Wednesday, November 30, 2022

Mirataz For Cats With Kidney Disease

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What Is Mirtazapine Used For In Cats

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Although Mirtazapine is used as an anti-depressant in humans, it has different functions in cats. Vets most commonly use Mirtazapine to treat vomiting, nausea, and appetite loss in cats. In some cases, vets prescribe Mirtazapine to treat behavioral problems.Mirtazapine should start to work for your cat within one to two days.

The Obesity Paradox: A Cushion Against Mortality

Obesity can be a complex issue to manage in cats with early CKD. On the one hand, obesity contributes to such conditions as osteoarthritis, diabetes, and urinary tract disease. On the other hand, excessive weight loss in feline patients with CKD can lower survival rate.10

Given high rates of both obesity and CKD in cats, it is inevitable that clinicians must weigh the relative risks and benefits of a weight reduction program in certain patients. The following steps are recommended:

  • Perform a BCS on every patient at every visit and review the diet history. This reveals trends over time, both before and after CKD diagnosis.
  • If the patient is 30% or more above ideal body weight, institute a judicious weight-loss program. If the patient is only mildly overweight , feeding for stability vs. weight loss is preferable.
  • When instituting a weight-loss program, restrict calories but do not restrict protein to avoid loss of lean muscle mass. Switching to a protein-restricted, energy-dense diet in the early stages of CKD is especially problematic because it can lead to concurrent body fat gain/muscle loss.

Once a nutritional recommendation is made, the patient should be monitored, with feeding recommendations adjusted as needed .

Benefit Of Fda Approval

Knowing a drug is safe, effective, and high-quality is the benefit of FDA approval. During the approval process for an animal drug, the agency evaluates information submitted by the drug company to make sure the drug is safe and effective for its intended use and that the drug is properly manufactured and adequately labeled and packaged.

FDA-approved Mirataz, Elura, and Semintra have been shown to be safe and effective in cats when used according to the directions on the label. Each drugs label provides dosing and safety information specific to cats. The drugs are also properly manufactured and adequately packaged.

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How Is Kidney Failure In Cats Is Diagnosed & Treated

Your vet will do a comprehensive examination of your cat, including blood and urine tests, X-rays, and possibly an ultrasound. A kidney biopsy might also be required.

If kidney disease is found, treatments could include intravenous fluids to correct dehydration, vitamin injections, supplements, medications, and possibly surgery to remove blockages. When treating kidney failure the goal is to manage the symptoms and slow down the progression of the disease.

You can support your cats treatment with a carefully managed diet and plenty of clean fresh water. Your vet will recommend that you gradually transition your cat to a kidney diet that is low in both phosphorus and protein and is enriched with vitamin D and omega-3 fatty acids.

For cats with end stage kidney failure palliative care will be required in their final days. This will include keeping them warm and comfortable, with food, water and a litter box nearby, as well as lots of loving human companionship.

Note: The advice provided in this post is intended for informational purposes and does not constitute medical advice regarding pets. For an accurate diagnosis of your pet’s condition, please make an appointment with your vet.

If your cat is exhibiting symptoms of kidney failure contact our Greensboro Vets right away or visit your nearest animal emergency hospital.

What Is The Rationale Behind Mirtazapine Use

Mirataz Transdermal Ointment for Cats

According to Mar Vista Animal Medical Center, Mirtazapine the bioactive compound in mirataz, is often prescribed to humans to mitigate depression. It doesnt have tricyclic properties like clomipramine or amitriptyline, but it belongs to the tetracyclic class. The drug works by triggering:

  • Serotonin- for relaxation and comfort
  • Norepinephrine- for stimulating neurotransmitters

Both neurotransmitters help the brain to relax and work towards treating depression. The most exciting part about medications used to treat anxiety and depression is that the side effects they bring are a blessing in disguise in veterinary medicine. That means the side effects offer great healing powers for animals. According to European Medicines Agency, Mirtazapine has appetite-stimulating properties, helping animals with a poor appetite to get the nutrition they require. In animals like cats, it works by exerting anti-nausea effects. For example, if your cat doesnt have an appetite and is vomiting, this drug will inhibit serotonin activity in their gut system, increasing their appetite for food.

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Mirtazapine In Cats: Dosage Side Effects And Efficacy

Jessica M. Quimby

DVM, PhD, DACVIM

After receiving her veterinary degree from the University of Wisconsin-Madison and completing a small animal rotating internship in Sacramento, California, Jessica Quimby spent 2 years in feline practice in Grand Rapids, Michigan, and then moved to Colorado State University for a combined small animal internal medicine residency and PhD program. She completed a PhD focusing on feline CKD in 2012 and was a faculty member at Colorado State until 2017. Dr. Quimby is now on the faculty at the Ohio State University. Her research continues to focus on chronic kidney disease in cats. Current research areas include the study of renal aging, telomere length and cellular senescence, novel treatment strategies, and evidence-based supportive care strategies. She has an interest in clinical trials and feline clinical pharmacology that is aimed at improving supportive care and quality of life in cats with CKD.

Both oral and transdermal mirtazapine are now commonly used in clinical practice. This article reviews studies of oral mirtazapine and current recommendations for cats, including normal cats, geriatric cats, and cats with kidney or liver disease. It also summarizes recent literature on transdermal mirtazapine in cats and briefly discusses mirtazapine use in dogs.

Several Changes On The Bloodwork Suggest Kidney Failure:

  • Increased blood urea nitrogen and creatinine levels: BUN and creatinine are waste products that normal-functioning kidneys easily eliminate.
  • Reduced potassium

A relatively new blood test that measures a substance called SDMA helps to diagnose kidney failure even earlier than can be done with routine bloodwork.

On a urinalysis, dilute urine would suggest kidney failure, especially if the bloodwork shows elevated BUN and creatinine. Protein may also be present in the urine.

Because hypertension can cause kidney failure, a veterinarian may also take a cats blood pressure to help confirm a kidney failure diagnosis.

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What Do My Cats Kidneys Do

The kidneys have many functions. They principally act to remove protein waste products from the blood stream, retain essential nutrients such as potassium and protein at the correct levels, maintain hydration, and remove waste in urine. They also help regulate red blood cell production, blood pressure and body temperature.

What Should I Do If Mirataz Ointment Accidentally Comes In Contact With My Skin Or Eyes

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Before administering Mirataz ointment on your cat, the first thing to do is wear impermeable disposable gloves. Once you finish applying the treatment, discard the used gloves immediately. If by any chance it slips into your skin, wash it thoroughly with water and soap. If your eyes feel irritated after the administration of Mirataz, wash them off with water. Consider calling a poison control center to give you a way forward.

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Mirataz And Elura For Managing Undesired Weight Loss In Cats

Weight loss is often the first sign of illness in cats. For example, cats with kidney or dental disease or those with stomach and intestinal problems often lose weight. Although treatment is aimed at managing or, hopefully, curing the underlying disease, medication may be needed to try to stop or slow down the undesired weight loss.

Compounded Products Made From Bulk Mirtazapine Are Unapproved

Many drug compounding pharmacies offer transdermal mirtazapine products for cats. These products are legal as long as FDA-approved Mirataz is the source of the mirtazapine in the compounded product.

However, some drug compounding pharmacies make transdermal mirtazapine products for cats that are compounded from bulk mirtazapine. These products arent legal and FDA considers them to be unapproved animal drugs. They havent been reviewed by FDA to make sure they are safe, effective, properly manufactured, and adequately labeled and packaged.

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Dosing And Administration Of Mirataz

Administer topically by applying a 1.5-inch ribbon of ointment on the inner pinna of the cats ear once daily for 14 days .

Step 1:Wear disposable gloves. Twist cap on tube counterclockwise to open.

Step 2:Apply even pressure on tube and squeeze a 1.5-inch line of ointment onto your gloved finger using the measured line on the carton or in the package insert.

Step 3:Using your gloved finger, gently rub ribbon of ointment on inside pinna of the cats ear spreading it evenly over the surface. Dispose of used gloves after each application. If contact with your skin occurs wash thoroughly with soap and warm water.

After application, care should be taken that people or other animals in the household do not come in contact with the treated cat for 2 hours because mirtazapine can be absorbed transdermally and orally.

The Purpose Of The New Clinical Trial According To Colorado State Universitys College Of Veterinary Medicine And Biomedical Sciences Is To Document The Appetite Stimulation Properties Of The Transdermal Form Of Mirtazapine In Cats With Kidney Disease

Mirataz Ointment 5g  PASADENA PET STORE

A new clinical trial at Colorado State Universitys College of Veterinary Medicine is studying the effects of the transdermal form of mirtazapine as an appetite stimulate in cats with chronic kidney disease.

Mirtazapine, commonly used in human medicine as an antidepressant, has been shown to be effective in increasing weight and appetite while decreasing vomiting in cats with chronic kidney disease. Although effective, many pet owners have difficulty administering pills to their cat. Therefore, Jessica Quimby, DVM, Ph.D., Dipl. ACVIM, an assistant professor at the college, wants to focus on the transdermal form of the drug.

The study builds on five previous studies into whether a transdermal gel works and how the appetite stimulant can improve nutrition for cats, who are known to become picky eaters as their kidney disease progresses.

Quimby will be enrolling 20 cats with early to moderate kidney disease with a picky appetite. Quimbys own cat, Sophie, will also be a part of the clinical trial, according to CSU.

The study involves clients bringing their cat to the CSU Veterinary Teaching Hospital for three visits and administering a gel to the ear for a total of six weeks.

All costs of the visits and the gel medication are covered by the study, which is funded by the Winn Feline Foundation, according to CSU.

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Side Effects Of Mirtazapine In Cats

The most common adverse effects reported to the ASPCA Animal Poison Control Center in 84 cats intentionally or accidently exposed to oral mirtazapine included vocalization, agitation, vomiting, abnormal gait/ataxia, restlessness, tremors/trembling, hypersalivation, tachypnea, tachycardia, and lethargy.6 Onset of clinical signs ranged from 15 minutes to 3 hours after ingestion, and clinical signs resolved in 12 to 48 hours. The most common doses associated with signs of toxicity were 15 mg and 3.75 mg only 1 call was received for the 1.88-mg dose. These data highlight the benefit of dispensing exact doses of mirtazapine, given the frequency of accidental oral administration of a full 15-mg tablet. The greater number of adverse effects at 3.75 mg than at 1.88 mg supports the recommendation that 1.88 mg is a more appropriate starting dose for stimulating appetite while limiting side effects.

Mirtazapine Products Approved For People

Several mirtazapine products are FDA-approved for people, which veterinarians can legally use in cats in an extra-label manner. However, the human-approved mirtazapine products haven’t been proven to be safe and effective in cats. Also, the labeling includes information on how to use the drug in people, not in cats.

Another concern with using human-approved mirtazapine products in cats is the difference in dose. The smallest strength for people is 15 mg while the typical dose for cats is 2 mg. Its very difficult to cut a 15-mg tablet for people into the appropriate dose for a cat.

With the approval of Mirataz, veterinarians can now prescribe an approved mirtazapine product with known safety and effectiveness in cats rather than rely on unapproved compounded products or products intended for people.

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Treatment Of Kidney Disease In Cats

Kidney disease is managed mostly with the aid of medications, diet, and hydration. Specific management is geared toward the underlying cause as well as the stage of the disease. A cat in any stage with an increase in either UPC or high blood pressure will most likely be treated with medication.

Based on the cause, additional therapy may be instituted, such as:

  • Aggressive IV antibiotics, if infection is present

  • Deworming medication for parasites

  • Immunosuppressive-type drugs for auto-immune diseases

  • Antithrombotics

  • Chemotherapy and/or surgery

If a urinary obstruction is noted, relieving the obstruction would be the treatment of choice.

Throughout your cats life, any disease process or illness that could affect hydration should be treated promptly with IV fluids. Drugs prescribed in the future for any other disease process will need to be tailored or substituted for a more kidney-friendly alternative, given that kidney metabolism will be decreased. If not, overdosages and/or worsening of the kidney disease could occur.

Additionally, for all stages of kidney disease, fresh water should always be available. Drinking should be encouraged and adequate nutrition should be given daily. Cats diagnosed with kidney disease are often prescribed a kidney-friendly diet which may include feeding your cat canned, wet foods that contain additional water.

How Does Crf Affect My Cat

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Because the kidneys perform a variety of different functions, the clinical signs of renal failure can be somewhat variable. The most common changes seen are weight loss, poor hair quality, halitosis , variable appetite which may be associated with mouth ulcers, lethargy, and depression. Less common signs include increased drinking or urinating, vomiting, diarrhea, and anemia.

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How Long Can I Expect My Cat To Live

Most cases of CRF advance very slowly, especially when caught early. With treatment and regular rechecks as prescribed by your veterinarian, your cat can have many years of good quality, active life ahead. Often, after approximately six months of SQ fluid treatment, the remaining normal kidney tissue can hypertrophy, or enlarge, and essentially compensate to some extent for the damaged kidney tissue. The best prognosis is with early detection, and intervention with appropriate treatments recommended by your veterinarian. We recommend all cats begin to be screened for kidney and other common geriatric diseases annually, starting at 10 years of age, or 8 years for purebred cats.

Kidney Disease In Cats Faqs

What is the life expectancy of a cat with kidney disease?

The life expectancy of a cat with kidney disease varies depending on the underlying cause and the stage at which it is diagnosed. Cats in the earlier stages can, if the underlying disease is treated appropriately, live a normal life.

Are cats in pain with kidney disease?

For most conditions listed above, I wouldnt classify kidney disease in of itself as painful. The systemic effects and long-term implications, however, can certainly be debilitating and often lead to painful conditions.

Can a cat recover from kidney disease?

Some cats that experience acute kidney insults can recover, although there may be long-term effects that can lead to chronic kidney failure. Cats in chronic kidney failure will not recover, in the sense that they will have no lingering effects of the disease, as it is not curable. However, cats can go on to live a relatively normal life, with some lifestyle changes and long-term management.

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Mirtazapine For Cats Dosage

Your veterinarian will recommend the ideal dosage and dosing frequency based on your cats individual needs.

The dose for the tablet form of mirtazapine may range from about 2 milligrams up to 3.75 milligrams, depending on goals and tolerance of side effects. The generic tablets only come in two sizes of 7.5 milligrams and 15 milligrams.

Dosing frequency for the oral tablets may only be required once every 48 to 72 hours, but a cats appetite should be carefully monitored to determine the best dosing interval.

As the proper dose and frequency may depend greatly on your cats needs and any current health conditions, always make sure to discuss mirtazapine dosing for your kitty with your veterinarian first, including current and past health conditions.

The topical product Mirataz, which is a mirtazapine transdermal ointment FDA approved to manage weight loss in cats, has a labeled dose of a 1.5-inch ribbon of the ointment applied to the inner pinna of the ear once every 24 hours for 14 days. This equates to a dose of about 2 milligrams.

With Mirataz, it is extremely important for the person applying the product to wear gloves to prevent absorption of the product on their own skin. Proper application of the product to the inner surface of the ear pinna is best done using a thumb or forefinger, but as a transdermal product, the medication could be absorbed through the skin of the person applying the product.

How Is Mirataz Applied To A Cat

Mirataz for Cats

Mirataz is a transdermal ointment that is applied to a cats pinna. Before applying Mirataz, wear disposable gloves so that its content doesnt contact your skin. Then follow these steps for maximum effect:

Step 1: Twist the Mirataz cap on the tube in a counterclockwise direction to open

Step 2: Using even pressure on the tube, press a 1.5-inch line of the topical treatment on your gloved finger. Use the line on the carton or in the package insert for accurate measurements.

Step 3: Use your gloved finger to gently rub a ribbon of ointment inside the cats ear , ensuring its evenly spread out over the surface. Dont apply to the external ear canal. To ensure the ointment penetrates the cats skin, clean your cats ear with a dry cloth immediately. You can start with the left ear on the first day, then alternate with the right ear the following day. Keep alternating until the 14-day dose is complete. If your cat misses a dose, apply Mirataz the following day and continue daily dosing.

Step 4: Throw away the used gloves after each application. Throw away opened Mirataz ointment after 30 days. If the ointment comes in contact with your skin when removing the gloves, wash your hands with lukewarm water and mild soap. Should it also accidentally find its way in your eyes, wash off with lots of water.

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