A more humane way to give metronidazole?

[treeclimber]

My cat is on metronidazole for intestinal dysbiosis. He HATES it.

He’s not a fan of having liquid meds squirted into his mouth in general, but he really REALLY hates the metronidazole and says it’s the worst thing he has ever tasted. His struggling gets more and more frantic and hard to control each time I give it, and afterward he runs around the bathroom with strings of drool hanging from his mouth.

Tonight he gave a frantic high-pitched meow-scream like a rat that’s been pinned down by a bully when I finally managed to squirt it in his mouth. He doesn’t even do that if I accidentally trim a claw too short and make it bleed - the only other time I’ve ever heard him make a noise like that was when someone stepped on his paw.

I’ve been trying to think of ways to make this easier on him. Hiding it in food is definitely not going to work. Mixing something in to make it taste better may not mask the bad flavor and would increase the volume of the liquid that has to be squirted into his mouth. The last time we got something flavored from a compounding pharmacy it took almost two weeks to get here, and he’s only on metronidazole for two weeks (knock on wood).

Is metronidazole available as a pill instead of a liquid in a cat-appropriate dose? Or is there anything else I can do to make this easier on him?

 

[Antonio65]

Is metronidazole available as a pill instead of a liquid in a cat-appropriate dose? Or is there anything else I can do to make this easier on him?

I gave my cat metronidazole along with Panacur for the treatment of giardia, and it was in pills, 10 mg metronidazole per pill. The dosage was 1 mg per kg.
I didn't even know it was available in liquid form.

 

[silent meowlook]

Hi. I am sorry you are struggling and so is your cat. Metronidazole is disgusting tasting. I have tried it myself. No treatment should ever be harming the patient. The reaction he is having is far worse than anything he could have medically going on.

Wedgewood pharmacy has Metronidazole in flavor tabs which are small chicken flavored tablets that you can just give as a pill or hide in a pill pocket. I would ask your vet to call in a prescription for that and not even try to give the disgusting metronidazole liquid again.

 

[treeclimber]

I gave my cat metronidazole along with Panacur for the treatment of giardia, and it was in pills, 10 mg metronidazole per pill. The dosage was 1 mg per kg.
I didn't even know it was available in liquid form.

Thanks!

How did your cat act with the pill? Did he/she seem to hate it more than other pills, or did it being solid keep the nasty taste from bothering him/her?

 

[Antonio65]

My cat didn't bother much about those pills (Panacur and Spiroxan 10), I guess she wasn't paying much attention to their taste, but she's a sweetie 24/7, so I can't really tell.
What is sure, is that if you can put the pill down your cat throat, as down his thorat as possible, he won't be able to taste it, and the reaction will be minimal.

 

[treeclimber]

Hi. I am sorry you are struggling and so is your cat. Metronidazole is disgusting tasting. I have tried it myself. No treatment should ever be harming the patient. The reaction he is having is far worse than anything he could have medically going on.

Wedgewood pharmacy has Metronidazole in flavor tabs which are small chicken flavored tablets that you can just give as a pill or hide in a pill pocket. I would ask your vet to call in a prescription for that and not even try to give the disgusting metronidazole liquid again.

Thank you.

I will talk to our vet and see if we can safely pause until we can switch.

I’m a little worried that whatever nastiness is growing in his gut might become antibiotic resistant if we pause partway through. He was sick enough to lose 1.5 pounds in 4 months, so it has been pretty scary.

But this is torture for him. We need an alternative ASAP, and a pause until then if the vet doesn’t think it will cause problems with antibiotic resistance. If I can pay out of pocket to get him metronidazole pills at a people-pharmacy so he can have them immediately, I’ll do it - I don’t want to keep doing something that seems like torture to him.

 

[Antonio65]

If I can pay out of pocket to get him metronidazole pills at a people-pharmacy so he can have them immediately, I’ll do it - I don’t want to keep doing something that seems like torture to him.

I don't know if in the US you can purchase human drugs in place of pet drugs. It isn't possible here in Italy/Europe, and we do need a prescription for an antibiotic, and the vets can not prescribe any human medicines if an equivalent pet medicine is available.

But if in the US you're so lucky to do so, I'd do that.

 

[treeclimber]

I don't know if in the US you can purchase human drugs in place of pet drugs. It isn't possible here in Italy/Europe, and we do need a prescription for an antibiotic, and the vets can not prescribe any human medicines if an equivalent pet medicine is available.

But if in the US you're so lucky to do so, I'd do that.

Yes - prescriptions written by a veterinarian can be filled at a human pharmacy in the US. It can be expensive (as human healthcare here tends to be), but there are sites like goodrx.com that can bring down the price.

Unfortunately, it looks like the lowest dose metronidazole tablet I could get at a human pharmacy is 250 mg, which I can’t cut down to 10 mg (stated as the dose by another poster in this thread), so it sounds like in this case a human pharmacy won’t be the answer.

 

[Antonio65]

Can't any pharmacy get you a pack of metronidazole (Spiroxan or whatever it is called in the US) for your vets' prescription?
How long could it take a pharmacy to get it for you?

Apologize for these silly questions, I don't know how it works in the US.
Over here a pharmacy can have it ready in a couple of hours.

 

[silent meowlook]

Below is a link to some information on what you said your cat has. I was wondering what the metronidazole would be for if it is an issue with the gut flora. I would think that pro and maybe pre biotics would be used but wouldn't Metronidazole damage the gut flora more? Anyway, read up and of course ask your vet before making any changes to what you are doing.

Canine and Feline Microbiota Dysbiosis Index - Gastrointestinal Laboratory (tamu.edu)

 

[Astragal14]

You have a few options here and I want to mention a few things first:

1. His reaction to the metronidazole is completely normal, it's because metronidazole has the worst taste of anything on earth. Please don't worry about causing harm. I know how jarring it looks but every cat reacts this way, mine included. I've taken metro myself and it is definitely ROUGH.

2. Be sure you're giving him a strong probiotic for the duration of an antibiotic plus an additional 7-10 days (even longer if you can). We have lots of recommendations if you need any. Keep the doses separated by a few hours otherwise the antibiotic will ruin the effectiveness of the probiotic.

3. Human pharmacies routinely fill pet prescriptions with pet-only medications and will be able to fill a low-dose prescription of metro, no need to cut down a large human dose.

4. There won't be any issues with antibiotic resistance and waiting for a new prescription shouldn't be a problem if the wait is only a few days; definitely talk to your vet about what length of delay would cause issues or indicate a change in treatment.

Now for the options:

1. A pill pen
My cats have taken metro as both a compounded, flavored liquid and as a tablet. The tablet is definitely easier because the pill pen is able to push the tablet back far enough to where they don't taste it. And definitely follow a pill pen with some water from a syringe (.3 to .5 mL squirted to the side of their mouth, not directly down their throat). Be aware of what size pill pen you're buying, some are more appropriate for large dogs and I find they don't work as well for cats. This is the exact pill pen our vet's office sells (as individual pens, not bulk like on Chewy): VetOne Pet Piller.

2. Secnidazole
This is another strong antibiotic that allows you to give the same strength as metro but in fewer doses, often a single dose is all that's needed. My cats took a single dose of this instead of a 7 day course of metro following a giardia infection. Ours was a compounded liquid (I don't know if it comes in other forms) and it's just as bad as a dose of metro, but at least it's a single dose. You still need to use a probiotic for a while after secnidazole. Not every vet has this in stock but they should be able to call it in to a human pharmacy.

3. A pill capsule and pill pen
You can use small empty capsules and fill them with fragments of metro and administer this with a pill pen; cats generally can take capsule sizes 3-5. Metro cannot be crushed into powder but it can be cut into as many small pieces as needed. And be sure to follow with a syringe of water. Here is more capsule information: Using Gelcaps for Pilling

4. Compounding
Most human compounding pharmacies also fill pet prescriptions; I've done this several times. Not all drugs can be compounded into all forms, so ask your vet about how metro can be compounded. Our local compounding pharmacy offers flavored gelatin cubes for some pet medications; they don't taste great but they're better than the liquids and can often be hidden in food or pill pockets. The flavored tabs mentioned by S silent meowlook also sound very promising, I would definitely look into this. Wedgewood is a large pet pharmacy so hopefully shipping won't take too long (they may also have individual pill pens and syringes available for purchase).

 

[daftcat75]

Metro does nothing for e. coli and clostridium except clear out its competition. I don't like metro being prescribed for dysbiosis because it's more likely to cause dysbiosis than to clear it up. Do you even know which strains you are targeting? Has he had a diarrhea PCR to identify pathogenic populations and the endotoxins they produce? The presence of a pathogenic strain in a PCR result doesn't always mean it's problematic. That's why you also need confirmation of the endotoxins.

In any case, s. boulardii will get you much better results for dysbiosis than metro. Use the Jarrow brand that has MOS. MOS is like scrubbing bubbles for pathogenic strains. It resembles the gut lining and thus it's like decoy gut cells. The pathogenic strains bind to it and are flushed out with his poop.

Even if you continue with the metro, you will want to dose the s. boulardii twice a day to combat antibiotic-induced diarrhea. Giving probiotics alongside antibiotics (even spacing the doses) is a losing battle. Probiotics won't colonize because the antibiotics will wipe them out. S. boulardii is the exception. It is yeast-based. It won't be affected by the antibiotics.

Plan on several months of s. boulardii after the metro is finished to help clean up any e. coli or clostridium that was allowed to flourish in the absence of competition. If your cat likes the taste, you can mix 1/4 capsule into his food twice a day. If he doesn't like the taste, I recommend size four gelatin capsules and a capsule filling machine from Etsy. Unfortunately, my efforts to link to it here don't resolve the redirects. Search for the seller "MYHERBAR". One human-sized Jarrow capsule should fill four cat-sized size 4 capsules making it easy to give 1/4 of the original capsule as 1 size 4 capsule instead.

Jarrow s. boulardii
https://www.amazon.com/dp/B0013OVW0E/?tag=thecatsite

And tips for getting that capsule into your cat:

SB + MOS will help reduce harmful populations. To restore the beneficial populations that metro destroyed, you'll probably need something stronger than probiotics (which are simply a handful of helpful strains and nothing near a complete and balanced biome.) You'll likely want to consider KittyBiome's Gut Restore Supplement. This is a microbiome transplant pill. And it will likely take more than one bottle to restore his gut health. KittyBiome has Gut Health testing which will tell you the extent of the dysbiosis and give you practical tips on how to correct it beyond simply the Gut Restore Supplement.

The Cat Gut Microbiome

Metro to me always seems like a desired quick fix for something that can't be fixed quickly. Plan on the s. boulardii twice a day for the forseeable future regardless of anything else you or the vets want to try.

 

[treeclimber]

Can't any pharmacy get you a pack of metronidazole (Spiroxan or whatever it is called in the US) for your vets' prescription?
How long could it take a pharmacy to get it for you?

Human pharmacies routinely fill pet prescriptions with pet-only medications and will be able to fill a low-dose prescription of metro, no need to cut down a large human dose.

Unfortunately it looks like even with online pet pharmacies the smallest dose available (without compounding) is 250 mg. A pharmacy can’t order a smaller tablet if no company makes one.

But it also sounds like the dosage for cats is around 10 mg/kg, not 10 mg total. So his dose would be around 45 mg. If I cut a 250 mg pill into thirds that’s 83.3 mg. Cut a third in half and that’s 41.6 mg. Googling, it looks like metronidazole tablets are huge, so I think this would be doable if it’s not too much of an underdose.

 

[treeclimber]

His reaction to the metronidazole is completely normal, it's because metronidazole has the worst taste of anything on earth. Please don't worry about causing harm. I know how jarring it looks but every cat reacts this way, mine included. I've taken metro myself and it is definitely ROUGH.

Thanks. I’ve given it to fosters before, but I’ve never seen the drooling afterward or the scream-meow as a response before. But all cats are different.

Ordering probiotics, but they’re not here yet.

My cats have taken metro as both a compounded, flavored liquid and as a tablet. The tablet is definitely easier because the pill pen is able to push the tablet back far enough to where they don't taste it. And definitely follow a pill pen with some water from a syringe (.3 to .5 mL squirted to the side of their mouth, not directly down their throat). Be aware of what size pill pen you're buying, some are more appropriate for large dogs and I find they don't work as well for cats. This is the exact pill pen our vet's office sells (as individual pens, not bulk like on Chewy): VetOne Pet Piller.

Looks great, thank you!!

You can use small empty capsules and fill them with fragments of metro and administer this with a pill pen; cats generally can take capsule sizes 3-5. Metro cannot be crushed into powder but it can be cut into as many small pieces as needed. And be sure to follow with a syringe of water. Here is more capsule information: Using Gelcaps for Pilling

How do you avoid the capsule sticking to the tongue instead of being swallowed? I’ve always found pilling with capsules to be really hard!

 

[treeclimber]

Do you even know which strains you are targeting? Has he had a diarrhea PCR to identify pathogenic populations and the endotoxins they produce? The presence of a pathogenic strain in a PCR result doesn't always mean it's problematic. That's why you also need confirmation of the endotoxins.

Our vet based the diagnosis on bloodwork showing high folate and low B12, no testing of specific strains has been done.

Our vet knows I’m struggling financially and that we’ve already run up more than $1000 in vet bills - she’s been trying to help us out with things like letting me do his B12 injections at home. So I understand why she didn’t order additional tests and decided to trial-treat and see how he responds.

For some reason cats with symptoms like his sometimes do respond to metronidazole, so as long as he doesn’t seem to be getting worse I’m willing to give it a two-week try as long as I can humanely get the meds into him. With lots of probiotics afterward.

In any case, s. boulardii will get you much better results for dysbiosis than metro. Use the Jarrow brand that has MOS. MOS is like scrubbing bubbles for pathogenic strains. It resembles the gut lining and thus it's like decoy gut cells. The pathogenic strains bind to it and are flushed out with his poop.

Thanks, I’ll look into that!

And tips for getting that capsule into your cat:

What an adorable video!

Unfortunately I don’t think he’ll do that - he’s barely even willing to eat his favorite cat food right now.

 

[daftcat75]

Our vet based the diagnosis on bloodwork showing high folate and low B12, no testing of specific strains has been done.

We’ve run up more than $1000 in vet bills and I was already struggling financially before that (which our vet knows), so I don’t blame her for not ordering additional tests and deciding to trial-treat and see how he responds.

For some reason some cats with IBD-like symptoms do respond to metronidazole, so as long as he doesn’t seem to be getting worse I’m willing to give it a two-week try as long as I can humanely get the meds into him. With lots of probiotics afterward.



Thanks, I’ll look into that!



What an adorable video!

Unfortunately I don’t think he’ll do that - he’s barely even willing to eat his favorite cat food right now.

Hills A/D is like kitty crack. It's meant for cats who aren't feeling much like eating. Ask your vet for a can or two. If he likes it, you can mix it in with his regular food to up his regular food's appeal and calorie content. This way, if he's eating less, he'll still get a decent number of calories. When he's finished with the metro, you can take the A/D out of his food and save it only for giving meds (e.g. coating the s. boulardii capsules) or the next time his appetite weakens. You may get lucky, and he may actually like s. boulardii. My last cat, Krista did. I would make little yeast balls with her food. 1/4 capsule made one or two small yeast balls. When she ate those, she could have the rest of her meal without anything added to it. You may also be able to mix the s. boulardii into the A/D and have him eat a couple of those yeast balls depending on how much he likes A/D vs. how much he likes or dislikes the yeast. It's worth the effort to get s. boulardii into him twice daily!

If you're in the US, I would have your vet send a metro prescription to Wedgewood and choose one of their formulations. Wedgewood can rush the prescription back to you within a day or three depending on what shipping you want to pay for.
Metronidazole for dogs and cats: Uses, Dosage & Side Effects

Finish the metro prescribed. Don't let the vet rope you into another course if it doesn't work.

Please do look into the s. boulardii. It is much better than metro. It will fix the damage metro is doing to his biome as well as reduce the bad boys that metro will let flourish. And there's other benefits to s. boulardii besides scavenging pathogenic strains that make it useful as an ongoing supplement for IBD cats.

 

[Antonio65]

But it also sounds like the dosage for cats is around 10 mg/kg, not 10 mg total.

You're right, I was misled by the name of the drug in my country and the fraction of a pill that I had to administer to my cat. I apologize.
But I found different dosages for the same drug, from 10 mg/kg to 50 mg/kg.
In my case it was 12.5 mg/kg.

Your vet might give you more info.

 

[treeclimber]

Hallelujah we’re getting pills!!! Vet has it as pills so we don’t even have to go to a people-pharmacy.

His dose is higher than I thought so he gets half a pill, but it looks small enough for him to swallow, and usually he’s pretty good about pills.

 

[treeclimber]

You're right, I was misled by the name of the drug in my country and the fraction of a pill that I had to administer to my cat. I apologize.
But I found different dosages for the same drug, from 10 mg/kg to 50 mg/kg.
In my case it was 12.5 mg/kg.

No worries, it all worked out! Thank you for your replies/advice!

 

[Astragal14]

Hallelujah we’re getting pills!!! Vet has it as pills so we don’t even have to go to a people-pharmacy.

His dose is higher than I thought so he gets half a pill, but it looks small enough for him to swallow, and usually he’s pretty good about pills.

Great news!! Ask your vet if they have pill pens and syringes too. And good luck!!