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Thread: Daisy and Her Medication

  1. #21
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    Hi

    Just had a phone call from Simon who explained that the question of "whether a dog who has SM and is prescribed frusemide and the dog then develops a heart murmur should continue taking this drug " raised many thoughts and comments amongst the cardiologist community .The consensus of opinion from our American friends indicated not to take the drug ,but without the help of any clinical trials and weighing all points Mr Swift advised that he will email G.S. and ask him to consider putting Daisy on cimetidine instead of frusemide though he is sure there are many Cavaliers affected by both SM and heart conditions that are still taking frusemide .So we wait for a day then I will ring Chestergates to confirm all and switch as soon as I can .Daisy weighs 8 kg so I presume she will take 3 x 50 mg daily of Zitac daily but I know Tagament is a generic of Cimetidine and that is available over the counter but of course is not on the NOAH website .
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

  2. #22
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    So pleased you are getting all this sorted out - whilst you are speaking to them, can you ask about dosage schedules as above please?
    Nicki and the Cavalier Clan Our photos www.scotlandimagery.com
    Supporting www.rupertsfund.com and www.cavaliermatters.org

  3. #23
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    Hi Nicki

    What shall I ask him ,what dose per kilo of weight ? Simon is a really nice person to speak .
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

  4. #24
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    Sorry Brian only just seen this

    [FONT=Calibri] [/FONT]There is a bit of confusion over dosage - Clare gives the dose for Zitac [Cimetidine] as 5-7mg per kg 3 times daily BUT

    NOAH compendium states 5 mg of Zitac per kg of bodyweight administered three times daily

    http://www.noahcompendium.co.uk/MSD_...gs/-56439.html


    The issue that is concerning me though is that Clare states that as Cimetidine reduces stomach acid, it may reduce the absorption of other drugs. It is recommended that other drugs are administered at least 2 hours before the administration of Cimetidine.


    This is giving problems with scheduling medications

    Kayleigh is on Gabapentin three times daily, 7am, 3pm and 11pm. If I have to give that 2 hours before the Cimetidine, it means I have to give her the Cimetidine at 1 am!


    SO if you get to speak to anyone, can you see if you can get any clarification please? I'm just in the middle of e-mailing my neurologist and I'm hoping someone is also going to speak to Clare about it.
    Nicki and the Cavalier Clan Our photos www.scotlandimagery.com
    Supporting www.rupertsfund.com and www.cavaliermatters.org

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    Hi Nicki

    Understand ,did read the discussion on this point so if I get him will ask .With that regime
    you would be up and down all night .
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

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    Quote Originally Posted by Brian M View Post
    Hi

    Just phoned Simon but he is in consultation ,but we will speak as the day goes on .I have printed off
    C. .R guidelines together with the NOAH Zitac information .
    Brian,

    Since dr. Swift is a top cardiologist with cavaliers and mvd, I would be curious to see what he says about treating both mvd and sm.

    I'm sure he talks to dr. Rusbridge (maybe not) but it would be helpful (just in my opinion) if they could communicate with others if there is a concern with one particular drug used to treat SM and the heart.



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    Anne Proud mother of Elton 5 and Angel Ella

  7. #27
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    Hello Annie

    Where have you been .?Could you ask the good
    Dr ,poss SS has already consulted with him.
    Brian M

    Poppy the Tri, Daisy the Blen, Rosie the Ruby and Lily the B & T

  8. #28
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    Quote Originally Posted by Brian M View Post
    Hello Annie

    Where have you been .?Could you ask the good
    Dr ,poss SS has already consulted with him.
    I am sorry!! I missed that part. I saw prilosec side effects, timing of drugs etc. I'm a dummie
    Anne Proud mother of Elton 5 and Angel Ella

  9. #29
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    I wanted to respond to this over the weekend and had some computer problems at home. I do have part of a response saved in a word doc at home, but I'll go ahead and start over again from another computer.

    I read the pages in Plumb's Veterinary Drug Handbook on cimetidine, and it's a little more complex than what has been said - which is not to give with any other drugs without a two hour window. Basically - the effect of SOME drugs taken with cimetidine is ENHANCED, and the effect of some OTHER types of drugs taken with cimetidine is DIMINISHED. There is a list of these drugs in Plumb's, and there is more extensive info in Plumb's than in the NOAH compendium, but here is a cut and paste from NOAH:

    "Due to inhibition of cytochrome P-450 activity by cimetidine, the metabolism and elimination of some drugs can be reduced. Clinically relevant interactions may occur with compounds having a narrow therapeutic index, e.g. beta-blockers, calcium channel blockers, benzodiazepines, barbiturates, phenytoin, theophylline, aminophylline, warfarin and lidocaine. Doses of such drugs may need to be reduced when administered concomitantly with cimetidine. The increased gastric pH resulting from cimetidine administration may lead to reduced absorption of drugs requiring an acid medium for absorption. It is recommended that at least 2 hours should elapse between administration of cimetidine and aluminium or magnesium hydroxide, metoclopramide, digoxin or ketoconazole when possible."

    Note that there is no mention of gabapentin or pregabalin type drugs in the above list. Also note that the more common problem is that drug effect is ENHANCED, not diminished. From what I've read, I don't see a problem giving gabapentin and cimetidine at the same time and it seems to be an over-generalization to say not to give ANY other drug at the same time. If I had an SM dog on these meds, I'd want to specifically read and understand where the problem is in Plumb's or another drug handbook. Also, I would consider the option of using one of the other H2 receptor antagonists such as omeprazole, ranitidine or famotidine.

    As far as different specialists communicating with each other, I'm afraid that is unlikely to happen. Specialists tend to stick with their own specialty and are reluctant to tread into each other's territory so I would be very surprised to see one specialist give an opinion about treating a disease of another speciality unless perhaps it was something related such as heart failure and kidney failure or hypertension and kidney failure.


    Pat
    Pat B
    Atlanta, GA

  10. #30
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    Quote Originally Posted by Pat View Post

    As far as different specialists communicating with each other, I'm afraid that is unlikely to happen. Specialists tend to stick with their own specialty and are reluctant to tread into each other's territory so I would be very surprised to see one specialist give an opinion about treating a disease of another speciality unless perhaps it was something related such as heart failure and kidney failure or hypertension and kidney failure.


    Pat
    You are very right. I know in human practice doctors and specialists can have certain reputations. My brother fits into the arrogant knows everything category, but my step father is a rare bird which I'm very proud of his humble reputation.

    He is a retired radiologist but wouldn't even talk about ellas mri, that for the specialists to recommend what to do (even though he has seen CM/SM and several mri's he wouldn't claim to even try to question anything.

    Not surprising because I have a friend whose mom is a tech at another hospital but talked about how they all know dr. Gettys because he treats them with as much respect as a brain surgeon. He often will say, "they know more than I do".

    What a man, I love that quality but it is not common.

    Sent from my Droid using Tapatalk
    Anne Proud mother of Elton 5 and Angel Ella

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