Daisy and Her Medication
I am not happy about Daisy still taking Frusemide and would much prefer her to be on Zitac ,but
who would I approach to get it changed would I need to go back to Geoff Skerritt or should I
just go to my own Vets .If I can get it changed what dose would you think would be suitable as she
is on only 10 mg of Frusemide daily .
If you're going to continue to use Geoff Skerritt as your neurologist I should have a word with him - your vet will probably consult him anyway. Also note that Clare Rusbridge has removed frusemide from the latest edition of her treatment algorithm.
Kate, Aled and Oliver (in haste, at it's my turn to go to the vet's - ie a hospital appointment!)
Brian - go back and tell Mr. Skerritt your concerns and the comments from Simon Swift and tell him you want to change. There should be no reason that he should not agree to that. I wouldn't wait to hear back from Simon; there is enough reason for concern already. The neurologist should always be in charge of what drugs your dog should take for SM.
Kate - I'm so pleased to read your news. As some of you know, I've been concerned about the use of furosemide (US spelling) for SM ever since the drug first became part of the treatment protocol.
Does anyone plan to circulate this updated protocol through the various SM lists? If not, I'll post this weekend to the groups to which I belong.
I just looked at Clare's website and I see that the treatment algorithm has been changed and furosemide was removed. The typeface is slightly different so it's obvious that there was a deliberate change to the algorithm. However, the body of her SM tutorial remains the same where there is discussion of what drugs are used to treat SM -
Originally Posted by Kate H
I can't determine if this is an oversight, and I don't want to assume that she no longer recommends using furosemide without knowing for certain so I won't post anywhere else. Anyone know?
I also found this interesting bit of trivia that I copied and pasted - Furosemide (INN) or frusemide (former BAN) - INN is international nonproprietary name or official generic name given to a pharmaceutical substance determined by the World Health Organization. A British Approved Name (BAN) is the official non-proprietary or generic name given to a pharmaceutical substance, as defined in the British Pharmacopoeia (BP).
Thanks for the push.I phoned Chestergates at 4.00 pm Geoff was there but I only spoke through his assistant who after I explained Simon's and my concern about Daisy being on frusemide the comment came back for me to speak to Simon as they had been in contact with each other about Daisy .Phoned North West Surgeons and Simon is off this week but back Monday so had a quick word with another Cardio who advised me to speak to Simon on Monday .Not too happy about this as I feel poor Daisy is in the middle and as GS prescribed the Frusemide I feel the change of medication would be more his decision ,but I intend to fully resolve this on Monday for certain.
Pat just send a pm .
Pat wrote: the body of her SM tutorial remains the same
Hi Pat, have you looked at the latest version? I downloaded it on Tuesday and there is no mention of frusemide anywhere, only cimetidine (Zitac) and omeprazole.
I think if Oliver was prescribed Zitac I would go bonkers - the recommended dose is 3 times a day, 2 hours after giving other drugs (in Oliver's case, gabapentin every 8 hours), so I'd be giving alternating gabapentin and Zitac 6 times a day - presumably starting with gabapentin at 6am and finishing with Zitac at midnight! :sl*p:
Kate, Oliver and Aled
Kate - As you say, furosemide is not mentioned on the chart but furosemide is still mentioned in the part of the website (I gave the link) that describes SM treatment and lists the potential drugs that are used. I don't know if that is an oversight (removed it on the chart but not from elsewhere in the SM discussion on the site) or not.
I agree that medication schedule would be difficult - esp for a working person. Guess I'd have to use omeprazole if I were treating an SM dog.
Sorry Pat, thought you were just talking about the treatment algorithm - I hadn't looked at the rest of the website. Perhaps she left it in elsewhere because she is realistic enough to know many vets will go on prescribing frusemide so need to know the drawbacks. I'm having a bit of a fight with one of the younger vets in my local practice, who in spite of training in London seems never to have heard of Clare, and has no idea why 'that woman' (as she calls her!) is suggesting not using it - seems to think she's just another neurologist with a bee in her bonnet!. I discussed with her moving Oliver off frusemide simply because his photo phobia (caused, according to an ophthalmologist, by his dilated ventricles) is getting worse, so his present dose of frusemide obviously isn't doing its job of reducing pressure.
The problem is, of course, that no vet can be expert in every canine disease and I think I'm the only one in this practice with a dog with confirmed SM (which doesn't mean of course that there aren't others with undiagnosed SM). I really miss the vet who left a few months ago to go home to Ireland (lucky Ireland!), who did her internship at Stone Lion and was very clued up about SM.
Kate, Oliver and Aled
Originally Posted by Kate H
I am a bit confused you say the recommended dose for Zitac is three times a day. Harley & Ebony are on 100mg only 2x a day. And I never knew that you have to give it two hours after giving other drugs. I read the instruction leaflet and it doesn’t tell you anything about when and how to give it. I just give mine after food.
It's so confusing isn't it? Kayleigh is on 50mg three times daily, she's only 7.3kg though.
I know Clare Rusbridge says 30 to 60 minutes away from Gabapentin [and presumably other meds] as it can affect their absorption.
NOAH compendium of Data Sheets for Animal Medicines says 5 mg of cimetidine per kg of bodyweight administered three times daily by the oral route
Due to inhibition of cytochrome P-450 activity by cimetidine, the metabolism and elimination of some drugs can be reduced.
The increased gastric pH resulting from cimetidine administration may lead to reduced absorption of drugs requiring an acid medium for absorption.
Clare's website says that Cimetidine may increase the kidney clearance of Gabapentin.
This is the link to the treatment algorithmhttp://www.veterinary-neurologist.co.uk/syringomyelia/docs/treatalgo.pdf