alternative for Propulsid/cisapride?

[poodlebone]

Harriet, one of the cats at my job, has been on Propulsid (cisapride) for years, along with lactulose.  I had been getting her cisapride from her vet, 10 mg twice a day.  My office just moved in June and the cats went to their new vet two weeks ago.  That vet only had 5 mg cisapride.  He also told me that now it's nearly impossible to get any more due to the FDA.  He said that some humans have been taking the veterinary supply for themselves (it was taken off the market for people years ago).  I don't know what I'm going to do when her supply runs out.  She's only getting half her usual dose.  The vet said there was another drug (Reglan?) but that it doesn't work as well.  Does anyone have a cat on Reglan?  Was your cat previously on Propulsid?  Is there any other option?

Some years ago I noticed Harriet going from one litter box to the next many times throughout the day, but she didn't produce anything.  After a couple of days and no stool I took her to the vet.  The vet was useless and she returned 5 times in the next couple of weeks before I took her somewhere else.  She's been on Propulsid & lactulose ever since.  The second vet said that for whatever reason she had gotten constipated and it might have stretched her colon (? not sure what part it was) and it formed a little bulge or pocket, and now all of her stool tends to catch in that area and builds up because she's unable to move it through herself.  That's what the Propulsid is for, plus lactulose to soften the stool.

Her stools tend to be fat and she doesn't go every day,  She also will poop on the floor if she's having trouble.  We have a large cage (from my boss' Labs) and I usually shut her in there with her box & food/water if she hasn't had a bowel movement in 24+ hours.  If she poops before I leave work, she's set free.  Otherwise she spends the night in the cage.  She ends up in the cage overnight maybe twice a week.  Because she lives in a retail store, we can't have her going on the floor.

 

[david's steph]

...

Some years ago I noticed Harriet going from one litter box to the next many times throughout the day, but she didn't produce anything.  After a couple of days and no stool I took her to the vet.  The vet was useless and she returned 5 times in the next couple of weeks before I took her somewhere else.  She's been on Propulsid & lactulose ever since.  The second vet said that for whatever reason she had gotten constipated and it might have stretched her colon (? not sure what part it was) and it formed a little bulge or pocket, and now all of her stool tends to catch in that area and builds up because she's unable to move it through herself.   That's what the Propulsid is for, plus lactulose to soften the stool.

...

Hello poodlebone, sounds like Harriet has chronic constipation/megacolon (when the vet told you the constipation stretched her colon).  My cat has the same condition, for years now.  We've been through the same, tried Lactulose, Cicipride (Propulsid), with no consistent results .. what has helped finally for us was not cicipride or lactulose, but MIRALAX, I give him 1/2 teaspoon every other day, it has been a lifesaver for him, look into it, there are quite a few threads here..

(ps let her out of cage for goodness sakes, poop can be cleaned off the floor, she is sad sitting in a cage!!)

 

[poodlebone]

Last year the vet did recommend Miralax.  She hasn't been getting it every day but if she doesn't go in two days she gets it.  She also gets it on Sundays because nobody at work is willing to give her pills or liquid, but mixing something into her food is easy.

As for letting her out of the cage, it is a problem because she's in a store.  Customers usually don't enjoy shopping someplace that has poop on the floor.  Putting her in the cage lets her know what she's supposed to do, and most of the time she does go withing 10 minutes of getting shut in.  Since I know she doesn't go every day, if she goes on Day 1 I don't worry about Day 2.  If by the end of Day 2 she hasn't gone, she goes to the cage.  Also, I leave earlier than some of my co-workers and they're instructed to check the box before leaving to let her out if she's gone.
 

 

[pineapple916]

IVE JUST GONE THROUGH THIS WITH MY CAT.... THEY WANTED TO PUT HER DOWN BECAUSE THEY THOUGHT SHE HAD A MASS IN HER RECTUM AREA... I LEFT THE VET AND TOOK HER TO A SPECIALIST WHERE THEY DID AN OSTIPATION..... MY CAT IS ON THE CIPASIDE AND A STOOL SOFTNER.....SHE IS GOING REGULARLY.... AFTER SOME RESEARCH THOUGH I HAVE ADDED SOME CANNED PUMPKIN TO HER WET FOOD..... SHE IS GOING ON A REGULAR BASIS AND THINGS SEEM TO BE MOVING ALONG.... TRY SOME CANNED PUMPKIN IN THE FOOD.

 

[purrfectcatlady]

You can still get Cisapride from a compounding pharmacy. I just reordered this medication from my local compounding pharmacy.  Or you an check with one of the mailorder compounding pharmacies like Roadrunner.

 

[franksmom]

Have you tried any diet changes? I know many people have treated constipation and mega colon with a combo of diet changes and laxatives and miralax seems like the most popular. Here are some good threads to read through on the topic (http://www.thecatsite.com/t/205398/diet-to-manage-megacolon) and (http://www.thecatsite.com/t/262510/constipation-issues). The megacolon thread is a really interesting one with some great information- good luck!

 

[purrfectcatlady]

My rescue cat came to me literally nearly dead, with multiple issues...a huge abscessed snake bite causing an open wound from her rib cage to the base of her tail, infested with maggots. Her digestive issues are not just the type usually described as mega colon, but include pelvic injury (probably from a car) which also broke both her back legs, never set, healed incorrectly.  She actually is shaped like the pointed end of a football, and the constriction causes her stool to become hard for her to pass.  She is on Cisapride, lactulose, pumpkin, Miralax and daily sub-Q fluids to assure sufficient fluids to her intestines.  I still have to be vigilant to prevent stool from becoming caught at the end of her tract and causing a hard obstruction.  I think we have made as many changes to her diet as are possible. 

 

[aoliver]

Like all of you I have been through the same thing. I have a three year old orange tabby who had to go into the vet 3 times for constipation. It broke my heart seeing him trying to strain to poo. The Vet put him on Cisapride and he got bound up again. After the second visit he was put on laculose as well. For a while it worked wonders on him before his stool became TOO runny. Now he is on the same does of cisapride and laculose as needed. He has gained his weight back and looks as handsome as ever. I would recommend keeping them on the cisapride. I know it costs a lot. We are paying a $157 for one bottle that lasts 4 months but it is worth it.

 

[jamesthecat]

Hello, James the Cat here. I too suffer from Megacolon. My human has told me my colon is 5 cm across in spots where a normal kitty's would be 2-3cm. I get horribly bound up and strain and struggle to make my number two in my kitty box. It can be horribly humiliating too when I have trouble and end up going #2 on the floor. For some reason I can never bury my poo when its on the strange fuzzy dirt in my humans house. I cannot dig through it though I sure try! It's almost as if they have covered the floor in some rough blanket wall to wall!  Several times Ive ended up at the emergency vet for a de-obstipation procedure. My human is so very terrified every time I go under anesthesia and honestly, Im not wild about it either... My human struggled with all manner of drugs and solutions. We tried Miralax, Pumpkin, Metamucil, Cisapride, Lactulose, Milk, you name it....

My human recently took me off my Cisapride altogether. He learned that in humans, Cisapride was taken off the market due to potentially deadly heart arrhythmia caused by this drug. He not only worries that I may suffer some type of cardiac event, but add to this my owner had a kitten in the past two years ( on a sidenote, they only brought home one kitten so I assume the rest of the litter didnt make it or perhaps mommy only had one kitten, bizarre...do humans only have one kitten at a time??/ really?) but I digress... they didnt want their youngling to get a hold of my medicine and potentially ingest this rather dangerous drug. I have to admist, human kittens are like walking talking clumsy disasters waiting to happen!! They run into walls, fall over, eat strange dirty things! If I were a human parent, I'd be worried too!!! 

So they now have me on a Miralax mix in my Fancy feast, they simply add a half teaspoon to my catfood gravy and sprinkle a few drops of water in until it dissolves, and when I do not poo for a day or more, I get a big syringe of Lactulose. I also get kitty treats for hairballs as they contain a bit of petrolium jelly as an ingredient and occasionally, I get a ribbon of Petromalt to "lubricate" things....Remember too, miralax is a "dose-to-effect" drug and the worst thing that will happen is the opposite of constipation with an overdose. It is non-toxic and relatively easy on the system. AND IT WORKS!!!

So that's my story and Ive been in good shape since coming off Cisapride. In my opinion, (then again, I am just a cat, but...) this drug is too dangerous and expensive to be worth the risk and cost. Especially since I have experienced great results since my human has kept me on Miralax, Petromalt, and the occasional dose of Lactulose when things get "hard"....I am also on wet food only. 

Best wishes to my fellow feline friends! 

Yours truly,

James the Cat

 

[soulsister]

Hi All,

My kitty Tinker (who is17yrs.old) has recently been prescribed Cisapride in combination with a no-name-brand stool softener which works the same way as Miralax (it is called Clearlax here in Canada - brand name one is Restoralax).

I too want to take him off the Cisapride as it is expensive but cannot find anything else that does the same thing exactly - there are similar meds for the upper intestine and for the lower stomach but not for the lower intestine/colon.

My vet assures me he is no danger from the side effects humans experienced before Cisapride was taken off the market (only animal doctors can get it here now) but it still bothers me that humans can die from complications with it.

My question to all you folk is: Did your kitty yowl and scamper around just before or after trying to defecate before you got them regular?  And did the yowling cease once they were pooping at least every other day?

Tinker is now going every second day regularly, thinner, longer, softer poops when the Clearlax was added but still howls/yowls before and after visiting the litter box.  He sometimes decides to 'play' at this time too, knocking toys about and chasing them down the hall - which he doesn't do at any other time now that he is older.  The yowling is worrying me...

I can't afford extensive testing - I pay the vet 50.00/month and have for almost 3 years as it is, trying to get an existing bill paid (he had eye surgery) and am on a disability pension. That is now in addition to the 35/month for the Cisapride. The guilt about this is enormous.  The people at the clinic seem so disapproving that I can't pay for this or don't pay for that... and sometimes other people too - the attitude being that you should not have an animal if you can't pay for it's care.  I try and tell myself that he was living in a garbage alley eating pigeons and rats when I first made him mine, I wasn't disabled then and he got the very best of expensive care for 10 years.  It's not likely he would have been adopted at 12 and 1/2 years old when I had to take a pension as there are so many kittens who do not get adopted, so he was likely better off with me, getting much attention and love.  But now, now he might have a blockage or God forbid cancer and I'm just treating the symptoms... 

He does not go off on his own but rather stays near me most of the day.  He plays actively with me and seems bright-eyed and happy.  But then, he seems pretty happy when he is yowling/scampering too...

Maybe a few yowls and some scampering are normal for an old cat with mega-colon? 

Thanks for any suggestions.  Happy Cat-Loving to you all.

 

[vmroski]

     my cat is taking cisapride and I get it from a compounding pharmacy, my vet orders it with a prescription and I don't have any trouble picking it up. you will need to have your vet send a prescription to a compounding pharmacy that's near where you live but I don't know if their is a limit on the milligrams or not I get 2.5mg. for my cat and he takes it 3 times a day.

 

[chauncey]

I know I am replying to this thread 2 yrs after it was posted but it seems a fair amount of cat owners have the same situation, megacolon, with their pets. Our cat, Chauncey, is now 10 yrs. old . He was diagnosed with megacolon about 8 yrs ago but probably had it way before that but we thought it was just constipation. He has been on cisapride and lactulose since diagnosed which helped but he still strained. We changed vets who still recommended these meds but just so happened one the vets had just returned from a symposiumon on cat constipation (interesting subject!). The information she got was just the thing Chauncey needed. Royal Canin makes a Gastrointestinal Fiber Response dry food for constipated cats. It is a prescription catfood that you need to get through the vet however It has been well worth it for Chauncey.
He and his sister will not drink water (which doesn't help with constipation). I mix water with their canned food. Chauncey's food I also mix the Cisapride and Lactulose in it then I sprinkle approximately 2 tbsp of the Royal Canin GI Fiber on top. I have been able to cut back on the doses of Cisapride (from .5cc to .3cc ) and Lactulose (from 1 cc to .7 cc) since introducing the GI fiber. I do this twice a day. I hope to cut back further to see how he does. This is a cat who was lucky to poop 2-3x a week - now he goes 1-2x a day and it is formed but soft. He is so mujch more peppy since he is pooping on a regular basis.
I hope this is helpful to some of you and your kitties.

 

[ozgur acar]

My cat also having problem with constipation. this has been like 3 years issue, but last two months, we went to vet twice and each time cos 500$ for clean her up. i tried wet food, with lactulose and miralax. did not work at all.  I was using RC fiber response and we were doing well last 3 years. but the wet told me not to use dry food and only use wet food. did not work as well. 

now using cissapride twice and miralex, day #3 and no poop yet.. she is only 5 years old. i cant put her down. the surgery next step but i heard good and bad things after surgery. 

now we back again RC fiber response dry food. and pry everyday that she going to poop. 

 

[molly92]

Hi @Ozgur Acar, this thread hasn't been active for a while so you may get some more responses if you start your own thread.

I can give you a bit of constipation advice based on what I went through with my cat, who is also 5.

Unfortunately changing and adding things to her diet is not going to affect the stool that has already been formed and is sitting in her colon, so at 3 days with no bowel movement there's a chance she is beyond remedies and may need yet another enema.

Dry food is not great because it causes the cat to be less hydrated, and dehydration contributes a lot to constipation. But constantly changing food can make it hard to figure out what works and what doesn't, so if you need to stick with the dry food for now try to encourage her to drink lots of water by putting bowls or even glasses of fresh water by her food and far away from her food, try a pet fountain if you have one, and turn on faucets for her to drink from if she likes that.

You can replicate the benefits of the fiber in her dry food but still keep her on a wet food diet by adding some canned pumpkin to her food, or, if she won't eat that, a quarter teaspoon of a soluble fiber supplement like acacia fiber powder. Do be careful with how much fiber you add to her food, though, because although fiber can help the stool absorb more water and be softer, it can also make the stool bulkier and more difficult to pass and puts strain on the colon over time.

One other remedy that is worth looking into is Slippery Elm Bark. You can make a mixture of it with water and add it to her food, and it's supposed to lubricate the colon and help a bowel movement pass. I tried it once with my cat, and while it definitely made her go, I do not think it reacted well with her because she got very panicked and seemed to be in a lot of discomfort. Some people have used it very successfully for their constipated cats, though.

What really worked for my cat was probiotics. She suffered constipation for months that was made a bit better by adding fiber and miralax and cisapride, but after a while those would stop working as well. I add probiotics to every meal and she is now completely regular, and I don't have to add extra fiber or anything. I started with the pricey Pet Ultimates Probiotics, which worked very well, but I switched her over to simple but effective PB8 acidophillus probiotic, and she is doing just as well on that. It is important to get a good quality probiotic with a high CFU count, because a cat's stomach is especially acidic and not all of the cultures will survive all the way to the intestine, and also contains the species acidophillus because that has been shown to be so helpful for digestive tract health.

Other simple things that can help cut down on constipation problems somewhat are helping your cat get more exercise by playing more, and also brushing her more often so she's not swallowing as much hair and getting it stuck in her intestine.

 

[jhona]

Question: less expensive alternative to Cisapride? My 6 year old female cat Callie spent a week going back and forth to the vets due to constipation. Don't know what caused it but she was
x-rayed which showed stool blockage, then given an enema. Still didn't help, put under for another, more invasive enema and extraction. She was on Lactulose for days but nothing helped til she had around 12 doses of Cisapride. Voila! She is back to being happy. However, it is so very expensive and the vet says she might have to be on it for life. I was not given a reason why this could have happened or if it will again. On SSI with little ability to pay for this so need to see if something else will help. Not even sure if it will happen again, but would hate to risk it. please advise, finances tapped out after vet bill.

 

[molly8]

Question: less expensive alternative to Cisapride? My 6 year old female cat Callie spent a week going back and forth to the vets due to constipation. Don't know what caused it but she was
x-rayed which showed stool blockage, then given an enema. Still didn't help, put under for another, more invasive enema and extraction. She was on Lactulose for days but nothing helped til she had around 12 doses of Cisapride. Voila! She is back to being happy. However, it is so very expensive and the vet says she might have to be on it for life. I was not given a reason why this could have happened or if it will again. On SSI with little ability to pay for this so need to see if something else will help. Not even sure if it will happen again, but would hate to risk it. please advise, finances tapped out after vet bill.

 

[molly8]

hello- I hope you are still on this site. I have a very similar story. I have a two year old rescue cat with severe obstination, not yet mega colon. her intestines and colon are normal size, but she will not poop. she was at vet for five days for testing which included a slow saline enema which did get poop from her. the vet sent her home on antibiotic because she did have a fever earlier (not now),cisapride 2xs daily at 2.5 mg and told me to give her 1/4 Miramax with her food and pumpkin if she will take it, which she does. she is home day 2 and no poop yet. I hate to have her have to keep going to the vet and it is very costly for me. this first bill was $1800. I am determined to find help for her because she is so sweet and seems so happy. I don't know her history as she has only physically been with me now four days since I got her. I would love some advice. thank you so much.