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Pimobendan issues

P

PRC

Member
On Tuesday my Bailey had another Cardio apt with another echo. She has now progressed from B1 to B2 and although I still do not have the written report with all her numbers, the Cardio DR said there is sizeable increase and she needs to start pimobendan. They gave me Vetmedin 5mg chewable tablets and told to give 1/2 tablet twice a day with meals. On Wed AM I gave her one after her meal (had to wrap in cheese because she wouldn't chew it plain). I could tell that afternoon it was bothering her stomach but I still gave her another after the evening meal. At 4AM Thurs she got me up to go outside and she only ate grass and then threw up bile. I tried to get her to eat when we got up but she wouldn't have anything to do with food. After a few hours it was getting past time for another dose so I gave it to her (in cheese) on an empty stomach-big mistake! She would not eat anything and at noon we went for a walk. She strained to poo 3 times, the 1st two were very small black stools and the 3rd was liquid which ran down her back legs. When we got home I cleaned her up and saw it was blood. Called Cardio and they said to stop the Vetmedin and called my local vet but couldn't get in till today(Monday). She gradually got better and started eating some on Fri/Sat and by Sunday there was no longer any blood but still loose stools. Today, Monday she seems back to normal, eating as usual and hasn't even pooped yet but doubt she has much if any diarrhea anymore.

After this long story I'm interested if others have had similar situation with starting pimobendan and what was the solution? Cardio DR said we can restart in a week but I don't want to, at least not at the same dose. Is there a formulary pimobendan for dogs with sensitive stomachs? Has anyone started with a lower dose and gradually worked up to the 2.5mg?
 
That sounds like a very worrying experience and I'm sorry to hear you've had some progression. I have never had any issues like that with pimobendan over the years, and most of my cavaliers have eventually been on it, but can see that gastrointestinal issues is listed as a possible side effect. On the other hand could this possibly have been coincidental, due to some other cause? I've had some cavaliers that got bloody stools a few times a year 😟 (that progressed to chronic pancreatitis in old age, though I'm not sure that is a common outcome, but bloody stools are often indicative of pancreatitis).

I've not heard of any particular pimobendan version that would be designed with stomach protection in mind. Would the cardiologist have any suggestions, such as taking it with omeprazole to protect the stomach? Or maybe giving it a couple of hours after a meal rather than in the morning before a meal? I'd wonder if under-dosing could cause its own problems as it wouldn't be adequate to doing the intended job in supporting the heart?
 
Thank you for responding to my post. I have now received the blood work report and there is nothing that is remarkable, however they did not test Lipase. She has always had very high lipase but the last CPL showed just short of confirming chronic pancreatitis which I have felt she has had for years. That said, I am certain the stomach bleed was from the Vetmedin. I can tell when she is nauseous from meds, had similar nauseous from Marbofloxacin but not the bloody diarrhea, She had a large amount of digested blood (size of a deck of cards)on Fri with a little fresh blood. By Sunday the diarrhea had stopped, no poo at all on Monday and yesterday was back to normal looking slightly soft logs, same today..
The Cardio DR called today and wants to wait a week to let her stomach heal. When I mentioned we need to start with half dose till her system can tolerate it, she suggested a compounded version without flavoring. I really can't imagine it was the flavoring that caused the stomach bleed. I don't understand the hesitancy to allow her to build up a tolerance to Vetmedin.
 
Sorry to hear about this, it's very unusual to hear of this effect with Vetmedin. Does she usually have cheese?
I am wondering if she has borderline chronic pancreatitis that the cheese may have caused an issue? My CP dogs would not tolerate cheese, it's very high in fat.

I'm not convinced a half dose would make much difference tbh in terms of reactions and would be insufficient to assist the heart condition.

I am really surprised that you were advised to give it with meals; it's usually given 1 hour before or 2 hours after meals, 12 hours apart. That is on the dataset.

Personally I would try the compounded version without flavoring, without cheese, and monitor closely.

Please keep us informed.
 
Cavalier Matters said:
Sorry to hear about this, it's very unusual to hear of this effect with Vetmedin. Does she usually have cheese?
I am wondering if she has borderline chronic pancreatitis that the cheese may have caused an issue? My CP dogs would not tolerate cheese, it's very high in fat.

I'm not convinced a half dose would make much difference tbh in terms of reactions and would be insufficient to assist the heart condition.

I am really surprised that you were advised to give it with meals; it's usually given 1 hour before or 2 hours after meals, 12 hours apart. That is on the dataset.

Personally I would try the compounded version without flavoring, without cheese, and monitor closely.

Please keep us informed.
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Thank you for responding. I feel like I'm on an island alone. Bailey loves cheese; however she rarely gets a small piece usually only as a pill pocket. Bread also works but she's a master at rolling it around eating the cover and leaving the med on the floor. Occasionally, when she won't eat her food I have resorted to a small sprinkle of Parmesan to get her to eat. I do also have unsalted peanuts that I can turn into a butter and works well as a pill pocket. Her food is lightly cooked low salt, moderate fat, high protein, low carbs that meets/exceeds NRC guidelines.

I'm scared given her reaction. It may have been the dose I gave on empty stomach that caused the bleed. Do you know what, if any reaction the dogs had that were killed from Vetmedin in the EPIC trial or since? The Cardio DR suggested with food because it would be easier on the stomach (she was nauseous within a half hour of eating) and I've since read it's ok if Vetmedin is intended to be given more than 6 months. Vetmedin's dosage chart shows .23mg per lb of weight so x16.5 lb, that would be 3.8mg per day (divided 2 doses) not the 5mg I was using.
 
UPDATE: Cardio DR emailed to re-start Vetmedin (pimobendan) at 1/4 of 5mg tablet twice per day with food. We started yesterday AM and no stomach upset and no diarrhea or blood. Yeah! She indicated if all is Ok to stay at this rate for 2-3 weeks then increase the PM dose to 1/2 tablet which would be 3.75mg total per day and closer to accurate for her weight.. I did ask if Bailey had any contract-ability issues on the echo and she said no, so we may be a little premature in starting pimo anyway. So it was not the flavoring but way too large of a dose that caused the stomach bleed and nausea. Wish us luck when we get to the 1/2 tablet PM dose.
Hope this helps anyone who may experience the same issues.
PS, I ground 1/4 cup unsalted peanuts, added 2 small drops honey and it is Play Doh consistency. Perfect for pill pocket and she loves it. It only takes a blueberry sized piece to entirely cover the 1/4 tablet.
 
Thanks for this update -- that's sounding cautiously optimistic, which must bring some relief for you! -- and the tip on homemade pill pockets is very useful. :)
 
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