scott@vtx-cpd.com

Replying to Belinda Lum 04/05/2022 - 09:51

Hey.

This is a brilliant question. Was this in dogs or cats?

Generally the worst side effect we see in dogs is hypersalivation. Capromorelin is dosed at 3 mg/kg PO q24h, which has been shown to increase food intake and weight gain in both inappetent client-owned dogs and healthy laboratory dogs. The pivotal field safety and effectiveness study evaluated 177 inappetent dogs (121 treated with capromorelin for 4 days, 56 with placebo). Treatment with capromorelin significantly improved appetite (68.6% versus 44.6%, respectively, P = 0.008) as well as mean body weight compared with placebo (1.8% versus 0.1%, respectively, P <0.001). The most commonly observed adverse clinical signs included diarrhea (7.0%), vomiting (6.4%), polydipsia (4.1%), and hypersalivation (2.3%).

There are some reports coming through with concerns with the clinical use of capromorelin in cats. The authors of the 2011 study of capromorelin in cats did note lethargy and depression, but cardiovascular parameters – such as heart rate and blood pressure – were not reported. There are unpublished reports of some cats become profoundly bradycardic and hypotensive within one hour of being given capromorelin at a dose of 3 mg/kg. It is likely there will be enough data for one or several institutions to publish data describing in more detail the incidence of adverse events in cats, and ideally identify at-risk populations. It might be enough evidence to use capromorelin in cats at a lower dose (2mg/kg).

I hope that helps.

Scott 🙂

Hello.

I hope you are well.

The mechanism causing hypercalcaemic pancreatitis may be calcium deposition in the pancreatic duct and calcium activation of trypsinogen in the pancreas.

I hope that helps.

Scott 🙂

Hello.

Thank you so much for your question. These are tricky cases!

The presence of enteric protozoans in diarrhoea samples does not prove that disease was due to the organism. Some enteric protozoans, especially Cryptosporidium spp., live chronically in the intestinal tract of normal animals; other conditions causing GI tract disease can induce repeat shedding. Thus, animals with enteric protozoal infections that do not respond to therapy should be evaluated for underlying causes of disease.

High-fiber diets are generally indicated if large-bowel diarrhea is occurring. However, feeding a high-fiber diet may also aid in the treatment of giardiasis due to inhibition of trophozoite attachment to duodenal epithelial cells. Use of probiotics may also have clinical benefit in some cases. A diet change may be a plan in these cases and possibly considering the Vivomixx probiotic.

Having said all of that, if the clinical signs are persistent, diet and probiotics not working, I might consider treating the cryptosporidium. Paromomycin, tylosin (10 to 15 mg/kg PO q 12 h), azithromycin (10 mg/kg PO q 24 h), and nitazoxanide (25 mg/kg PO q 12 h) have all been used to lessen diarrhea in dogs, cats, calves or people with cryptosporidiosis, but no treatment has consistently stopped Cryptosporidium spp. oocyst shedding. The drugs are generally prescribed initially for 7 to 10 days. However, it sometimes takes as long as 4 to 6 weeks to achieve total resolution of diarrhoea. The most commonly prescribed drugs to treat Cystoisospora spp. infections of dogs and cats are trimethoprim-sulfonamide, sulfadimethoxine, furazolidone, amprolium, or amprolium-sulfadimethoxine. Quinacrine, spiramycin, toltrazuril, roxithromycin, and ponazuril have been used on a limited basis. Ponazuril appears to be safe in most puppies and kittens and can eliminate infection after one dose (50 mg/kg PO). However, administration of ponazuril daily for 3 days at 50 mg/kg was the most effective protocol in one study.

As far as I was aware metronidazole is not helpful for Tritrichomonas foetus. Really useful information from the iCatCare website:

”Unfortunately, most studies on the treatment of T. foetus infection in cats have been unrewarding. The organism is resistant to most traditionally used anti-protozoal drugs such as fenbendazole and metronidazole. The use of a variety of different antimicrobial drugs has been reported to improve faecal consistency during therapy of infected cats, possibly because of interaction between T. foetus and the bacteria normally present in the intestine, and/or other concurrently carried enteric pathogens. However, such antibiotic use is not recommended as it may ultimately prolong the shedding of the organism, and does not resolve the underlying problem.

A study by Dr Jody Gookin at the North Carolina State University (who has performed most of the work on this infection in cats) identified that ronidazole and tinadazole (antibiotics similar but not the same as metronidazole) have some efficacy against T. foetus infection in cats (JVIM, 2006;20:536; Am J Vet Res, 2007; 68:1085), and that ronidazole is more effective than tinadazole. Ronidazole appears to be relatively safe, although a small number of patients have developed neurological signs eg, twitching and seizures, which have resolved on stopping the drug. The neurological signs are similar to those seen in some kittens or cats with liver disease, when they are given standard or high doses of metronidazole. However, ronidazole is not licensed for use in cats; it should only be used with caution and with informed, signed, owner consent. Initial studies suggested that a dose of 30-50mg/kg once to twice daily for two weeks is capable of both resolving clinical signs and potentially eradicating T. foetus but it can also be associated with neurological side effects, plus occasional lethargy and/or vomiting. Therefore, we now recommend 20-30mg/kg once daily for two weeks, which should be reduced for young kittens or cats with hepatopathy to 10mg/kg once daily for two weeks. To ensure that each kitten receives the correct dose, and so reduce the risk of side effects, it is important to weigh the kittens prior to ordering the reformulated capsules. The bitterness of the powder means that it must be placed in capsules prior to administration. For the same reason it is important not to split tablets or open capsules and sprinkle the contents on food.”

The PCR test is pretty sensitive here, but if you really still thought they had the infection you could re-test.

I hope that helps.

Scott 🙂

Replying to Nichola C. 28/04/2022 - 09:46

No problem.

How did the case get on?

Scott 🙂