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View Full Version : Blondie on gabapentin and question about pill dispenser



Blondiemonster
22nd March 2011, 08:42 PM
So we visited Dr. West for a 6 month check up and he decided to put her on Gabapentin. According to him there here isn't any real "decline" and no signs of muscle weakness but he did notice a increase in something which I can't remember the word of but it starts with "hyper" :) He say that when she doesn't see u coming and you touch her there is some kind of "ghost" neuropathic reflex associated with pain. Anyways, he wants to try gabapapentin at 150 mg 3 times a day. It's messy coz I have to break capsules in half and the powder falls out etc.. I tried the greenies pillpockets just now and they are too big so some of the powder fell out when she ate it. But ayways. Do any of you guys have advice? Also any of you use an automatic pill dispenser you can time??? I'm a real forgetful person and the 3 time a day thing is going to be a real challenge.

Blondiemonster
22nd March 2011, 08:47 PM
i found this http://www.smarthome.com/6100/Ani-Mate-212-Automatic-Pet-Feeder/p.aspx

anniemac
22nd March 2011, 11:40 PM
Someone said the greenies pill pockets are very bad for them. (Although ella has used them and I would split them up). You break open the gabapentin capsule? Some have suggested putting in yogurt. I have to be honest and say that I put a little cream cheese on hers. Ella was quite good at spitting out the pills but people always suggested opening the capsule but if its messy... have you tried to give her a full capsule? Does it not come in 150mg capsules? I'm trying to remember.

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Blondiemonster
23rd March 2011, 03:13 AM
No they only had 100 mg capsules... Yoghurt. That may not be a bad idea.
Or peanut butter. The greenies pill capsules r so big and chewy!!!!

Love my Cavaliers
23rd March 2011, 12:33 PM
I use the cat pill pockets for Riley. They're much smaller than the dog pill pockets - even the smaller sized ones. She takes prednisone every day and those pills are so small. I can squish her prednisone and her pepcid in the cat pill pocket together.

Charlifarley
23rd March 2011, 01:25 PM
Bosco is so greedy he will eat his pred and Lyrica when I put them in with his breakfast. He doesn't seem to notice that they are there. I give him his second dose of Lyrica in the evening with a piece of carrot - I just offer them both to him at the same time, and sometimes the capsule might be 'ejected', but a second piece of carrot sorts that out. :p
I'm sure you have the right dose, but 150mgs seems quite a high dosage to start with - it was definitely 150 mgs 3x daily, and not in total?

Blondiemonster
23rd March 2011, 03:11 PM
Hey Charlifarley. No its defenitely a 150 mg... I asked Dr. West about the dosage. He said it was the lowest dosage he believes works. He says that if Gabapentin is given below a certain dosage, it doesn't work at all. What are the usual dosages for cavaliers? Is this something I should ask him about? Her symtoms are quite minor, and honestly i haven't seen a change in last time we went and he said she didnt have to be on anything at all. But i know that neurologists can pick up on subtle things, so that's why we went back after 6 months... But there is no head rubbing, no scratching, no weakness, she plays all day, but there is an occasional yelp out of nowhere a few times week, also when she gets excited and touched the wrong way she may yelp too so gotta assume there is some level of discomfort. I also dont feel like i have another choice but to trust him...

Blondiemonster
23rd March 2011, 04:39 PM
Btw, day 2 on gabapentin and shes a total ragdoll/zombie which hurts my heart coz she is usually such a playfull girl who wants to play tug o war all the time :(

Charlifarley
23rd March 2011, 04:51 PM
Btw, day 2 on gabapentin and shes a total ragdoll/zombie which hurts my heart coz she is usually such a playfull girl who wants to play tug o war all the time :(
I know, its a difficult decision, to put them on meds that are supposed to help the pain, and then see them doped up to the eyeballs as a result. I have found it very hard to come to terms with this to be honest. If it helps - Bosco was doped on the lower dose of 3 x 100mg too.

Karlin
23rd March 2011, 05:08 PM
You might look into getting the 600mg tablets and splitting them in fourths with a pill cutter. That's what I did for Leo for some time. Now he is on 200mg 3x so is back to 100mg capsules. Why did he decide to start on 150mg? That would be kind of high to start with unless you have a larger cavalier. (oops just reread previous post ...) I disagree totally with him -- while it is true that sometimes dosage needs to be increased over time, many manage perfectly well on far lower than that.Clare Rusbridge's treatment diagram has the starting dosages. leo did perfectly well on far lower doses for a year or more each time. A dog should not have to be doped -- it would be better to lower the gabapentin and add a painkiller and CSF inhibitor, try Lyrica, etc to get a better mix for any dog that is doped.

I think the Greenies pill pockets are really great for dogs and cats that have trouble taking meds. My dogs are all Greenie fans anyway... :)

Zumie05
23rd March 2011, 05:17 PM
I just read an interesting article stating that gabapentin isn't licensed for dogs in the US. What exactly does that mean? Are vets not supposed to be prescribing it?

http://www.aquaticcommunity.com/dog/health/nerv/Syringomyelia.php

I hope Blondie gets back to her normal self soon, I would imagine after she gets used to the medication she won't be so doped up anymore. Did the vet say she will act this way until her body acclimates to the new medication?

Blondiemonster
23rd March 2011, 05:25 PM
Hey Karlin, I asked him about the dosage and he said he thinks "it's the lowest dosage that can be effective", meaning that according to him a certain minimum dosage of Gabapantin is needed to be effective at all, and that dosage seemed to be 150 mg...
Is this something I should question more? She is only 18 pounds.
@ ZUmie; yes I was warned about the doped up thing.

Pat
23rd March 2011, 06:23 PM
I just read an interesting article stating that gabapentin isn't licensed for dogs in the US. What exactly does that mean? Are vets not supposed to be prescribing it?

That just means that it is being used "off label" for dogs. This is quite common; many drugs for dogs are used "off label." There is no negative meaning here. (I do understand that some insurance companies won't pay for off label drugs prescribed for dogs, though......)

Pat

http://www.petmd.com/blogs/fullyvetted/2009/september/veterinary-drugs-their-label-usesand-why-some-vet-drugs-cost-so-much

http://www.bsava.com/Advice/BSAVAGuidetotheUseofVeterinaryMedicines/Prescribingcascadeandofflabeluse/tabid/360/Default.aspx

Kate H
23rd March 2011, 07:04 PM
Gabapentin isn't licensed for dogs in the UK either - I have to get a monthly prescription from the vet and take it to the (human) pharmacy next door. Last month they had new stock of Gabapentin - price for 90 x 100mg had jumped from 5.50 to 24!! World shortage of the 100mg tablets apparently (but not of the higher doses).

Kate, Oliver and Aled

anniemac
23rd March 2011, 09:43 PM
I think the Greenies pill pockets are really great for dogs and cats that have trouble taking meds. My dogs are all Greenie fans anyway... :)

Well thank goodness! I was in canine cafe Saturday (barbara the owner makes treats and sells them around the country) saying that someone said they were not healthy. She reviewed the ingredients and said she can't see why. Maybe they are just fattening. They work so well but I suggest getting the bigger ones and splitting them. (More for money).




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anniemac
23rd March 2011, 09:52 PM
Gabapentin isn't licensed for dogs in the UK either - I have to get a monthly prescription from the vet and take it to the (human) pharmacy next door. Last month they had new stock of Gabapentin - price for 90 x 100mg had jumped from 5.50 to 24!! World shortage of the 100mg tablets apparently (but not of the higher doses).

Kate, Oliver and Aled

That is a huge jump but still better than lyrica.

Lynn,

I think overall it takes time, adjustment and changes to get the right match. What works for one may not for another but that does seem like a high dose to start out with. I would personally like to start low, increase etc.


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Kate H
23rd March 2011, 09:59 PM
There were several cases in the UK last year or the year before of the Greenies treats swelling in the stomach and causing life-threatening problems (I seem to remember some dogs actually died). Not surprisingly, this got Greenies generally a bad name. If they are OK now, I would guess they have changed the ingredients to prevent these problems, but my local pet shop won't stock them.

Kate, Oliver and Aled

Karlin
23rd March 2011, 10:15 PM
Hey Karlin, I asked him about the dosage and he said he thinks "it's the lowest dosage that can be effective", meaning that according to him a certain minimum dosage of Gabapantin is needed to be effective at all, and that dosage seemed to be 150 mg...
Is this something I should question more? She is only 18 pounds.
@ ZUmie; yes I was warned about the doped up thing.

I added to my first post as I saw you'd explained why he made that choice but must not have edited it fast enough! This is what I said:


I disagree totally with him -- while it is true that sometimes dosage needs to be increased over time, many manage perfectly well on far lower than that.Clare Rusbridge's treatment diagram has the starting dosages. leo did perfectly well on far lower doses for a year or more each time. A dog should not have to be doped -- it would be better to lower the gabapentin and add a painkiller and CSF inhibitor, try Lyrica, etc to get a better mix for any dog that is doped.


I know of very few dogs that have ended up 'doped'. Most just need their meds adjusted around. 150mg 3x is pretty high as a starting dose. If leo had started on that he'd have been sleepy too. But now he needs more than that to manage his symptoms and is not at all lethargic on a higher dose.

Blondiemonster
23rd March 2011, 11:34 PM
Hey Karlin. Thanks so much for the info. I'm a little worried now.. Why this much? Dr. West was so conservative in his treatment last time (CSF reducers only 6 months ago) and I have not seen any change in clinical signs since then, she was and is doing well even without painkillers. He picked up on a subtle change during clinical exam, but said he wouldnt call it "a decline" he said he may have just caught her on a bad day but has to go with what he sees.
So Im confused why all of a sudden such a high dose? I will phone him and ask. What is the usual starting dosage on claire's scheme? Would it be crazy to lower her dose to 100 mg 3 times a day myself until I get a hold of him? She is also on 8 mg of omeprazole once a day.

Pat
24th March 2011, 12:14 AM
Well thank goodness! I was in canine cafe Saturday (barbara the owner makes treats and sells them around the country) saying that someone said they were not healthy. She reviewed the ingredients and said she can't see why. Maybe they are just fattening. They work so well but I suggest getting the bigger ones and splitting them. (More for money).

Active Ingredient(s): For dogs; Chicken, Wheat flour, Glycerin, Vegetable oil, Dried corn syrup, Wheat gluten, Corn flour, Natural flavors, Lecithin, Brewer's dried yeast, Potassium sorbate (to preserve freshness), Salt, Methylcellulose, L-ascorbic acid phosphate (source of vitamin C) mixed tocopherols, Vitamin E supplement.

Well, yeah, these are crap ingredients and added salt in addition! I wouldn't use them. I've had great success coating pills with raw honey and I use cheese spread (low fat, low sodium) for dogs not in heart failure or kidney failure. I wouldn't feed any food, even small amounts, containing most of these ingredients.

Pat

mommytoClaire
24th March 2011, 12:57 AM
I'm sorry that the Vet felt it necessary to put her on the med at this point. I felt your pain when you said it hurt your heart to see her dopey and not wanting to play.

I can't imagine how that makes you feel. I hope you're able to work through it with the Vet and lower the meds quite a bit until, or if she ever needs more. Can it be something that is given every other day to start? Just curious. And like you said, you haven't seen changes in her.

I'm just sad for the progressions into the gabapentin at this point.

Give Blondie a hug from Claire and I.

Cindy and Claire

Blondiemonster
24th March 2011, 02:36 AM
This is what I emailed him. Hope to hear from him soon.

"Hello Dr. W

This is Blondie's mom, Lynn. We saw you yesterday at Animal Medical Center.
I have a question about Blondie new medication: Gabapentin 150 mg 3 times a day.
When I look at Claire's R. treatment algorithm (http://www.veterinary-neurologist.co.uk/syringomyelia/docs/treatalgo.pdf)
and talking to other cavalier owners with SM, it seems to be an extremely high dose to start off with...
I remember you said something about the medication not working at a low dose, but could you please explain more?
I know you are able to pick up on subtle clinical symptoms etc, hence why we come to see you,
but we have not noticed any clinical worsening (if anything I'd say she is more playful and active)
of Blondie since we saw you 6 moths ago and are wondering; why starting of at this high dose?
I do understand and acknowledge there must be a level of discomfort, but, referring back to Claire's algorithm, may I also ask
why the NSAID step was skipped and why the dosage is 150 mg 3 times a day rather than the recommended 100 mg 2 times a day?
She is reacting pretty "ragdoll" to the drug and I know she will probably get used to it, but I am also worried about jumping to fast to a high dosage
and having "nowhere to go" after."

Blondiemonster
24th March 2011, 02:37 AM
I'm sorry that the Vet felt it necessary to put her on the med at this point. I felt your pain when you said it hurt your heart to see her dopey and not wanting to play.

I can't imagine how that makes you feel. I hope you're able to work through it with the Vet and lower the meds quite a bit until, or if she ever needs more. Can it be something that is given every other day to start? Just curious. And like you said, you haven't seen changes in her.

I'm just sad for the progressions into the gabapentin at this point.

Give Blondie a hug from Claire and I.

Cindy and Claire

Thanks Cindy!!!! Yes, it's all a bit stressful, I am just trying to make the best decisions for her... I trust my vet but I also think that I know her best so I am gonna get to the bottom of this!!! :) It doesn't feel quite right to have the dosage this high. It's a gut thing.

lovecavaliers
24th March 2011, 02:50 AM
Hi Lyn

How is Blondie feeling now? I remember Jack was very "dopey" for the first few days on gabapentin. He went to Dr. West after being put on 100mg twice daily by Dr. Marino. Dr. West wanted him on 150 3x's daily but said if I could do 100mg for a while and then increase to 150mg Jack was still symptomatic so then we went to 150mg 3x and finally 200mg 3x's. Jack weight ~21 lbs (yes a big boy)
I use a cat timer called "Animate C10 Cat Mate Feeder" that I purchased from amazon.com for around $24, it works great when I can't get home for his mid day dose. I too use the greenies pill pockets just for this dose (as Anne said, I get the large capsule size and break it up to cover all his pills; saves money) for all the other times, i use cheese or mix it in his food. I don't like to give the greenies too much because they are junk ingredients but work well for that one dose, since they dont need to be refrigerated
When I had to do the 150mg dose, I would just open the capsule and try to evenly distribute the amount, it was very frustrating to say the least. Does the compounding pharmacy where you get Blondie's omeprazole also do 150mg caps of gabapentin?
I am curious as to what he says about the dosage when you talk to him again. Surely he would agree to a 30 day trial on 100mg 3x day and then reassess?
I know how frustrating all this can be. I feel like of the two neuro vets that have seen Jack I don't agree 100% with either one:eek:. Obviously, I am not an expert but I love and know my dog more than anyone and that needs to count for something.
Hugs to Blondie

lovecavaliers
24th March 2011, 02:52 AM
Just saw your post after I posted. E-mail sounds great! Hope you get some answers

Blondiemonster
24th March 2011, 03:12 AM
thanks Irene! Yes very frustrating it is! I am totally confused. Blondie is generally doing really well, not different than 6 months ago.:confused::confused:
I would feel much more comfortable starting at 100 mg twice a day like Claire recommends. Unless I am a total idiot I haven't noticed increase in symptoms in her. And I spend sooo much time with her... She does 2-3 strokes of air guitar scratching maybe once a day (not every day) and an occasional yelp when touched wrong but that hasn't changed as oppsosed to 6 months back.

Karlin
24th March 2011, 04:58 PM
I think it's a good e-mail–polite but to the point. It's important to keep in mind that every neurologist may have their own approach, and I think that if you are seeing air scratching, you probably are at the point where you want to start gabapentin. On the other hand, just something like frusimide helps stop scratching for some cavaliers. If you aren't happy with the treatment approach, you can always go to a different neurologist for a second opinion.

For what it's worth, Leo was on less than 100 mg twice a day (he's a small Cavalier) for about a year before going up to 100 mg twice a day. It was quite a while before he had to jump to 100 mg three times a day, and we have gradually gone up from that. He started medication at around age 2, and now is about 7 1/2. He scratches daily from time to time, and very occasionally he can be sensitive to touch. He also has a heart murmur now.

Blondiemonster
24th March 2011, 05:44 PM
Hey karlin. It is great to hear leo has been so succesfully managed. I know it may be against medical protocal but Last night i decided lower blondies dose to 100mg twice a day. After giving her the lower dose twice she is so much more herself. My philosphy is its easy to go back up but going back downis harder when on high dose too long. I think its an informed temporary decision from a concerned mother.:) I like dr west but a second opinion may not hurt. I had no idea aboutthe frumiside and will also ask. As for the scratching; blondie is very inconsistent with her symptoms. Mild Scratching comes and goes... Its so hard to know at what point do u treat and how....

Karlin
25th March 2011, 02:41 PM
If she is scratching, and occasionally shows pain, she definitely has symptoms, and needs to be treated. I think it's a good idea for any dog with SM to be on some kind of CSF inhibitor like frusimide, for reasons explained in various threads over time. There is some evidence that if you start it early you can halt the progression of a syrinx or at least slow it down in some dogs.

Blondiemonster
25th March 2011, 07:51 PM
Hey Karlin. Agreed. ALso; do u have any opinion on what CSF works best? Do you think furmiside works better than omeprazole?