user="nobbygonzo"]Thanks, still can't find it though and wholesaler don't have it in that size. Perhaps it isn't out yet...[/quote]

Metrobactin definitely available through Henry Schein. Small size is 250mg divisible into 4.
For smaller strengths either special tablets from Summit or human oral suspension.

RE: Metronidazole for cats

nikki — Tue, 09 Aug 2016 22:08:48 GMT

I don't think there is a 50mg one coming out. The metrobactin 250mg is licensed for cats and splits easily into quarters. It is licensed at a dose of 50mg/kg/day.

RE: Metronidazole for cats

Catriona MacIntyre — Tue, 09 Aug 2016 20:03:42 GMT

If you can't get hold of it Summit Pharmaceuticals do 25mg and 50mg generic metronidazole

RE: Metronidazole for cats

Karen Eggleton — Tue, 09 Aug 2016 19:33:45 GMT

Thanks, still can't find it though and wholesaler don't have it in that size. Perhaps it isn't out yet...

RE: Metronidazole for cats

Catriona MacIntyre — Tue, 09 Aug 2016 19:26:49 GMT

Metrobactin I think