Mirtazapine as regular treatment for CKD cats.

RE: Mirtazapine as regular treatment for CKD cats.

Kate Richardson — Fri, 15 Jan 2021 15:22:02 GMT

haven't found many that are tasty to be honest! But Bova do a chicken flavoured Aluminium hydroxide which I would be inclined to try

RE: Mirtazapine as regular treatment for CKD cats.

Kate Richardson — Fri, 15 Jan 2021 15:15:18 GMT

If I'm going to use an H2-antagonist (which is rare) I use famotidine, predominantly as it can be given once daily, although some authors advise twice daily. I would usually go for omeprazole as well, Summit and Bova both make 2.5mg and 5mg tablets which is helpful. I'm a bit sceptical about the usefulness of antacids to be honest though, although some people seem to dish them out like smarties. Often hard enough for clients to medicate their cats, so I tend to keep things as minimal as possible.

RE: Mirtazapine as regular treatment for CKD cats.

Joyce Whitehead — Thu, 14 Jan 2021 21:25:05 GMT

We tend to use Pronefra as liquid so easier to get down the animal. I’m actually not sure what the flavour is though?

RE: Mirtazapine as regular treatment for CKD cats.

Beats — Thu, 14 Jan 2021 17:00:59 GMT

And lastly..>!

Best flavoured phosphate binders?

Mollass flavoured by preference :-)

RE: Mirtazapine as regular treatment for CKD cats.

bevs2251 — Thu, 14 Jan 2021 01:40:23 GMT

Used on 2 of my own CKD cats for over 12 months, every second day. 15mg 1/4 tab (too difficult to split in 1/8s). Appetite excellent in both right to the end.

RE: Mirtazapine as regular treatment for CKD cats.

David Mills — Wed, 13 Jan 2021 12:22:16 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29578/mirtazapine-as-regular-treatment-for-ckd-cats/227788#227788"]Can I ask a preferred H2-antagonist for cats at the same time.[/quote]

Ranitidine and cimetidine make no difference to stomach pH when compared to saline - there were some studies done in Iran in cats (and dogs I think) which showed this. Not sure about famotidine, never used it. We normally use omeprazole 10mg/cat SID or BID. If giving SID apparently best to give in the evening as proton pumps are manufactured overnight, but takes a week to hit full effect. The stuff about hypertrophy with long-term use comes from a lab study in rats (which were given a relatively high dose I think) and has not been demonstrated clinically.

Ondansetron is used widely in humans undergoing chemotherapy and is apparently a powerful and safe anti-nausea and anti-sickness medication in humans, but I've never used it in animals. Referral centres seem to love it.

RE: Mirtazapine as regular treatment for CKD cats.

Beats — Wed, 13 Jan 2021 10:05:40 GMT

Thanks folks.

I'm going to get some of the Summit 2mg ones and try a lower dose of 1mg per cat q24hours and see how that goes.

Can I ask a preferred H2-antagonist for cats at the same time. I've never used the 5mg SUmmitt famotidine - are those worth a go? Preference beween these and the Summit ranitidine tablets? Preference for something else? (Must be tablet rather than liquid for specific cat I have in mind, but general suggestions of preference to include liquid useful for future occasions!).

Cat in question was losing weight with CKD and inappetant. On getting 1/8th mirtazapine 15mg tablet daily for a week, did not do great - unclear if that was result of the tablets, or not doing great in spite of tablets. I'm going to try on a H2-antagonist next most likely (but will consider Lucy's suggestion of maropitant instead- what dose for average CKDcat, Lucy?), but might restart the mirtazapine at 1mg q48hrs as wonder if dose I was giving was just a bit high for this cat.

RE: Mirtazapine as regular treatment for CKD cats.

Lucy Fleming — Mon, 11 Jan 2021 12:02:14 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29578/mirtazapine-as-regular-treatment-for-ckd-cats/227702#227702"]I do have concerns about using them long term, from the point of view if we have to stimulate the appetite, is the cat really well and happy?[/quote]

I've never used it much, for exactly this reason, and have tended more towards using maropitant instead, but good to hear success from others. Anything that keeps food intake up and avoids excessive muscle catabolism is always a plus (perhaps that is what led to improved renal values in the study David mentioned?)

RE: Mirtazapine as regular treatment for CKD cats.

Kate Richardson — Sat, 09 Jan 2021 12:33:56 GMT

I use the Summit 2mg tablets, and give 1/2-1 tablet as needed. No hesitation in using them daily if a) effective and b) no side effects, but I do have concerns about using them long term, from the point of view if we have to stimulate the appetite, is the cat really well and happy? I accept it could be controlling nausea which in turn makes them feel better and eat better, but if there is no nausea and it's just stimulating appetite, is that ethical? In some cases are we just keeping them going for the sake of it? Not saying I've got all the answers!

haven't used the transdermal enough yet to comment on its efficacy, not overly effective in the couple of cats I tried it on.

RE: Mirtazapine as regular treatment for CKD cats.

Joyce Whitehead — Thu, 07 Jan 2021 22:20:25 GMT

That’s interesting the the every 3 days as generally that is how I’ve used it, but on some cases I’ve increased to every other day. I’d agree it seems to perk them up and make them feel happier as well as improve appetite, not too surprising I guess as it is an anti depressive in people. I’ve also used it in late stage heart failure dogs when they have poor appetites to good effect.

RE: Mirtazapine as regular treatment for CKD cats.

Julie Turner — Tue, 05 Jan 2021 20:59:25 GMT

I just use it as necessary, but not more frequently than q48 hours

No scientific papers but it certainly works David

sometimes the scientific proof lags behind - any cat specialists here to comment?

Sometimes the “drug” is just snake oil/placebo. I really believe this works on appetite - as I wrote, I don’t know the long-term side-effects, I can only be anecdotal but in elderly cats it makes a big difference within 30 minutes and their QOL is better in my opinion

RE: Mirtazapine as regular treatment for CKD cats.

David Mills — Tue, 05 Jan 2021 16:52:16 GMT

There was an American paper on its daily usage for cats with CKD that was presented at BSAVA a few years back during a lecture, small numbers, but I think they showed consistently improved appetite and reduction in renal values over time in these cats.

We use a quarter of the generic per cat per day as required, not sure the every 3 days has any basis in any science whatsoever.

RE: Mirtazapine as regular treatment for CKD cats.

Emily Rainbow — Tue, 05 Jan 2021 13:37:55 GMT

Also a transdermal formulation too!

RE: Mirtazapine as regular treatment for CKD cats.

Sara Ramsey — Mon, 04 Jan 2021 20:07:38 GMT

Summit do 2mg tablets

RE: Mirtazapine as regular treatment for CKD cats.

Beats — Mon, 04 Jan 2021 20:00:45 GMT

Thanks Julie,

Which brand of 2mg tablets?

RE: Mirtazapine as regular treatment for CKD cats.

Julie Turner — Mon, 04 Jan 2021 19:29:26 GMT

I use it as an appetite stimulant and anti-vomiting

2mg tablets - half to one every 3 days but could be less and less frequently. The cat tends to look a bit spaced initially, some foam at the mouth a bit too, but I find it incredibly useful. It’s mostly older cats that get it on a regular basis - only because I don’t know the full dynamics, so would be hesitant using regularly in a cat with a prospective longer lifespan.
I have used it for over 10 years now I think.
currently my own hyperthyroid (only on thyronorm) cat whose renal and hepatic enzymes have been raised for over a year, intermittently vomits/goes off her food, gets it if she’s been inappetant or vomiting for more than 12-24 hours.

obviously you have to observe the cascade but I don’t know anything as useful!