Maropitant dosing query

RE: Maropitant dosing query

dred.hall — Wed, 03 Jul 2019 15:45:44 GMT

When Pfizer/Zoetis surveyed several hundred owners with dogs that had motion sickness the most common reported sign was drooling not vomiting. The assumption is that this major sign is due to nausea (how do we know?) and in people nausea is a conscious perception (they feel 'sick'). Therefore maropitant is probably working at somewhere different from the vomiting centre at higher doses in order to reduce nausea. Vomiting due to vestibular disease is due to neural input from the vestibular apparatus to the CRTZ and the 'vomiting centre' in the medulla and therefore ought to be effective at the anti-emetic label dose.

RE: Maropitant dosing query

Aine Seavers — Sun, 30 Jun 2019 03:19:06 GMT

looks very good-handy to know for humans at least

RE: Maropitant dosing query

Aine Seavers — Sun, 30 Jun 2019 03:13:16 GMT

Normal dose of Cerenia-in at risk breeds like some lines of sighthounds/Basenji, I have the owners keep some cerenia at home to hand to start asap. We see it more in sighthounds in cold winter weather

Dexason if vomiting-it is a super-antiemetic-a fact often overlooked and is safe to use with Cerenia and Ondenestron (latter not used in VD yet-just a general comment).

Vivitonin-does help.

Routine BP checks on these cases

Elevated food or the dreaded hand-feeding in the first 48hrs

Re Serc or betahistadine-we all use it but my eldest daughter with severe vertigo later told by neurospecialist it was a waste of time. We still take it or Stemetil but not at the very high doses the hospitals originally prescribe and find it does help...

RE: Maropitant dosing query

Andrea Tarr — Wed, 26 Jun 2019 19:17:00 GMT

Dose of maripotant in motion sickness

The reason given in the EPAR (European Public Assessment Report) is that tests of the drug in a laboratory model of motion sickness indicated that the 2mg/kg dose would not be effective in clinical use. They chose the higher dose 8mg/kg based on safety studies as opposed to dose-titration studies. That is, 8mg/kg was the highest dose known to be safe and so this was the dose used in the placebo-controlled trials in dogs with motion sickness.

https://www.ema.europa.eu/en/documents/scientific-discussion/cerenia-epar-scientific-discussion_en.pdf

RE: Maropitant dosing query

Lucy Fleming — Tue, 25 Jun 2019 17:00:38 GMT

[quote user="Michael Woodhouse"]No one else giving steroids?[/quote]

I don't always, but still sometimes do. My understanding was that there's no evidence they lead to quicker resolution, but as you say might generally make them feel better. I've never used them for anti-emetic purposes though, do you know how reliable/ strong that effect is?

Interestingly, I saw two cases this weekend, both elderly dogs (one a 15 year old Westie with a pacemaker, which didn't appear to respond that well to the increased cardiac requirements of a distressed, falling over dog , mildly stressful) One was already on steroids, the other already on metacam, so I didn't add anything other than the maropitant to those.

RE: Maropitant dosing query

Thomas Johnson — Tue, 25 Jun 2019 14:37:19 GMT

[quote user="Michael Woodhouse"]

No one else giving steroids? My first boss was keen they helped and anecdotally they seem to. Makes them feel better and is an anti-emetic. Also use alongside maropitant.

[/quote]

I usually give maripotant, and occasionally a single injection of diazepam if they are really distressed, and it does really seem to help.

The argument I was given against steroids in the past is that they cause polyuria in an animal that may be reluctant to drink so could lead to dehydration, I'm not sure I buy into the argument, but thought I'd mention it...

RE: Maropitant dosing query

Beats — Tue, 25 Jun 2019 07:31:24 GMT

[quote user="Michael Woodhouse"]No one else giving steroids?[/quote]

Again my limited experience is that steroids assist as much as betahistine or propentofylline or nicergoline for the self-resolving cases (i.e. I haven't appreciated a difference versus not giving, but one may exist). Having said that, I'd expect the feel good factor from a colvasone injection probably the most promising of those options.

For non-self-resolving cases (e.g. otitis media/interna) then I personally do give some steroid and am of impression it helps.

It's all very subjective - isn't it?

RE: Maropitant dosing query

Michael Woodhouse — Tue, 25 Jun 2019 00:12:01 GMT

No one else giving steroids? My first boss was keen they helped and anecdotally they seem to. Makes them feel better and is an anti-emetic. Also use alongside maropitant.

RE: Maropitant dosing query

Beats — Mon, 24 Jun 2019 19:25:34 GMT

[quote user="Rob Davis"]I have been using betahistine in these for some time (following recommendation on here if I recall correctly), but have no idea whether or not it helps! Is anybody aware of any evidence?[/quote]

My extremely limited experience is that if you give it to a dog with vestibular syndrome then it recovers as one would expect; if you give it to a dog that has vestibular problems that you don't expect to resolve rapidly, then no effect is obvious.

Presently: presumed self-resolving peripheral vestibular cases get maropitant and nursing care from me only. I've still not been brave enough to try the modified Epley manouever adapted for a dog, but I look forward some day to meeting someone who has.

(https://www.ncbi.nlm.nih.gov/pubmed/25103883)

RE: Maropitant dosing query

Anthony Dennison — Mon, 24 Jun 2019 17:22:58 GMT

It's prescribed in humans. My wife has bad vestibular episodes now and again. Couple of years ago they were really bad and she was prescribed betahistine - worked a treat.

RE: Maropitant dosing query

Rob Davis — Mon, 24 Jun 2019 14:37:50 GMT

[quote user="robloxley"]Have you looked at betahistine in these vestibular cases?[/quote]

I have been using betahistine in these for some time (following recommendation on here if I recall correctly), but have no idea whether or not it helps! Is anybody aware of any evidence?

RE: Maropitant dosing query

Rob Loxley — Sun, 23 Jun 2019 10:46:30 GMT

[quote user="Lucy Fleming"]Should I be using the "prevention of motion sickness" dose of maropitant?[/quote]

Note that 8mg/kg is only licensed for repeating on a maximum of 2 consecutive days, as at this dose you start to get accumulation of the drug.

[quote user="Lucy Fleming"]What's the rationale behind this requiring a higher dose anyway?[/quote]

My understanding is that when they field-trialled the drug on their group of motion-sickness sensitive dogs, they needed to use this high dose to get good enough improvement in this group overall. Note that the datasheet does say lower doses than recommended may be sufficient; I certainly find this and will typically start at 2mg/kg orally. Note also that at the 8mg/kg dose, post-treatment vomiting is commonly reported, especially if animals are completely starved.

Have you looked at betahistine in these vestibular cases?

RE: Maropitant dosing query

Ian Ramsey — Sun, 23 Jun 2019 09:17:55 GMT

I have often wondered the same question myself! Why not contact the technical support of the company (there are 2 now so not sure which product you have) to provide an authorative answer as to why the two doses are different and post the reply? Would be interested to hear!

Ian

RE: Maropitant dosing query

janine redman — Sat, 22 Jun 2019 23:41:39 GMT

I have found the lower dose is effective and have not needed the higher dose. If I had a patient who was nauseous or slow to respond then I would consider the higher dose .