Tanya

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

   

TIPS ON MEDICATING YOUR CAT

 

ON THIS PAGE:


Cautions


Preparing Your Cat


Methods of Administration


How to Give Medication


How to Give Pills


How to Give Liquids


How to Give Injectables


Pill Pockets and Similar Products


Pillshooters


Gelatin Capsules (Gelcaps)


Compounded and Medications


Transdermal Medications


Pillcutters


Timings


Measurements


Drug Reference Guides


Medical Abbreviations


 

 

HOME


Site Overview


Just Diagnosed? What You Need to Know First


Search This Site


 

WHAT IS CKD?


What Happens in CKD


Causes of CKD


How Bad is It?


Is There Any Hope?


Acute Kidney Injury


 

KEY ISSUES: PROLONGING LIFE


Phosphorus Control


Hypertension

(High Blood Pressure)


Proteinuria


Anaemia


Potassium Imbalances


Pyelonephritis (Kidney Infections) and Urinary Tract Infections NEW


Metabolic Acidosis


Kidney Stones


 

KEY ISSUES: HELPING YOUR CAT FEEL BETTER


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The B Vitamins (Including Methylcobalamin)


Constipation


 

CAT FOOD DATA


Ways of Assessing Food Content, Including What is Dry Matter Analysis


How to Use the Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Brands: Helpfulness Ratings


USA Cat Food Brands: Contact Details


USA Food Data Book


UK Canned Food Data


UK Dry Food Data


UK Cat Food Brands: Helpfulness Ratings


UK Cat Food Brands:

Contact Details


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Important: Crashing


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Early Detection


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Phosphorus Binders


Steroids, Stem Cell Transplants and Kidney Transplants


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


2007 Food Recall USA


 

FLUID THERAPY


Oral Fluids


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

OBTAINING SUPPLIES CHEAPLY


UK


USA Online


USA Local (Fluids)


Canada


 

SAYING GOODBYE


The Final Hours


Other People's Losses


Coping with Your Loss


 

MISCELLANEOUS


Prevention


Feline CKD Research, Including Participation Opportunities


CKD Research in Other Species


Share This Site: A Notice for Your Vet's Bulletin Board or Your Local Pet Shop


Canine Kidney Disease


Other Illnesses (Cancer, Liver) and Behavioural Problems


Diese Webseite auf Deutsch


 

SITEOWNER (HELEN)


My Three CKD Cats: Tanya, Thomas and Ollie


My Multi Ailment Cat, Harpsie


Find Me on Facebook


Follow Me on Twitter


Contact Me


Home > Treatments > Tips on Medicating Your Cat

 


Overview


  • With luck, your cat is going to live a long time with CKD, so it pays to learn how to make medicating your cat as easy and stress-free as possible.

  • Many cats dislike being restrained and pilled, so this page explains ways in which to make the process go more smoothly for both of you.

  • There are also links to veterinary drug reference information and how to check for possible drug interactions.

  • For information on cutting amlodipine (Norvasc or Istin, used for hypertension) into cat-sized doses, see All About Hypertension.

 


Cautions


 

Make sure you have been given the correct medication! Mistakes can happen. If you get your next round of supplies in before you have run out, you can check to see if the pills look the same. If you have any concerns, check with the pharmacist and your vet. You can also check some medications online (see below).

 

Ask your vet before crushing a pill or mixing it with liquid. Some medications are extended release, meaning that giving the pill in crushed form releases all the medication in one go, which might be dangerous with some medications. Other medications may be enteric-coated, meaning they are intended to reach the small intestine intact. Crushing or cutting such pills will stop this happening.

 

Never give a cat liquid medication from the front. You should always syringe liquid medication from the side of the cat's mouth.

 

If you forget to give a pill, check with your vet, but the general recommendation is to give it as soon as you remember, unless it is nearly time for the next dose, in which case you should simply give the next dose. So if you find your cat has spit up a daily morning pill six hours after you gave it, you can give it again; but if you find the pill the next day, just before you are due to give the next dose, do not double up but simply give one dose.

 


Preparing Your Cat


I recommend always telling your cat what you are doing and why, and how it will help them feel better. It may sound strange, but some people have found that their cats tolerate treatment better after they've explained it all to them.

 

You can also choose a special word or phrase that tells them you are about to give them medication and/or fluids - the cat will soon learn what this means, and will then not be stressed when you approach him/her at other times. It can also be worth using treats after pilling so your cat does not associate pilling only with bad things.

 


Methods of Administration


 

There are four main methods of administration, though oral medications are most commonly used:

If you only have to give one or two medications a day that do not have a nasty taste, I would recommend Pill Pockets. I gave my two girls their amlodipine (for hypertension) in Pill Pockets for more than three years. They both loved them, thought they were a treat and ate them willingly (and even asked for more), which meant so much less stress for them and me. I used the salmon flavour.

 

If you have to give several medications a day, or if you have to give one that tastes unpleasant, I would consider gelatine capsules. You can put several medications in the capsule at once (exactly how many depends on the size of the pills and the size of the capsule) so you only need to pill your cat once, and your cat won't have to taste the nasty pill.

 

For guidelines on using Epogen, Procrit, Eprex, NeoRecormon or Aranesp, and additional tips, see the Erythropoiesis Stimulating Agents page.

 

For information on how to give Azodyl or Renadyl, click here.

 

For tips on the Sub-Q process, see How to Give Subcutaneous Fluids with a Giving Set and How to Give Subcutaneous Fluids with a Syringe.

 


How to Give Medication to a Cat


The Importance of Medicating Your Cat Correctly


It is important to give oral medication correctly, because getting it wrong may cause aspiration pneumonia, i.e. the medication goes down the wrong way, into the windpipe and the lungs rather than to the stomach. This is more common with liquid medications if they are given incorrectly, but may occasionally occur when giving pills.

 

Pet Place has more information on this.

 

Cornell University College of Veterinary Medicine discusses aspiration pneumonia.

 

Never give a cat liquid medication from the front. You should always syringe liquid medication from the side of the cat's mouth.

 

How To Give Pills


The best way to give a pill is for your cat to freely take it from you. There are products which can help with this, see below.

 

If you do have to place the pill in your cat's mouth, the goal is to get it on the back of your cat's tongue. Tilting the head slightly can help. Hold the mouth shut for a few seconds while the cat swallows it. Some people find blowing gently on their cat's nose after placing the pill on the back of the tongue encourages the cat to swallow.

 

You might also want to try hiding the taste of your cat's pills, for example by covering them with butter, or mixing them in baby food. Don't do this with bitter tasting medication such as famotidine (Pepcid) though.

 

Cornell University College of Veterinary Medicine has a video on how to give a cat pills or capsules.

 

Training cats to love receiving oral medications Yin S is an article by a veterinary behaviourist.

 

Washington State University College of Veterinary Medicine has a series of photos showing how to give oral medications to a cat.

 

Veterinary Anesthesia and Analgesia Support Group has a number of tips on how to make pilling less stressful for you and your cat.

 

Pet Place describes how to give a pill.

 

How To Give Liquid Medications


Never give a cat liquid medication from the front. You should always syringe liquid medication from the side of the cat's mouth into the cheek.

 

Cornell University College of Veterinary Medicine has a video on how to give a cat liquid medications.

 

The Importance of a Water Chaser


Recent studies have shown that cats find it much easier to swallow pills if they are given some water immediately afterwards. It may also help to give a little water before giving a cat a pill.

 

Here are some ways of using water chasers:

  • You can use the sort of bottles used for feeding kittens.

  • You can follow pills with some watered-down syringed food.

  • Alternatively you could give a little moist food, such as a spoonful of baby food.

  • Some pillshooters have built in water reservoirs which enable you to give water immediately after  pill.

Suspected clindamycin-associated oesophageal injury in cats: five cases (2006) Beatty JA, Swift N, Foster DJ, Barrs VR Journal of Feline Medicine and Surgery 8(6) pp412-9 reports on problems resulting from giving medication without food or water chasers. 

 

Oesophageal transit of capsules in clinically normal cats (2000) Graham JP, Lipman AH, Newell SM & Roberts GD American Journal of Veterinary Research 61(6) pp655-7 recommends feeding a small amount of food after giving medications.

 

Evaluation of oesophageal transit of tablets and capsules in 30 cats (2001) Westfall DS, Twedt DC, Steyn PF, Oberhauser EB & Van Cleave JW Journal of Veterinary Internal Medicine 15(5) pp467-70 recommends a water chaser after pilling.

 

PetCoach has an overview of these studies.

 

Injectable Medications


Some people prefer to use injectable medications, finding this much less stressful for both themselves and their cats. It also gets around the problem of foul-tasting medicines. If you wish to do this, ask your vet to teach you how to do this safely.

 

Training your cat to love injections without ruining your relationship Yin S has tips on helping your cat accept injections.

 

The downsides of injectable medications are that not many medications are available in this form (you cannot inject oral medications, only medications formulated specifically for injection), those that are available are usually relatively expensive, and in most cases they only last for a month. Centers for Disease Control and Prevention explains more about this.

 


Products to Help With Giving Pills: Pill Pockets and Similar Products


 

I am not very good at pilling, so I try to use products which are intended to make the process less stressful for all concerned. Possible products to use include Pill Pockets, Flavor Doh, Pill Wraps, Goofurr or Lick-e-Lix.

 

Pill Pockets


Pill Pockets are chicken or salmon flavoured treats (45 to a pack) with a hidden pocket in which to hide your cat's medication. There is also an allergy formula available, duck and pea.

 

A comparative study evaluating the esophageal transit time of eight healthy cats when pilled with the FlavoRx pill glide versus pill delivery treats (2010) Bennett AD, MacPhail CM, Gibbons DS & Lappin MR Journal of Feline Medicine & Surgery 12 p286 found that Pill Pockets work well for getting medication into a cat and reduce the risk of problems with the pill getting stuck in the oesophagus.

 

When both my cats were on medication for high blood pressure, I found Pill Pockets a godsend. They both took their medication happily, thinking it was a treat.

 

Unfortunately a CKD cat who doesn't feel well might not eat Pill Pockets, and some cats do go off them, but if you don't use them for bitter-tasting medications (such as famotidine (Pepcid)), you improve your chances of ongoing acceptability. You can also give a few empty Pill Pockets, with the odd one containing the medication (always end with an empty one). My girls ate them happily every day for more than three years. Although they didn't have CKD, Indie was even happy to eat hers when she refused to eat normal food because of dental problems.

 

Some people find that, if they are only giving small amounts of medication, they only need to use half of a Pill Pocket, which means they last twice as long. I did this with my girls, since it can be hard (though not impossible) to get Pill Pockets in the UK. One member of Tanya's Support Group found that Pill Pockets  stay fresher longer if they are kept in the fridge.

 

I am occasionally asked if Pill Pockets are high in phosphorus. Actually, they aren't, they have only around 0.64% phosphorus on a dry matter analysis basis, but since you only give one or two a day, I would not be too concerned if they had higher phosphorus levels.

 

Maropitant (Cerenia) should not be given in Pill Pockets or mixed with food as this may stop it being properly absorbed in the cat's body, though some people do give them this way, apparently with no problems.

 

USA


 

Pill Pockets USA


I used to buy Pill Pockets from Wholefoods. One person found Pill Pockets at her local Costco pharmacy for US$4.95 a packet.

 

Vitacost sells 45 Pill Pockets for US$4.99..

 

Entirely Pets sell 45 pill pockets for US$5.99.

 

Thriving Pets sell 45 Pill Pockets for US$7.95.

 

Other Pilling Products USA


 

Flavor Doh


A similar product but it comes in a tub and you use enough to wrap around the pill. It is available from Revival Animal Health and Amazon.

 

Pill Wraps


Pill Wraps (sometimes known as Pillmasker) are a similar product made by Vetoquinol. They are available from a variety of sources, including Entirely Pets and Chewy.

 

Tomlyn Pill Masker


This is a bacon flavoured wrap product which some people have found helpful. It is available from Amazon.

 

Goofurr


Goofurr is a paste made from smoked salmon. Apparently most cats will eat it willingly, but you can also smear it, complete with medication, onto your cat's fur and the cat will lick it off. (Well, that's the theory. When I gave Harpsie a similar product once, he carefully wiped his paw on my cream sofa).

 

Shipping is quite expensive. Several members of Tanya's CKD Support Group have tried it and found it effective.

 

Vet Chews and Gourmeds


BCP Vet Chews

Made by BCP Veterinary Pharmacy, which will compound your cat's medications into flavoured chews.

 

Wedgewood Pharmacy

Sells Gourmeds, another type of flavoured chew.

 

Other compounding pharmacies may be able to offer a similar service.

 

UK


 

Pill Pockets UK


Unfortunately Pill Pockets are not available in Europe, and the manufacturers have no plans to introduce them into this market, but there are ways to obtain them:

 

Amazon UK sells Pill Pockets for £7.57 with free shipping. I have bought these myself, ordering on a Saturday, and they arrived the following Wednesday. Unfortunately they are not always in stock, however, if you wait a few days they usually reappear. If you are desperate, they are also usually available from other sellers based in the USA, but with very high shipping costs and they may take longer to arrive. If they are not in stock at the free shipping price and you need them urgently, it can be worth checking Amazon.com too, because the sellers there may charge you less overall.

 

Vitacost in the USA sells Pill Pockets for US$4.99 per pack plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast.

 

Other Pilling Products UK


 

Lick-e-Lix


Lick-e-Lix is a product with a yoghurty texture which can be used to disguise tablets, especially crushed up tablets. Some people also find these helpful for encouraging their cats to eat.

 

One member of Tanya's Support Group asked the manufacturer about Lick-e-Lix and was told the phosphorus level was around 1.1%.

 

Amazon sells Lick-e-Lix in salmon flavour.

 

Canada


 

Pill Pockets Canada


Amazon Canada sells Pill Pockets.

 


Pillshooters


 

If your cat is hard to pill, it can sometimes help to use a pillshooter. Here is a picture of one we purchased from our vet for £1.25. You can buy some pillshooters in syringe form, so that you can follow the pill immediately with some water as recommended above.

 

Washington State University College of Veterinary Medicine has a series of photos showing how to give oral medications with a pillshooter.

 

In the USA, the Buster pet piller, which allows you to give water after the pill, is available from Jeffers Pet for US$2 or from Amazon for US$6.50.

 

Entirely Pets sells a pillgun which costs US$2.90.

 

Drs Foster and Smith sell a pillshooter which costs US$4.99.

 


Gelatin Capsules


 

If you have to give your cat several medications, it can be much easier to give them all at once by placing all the medications in an empty gelatin capsule (sometimes referred to as gelcaps in the USA) and just giving the one capsule; this also gets round the problem of foul-tasting medicines. 

Gelatin Capsules: How To Use


You buy empty gelatin capsules and fill them with the medications of your choice (though check with your vet about the combinations you have in mind, since not all medications can be taken with others).

 

It may help to coat the capsule in butter before giving it to your cat: most cats like the taste of butter and it helps the gelcap go down smoothly.

 

It is also helpful to follow any medications with water (see the importance of a water chaser).

 

Gelatin Capsules: Sizes


Gelatin capsules come in various sizes, from 000 - 5, with size 5 being the smallest.

 

As a general rule, you need the smaller sizes for cats, and most people on Tanya's CKD Support Group use size 3-4, or occasionally sizes 2 or 5, depending upon how many medications they will be putting in the capsule and how big their cat is. 

 

If you can only buy size 0 or size 1, one member found that if she took the capsule apart and cut part off the top of one end, when it was reassembled it was smaller and easier to give.

 

Torpac sizes shows actual sizes of capsules from one manufacturer and gives some indication of how much you can fit in each capsule size.

 

Torpac also provides a pdf dosing guide.

 

Torpac dimensions gives the dimensions of the capsules.

 

Gelatin Capsules: How To Fill


Filling gelatin capsules can be a bit fiddly so most people set up a little production line and fill several at one time. After all, what else are Sunday afternoons for? (Cake, if you ask me).

 

The easiest way to fill gelcaps is usually to buy a funnel. You can buy funnels from some pharmacies or at Bed, Bath and Beyond (they are sometimes used to decant perfume), but you need to be sure the funnel you buy will fit your capsules.

 

Torpac sell little funnels which fit their capsules. You have to specify which size capsules you are using, but people have told me the funnels may also work for a size smaller too e.g. a size 4 funnel may work for both size 4 and size 5 capsules.

 

Empty Caps Company sells a number of capsule fillers starting at US$19.95 plus shipping. It also sells capules in various sizes.

 

Amazon sells a pack of ten funnels though they ship from China so may take time to arrive.

 

Some people use otoscopes, available from Amazon here and here.

 

Holding trays can be useful to hold the capsules while you are filling them. Capsuline sells these in various sizes for US$9.99.

 

Other people fold a piece of paper or foil and pour the contents into the capsules.

 

Gelatin Capsules: Where to Buy


It used to be difficult to find capsules but fortunately they are now widely available, as follows:

Gelatin Capsules: US Suppliers


Many health food shops or compounding pharmacies sell empty gelcaps. Health food shops usually sell the NOW brand in a size 3. If they don't have them in stock, they can usually order them for you quite quickly.

 

Thomas Labs

Charge US$10.36 for 1000 size 4 gel caps with shipping and handling costing US$6.95.

 

Always Affordable Vitamins

Sell 1000 size 3 gelcaps for US$8.99.

 

Thriving Pets

Sell a variety of gelcaps from size 0 - size 5, with sizes 3 and 4 costing US$3 for 100. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$100. Shipping is free for orders over US$80 (after the discount).

 

Capsuline

Sells size 3 beef or chicken flavoured Cat Caps for US$23.95 per 1000 plus shipping. Also sells unflavoured gelcaps, 1000 size 4 cost US$9.99.

 

Capsule Direct

Sells 1000 size 3 capsules for US$9.

 

Capsule Supplies

Sell 1000 size 3 capsules for US$11.82.

 

Amazon

Sells 1000 size 4 for US$14.95.

 

Amazon

Sells 1000 size 4 for US$17.74

 

Amazon

Sells 1000 size 5 for US$29.

 

Amazon

Sells two 1000 pack of NOW size 3 capsules for US$19.95.

 

Gelatin Capsules: UK Suppliers


Amazon UK

Sells 200 size 3 capsules for £2.72 plus £2.92 shipping.

 

Amazon UK

Sells 100 size 4 capsules for £3.97 plus £4.48 shipping. Also offers 200 capsules for just £1 more in total.

 

Capsule World

Sells size 3 chicken-flavoured capsules for €12,90 for 250 plus shipping.

 

Pure Capsules

sell 100 size 4 capsules for £1.07 and 500 for £5.35. I don't know anybody who has used this company yet. Their English is not that of a native speaker, though they are supposedly based in Corby.

 

Some of the US sellers above will ship to the UK, though shipping costs are likely to be high.

 

Gelatin Capsules: Canadian Suppliers


Capella Enterprises

Sell capsules in varying sizes. They cost CAN$14.50 for 1000 size 4, plus tax and shipping and handling of around CAN$10.

 

Thriving Pets

Sell a variety of gelcaps from size 0 - size 5, with sizes 3 and 4 costing US$3 for 100. They will ship to Canada but you will have to pay a US$10 Customs Paperwork Fee plus shipping. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$100. Shipping is free for orders over US$80 (after the discount).

 

Capsuline

Sells size 3 beef or chicken flavoured Cat Caps for US$23.95 per 1000 plus shipping. Also sells unflavoured gelcaps, 1000 size 4 cost US$9.99. Will ship to Canada.

 

Gelatin Capsules: Australia


The Melbourne Food Ingredient Depot

Sells 1000 size 3 capsules for AU$60. Other sizes are also available.

 


Compounded Medications


 

In the USA and some other countries, it is possible to have medications compounded into a base of your choosing. These can be in either pill, liquid or capsule form.

 

Common flavours popular with cats are fish, chicken etc. Not all cats like the taste of compounded medications, and they are relatively expensive, but they are worth considering for hard-to-pill cats. Compounding is essential for calcitriol - it is the only way to obtain cat-sized doses, and it seems to work very well in compounded form.

 

See below for information on finding a compounding pharmacy.

 

Compounded medications have a short shelf life, a maximum of thirty days for many medications, so check with the pharmacist and be sure not to use a product beyond its expiry date. If the product you are purchasing has a longer shelf life, it is often not much more expensive to buy 60 days worth of medication than it is to buy 30 days. 

 

Do double check with your pharmacist regarding the medication you are considering having compounded, and consider switching to pills if the compounded form does not seem to be working as well as you expected. If you use a liquid compounded medicine, be sure to shake it very well before giving it to your cat.

 

Confounding compounding is a 2009 report from the Veterinary Information Network into the pros and cons of compounded medications.

 

FDA calls veterinary compounding at Francks illegal is a report from April 2010 on how and why the FDA appears to be clamping down on the compounding of medications for veterinary use.

 

Compounding Pharmacies USA


International Academy of Compounding Pharmacies

You can type in your zipcode and how far you are prepared to travel and you will be given details of suitable pharmacies. This site also provides details of compounding pharmacies in Spain, Portugal, Canada, Chile, Brazil and Australia.

 

Mar Vista Vet

Has a list of some compounding pharmacies in USA.

 

Animal Pharmacy

Compounds medicines for animals.

 

Pet Health Pharmacy

Can provide a number of different medications.

 

BCP Veterinary Pharmacy

Can compound your cat's medications into flavoured chews.

 

Wedgewood Pharmacy

Sells Gourmeds, another type of flavoured chew.

 

Compounding Pharmacies UK


In the UK, compounding (known as "unlicensed specials") is not very common and often very expensive.

 

This is because UK law requires veterinary surgeons to comply with something known as the veterinary cascade, whereby vets must prescribe medicines in a particular order, starting first with medications approved specifically for the veterinary market and only moving on to other products if there is a valid medical reason for doing so (e.g. the cat is allergic to something in the licensed veterinary product).

 

Beva explains more about how the cascade works and how specials fit into it..

 

Summit Veterinary Pharmaceuticals Limited sells amlodipine (for high blood pressure) in cat-sized 0.625mg doses. My vet obtained these for me and I found them very effective.

 

The Specials Laboratory can compound famotidine into cat-sized doses and will quote for other medications.

 


Transdermal Medications


 

With some medications, it is possible to have them compounded into a transdermal gel, which is rubbed on the inside of the cat's ear and absorbed through the cat's skin. This is usually much less stressful for both the cat and the caregiver.

 

Wedgewood Pet Pharmacy has more information about transdermal medications.

 

Advances in transdermal drug delivery (2013) Mills P Presentation to the 38th World Small Animal Veterinary Association World Congress discusses the mechanism of transdermal medications and factors which affect their efficacy.

 

Transdermal drug administration (2012) is a video by Dr DM Boothe which discusses the pros and cons of this method of administation.

 

Drug compounding for veterinary patients (2005) Papich MG  American Association of Pharmaceutical Scientists Journal 07(02) ppE281-E287, discusses the use of compounded medications, including transdermals, and states that evidence to date suggests that "absorption was incomplete, nonexistent, or highly inconsistent among cats".

 

Trandermal Medications: Suitable Medications


Medications that appear to be effective when given transdermally include methimazole for hyperthyroidism and mirtazapine (an appetite stimulant).

 

If you do use transdermal medications, you should apply them using gloves so as to avoid absorbing any of the medication through your own skin. The Veterinary Information Network has some information on this. You should also clean your cat's ears regularly so the medication can be absorbed properly.

 

Efficacy and safety of transdermal methimazole in the treatment of cats with hyperthyroidism (2004) Sartor LL, Trepanier LA, Kroll MM, Rodan I & Challoner LJ Journal of Veterinary Internal Medicine 18(5) pp651-5 found that transdermal methimazole (for hyperthyroidism) took longer to work than oral medications but appeared to have fewer side effects.

 

Hyperthyroid cats and transdermal methimazole is a helpful video which explains more about how to use transdermal medications in cats with hyperthyroidism. It includes tips on cleaning your cat's ears.

 

Not Suitable Medications


It is wiser not to give certain medications transdermally because they do not all give good and/or consistent results. This applies in particular to:

  • antibiotics

  • heart medications

  • blood pressure medications

Some members of Tanya's CKD Support Group have found for example that transdermal amlodipine has not successfully controlled their cat's blood pressure, whereas amlodipine tablets have done so. Plus some cats may develop sore ears where the compounded medications are applied; alternating ears may help with this. 

 

Do double check with your pharmacist and consider switching to pills if the transdermal form of the medication does not seem to be working as well as you expected.

 


Pillcutters


 

Since cats often require low dosages of medication, you often have to cut tablets in order to give them the correct dose. This is particularly hard with ranitidine, where you often have to cut the tablets into eighths.

 

Invest in a pillcutter (Betterware sell them for about £4, or you can often find them in chemists), and apply hard, fast taps when you cut the tablet - don't try to cut it slowly or the pill will crumble.

 

Walgreens sells the Apex brand for US$4.93. I have two of these and really like this model - it cuts well, and has a useful little container to hold the pills after you've cut them.

 

For information on cutting amlodipine (Norvasc or Istin, used for hypertension) into cat-sized doses, see All About Hypertension.

 


Timings


 

It can be fiddly working out suitable timings for your cat's medications, particularly if you work outside the home and are using medications that need to be given apart from other medications. It does not help that some medications need to be given with food and some away from food.

 

Pill Pockets or gelatin capsules can help for meds that can be given together. With gelatin capsules, you can package your cat's medications in advance (see above).

 

Here is a sample timing schedule based on commonly used medications. It should be noted that slippery elm bark and phosphorus binders ideally should be given apart from other medications, but phosphorus binders should be given with food. Check your other medications against a drug interaction website (see below), and double check with your vet or pharmacist.

 

7.30   a.m. Medications in a gelatin capsule: famotidine, B complex, mirtazapine, MiraLAX PAIN ANTI

8.30   a.m. Breakfast mixed with methylcobalamin and phosphorus binder if required

Daytime   Food with added phosphorus binder

6.30   p.m. Medications in a gelatin capsule: B complex, mirtazapine PAIN ANTI

7:30   p.m. Dinner mixed with methylcobalamin and phosphorus binder if required

11.00 p.m. Famotidine

 

https://medisafe.com/

is an app that can be used to log and remind you about when medication is due.

 


Metric and American Measurements


 

It can be confusing when you are trying to measure medications because Americans are used to thinking in pounds and ounces but the veterinary recommendations are often in kg and g and mg. It may help to know that:

  • a kg is 2.2 lbs.

  • A pound is a little under 500g.

  • 100g is roughly 3.5 ounces.

  • Teaspoons vary in size, but a teaspoonful is usually considered to be the equivalent of 5ml. If you are given medication in the UK with a teaspoon included, it will hold 5ml or 5g.

  • One advantage of the metric system is that measurements are uniform, so for example (if you are measuring volume) 1cc is the same as 1 ml.

Convert Units will help you with calculations.

 

Measuring Small Amounts


If you need to measure small amounts, Amazon sells Norpro measuring spoon for a pinch, smidgen etc. A member of my support group measured these spoons and said that the spoons measured as follows:

Tad =                   1/4 tsp

Dash =                1/8 tsp

Pinch =             1/16 tsp

Smidgen =       1/32 tsp

Drop =              1/64 tsp

Amazon also sells a set of measuring spoons which includes a quarter and an eighth of a teaspoon. The same set is also available from Amazon UK.

 

Amazon also sells an "odd sizes" set of measuring spoons which includes two thirds  of a teaspoon and an eighth of a teaspoon.

 


Drug Reference Guides


 

Commonly Used Medications


VetBook has a list of medications commonly used in cats with details of typical dosing.

 

Finding the right balance: medical management of renal patients (2014) Vaden SL Eukanuba Veterinary Diets Clinical Symposium pp11-14 has a list of drugs commonly used in CKD cats on page 12.

 

Pet Place has a drug library which offers information on 105 different drugs.

 

PetCoach also has a drug library with information on various medications.

 

Dosage Adjustments in CKD Cats


Drug dose adjustments for disease (2010) Trepanier LA CVC in Washington Proceedings discusses the need to adjust dosing levels for some medications when diseases including CKD are present.

 

Chronic renal insufficiency and its associated disorders: kitty kidneys and the kitchen sink (2007) Scherk M The 2007 Nestlé Purina Veterinary Symposium on Companion Animal Medicine also discusses adjusting dosages in CKD cats.

 

Possible Interactions


Mar Vista Vet has helpful information on various drugs, including how they work and possible interactions and side-effects.

 

Express Scripts allows you to type in the names of medications and check for interactions. It also allows you to see photos of a medication in various strengths. The information is human-based but can be a helpful starting point.

 

Books: Plumb's Veterinary Drugs Handbook


Plumb's Veterinary Drugs Handbook

 

This is an excellent reference book. The Ninth Edition was published in February 2018. It is available from Amazon in the USA and from Amazon UK in the UK.

 

The sixth edition is also available online here but is obviously somewhat out of date.

 


Medical Abbreviations


 

The most commonly seen abbreviations on medications are:

SID (semel in die): once a day

BID: twice a day

TID: three times a day

PRN: as needed. This can be helpful on prescriptions because it can enable you to order more of an item when you run out without needing to obtain a new prescription (though prescriptions are normally only valid for a maximum of one year).

The University of Illinois has information on veterinary abbreviations.

 

 

 

Back to Page Index

 

This page last updated: 06 May 2018

 

Links on this page last checked: 06 May 2018

 
   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

Copyright © Tanya's Feline CKD Website 2000-2018. All rights reserved.

 

This site was created using Microsoft software, and therefore it is best viewed in Internet Explorer. I know it doesn't always display too well in other browsers, but I'm not an IT expert so I'm afraid I don't know how to change that. I would love it to display perfectly everywhere, but my focus is on making the information available. When I get time, I'll try to improve how it displays in other browsers.

 

You may print out one copy of each section of this site for your own information and/or one copy to give to your vet, but this site may not otherwise be reproduced or reprinted, on the internet or elsewhere, without the permission of the site owner, who can be contacted via the Contact Me page.

 

This site is a labour of love, from which I do not make a penny. Please do not steal from me by taking credit for my work.

If you wish to link to this site, please feel free to do so. Please make it clear that this is a link and not your own work. I would appreciate being informed of your link.