Liquid acei for cats?

RE: Liquid acei for cats?

Dave Dickson — Mon, 25 Nov 2019 12:09:14 GMT

Sounds like a plan. I will give cats with severe outflow obstruction (>5m/s) atenolol then re-scan an hour or two later to see if the PG has dropped. If it has then I keep them on it.

but I don't treat alll HOCM cats as there is no evidence drugs help and most cats/owners aren't great at taking pills.

RE: Liquid acei for cats?

Anthony Dennison — Mon, 25 Nov 2019 12:03:34 GMT

[quote user="Dave Dickson"]

That's a bit broad!

If you mean what do I use for typical HCM in cats without complications then I use the following rules of thumb:

No atrial enlargement, no arrhythmia, no significant outflow obstruction: nothing

Atrial enlargement but no clinical evidence of CHF: clopidogrel

Atrial enlargement, CHF: clopidogrel and a diuretic (frusemide or torasemide)

Occasionally, I will add in Cardalis or Vetmedin, depending on the case.

Dave

[/quote]

That's perfect, great information thank you.

So scanned a cat this morning - evidence of HCM with outflow obstruction from the mitral valve, ECG all normal, no left atrial dilation. Cat was sent to me to be scanned because of intermittent tachypnoea but also suffers from hairballs. I suspect it's the latter causing the issue - would you give any meds now or monitor and rescan in 3-6 months?

RE: Liquid acei for cats?

Dave Dickson — Mon, 25 Nov 2019 10:20:03 GMT

Hi Anthony

[quote user="Anthony Dennison"]So what do you use for feline heart disease?[/quote]

That's a bit broad!

If you mean what do I use for typical HCM in cats without complications then I use the following rules of thumb:

No atrial enlargement, no arrhythmia, no significant outflow obstruction: nothing

Atrial enlargement but no clinical evidence of CHF: clopidogrel

Atrial enlargement, CHF: clopidogrel and a diuretic (frusemide or torasemide)

Occasionally, I will add in Cardalis or Vetmedin, depending on the case.

Dave

RE: Liquid acei for cats?

Anthony Dennison — Mon, 25 Nov 2019 09:26:28 GMT

[quote user="Dave Dickson"]

Hi Topaz

There used to be one but I haven't seen it for years. However, at least for cardiac disease, the recent paper in JVIM (https://onlinelibrary.wiley.com/doi/10.1111/jvim.15572) has pretty much stopped me using ACEi in cats anyway.

Dave

[/quote]

So what do you use for feline heart disease?

RE: Liquid acei for cats?

topaz koch — Sat, 23 Nov 2019 21:49:44 GMT

Thank you so much everyone for your answers and thought provoking comments and so rapidly. Such a great community to have access to! I find it tough decision making when a lack of clear benefit / negtive effect. I always discuss this with owner along with complaince and finance and make a decision on a case by case basis.

Again thanks and have a good weekend all

RE: Liquid acei for cats?

Dave Dickson — Sat, 23 Nov 2019 21:05:02 GMT

[quote user="robloxley"]What's the current feeling on pimobendan in feline congestive heart failure?[/quote]

Much debate, little evidence. A couple of retrospective studies showing it is well tolerated and one suggesting that in HCM it confers benefit, but there are no published prospective studies to date showing it works. There is a paper in review at the moment which shows it can be harmful (data were presented at a conference recently).

I do use pimo in cats, but only occasionally - specifically when there is significant systolic dysfunction, there is no outflow obstruction and the cat will take it.

Others on the forum will have different approaches I'm sure - cats are great because there is so little data, robust opinion serves us well instead!

Dave

RE: Liquid acei for cats?

Rob Loxley — Sat, 23 Nov 2019 13:39:16 GMT

[quote user="topaz koch"]Hi does anyone know of or use a liquid palatable acei for cats?[/quote]

Is Prilium still around (off label in cats as indicated for dogs)

[quote user="Dave Dickson"]Cats are such a nightmare to medicate. We know that diuretics work and we have good evidence that clopidogrel is next in line. After that, the evidence is lacking[/quote]

What's the current feeling on pimobendan in feline congestive heart failure?

RE: Liquid acei for cats?

Roger Wilkinson — Sat, 23 Nov 2019 13:24:08 GMT

Talking of ACEi... What has happened to the VALVE study Dave?

RE: Liquid acei for cats?

Roger Wilkinson — Sat, 23 Nov 2019 12:58:18 GMT

yeah I maybe should have said that I never give them ACEi either....

that was more of a theoretical debate!

RE: Liquid acei for cats?

Dave Dickson — Sat, 23 Nov 2019 12:50:11 GMT

Call me a sceptic, but if the Fox 2003 paper had actually produced positive results, it would have been published by now. Rumour is that they never got enough cases for statistical robustness, hence it never got through review. So I don't give it much credence.

I've always be sceptical about the utility of ACEi - there is so much wishful thinking in cardiology that they work yet the evidence is seriously lacking. Perhaps one day we will get a really nice paper showing that they work. But until we do, I think the argument for using them in dogs and cats is getting weaker by the day.

I've not switched to ARBs yet either. The Cochrane review found no benefit in people so despite all the hype and pharma-marketing, yet again I think we need better evidence.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003040.pub2/full?highlightAbstract=arb%7Cwithdrawn

Cats are such a nightmare to medicate. We know that diuretics work and we have good evidence that clopidogrel is next in line. After that, the evidence is lacking and going from x2 to x3 meds a day is a big leap.

I believe most cats would be better served by fewer meds given consistently.

Dave

RE: Liquid acei for cats?

Roger Wilkinson — Sat, 23 Nov 2019 12:37:06 GMT

imidapril is an option (see below)

...interesting issue whether ACEi are interchangeable in cardiac or renal disease or indeed whether ARBs might be better anyway

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753869/

https://www.medscape.com/viewarticle/894876

Obviously a lot more evidence on this in human medicine....which may or may not be extrapolatable but at least implies there my be some differences.

Recent Benazepril paper is obviously best evidence for benazepril as per Dave. Worth considering also interim (only ever published as a research abstract) results of the muticenter feline chronic heart failure study (Fox PR, et al. J Vet Intern Med 2003;17:398.) revealed median survival:

frusemide + enalapril 920 days
frusemide + diltiazem 227 days
frusemide +placebo 235 days
frusemide + atenolol 72 days

all the best

Roger

-----

J Vet Cardiol. 2003 May;5(1):29-34. doi: 10.1016/S1760-2734(06)70042-X.
Long-term tolerance of imidapril in the cat.
Thoulon F, Woehrlé F, Boisramé B.
Abstract
OBJECTIVES:
: To determine the long-term tolerance of imidapril HCl, a novel angiotensin-converting enzyme inhibitor (ACEi), after repeated administrations in the cat.

BACKGROUND:
: ACEi's are the first-line treatment for congestive heart failure in small animals. They are believed to have potential protective effects on kidney, especially in cats. As they are used for chronic pathologies, their long-term tolerance has to be proven before clinical studies may be performed.

METHODS:
: To determine chronic tolerance, 24 cats were administered 0.5, 1.5 or 5 mg/kg/day of imidapril or a placebo for 3 months. Cats were subjected to clinical examination, cardiovascular follow-up (ECG and blood pressure determination), haemato-biochemistry and urinalysis. A toxicokinetic follow-up was carried out, and a complete necropsy performed at the end of the study.

RESULTS:
: After three months of administration, there were no clinical, cardiovascular, haemato-biochemical, or urinary adverse effect. At necropsy, cats from the high dose group (5 mg/kg/day) showed a slight hypertrophy of the juxtaglomerular apparatus with increased granulation. This was considered to be a pharmacological rather than a toxic effect.

CONCLUSIONS:
: No sign of toxicity was seen during this study. As preclinical data suggested that pharmacodynamic effect in the cat was obtained with a posology of 0.5mg/kg/day, imidapril can be considered as perfectly safe for long-term administration in the cat.

RE: Liquid acei for cats?

Dave Dickson — Sat, 23 Nov 2019 12:07:07 GMT

Hi Topaz

Dave