Pepcid For Acute Kidney Failure???

petparentsurrogate · Dec 18, 2018

I have been going over the many threads regarding antacids and kidney failure. Our spayed female had acute renal failure 4 yr ago due to low blood pressure, likely from anesthesia, during minor surgery. She eventually recovered, and the three annual blood tests all looked great for kidney function.
Last week we took her to our vet for possible minor pain in side and hips. She is somewhere between 12-15 years old we believe. His exam found nothing wrong but gave her an injection of some sort of nsaid for the pain. Apparently he forgot about her arf, and the drug used was inappropriate for her. We do not know if the injection aggravated, triggered, or was unrealted (does not matter now. We still have confidence in the vet.) to another session of renal failure a couple of days later.
Anyway, after six days and 3.3k$ at the emergency center, she is back home. We have blood tests again tomorrow so will see how she is doing.
The emergency vet gave us generic pepcid tablets for her. We are naturally leary now of anything given to her. On the one hand, the potential need for a cat to have antacids coming out of arf is clear. However, one vet site on the internet says pepcid is safe for cats but can cause diarrhea, which she has, and complicate matters kidney and liver problems.
Will talk to emergency vet tomorrow for clarification but does anyone have any experience with this? Thanks!

Furballsmom · Dec 18, 2018

Hi!
From what I'm reading here from other members, be sure to get explicit, detailed instructions about dosing, based on the cats' size, and also including which to use, --only the regular strength ( not maximum or complete).
I'm sending you loads of good healing thoughts!

FeebysOwner · Dec 18, 2018

Hi. I wish I could help with knowledgeable information. The only thing I can offer, which you probably already know, is that I REPEATEDLY see meds prescribed for pretty much any kind of treatment list side effects which are some of the same symptoms the cats (humans, dogs, etc.) is already experiencing. It is frustrating, to say the least. As you said, talk to the vet about this aspect, and see if s/he can shed any light on it.

I wish you well, and good luck with the vet visit. Please let us know what happens.

Furballsmom · Dec 18, 2018

Here's a current post;
Ibd, Chronic Pancreatitis, Renal Failure And Hip Osteoarthritis

white shadow · Dec 18, 2018

.
Hi petparentsurrogate and welcome to the forum !

There is a well-respected, reliable website that's widely regarded as the go-to for all things kidney-cat. It is massive, so I'll pull out the section on Pepcid (it's actually Pepcid AC as a brand name, famotidine the chemical/generic name). That's here: famotidine. It is part of a larger comprehensive 'chapter' here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Appetite Loss, Nausea and Vomiting.

Pepcid AC is commonly used with these cats - do take note of the advice in that section to start with a low dose. As well, there's the issue of its bitter taste that can cause extreme salivation.

Mamanyt1953 is one of our most experienced folks where it comes to kidney issues. Perhaps she will offer some thoughts.

What a shame that this has happened. NSAIDs have a very narrow safety margin in cats in any case, and in your case was used off-label (a purpose for which it is not licensed in cats). There are two of these licensed in the US, Metacam and Onsior, and both are approved only for spay/neuter surgery in cats.

You wrote that the NSAID was "inappropriate for her". IF the given drug was Metacam, then it's more likely that an overdose was given, rather than the drug being improper. Metacam has been shown as safe for cats with reduced kidney function......at very low, very carefully measured doses. (I don't believe there are similar studies for Onsior, though.)

You said you remain confident in your Vet. If this is the same Vet who performed the minor surgery (when her blood pressure was not properly monitored), I wouldn't be sharing that confidence, I don't think. If this is a general-practice Veterinarian, I would be seeking out a well-experienced cat-only Vet.

Let's hope that she recovers her full kidney function once again. Should she not, she will be considered to have "chronic" kidney disease/insufficiency ("failure" is becoming used much less frequently these days, because it doesn't accurately describe the condition). Cats with CKD can live near-normal lives, often with reasonable interventions only.

Now.....so far you haven't identified her.......and, she cannot remain anonymous :nono:

...............and, could we see some pictures...pleeeeese?
.

white shadow · Dec 18, 2018

.
About the diarrhea.......when did it start? What were you feeding....and, what exactly are you feeding now? Were you given anything (or any advice) for diarrhea?
.

petparentsurrogate · Dec 18, 2018

white shadow said:
.
Hi petparentsurrogate and welcome to the forum !

There is a well-respected, reliable website that's widely regarded as the go-to for all things kidney-cat. It is massive, so I'll pull out the section on Pepcid (it's actually Pepcid AC as a brand name, famotidine the chemical/generic name). That's here: famotidine. It is part of a larger comprehensive 'chapter' here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Appetite Loss, Nausea and Vomiting.

Pepcid AC is commonly used with these cats - do take note of the advice in that section to start with a low dose. As well, there's the issue of its bitter taste that can cause extreme salivation.

Mamanyt1953 is one of our most experienced folks where it comes to kidney issues. Perhaps she will offer some thoughts.

What a shame that this has happened. NSAIDs have a very narrow safety margin in cats in any case, and in your case was used off-label (a purpose for which it is not licensed in cats). There are two of these licensed in the US, Metacam and Onsior, and both are approved only for spay/neuter surgery in cats.

You wrote that the NSAID was "inappropriate for her". IF the given drug was Metacam, then it's more likely that an overdose was given, rather than the drug being improper. Metacam has been shown as safe for cats with reduced kidney function......at very low, very carefully measured doses. (I don't believe there are similar studies for Onsior, though.)

You said you remain confident in your Vet. If this is the same Vet who performed the minor surgery (when her blood pressure was not properly monitored), I wouldn't be sharing that confidence, I don't think. If this is a general-practice Veterinarian, I would be seeking out a well-experienced cat-only Vet.

Let's hope that she recovers her full kidney function once again. Should she not, she will be considered to have "chronic" kidney disease/insufficiency ("failure" is becoming used much less frequently these days, because it doesn't accurately describe the condition). Cats with CKD can live near-normal lives, often with reasonable interventions only.

Now.....so far you haven't identified her.......and, she cannot remain anonymous ...............and, could we see some pictures...pleeeeese?
.

petparentsurrogate · Dec 18, 2018

The photo, if it comes out, is Rayne. She was rescued in an abandoned car during a heavy rainstorm. She had kittens but all but one was dead and she herself was near death. I do not know what she weighed when rescued. Rayne was considered too weak to be spayed so was placed in foster care for SIX months. When she was spayed at the end of six months, she weighed five pounds. She is now normally 14 pounds but has lost a pound with this episode.

petparentsurrogate · Dec 18, 2018

white shadow said:
.
Hi petparentsurrogate and welcome to the forum !

There is a well-respected, reliable website that's widely regarded as the go-to for all things kidney-cat. It is massive, so I'll pull out the section on Pepcid (it's actually Pepcid AC as a brand name, famotidine the chemical/generic name). That's here: famotidine. It is part of a larger comprehensive 'chapter' here: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Appetite Loss, Nausea and Vomiting.

Pepcid AC is commonly used with these cats - do take note of the advice in that section to start with a low dose. As well, there's the issue of its bitter taste that can cause extreme salivation.

Mamanyt1953 is one of our most experienced folks where it comes to kidney issues. Perhaps she will offer some thoughts.

What a shame that this has happened. NSAIDs have a very narrow safety margin in cats in any case, and in your case was used off-label (a purpose for which it is not licensed in cats). There are two of these licensed in the US, Metacam and Onsior, and both are approved only for spay/neuter surgery in cats.

You wrote that the NSAID was "inappropriate for her". IF the given drug was Metacam, then it's more likely that an overdose was given, rather than the drug being improper. Metacam has been shown as safe for cats with reduced kidney function......at very low, very carefully measured doses. (I don't believe there are similar studies for Onsior, though.)

You said you remain confident in your Vet. If this is the same Vet who performed the minor surgery (when her blood pressure was not properly monitored), I wouldn't be sharing that confidence, I don't think. If this is a general-practice Veterinarian, I would be seeking out a well-experienced cat-only Vet.

Let's hope that she recovers her full kidney function once again. Should she not, she will be considered to have "chronic" kidney disease/insufficiency ("failure" is becoming used much less frequently these days, because it doesn't accurately describe the condition). Cats with CKD can live near-normal lives, often with reasonable interventions only.

Now.....so far you haven't identified her.......and, she cannot remain anonymous ...............and, could we see some pictures...pleeeeese?
.

Thanks for your help. Hopefully a photo of Rayne and another reply is here somewhere. The vet who gave the injection is not the one who did surgery. I believe metacam was the drug used.

petparentsurrogate · Dec 18, 2018

white shadow said:
.
About the diarrhea.......when did it start? What were you feeding....and, what exactly are you feeding now? Were you given anything (or any advice) for diarrhea?
.

It started while at the emergency clinic stay. She is normally fed Hill's KD prescription dry food. At the clinic she was feed a can food which they said was very moist and likely caused the runny stools. They were not concerned. She is eating the dry again but perhaps not quite as much yet as she was. Hopefully the stool problem will soon resolve.

FeebysOwner · Dec 18, 2018

petparentsurrogate said:
View attachment 267043

LOVE the pic!! Rayne looks happy in her serene surroundings.

Mamanyt1953 · Dec 18, 2018

Well, I'm running into the same information that has already been given to you, so I'm going to be of minimal help here. Pepcid, like ALL medications, can have side effects. Most of these are mild, and most people/pets taking it will not experience any of them.

This is how to calculate dosages:

Dosage varies from cat to cat, underlying health problems must be taken into consideration when deciding the safe dosage for cats. The typical dose of Pepcid is 0.25 to 0.5 mg per pound or 0.5 to 1.0 mg/kg every 12 to 24 hours.

I'd start on the low end, and work up, should you decide to use it.

white shadow · Dec 18, 2018

.
Oh oh.......

Mamanyt1953 - with all respect to you and all you know about cats.....I messed up! It was somebody else I was thinking of when I sung your praises back there.........

It's mrsgreenjeens I was meaning to call in - because it's her posting on CKD issues that usually come to mind.

I think I need to take a break!
.

Mamanyt1953 · Dec 18, 2018

That's fine...I was pretty sure you were thinking of another member. Although I've done my share of researching for our members,

mrsgreenjeens is the real go-to on this! With so many wonderful, knowledgable folks here, not surprising that the wrong name comes up here and there!

Jem · Dec 19, 2018

How is her heart? Have you started subQ fluids at home with her yet?

mrsgreenjeens · Dec 19, 2018

OK, here's my take on it. It should ONLY be Pepcid A/C, no other kind of Pepcid. We actually used Famotidine rather than the OTC since we used it as an injectable rather than in pill form, but it's the same drug, really.

Now whether or not it's actually needed depends on whether or not Rayne appears to have a problem with over-acidity. Some cats, whether they are kidney cats or not, have this problem, just like people. Having Acute Kidney Failure really doesn't have that much to do with it, in my mind. If she doesn't get it and starts throwing up that frothy vomit, particularly early in the morning, then I'd say she needs it. Otherwise, I don't see any reason to give it to her.

OH, BTW, none of my cats ever got diarrhea from Pepcid A/C. They always were constipated. Not sure if that was from the drug or simply from the kidney issue. They ALL needed to take Miralax :frown:

Here are some famous TCS healing vibes for Rayne. Two times with Acute Kidney Failure. Wow! That's brutal. Fingers crossed that she comes out of this with no further issues.

petparentsurrogate · Dec 22, 2018

Furballsmom said:
Here's a current post;
Ibd, Chronic Pancreatitis, Renal Failure And Hip Osteoarthritis

Jem said:
How is her heart? Have you started subQ fluids at home with her yet?

Her heart is fine. No cancer on kidneys. Apparently there is an "injury" I think is the word they used to a kidney. However, it apparently is not an injury in the usual sense but rather a general term for some sort of insult to the kidney. I still do not quite understand it.
Her Wednesday tests at her own vet were all in normal range but much higher than last year. The tester was a different company with different values so still concerned. Not eating well but seems fine and normal otherwise. Will take her back next week to emergency vet for more tests or sooner if concerned.
The renal failure 4 years ago resulted in our doing the fluid thing at home. This time it was not recommended.

Furballsmom · Dec 23, 2018

Has your vet suggested an appetite stimulant? Do you have some things you can try to entice her to eat more?

petparentsurrogate · Dec 23, 2018

Hi! Our ace in the hole was tuna. Rayne gets obssessed with things, e.g., brushing. Before her ARF in 2014, she was obssessed with tuna; but she has not had any since her kidney failure. Our idea was to pour a bit of tuna juice over her canned Hills k/d. Didn't work.
This morning we took her to the emergency vet again. Her counts are elevated bit, not a whole lot. She may have been released a day or two early as the bill was getting close to its upper estimate. Anyway, they are keeping her another couple days or so and when she comes home this time it will be with the home hydration and flush procedure.
We are planning on asking about an appetite stimulant. Thanks!

Furballsmom · Dec 23, 2018

Pepcid For Acute Kidney Failure???

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