cimetidine vs omeprazole
I just got a call back from Elton's vet. He said he consulted with his neurologist and they both agree that cimetidine will not do what prilosec will in reducing the CSF fluid. He said to start on that and then try Lyrica (which he said is expensive, which I know). He then mentioned steroids.
I found this on Rod's website http://www.cavalierhealth.org/syringomyelia.htm (I hope you don't mind the quote.
"Neurologists have been prescribing cimetidine (Tagamet, Zitac), which is a histamine H2-receptor antagonist -- an antihistamine. Histamine contributes to inflammation and causes smooth muscles to constrict. Cimetidine is diffused into the cerebrospinal fluid and reportedly may contribute to reducing the flow of CSF. When taken with gabapentin, cimetidine also reportedly may increase the amount of gabapentin in the blood by decreasing its elimination. Therefore, when taken together, the dosages may require adjustment."
I have already talked about switching and making an appointment with the neurologist here. I would much rather work with a neurologist than this vet. However, I would like to know more about the differences in these two drugs. Something is definately going on with him. It's hard to "break up" with Ella's/Elton's neurologist but I think it's better to say that I just can't make it for appointments out of town. I am going to ask the vet for a referral but I hope he does not take it as I don't trust his opinion (which I don't because he is not a neurologist).
Anyway, can someone point me to any research? I know it is on Clare's treatment algorithm. Karlin, you also mentioned that it may do better with CM dogs. Do you know why? I am at a loss and I don't want to push a drug if they say not to but I have read on forums that many people give this to their cavaliers/some give prilosec.
Anne, I'm a little (perhaps more so) confused about your issues. Are you adverse to giving Prilosec (omeprazole)? Just about all the published research that exists about these drugs is on http://cavalierhealth.org/sm2.htm#Veterinary_Resources so you can word-search for reports on CM/SM drugs (use the generic names for starters).
My neurologist also gave omeprazole and specifically said the only studies he could find for cimitidine were in humans and increased CSF production. So your neurologist isn't the only one who feels that way.
Actually the neurologist that my vet consulted is the one here. I scheduled an appointment tomorrow morning. I don't know Rod. I will talk to the neurologist about things and we can go from there. I also have Elton's MRI images but he can evalutate him and talk about starting medication or seeing if there is something else causing the issues.
Hmmm -- will see if I can get the info on why cimetidine is used. Omeprazole has far more potential side effects and seems to make many dogs nauseous too.
I'd tend to trust the neurologists who have made the condition a point of serious research and study as well as treatment for a decade and trialed all these medications on hundreds of affected dogs. Cimetidine has been successful in stopping CM/SM symptoms on its own for a lot of people over the years- - would seem impossible if it were increasing CSF pressure.
I just did a search for veterinary journal publications about cimetidine and the canine brain and/or the spinal column, and I have found nothing. The reason for its mention at http://cavalierhealth.org/syringomyelia.htm#--_drugs is because some neurologists have been prescribing it (including Dr. Rusbridge), to reduce the flow of CSF.
I just want him to feel better. He has been having increased symptoms and one that can't be attributed to allergies is his fly catching which I have seen a lot recently.
I really wish I had more time to get videos to show him. I do have some from last year. I recently viewed them and I thought they were of Ella because of how he looked (head rubbing, scratching, could not get comfortable).
Hi Rod -- I checked and the cimetidine paper is the one you have on CSF pressure reduction in a cat, using cimetidine.
There has also been lots and lots of anecdotal evidence from use. Many neurologists were dubious about using frusemide at first as well -- Geoff Skerritt started prescribing it for CSF pressure reduction very early on (at least 10 years ago). Eventually people found it did work -- a couple of neurologists including Clare Rusbridge have seen pre-syrinxes reduce. Mr Skerritt told me he had had dogs with syrinxes scan clear after using frusemide. However to my knowledge he has never done a proper study -- though others have. But then frusemide has potential probes in a breed with heart problems (even though it used to help heart issues in advanced MVD).
The new drug that the RVC is trialling that has been so effective for Oliver reduces intercranial pressure but also reduces CSF flow - on Clare's advice we took him off cimetidine when he started long-term use of the new drug, and we're checking his kidneys etc every 6 months. So far it has had no side effects (beyond three times a day being the maximum dose for Oliver - we tried giving him an extra one on the bad pressure days and he promptly got a runny tummy for the first time in his life - which is the most common side effect in humans). So if it is made generally available, for some dogs it might be able to replace both cimetidine and omeprosale, which would solve the argument! :thmbsup:
Kate, Oliver and Aled
That's great news; look forward to them publishing results and naming the drug!