Me too!
Vets give such conflicting advice on heart treatment that I mostly discount their views (I really like my vets!
but still...). The majority, easily the majority, start dogs too early on medications despite there being no evidence that this helps and is at best a waste of money but more seriously, means when dogs do actually need the medications they have to take them at a higher dose, thus increasing the risk of running out of medication options too early. And as Rod has noted many times, there's also evidence that starting vetmedin before a dog is in CHF may actually worsen MVD. In my experience most vets are off at least a full grade on murmurs, over or under estimating them, compared to cardiologist's auscultation. As with annual vaccinations, starting any dog with a murmur on heart meds seems to be the rule, with few exceptions, regardless of long standing evidence and advice that neither should be done.
:sl*p:
So for me the issue is more what cardiologists are advising. I cannot understand why cardiologists would recommend not following the drug manufacturer's guidelines, when the reasoning is clearly stated in the accompanying literature -- there's definitely evidence that affectiveness decreased by up to more than half if given with food or too close to a meal, with a liquid form of pimobendan (vetmedin). Unless there has been new research to the contrary, then the only defence for giving it with food would be 1) possibly a dog cannot tolerate it on an empty stomach -- but I've never come across that before, though it may well occasionally happen; or 2) that the cardio feels that the statement that it is *unknown8 if the same happens with the drug in tablet form is being taken to mean that the manufacturer's directions can be dismissed unless specifically proven to the contrary. But this seems a very strange approach when there is definite proof that it does affect absorption in liquid form.
In other words, why would a professional advise people to risk poorer performance of a critical drug on the basis that it might not matter, or matter to the same degree? I just can't imagine a doctor advising a mother ignore existing evidence if the treatment were for a child's heart failure, for example.
The Companion discussion was the first time I have ever heard of a cardiologist say it doesn't matter if this drug is given with food. I thought maybe this might be based on new evidence, but I tried to search for any and can't find anything. Hence the question.
I'd not think it matters if it's given with food now and then if that can't be avoided, but it's quite another thing to say it actually doesn't matter when the existing evidence right now says it does
. My other worry would be, it isn't like this is a long term drug option either -- by the time a dog is correctly prescribed pimobendan, they are usually in their last 6-12 months of life (I believe studies show the average survival rate is 9 months after starting?) -- I just wouldn't want to risk giving a dose that is less than optimal.
All that said: there's definitely uncertainty about aspects of these drugs and overall heart treatment! And I wonder why after all this time, the manufacturers haven't done a study on the absorption issue with the tablets and are relying on the liquid research?