sublingual temgesic dose for cats

Re: sublingual temgesic dose for cats

Kirsten Simpson — Tue, 16 Feb 2010 22:03:42 GMT

That's pretty much what I was getting at really. Ta!

Re: sublingual temgesic dose for cats

Matt Gurney — Wed, 03 Feb 2010 20:13:26 GMT

[quote user="salome2001"]as far as I am aware there is no veterinary licensed sublingual preparation of buprenorphine licensed for pain control in cats so this is perfectly within cascade.[/quote]

Vetergesic is licensed for use in cats therefore under the cascade you should use this product over a human product, regardless of route. There is no justification for the use of Temgesic in this case.

Matt Gurney

European Specialist in Anaesthesia & Analgesia

Re: sublingual temgesic dose for cats

warwickshire vet — Mon, 01 Feb 2010 09:10:07 GMT

The other option for your cat with OA is to go the cartrophen/glucosamine route, slower to sort but will be better in the long term

Re: sublingual temgesic dose for cats

salome2001 — Sun, 31 Jan 2010 16:33:33 GMT

I take this on board. I do think that there is the additional consideration of dispensing a controlled drug in an injectable form, and I think the practice's decision to use a non-injectable formulation is reasonable and cautious.

Re: sublingual temgesic dose for cats

Laurence Webb — Sun, 31 Jan 2010 15:08:55 GMT

Personally I'd be happy to use buprenorphine in this sort of situation although it may be worth considering playing around with other immunosupressants to get better control over the arthritis (nb ciclosporin also causes insulin antagonism though). Rheumatoid arthritis isn't one of my strong points so this is more of a suggestion rather than advice!

You could also consider fentayl patches which could be changed by the practice every 3-4 days if the pain is severe enough or using NSAIDs alongside omeprazole, which is a common combination in humans. If the practice applies and disposes of the patches (they'd need to go in controlled drug waste anyway) then that would enable them to check they're not being misused.

As far as the cascade goes you should be using any animal licensed product before using a human generic...

If there is no suitable authorised veterinary medicinal product in the United Kingdom for a condition in a particular species, in order to avoid unacceptable suffering veterinary surgeons may exercise their clinical judgement according to the 'Cascade', whereby they select in the following order

a. a veterinary medicinal product authorised in the United Kingdom for use with another animal species, or for another condition in the same species (off-label use); or

b. if, and only if, there is no such product that is suitable, either:

a. a veterinary medicinal product authorised in the United Kingdom for use with another animal species, or for another condition in the same species (off-label use); or

b. if, and only if, there is no such product that is suitable, either:

i. a medicinal product authorised in the United Kingdom for human usei. a medicinal product authorised in the United Kingdom for human use

so the correct order would be an animal licensed injectable given oraly before using a human product unless there are clinical reasons for not doing so. The same goes for fentanyl patches. In practice it would be a real jobsworth and the VMD to pull you up on that one though! It's not as though you're choosing to buy in human generic cephalexin instead of stocking Ceporex etc to save money. Your choice of medication is based on clinical factors and not financial ones

Re: sublingual temgesic dose for cats

salome2001 — Sun, 31 Jan 2010 13:51:14 GMT

[quote user="Kirsten Simpson"]

Shouldn't you be using the animal preparation legally? I'm sure that is correct from the prescribing cascade?

[/quote]

as far as I am aware there is no veterinary licensed sublingual preparation of buprenorphine licensed for pain control in cats so this is perfectly within cascade.

Cat has serologically confirmed rheumatoid arthritis and is on oral prednisolone, cannot increase the preds as is diabetic as well, cannot use NSAIDS without considerable risk due to corticosteroid contraindication, this is the only noninjectable form of an opiate drug that the practice is happy to dispense for chronic use. The cat is in worsening pain in the cold weather. I think the treatment is justified.

Re: sublingual temgesic dose for cats

warwickshire vet — Sun, 31 Jan 2010 02:36:10 GMT

tend to gauge client skills - usually use a ml of vetergesic in syringe, drops in buccal cavity according to pain etc, but use tablets where syringe difficult, equally would bring back for reg injections if client really struggling. would question whether cat needing this level of opiods should discharged?

Re: sublingual temgesic dose for cats

Kirsten Simpson — Sun, 31 Jan 2010 02:06:54 GMT

Shouldn't you be using the animal preparation legally? I'm sure that is correct from the prescribing cascade?

Re: sublingual temgesic dose for cats

Rob Loxley — Sat, 30 Jan 2010 23:07:26 GMT

[quote user="salome2001"]I was actually intending to use the human sublingual tablets: the cat is already on them but is not doing well[/quote]

Generally find the liquid is easier for cat owners than the tablets. Or show the owner how to do s/c injections?

Re: sublingual temgesic dose for cats

salome2001 — Sat, 30 Jan 2010 19:42:55 GMT

thanks all. I was actually intending to use the human sublingual tablets: the cat is already on them (prescribed by another vet so I don't know where the dose came from) but is not doing well and I was trying to find out if we have room to increase the dosage

Re: sublingual temgesic dose for cats

Rob Loxley — Sat, 30 Jan 2010 18:31:27 GMT

20mcg/kg

Apparently the Vetergesic Multidose tastes worse than the stuff in the glass vials, but I've not had any experience from cases to back this up.

Also reports suggest the bioavailability of buprenorphine trans-mucusmembrane in the dog is much lower than the cat (38 vs 112% @20mcg/kg), which seems to correlate with what I've found in practice. Tend to stick with buprenorphine by injection in dogs therefore, or tramadol for an oral 'opiod'.

Re: sublingual temgesic dose for cats

Charlotte Marshall — Fri, 29 Jan 2010 20:20:05 GMT

I use a standard dose same as injectable and it seems to work.

Re: sublingual temgesic dose for cats

Toby Birch — Wed, 27 Jan 2010 23:58:14 GMT

I use the same dose as I inject. As far as I was aware the pH of a cats mouth means that it is stable and therefore the dose can be the same. In dogs you need to use 50% more as approx 1/3 is broken down because of the pH. Sorry don't have the reference to hand to double check though.