21st July 2014, 12:33 AM
Food and pimobendan
Question for Rod and Pat, if you see this: manufacturers of pimobendan (Vetmedin/Cardisure) advise it be given on an empty stomach, and the accompanying literature states this is because absorption was seen to be significantly affected in testing with a liquid suspension of the drug, noting whether this is also true for tablet form is unknown.
Just wonder if there's any more recent research that has shown it doesn't matter if given with food. I am curious as apparently a UK cardiologist has told a client it doesn't matter whether it is given with food.
I was on the phone to Leo's cardiologist this past week who said to be sure to give on an empty stomach as the efficacy of the dose could otherwise be cut by around half; this is what I've always been told by vets as well.
In memory: Lucy
21st July 2014, 11:15 AM
Picking upon the discussion of this on the Companion Club Facebook page, I wonder if the difference of views has to do with liquid versus tablets? I would think that if liquid is given with food, it will get diluted by the moisture in the food (or the stomach juices produced to deal with dry food) and therefore be less effective. The tablet (even half of one) is so big that it would take some time for it to be affected in the same way and will stay more or less at full strength. Perhaps the manufacturers Glaxo need to be clearer in their instructions and not just say 'we don't know' about whether the tablets are affected by food in the same way as the liquid. They can afford to do some tests to find out!
Kate, Oliver and Aled (whose heart failure was behind my original question that sparked the discussion)
21st July 2014, 12:40 PM
I am not aware of any recent studies on the question of when to give pimo, but the UK Vetmedin website has this information:
"How is Vetmedin® given? -- Vetmedin is available as a flavoured tablet or capsule. It should be given to your dog by mouth twice a day, approximately one hour before food, ideally in the morning and evening (about 12 hours apart). Use the dose that your vet prescribes."
21st July 2014, 12:47 PM
I have always been advised by my vet to give Pippin his first thing but then breakfast straight after, when I questioned her advice I was informed that with the tablets it is not such a big issue and the reason she advised food be given straight after, was that a lot of clients dogs were being sick after taking the tablet which then greatly reduced it's effectiveness...Pippin has always done and continues to do well on it and has been on the medication since April 2011.
There seems to be a lot of conflicting advice, for instance although Pippin was only diagnosed with a grade 2 murmur, after ECG and Doppler scan he was prescribed Pimobenden, he is now in early CHF and is on other meds too, where as DJ was diagnosed with a grade 2 murmur a year ago which is now a grade 3 but requires no medication, they both attend the same vet.
I think like everyone here we all just want what's best for our dogs and as with GP's, vets seem to differ and some offer advice different to what's on the manufacturer's leaflet depending on the dog, as GP's do depending on the human JMO
Wishing all of you and your doggies well <3
21st July 2014, 02:42 PM
When Jasper was put on Vetmedin in October last year, the vet said to give it twice a day, an hour before food and 12 hours apart, although we don`t give it at such a big gap, he was put on this after being on Fortekor and Fruisimide for about 3 years, but his cough had got worse so the vet decided Vetmedin would be the best medication to add.
21st July 2014, 03:19 PM
When Leo was started on Vetmedin last December I was advised to give 1 hr before food twice a day.....12 hrs apart.
I give him one tablet an hour before his breakfast and the other one an hour before his dinner (about 4pm)
I spoke to my cardiologist about times and she said it doesn't have to be exactly 12 hours apart but make sure it was given on an empty stomach and don't feed for an hour after....
I was surprised to read the conflicting advice some people have had
Mumma to Leonardo (Leo to his friends)
Waiting at the bridge
21st July 2014, 05:02 PM
Vets give such conflicting advice on heart treatment that I mostly discount their views (I really like my vets! but still...). The majority, easily the majority, start dogs too early on medications despite there being no evidence that this helps and is at best a waste of money but more seriously, means when dogs do actually need the medications they have to take them at a higher dose, thus increasing the risk of running out of medication options too early. And as Rod has noted many times, there's also evidence that starting vetmedin before a dog is in CHF may actually worsen MVD. In my experience most vets are off at least a full grade on murmurs, over or under estimating them, compared to cardiologist's auscultation. As with annual vaccinations, starting any dog with a murmur on heart meds seems to be the rule, with few exceptions, regardless of long standing evidence and advice that neither should be done.
So for me the issue is more what cardiologists are advising. I cannot understand why cardiologists would recommend not following the drug manufacturer's guidelines, when the reasoning is clearly stated in the accompanying literature -- there's definitely evidence that affectiveness decreased by up to more than half if given with food or too close to a meal, with a liquid form of pimobendan (vetmedin). Unless there has been new research to the contrary, then the only defence for giving it with food would be 1) possibly a dog cannot tolerate it on an empty stomach -- but I've never come across that before, though it may well occasionally happen; or 2) that the cardio feels that the statement that it is *unknown8 if the same happens with the drug in tablet form is being taken to mean that the manufacturer's directions can be dismissed unless specifically proven to the contrary. But this seems a very strange approach when there is definite proof that it does affect absorption in liquid form.
In other words, why would a professional advise people to risk poorer performance of a critical drug on the basis that it might not matter, or matter to the same degree? I just can't imagine a doctor advising a mother ignore existing evidence if the treatment were for a child's heart failure, for example.
The Companion discussion was the first time I have ever heard of a cardiologist say it doesn't matter if this drug is given with food. I thought maybe this might be based on new evidence, but I tried to search for any and can't find anything. Hence the question.
I'd not think it matters if it's given with food now and then if that can't be avoided, but it's quite another thing to say it actually doesn't matter when the existing evidence right now says it does . My other worry would be, it isn't like this is a long term drug option either -- by the time a dog is correctly prescribed pimobendan, they are usually in their last 6-12 months of life (I believe studies show the average survival rate is 9 months after starting?) -- I just wouldn't want to risk giving a dose that is less than optimal.
All that said: there's definitely uncertainty about aspects of these drugs and overall heart treatment! And I wonder why after all this time, the manufacturers haven't done a study on the absorption issue with the tablets and are relying on the liquid research?
In memory: Lucy
21st July 2014, 06:28 PM
For Sydney, instructions were an hour before a meal or 2 hours after. Since he wanted to eat breakfast right away after getting up, giving him his medication at 830 am and 830 pm worked best. He never had any tummy issues from taking vetmedin on an empty stomach.
Joyce - Proudly owned & loved by
BellaMia (Aug. 30, 2012) My Beautiful Ruby Milo (Jan. 20, 2014) My Handsome Tri
Sydney (April 16, 2000~April 4, 2012) Always and Forever In My Heart
22nd July 2014, 09:24 PM
I had a Rottie with dilated cardiomyopathy at 6 and she was put on the capsules which were cheaper. Soon they became very difficult to get hold of until a lot of dogs were found to be sick on the pills. The Vet at that time said to give with food.
Last edited by germarey; 22nd July 2014 at 09:26 PM.
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