Gabapentin

[cavluvver]

Thanks again for your input, it's greatly valued. The neurologist has given us tramadol to be taken on it's own. He never mentioned upping the gabapentin [Rossi was on 100 mg x3 daily]. He just said that it looked like it wasn't helping Rossi. I mentioned CSF inhibitors at the last appointment but, as I said, he was very reluctant to use one and said that omeprazole can cause stomach tumours. I don't know how long tramadol takes to work but Rossi has been on it 2 days now and his symptoms are just the same. I just don't know whether to really push for getting on a csf inhibitor as it may really help Rossi but I am very scared of causing another really serious problem as I think Rossi has enough at the moment. It's terrible when you know that their well being depends on your decisions when there are so many conflicting ideas of what routes to take. I just don't know what to do

[Karen and Ruby]

Cimetidine (also known as Zitac) is reletively safe and recommended by Dr Rusbridge. Ruby has been on it for 3 years and Charlie for 14 months and neither have had any side effects.

One of the most sensible things anyone has said to me was when I was talking to Dr Rusbridge about my fears of giving long term Metacam to Ruby and she simply said to me


"what would you prefer, for dog to live a long existance on safe medications that dont really work and they live in pain and discomfort than to give her everything you can, give her the best possible chance and have her live a normal life for less time?"

And well Ruby has been living her normal life for over 2 years, with no side effects from the meds, she has a blood screen done very 6 months to check her organs. She does every thing that other dogs do and is pretty much pain free for the majority of the time.

And I still have options left, Trocoxil, Tramadol,Steroids etc etc for the future if needed.

So I would do anything you can to make him comfortable as ehat would you prefer?

At the end of the day, what ever we do there is a chance it will cause other problems- just watch the news, we cant drink wine, eat chocoate as that MAY cause cancer!! Do we care? No as I like Wine and chocolate!!!

Im sure Rossi wouldnt care if you asked him?

[cavluvver]

Thanks Karen for your advice. I am so angry that I didn't push to try a CSF inhibitor just because the neurologist makes me feel so uncomfortable when I mention the forum and especially if I mention Claire Rusbridge. He just looks at me as dissaprovingly as if I should be listening to him and nobody else, He seems so reluctant to try one and when I them before he gave me the ''look'' and said, ''which one'' and as I was put on the spot, like a child in the classroom, I could only remember omeprazole, to which he replied, ''that can cause stomach tumours''. He said that he would never put a dog on that for more than 6 weeks. But why did he not mention the other csf inhibitors that don't seem to cause terrible problems? He just doesn't make me comfortable discussing other drug options and he seems to have the attitude that HE knows best. I so wish we lived nearer to The Stone Lion so I could have dealt with Claire. Anyway, if Rossi doesn't seem to respond to tramadol by the time he goes for his leg op I am going to ''man up'' as they say and insist that we try cimetidine. I am just not happy!!!

[Holly]

If I'm not mistaken, wasn't that study with the Omeprazole and the stomach cancer done on rodents? I think some people will do a period of time on it and a period of time off of it, to reduce the risk, just in case. Scarlett, who is severely affected, has been on Gabapentin, Previcox, and Omeprazole (with an occasional Tramadol, if needed), for about 2.5 years and her bloodwork always comes back perfect-- knock on wood. I also agree with the person who said that they would rather their dog have a good quality of life for the time she is here, using meds that do truly help her.

How about contacting Dr. Rusbridge for a consultation? You can send her the MRI results and explain what is happening and she can get you on the right meds regime. I don't think a consult is too expensive and it would give you peace of mind.

In my experience, I think the CSF inhibitor is very important for these dogs.

[Nicki]

I totally agree with Clare, quoted by Karen

"what would you prefer, for dog to live a long existence on safe medications that don't really work and they live in pain and discomfort than to give her everything you can, give her the best possible chance and have her live a normal life for less time?"

I have never heard of Tramadol being used in isolation, it is generally given in addition to other medication, and usually only for palliative care, as it is very addictive.

If you are not happy with the treatment prescribed, then it is your decision and your choice to consult with different practitioners. It is sad that Mr Skerritt is so against the forum, I have learnt so much here, there is a lot of feedback here about the results of treatments.

Do you have the treatment algorithm printed out?


You are right Holly - see below!


Omeprazole - in humans there is a risk of bowel cancer with long term usage Pulse therapy is recommended, where you have 4-6 weeks on, 1-2 weeks off. It's not known about long term risk in dogs.
I also found that high doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine - again in humans.


A few years ago, 2007 my vet contacted Gregg Kortz DVM Diplomate ACVIM - Neurology about the long term use of Omeprazole - at that time he had only be using it for about a year, but had not seen any problems in that time. He kindly sent some a few of the articles on Omeprazole toxicity.


Neuroendocrine cell hyperplasia and neuroendocrine carcinoma of the rodent fundic stomach.
Poynter D, Selway SA.
Glaxo Group Research Ltd., Ware, Herts, U.K.

Certain substances when given orally to rats have effects on the neuroendocrine cells of the fundic stomach. Such compounds also have effects on acid or its secretion, which is to a greater or lesser extent suppressed, with a consequent rise in serum gastrin, followed by an increase in the number of histamine-secreting ECL cells. These changes are seen with the histamine H2 receptor antagonists loxtidine, SKF 93479, ICI 162,846 and ranitidine; with the hypolipidaemic agents clofibrate, ciprofibrate and benzofibrate; with sodium bicarbonate and pentagastrin; and with omeprazole, a potent inhibitor of the parietal cell proton pump mechanism. Changes in the pH of the rat stomach stimulate the neuroendocrine G cells of the pylorus to secrete gastrin, which acts on the ECL cells of the fundus causing the production of histamine, which in turn stimulates the parietal cell. This sequence leads to an excess of circulating gastrin, which is detectable within 5 days. Subsequently increases in the number of ECL cells occur, the hyperplasia being related to hypergastrinaemia and the degree of acid suppression. The hyperplastic response is rapid, being so obvious with loxtidine at 39 days that there is good reason to suppose it could well be detected earlier. Using omeprazole, hyperplasia was found at 28 days after oral doses of 140 mg/kg/day. In order to get an equivalent degree of acid suppression with ranitidine it was necessary to deliver 420 mg/kg/day by subcutaneous infusion using an osmotic minipump, when hyperplasia occurred. Interestingly, only omeprazole produced a hyperplastic response of G cells. Such results reflect the covalent binding of omeprazole to the proton pump as opposed to the competitive binding of ranitidine to the histamine H2 receptor site. In addition to ECL cell hyperplasia there is ample evidence from lifetime studies in rats and mice that neoplasia may result. Neuroendocrine carcinomas (carcinoids) of the rat fundic stomach have been observed with loxtidine, omeprazole, SKF 93479 and ICI 162,846. They are seen late in the 2-year rat studies and are most unlikely to have arisen purely as an extension of the hyperplastic response. It is possible that the prolonged disturbance of gastric homoestasis resulting from achlorhydria result in the production of a carcinogen or carcinogens, in which event it is not too surprising, in view of the neuroendocrine hyperplasia, that the tumours seen are neuroendocrine carcinomas.(ABSTRACT TRUNCATED AT 400 WORDS)




Pharmacology and toxicology of omeprazole--with special reference to the effects on the gastric mucosa.
Carlsson E, Larsson H, Mattsson H, Ryberg B, Sundell G.
Omeprazole is a long acting inhibitor of gastric acid secretion in different species including rat and dog. Due to the long duration of action, steady state inhibition at repeated once daily administration is reaches within 4-5 days in dogs and in about 3 days in rats. Daily dosing at high dose levels results in virtually complete 24-hour inhibition of acid secretion in experimental animals. The elimination of the inhibitory feedback effect of acid on gastrin secretion leads to hypergastrinaemia. Because gastrin has a trophic effect on the oxyntic mucosa, the hypergastrinaemia results in a reversible hypertrophy of the oxyntic mucosa and an increased capacity to produce acid following maximal stimulation with exogenous secretagogues after discontinuing treatment. Despite the increased capacity to produce acid, basal acid secretion seems to be unchanged. The pronounced hypergastrinaemia which occurs during long-term treatment with high doses rapidly normalizes after discontinuing treatment. The hyperplasia of the oxyntic endocrine ECL cells, and the eventual development of gastric ECL cell carcinoids after lifelong treatment of rats with high doses, can also be attributed to the hypergastrinaemia developing after almost complete elimination of gastric acid secretion in these animals.




Toxicological studies on omeprazole.
Ekman L, Hansson E, Havu N, Carlsson E, Lundberg C.
As part of the safety evaluation of the gastric antisecretory drug, omeprazole, toxicological studies have been performed in several species of animals. The acute toxicity after oral administration to rodents was low. The oral LD50 value was above 4 g/kg. The general toxicity after repeated administration has been studied in rats and dogs. No clinical signs of adverse reactions were seen. Some minor changes in hematology parameters were observed. In rats and mice decreases in the erythrocyte count, hematocrit and hemoglobin have occasionally been found at doses of 125 mumol/kg/day and more. Hyperplasia of oxyntic mucosal cells, concomitant with increases in stomach weight, oxyntic mucosal thickness and folding, has been observed in the species investigated, the dog, rat and mouse. In addition, slight chief cell atrophy and eosinophilia of the chief cell granules were observed in rats. The oxyntic mucosal effects were reversible upon treatment being discontinued. In the oncogenicity studies, gastric carcinoids occurred in the rat but not in the mouse. Investigations of the carcinoids showed that the vast majority of the endocrine cells could be characterised as ECL-cells. The hyperplasia of oxyntic mucosal cells, including hyperplasia of endocrine ECL-cells and development of gastric carcinoids in rats, is attributable to the pronounced hypergastrinemia produced as a secondary effect of almost complete inhibition of acid secretion by the large doses of omeprazole used in the toxicity studies. In agreement with this hypothesis, the hyperplasia of the oxyntic cells was prevented by antrectomy. The reproduction studies performed in rats and rabbits showed no sign of fetal toxicity or teratogenic effect. The results of the short-term mutagenicity tests, Ames test, the micronucleus test in mice and the mouse lymphoma test were all negative.




A review of the effects of long-term acid inhibition in animals.
Carlsson E.
Gastrointestinal Research, AB Hässle, Mölndal, Sweden.

Studies with H2-receptor antagonists have revealed a trophic effect on the gastric mucosa - an effect which has been ascribed to hypergastrinaemia secondary to acid inhibition. Such hyperplasia of oxyntic mucosal cells has also been demonstrated in chronic toxicity studies following profound, long-standing inhibition of gastric acid secretion with omeprazole. The central role of gastrin in this effect was clearly demonstrated in the omeprazole studies, as antrectomy prevented this effect in both rats and dogs. The hyperplasia was fully reversible in both species. The close correlation between serum gastrin and hyperplasia of enterochromaffin-like (ECL) cells in the rat oxyntic mucosa has been demonstrated in a large number of experiments using different means to induce hypergastrinaemia, including administration of exogenous gastrin, treatment with antisecretory drugs and partial fundectomy. The hyperplasia of ECL cells was fully reversible even after 1 year of sustained gastric acid inhibition following treatment with a high dose of omeprazole. Marked long-standing hypergastrinaemia explains the findings of gastric ECL cell carcinoids in the life-long rat toxicity studies with both omeprazole and other inhibitors of gastric acid secretion.

[Nicki]

It seems to be only in recent years that it was discovered that some of these drugs reduced CSF pressure, I don't know if they are being used in humans with SM yet, but that is why there is very little info around about them. There are not any studies at present, it is unlikely that there will be so as it would be very hard to tell how things would have developed with or without the Cimetidinel.

Many of these drugs will never be licensed for use in the treatment of SM, as licensing costs a considerable amount of money which would not be recouped as there is only a limited market for the product. Cimetidine is licensed in dogs due to its existing use in gastric issues.

[Sabby]

To start off you are paying a lot of money seeing this neurologist. You say he made you feel like a kid in a class room. I am sorry it’s time to see someone else. Like everybody said tramadol doesn’t do anything by itself and it won’t do a thing if gabepentin has stopped working. My Harley was on tramadol for nearly a month and it didn’t do a thing only made him sleep. After seeing Clare he is now on Zitac. When Clare wrote the report for my vet she mentioned this Forum and that there is a wealth of knowledge on here. I wonder why he is so disapproving of Clare and this Forum.

[Brian M]

Hi

Pls Pm me your phone number so we can speak .Dont forget Daisy went to Chestergates in August
of this year ,she was prescribed Frusemide but is now taking Zitac .I dont really want to post
what happened with Daisy ,Chestergates and me so it will be much better if we speak privately .

[sins]

I know it's not easy to keep stress at bay when you're trying to get the right treatment for your dog,especially if they're already in some degree of trouble.
I often feel myself,like we're always just one step behind with medication,just as we seem to have gotten it right,then things change and we have to be flexible again.
Sometimes SM causes different symptoms from dog to dog and some manage quite will with little or no intervention,but for those who have symptomatic cavaliers,remember,medicating for symptoms is still in the experimental stage.There's an increasing array of meds being offered,depending on what's needed.
What may suit one dog,may not suit another.It's really down to the owner to work with your specialist to report back on what does or doesn't work.
My Daisy can't tolerate Rimadyl and does poorly on Metacam.Frusemide leaves her wiped out and worn.
Yet,other dogs fly on it.Gabapentin works well with no notable side effects for her.
If your specialist prescribes a medication,then I feel try it,note any changes and if it's not helping,then go back and say so.
It's still trial and error to find what suits best.
Don't be disheartened though,you'll get things sorted to your satisfaction very quickly.
Sins

[sarahsum]

Hi, I've just had a glance through the last two pages, I'm sorry you have been put into a pickle with the neurologists attitude, its not fair to you as you have enough worry already. is there a chance he has been prescribed the tramadol more for the pain in his tibia? When Blue was first thought to have a disc problem causing his limp & scoliosis my vet put him on tramadol. I can say it just zonked him out & made his gait worse. After the scan & correct diagnosis we were put on a 5 day course of omeprazole to protect his tummy from the meds (steroids, gabapentin etc), and within 3 days he was showing considerable improvement. Then when the course finished, within five days he was almost immobile. I asked my vet to represcribe it on a permanent basis after seeing it on here & Clares site, he mentioned about the long term side effects of cancer...but like i said, he won't have a long term if he cant flipping walk & is in pain!! So we got the omeprazole & literally in the space of four days he went from a dog who had dull eyes, couldn't stand to be touched, wouldn't eat or walk, had horrendous front limb drag.....to a dog I took round the fields this morning for 30 minutes without a limb drag, who can run upstairs & is continuously shoving toys under my feet. We go to Chester gates on wednesday, but if anyone even suggests taking him off this drug they will get told NO, NO WAY.