Daisy and Her Medication

[Tania]

Molly and Dougall are on Gabapentin and cimetidine three times per day. We have alwasy been told to leave a two hour window between the two drugs.
As you can imagine it does make life difficult.

[Brian M]

Hi

Dont know were to start except to say I am highly disappoitment ,irritated and confused and had better not
spill my inner thoughts and feelings here .
A pxxxxx off brian


I'm sorry Brian I understand you are very upset but do not feel it is appropriate to be posting this on a forum which can be read by anyone. If you wish to send this to friends privately obviously you can do this by PM

[Tania]

I think you have received excellent advise from Simon Swift and also Pat. I would go back to your
own vet and get the cimetidine. Daisy is your dog and I am sure your vet would understand and prescribe.
I think the sooner she is on the correct medication the better. Then perhaps look for a different neurologist.

[Sabby]

[removed by admin --
please folks: remember to take personal discussions about identifiable professionals private -- as Nicki reminds earlier, they don't belong on a public board.


Thanks -- Karlin]

[Kate H]

I've been discussing with my vet using a different CSF inhibitor with Oliver (mainly because I think a different one might be more effective). She rang round Chestergates, the Willows and Clare Rusbridge for advice, and all of them actually said leave him on frusemide until he can be scanned again to see how far his eye problems are caused by his dilated ventricles (which for domestic reasons won't be until the new year at the earliest). So at the moment opinion does seem to be divided (in the UK at least) about the pros and cons of frusemide - from what Simon himself has said, not even all the cardiologists are in agreement.

Kate, Oliver and Aled

[Nicki]

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.

Thank you SO much for posting this Pat, that has put my mind at rest. I'm going to forward this on to my neurologist too.

Just found the appropriate section in the British National Formulary http://bnf.org/bnf/bnf/current/41001i744.htm

Like Plumb's, it shows interaction information and Gabapentin and Pregablin are NOT mentioned.


ranitidine also gives a reduction of gastric acidity - it also reduces or increases absorption of many drugs, but again Gabapentin and Pregablin are NOT mentioned. Ditto for famotidine and omeprazole.

[Nicki]

Could I just remind people of the rules:

While a large degree of latitude is allowed for personal styles of expression, personal attacks, namecalling, and disparagement ...-- singly or collectively -- is not acceptable.


see http://www.cavaliertalk.com/forums/s...hip-guidelines

[Brian M]

Hi

After further professional advice form Daisy's cardio and from many other sources of information and guidance from
many people and including C. R. Sm treatment cascade I have decided that it is not in Daisy' wellbeing to continue with furosemide .I have futher decided not to approach Daisy's neuro for an alternative treatment but I have approached Daisy's vet and requested that he prescribe a change of medication ,I have supplied him with copies of all information to substantiate the reasons for my request and will hopefully have a call back this afternoon .I am
happy with the information I have , and concluded that furosemide should not be administered to a dog with a heart murmur even though Daisy has been diagnosed by full body scan MRI with Sm ,CM and PSOM .We are hopeful that Daisy' vet will prescribe Cimetidine (Zitac ) 50 mg three times daily or possibly consider Ranitidine ,but if not I always have the option of purchasing a generic Cimetidine such as Tagamet over the counter.

Any thoughts please.

[Karlin]

Please folks: remember to take personal discussions about identifiable professionals private -- they don't belong on a public board.

Brian said this:

and had better not
spill my inner thoughts and feelings here

And that is where that post and others should leave things -- Brian I am not sure why the decision was then made to then go ahead and make a long post identifying individuals even after this was said by you?

I understand people have frustrations at times with vet care and fully sympathise -- we have ALL been there at one point or another -- but that doesn't mean those frustrations are appropriate to a public board.

Please reread the Getting Started section if anyone is unsure what is OK to post in such situations. These are better conversations to be had amongst yourselves by phone or email, please.

If you are referring to individuals or commenting on someone's post referring to individuals, please contact a moderator or me to see if it is OK to post - or better yet, don't: simply talk privately to those you want an opinion or support from.

[Karlin]

On the actual topic: and please ALL further posts are to stay on topic please! The issue of frusomide has only very recently arisen because probably SM is one of the ONLY no heart related conditions it has been given for.

As Simon Swift himself indicates: this remains an issue of dispute, and there is not clear agreement even amongst cardiologists. Until Swift mentioned this less than month ago to you Brian, I had never even heard this issue mentioned once. I understand part of the reasoning is that the dose is so small with SM that it is not considered too likely that it would cause issues. I suppose on the realistic side -- sadly there is a higher rate of euthenisation amongst dogs that remain on medications alone for CM/SM as well -- so there would be a question of whether a dog put on this drug for SM is going to live long enough and take enough of it for the heart to be affected. Those are some of the blunt issues we all face in deciding on routes of care with this frustrating, depressing condition.

Likewise there seems a *lot* of dispute over omeprazole. It was very old studies, if I recall, that associate stomach cancer with long term use of this drug and in humans, long term effects meant very long -- dogs live a fraction of the time humans do. I also had read studies that disputed the cancer association. Yet a lot of vets and vet specialists still are uncertain about prescribing omeprazole because of a (disputed?) human cancer risk.

I believe the main reason Clare had moved away from frusemide (at least til recently perhaps?) is not so much the heart concern as just that she feels there are better drugs with fewer side effects. Frusemide causes a lot of excessive urination. She told me recently that she hadn't prescribed it for those reasons in quite a while. Perhaps she has removed it now completely because the jury is out on heart effects and it isn't really necessary to choose frusemide as several meds do the same thing -- inhibit CSF flow.

Different specialists take very different approaches with this condition and any one of them will certainly say there is *no one best approach* so it really makes little sense to berate one approach over another. If someone is unhappy with one approach I'd just get a second opinion/move to a different specialist.

I would NOT leave a dog with CM/SM off neurological care and only rely on a vet -- they do NOT have the expertise around this specialist condition and should not be making treatment decisions! If anyone is unhappy with their specialist, then see another, but please do not leave any dog with this specialist condition without specialist care.