scott@vtx-cpd.com

Replying to Angela Tiivel 10/08/2025 - 09:53

Hi Angela,

Thanks for your message. I understand how frustrating it can be to lose access to products like Denamarin, Zentonil, and Samylin, as they are widely used in many countries for hepatic support. In situations where these aren’t available, the goal is to select from what you do have access to, ensuring you can still provide adequate doses of the key active ingredients with the strongest evidence for liver protection, namely S-adenosylmethionine (SAMe) and silybin (the bioactive extract of milk thistle), ideally in combination with antioxidants such as vitamin E.

Of the products you mentioned, VETEXPERT Hepatiale Forte Advanced would probably be my first choice for most cases, as it contains SAMe together with phosphatidylcholine, which aids hepatocyte membrane stability and can improve bioavailability of silybin if given together in some cases. However, if the formulation you have does not already include silybin, I would look at adding this separately, either through a combination product or a stand-alone silybin supplement with proven bioavailability (often in the form of silybin–phosphatidylcholine complexes).

DRN Epato and Bioiberica Prolivet are also reasonable options — both can provide useful support depending on their exact composition in your market. Epato products often contain silybin, phosphatidylcholine, and sometimes artichoke extract or other antioxidants; Prolivet typically contains silybin and other liver-supportive nutrients. The main thing is to check the label for the actual amount of silybin and/or SAMe per tablet or capsule, as the doses in many nutraceuticals are quite low compared to those used in published studies.

When selecting and dosing:

SAMe: Aim for a therapeutic dose of roughly 18–20 mg/kg once daily on an empty stomach. This helps maximise absorption and avoids degradation by food.

Silybin: Aim for 4–5 mg/kg once daily (or divided twice daily), ideally in a phosphatidylcholine-bound form for improved absorption.

Vitamin E: May be beneficial in chronic hepatopathies or where oxidative stress is suspected, but dosing should be tailored to avoid excess.

If a single product doesn’t contain both SAMe and silybin in adequate amounts, you can combine two complementary products to reach the desired doses. For example, you might use Hepatiale Forte Advanced to supply adequate SAMe and then pair it with Epato to provide the silybin component.

Regarding your comment on liver enzyme improvements after discontinuing Apoquel, there have been occasional reports of mild ALT or ALP elevations in dogs on oclacitinib, though it’s not considered a common side effect. In cases where there’s a temporal association between starting Apoquel and enzyme elevation, particularly if other causes are not identified, a trial off the medication can help clarify the relationship. If Apoquel is needed for pruritus control but liver enzyme elevations persist or worsen, switching to an alternative antipruritic may be considered.

I really hope you are enjoying the course.

Best regards,

Scott

Replying to Victoria R. 08/08/2025 - 14:31

No problem!

I am looking forward to trying it too!

Scott 🙂

Replying to Sarah Keir 02/08/2025 - 18:25

Hahahaha!

There has to be a home for our old university gowns!

Scott 🙂

Replying to Riley D. 03/08/2025 - 21:02

Hey Riley,

Thanks for sharing the case. I’ll be curious to see how things go with his check up and whether you detect any effusion you can tap for RT-qPCR.

For what it’s worth, I’ve just been following an older kitty, “Emma Jane,” with a long, twisty file: chronic pleural effusion, persistent hyper-globulinaemia, a static right-ventricular mass, previous pericardiectomy, and a relapse of presumptive FIP now on a second 84-day GS course. Her echo shows mild HCM-type changes plus that ventricular mass, and her troponin’s been intermittently high—so I’m watching her as another possible example of the cardiac-FIP spectrum. The one thing that does not make sense with her is her age!

Keep us posted.

Cheers,

Scott