ANYONE FAMILIAR WITH ONSIOR? I'M NOT AND WOULD APPRECIATE ADVICE, ANECDOTES AND OPINIONS

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maggiemay

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I have been searching through threads trying to find information on an NSAID called Onsior.  My daughter's 5 lb., 16 year old, Lexi, has been prescribed Onsior (1/2 tab daily) by her oncologist. We do not yet have a definitive diagnosis of cancer (cytology came back "suspicious" for cancer), but she probably has lymphoma.  She will be aspirated again next Monday and hopefully we will then have a diagnosis, and chemo is definitely an option we are considering.  Because of her age and small size, she is not a candidate for surgery per the oncologist.  Wherever the mass is actually located (somewhere beneath the liver or perhaps in the stomach), it is causing edema in her back legs, which are somewhat swollen, although she still has good blood flow to her feet and legs.  Heart and lungs are not impacted by fluid, all good there.  Blood work is perfect, with the oncologist saying that she has the metabolic profile of a 4-year-old.

When she was given her initial dose of Onsior, Lexi became almost catatonic, immobile to the point where my daughter (her mom) became panicked.  However, the swelling in her legs was reduced a great deal with that initial dose.  Since Lexi became immobile after her intial Onsior dose, my daughter reduced the dose to 1/3 of a tablet rather than 1/2 tablet, after running it by her oncologist, with no more catatonia but also no further impact on the swelling.  I realize that not every drug effects every cat in the same way.  I have no experience with Onsior myself, and this cat is so small and so old.  We want to reduce the swelling and steroids are not an option until we decide whether or not to go forward with chemo.  Apparently steroid use prior to chemo could cause any possible lymphoma to resist the chemo. Not a fan of steroids, but we would use them if not for this possible chemo resistance. 

May I ask what your personal experiences with giving Onsior have been and what are your opinions regarding daily use? I know the package insert says the drug is to be given for three days only as a post-surgery drug, and not given to cats who weigh less than 5 1/2 pounds, but the oncologist wants Lexi on it daily.  During the last two appointments, the oncologist has really pushed the Onsior which is, of course, being used off-label.  I am afraid that Lexi may be one of those cats who simply has a bad reaction to NSAIDS in general and am looking for advice, anecdotes and/or opinions.  She is also on Buprenex for pain.  The oncologist said that the two could be given together, although they are not given at the same time.  The Onsior is supposed to be given once daily and the Buprenex is being given twice daily.  I did find a thread on the site in which a cat who had been given Onsior developed acute kidney failure, but did pull through, so that has me very concerned.  Thanking you all in advance; any help will be much appreciated!
 

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Here is quite a lengthy thread on the use of Onsior for pain relief.   http://www.thecatsite.com/t/301292/...arthritis-onsior-buprenex-tramadol-or-adequan    And, yes, kidney issues are one of the side effects of it if not used "correctly". 

Since the oncologist is using it "off label", I guess he's not using it for pain at all, but to do what a steroid would normally do?

Mainly I'm just bumping this thread up for you since no one has  responded so far.
 
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maggiemay

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Here is quite a lengthy thread on the use of Onsior for pain relief.   http://www.thecatsite.com/t/301292/...arthritis-onsior-buprenex-tramadol-or-adequan    And, yes, kidney issues are one of the side effects of it if not used "correctly". 

Since the oncologist is using it "off label", I guess he's not using it for pain at all, but to do what a steroid would normally do?

Mainly I'm just bumping this thread up for you since no one has  responded so far.
You are such a sweetheart!  Thank you so much for this link and for bumping this question..  I had searched the site without much luck.  I will go and read it immediately.  She prescribed Onsior for help with the swelling and for pain.  Off-label is basically because it's being used for more than three days, post-surgery, which is what the label says. Buprenex seems far more effective at pain relief without the zombie effect, but it can constipate her.   Lexi goes back to the oncologist on Monday morning and hopefully we will have a diagnosis and go from there.  She also gave Lexi an acupuncture treatment that seemed to help quite a bit.  Thanks again!
 

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When my cat came home from dental surgery, I had 3 Onsior tablets for her and was instructed to give one a day for two days, with the third day being optional depending on how she seemed to be doing. She came home in the late afternoon and I gave the Onsior immediately and she was a complete wreck for the rest of the night, wandering around, falling over, trying to jam herself into really weird, small places like the tiny clearing between the bottom of the kitchen cabinets and the floor. However, I think that was primarily related to residual effects of the anesthesia, because she didn't act weird the following evening. It did indeed seem to help her pain level, and I also noticed that the swelling in her face went down significantly after the second dose. She actually had a few moments of really perking up and wanting to play, and I wondered if it might have made her a little high in addition to making her pain better. She seemed much more back to normal by the third evening, enough so that I decided not to give her the final dose.

So -- short version: my experience with Onsior was pretty normal and unremarkable and that it seemed to work as advertised. But my cat is about twice the size of yours, and the meds were prescribed by the book rather than off label. So there's that.

Not sure if any of this will be at all helpful to you, but yeah, that's my personal experience with it. I'd never heard of it before, either -- must be the latest thing?

As for my opinion about using it for daily use: I think that all depends on how much you trust your vet, and how confident you and your daughter feel reading Lexi's signals. Good luck getting it sorted, and I wish you all the best!
 
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maggiemay

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When my cat came home from dental surgery, I had 3 Onsior tablets for her and was instructed to give one a day for two days, with the third day being optional depending on how she seemed to be doing. She came home in the late afternoon and I gave the Onsior immediately and she was a complete wreck for the rest of the night, wandering around, falling over, trying to jam herself into really weird, small places like the tiny clearing between the bottom of the kitchen cabinets and the floor. However, I think that was primarily related to residual effects of the anesthesia, because she didn't act weird the following evening. It did indeed seem to help her pain level, and I also noticed that the swelling in her face went down significantly after the second dose. She actually had a few moments of really perking up and wanting to play, and I wondered if it might have made her a little high in addition to making her pain better. She seemed much more back to normal by the third evening, enough so that I decided not to give her the final dose.

So -- short version: my experience with Onsior was pretty normal and unremarkable and that it seemed to work as advertised. But my cat is about twice the size of yours, and the meds were prescribed by the book rather than off label. So there's that.

Not sure if any of this will be at all helpful to you, but yeah, that's my personal experience with it. I'd never heard of it before, either -- must be the latest thing?

As for my opinion about using it for daily use: I think that all depends on how much you trust your vet, and how confident you and your daughter feel reading Lexi's signals. Good luck getting it sorted, and I wish you all the best!
Thank you so much for sharing your experience.  I appreciate any information I can get about this drug.  Lexi was in a complete stupor after 1/2 of a tablet.  Some cats have high sensitivity to NSAIDS and she may be one of them, but good to know how your baby responded to it.  
 

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I'm sorry about your daughter's cat possibly having cancer. I don't have much to offer on long-term use of Onsior, and I've never really heard of it being used for cancer. My Boo was on it twice short-term (three days) with no ill effects - once for a calicivirus flare (to help with inflammation/ulcers on his tongue) and another time as a trial to see if it would help with his feline hyperesthesia (they thought it might have been spinal inflammation). It's my understanding that there are risks with giving Onsior daily over an extended period of time, just like there is with Metacam. And you might be right about Lexi being sensitive to the drug. Some cats just are. Did your daughter check with her regular vet to get his/her thoughts on the medication prescribed by the oncologist?
 
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maggiemay

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I'm sorry about your daughter's cat possibly having cancer. I don't have much to offer on long-term use of Onsior, and I've never really heard of it being used for cancer. My Boo was on it twice short-term (three days) with no ill effects - once for a calicivirus flare (to help with inflammation/ulcers on his tongue) and another time as a trial to see if it would help with his feline hyperesthesia (they thought it might have been spinal inflammation). It's my understanding that there are risks with giving Onsior daily over an extended period of time, just like there is with Metacam. And you might be right about Lexi being sensitive to the drug. Some cats just are. Did your daughter check with her regular vet to get his/her thoughts on the medication prescribed by the oncologist?
Hi, and many thanks for your response.  I don't think the oncologist was giving the Onsior for the cancer, per se, but for pain and swelling until we get a definitive diagnosis.  This oncologist has a sterling reputation and we really like her.  She said that she's had great success using Onsior in this off-label, daily basis use.  Lexi's pain has actually been controlled well with Buprenex, which hasn't caused very much constipation.  She's been given Miralax and pumpkin with the Buprenex and it seems to be working well.  I realize that Buprenex long-term is iffy as well, but without a diagnosis, the goal has been to keep her as pain-free as possible until treatment begins.  Since there is definitely a mass, the oncologist believes she has the large-cell form of lymphoma.  The silver lining here is that large-cell lymphoma responds very quickly to chemo in many cats.  If she is put on chemo, she will be given prednisolone along with it, which should help a lot with the swelling.

Leslie (my daughter) wasn't pleased with the vet who originally found the mass.  He thought the mass was over a kidney and said that the only option was to have surgery.  He told her that if cancer was present and didn't have definite margins, they would not wake Lexi up from surgery.  So on to the oncologist from there, and that particular vet is history.  The oncologist said that surgery is NOT an option given Lexi's size (4.5-5 lb including fluid retention) and age (16).  She did an ultrasound and palpation and believes the mass is beneath the liver.  Earlier this week, my daughter took Lexi to yet another regular vet (no appointment available with the oncologist) because the swelling in her legs was increasing and we were concerned about her pulmonary function.  That vet was familiar with Onsior in off-label use, acknowledged that some cats have side effects from Onsior, and recommended continuing the Buprenex.  They did a thorough examination of Lexi's heart and lungs, which aren't impaired by the fluid buildup, both very strong, so that was good news.  Two vets at that practice palpated the mass and did an ultrasound and these vets think it's in her stomach.  So we really have no idea which organ(s) the mass is impacting, but treatment needs to begin quickly.  

Her next oncology appointment is on Monday.  She's been eating fairly well and today the swelling seems to have gone down somewhat.  She's moving around more frequently and easily.  If the initial Onsior dose is responsible for the dramatic decrease in swelling within just hours of her first dose, my daughter is willing to try it again over the weekend.  I believe she's comfortable with adding another 1/6 of a tablet, which will be right between 1/3 tablet (no zombie behavior but no fluid decrease) and 1/2 tablet (major fluid decrease, basically immobile cat until it wore off).  I am so used to flinching at the thought of a cat and an NSAID that I don't quite trust it, given Lexi's initial reaction to the only dose that's been effective.  But we are trying our best to help this little girl until she goes to the oncologist on Monday.  She's such a sweet-natured and very good little patient.  I cannot believe how many cats are now struggling with this horrible disease.  It's heartbreaking.
 
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lcat4

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So sorry to hear about your daughter's cat's situation. I had a cat, who at 16 years, was diagnosed with bladder cancer and took Onsior daily for about 9 months. His weight at the time was around 11 pounds. This was back in 2013 and using Onsior at all, let alone off-label was rather new.  Our oncologist had never prescribed it before, just read about it. With bladder cancer, the standard protocol was to give Piroxicam (another NSAID) but when we tried that under a different oncologist's care a couple years before, our cat had a similar reaction to Piroxicam as your cat to Onsior. He was a zombie and had an immediate creatinine increase. Since at the time we weren't absolutely positive he had cancer, we stopped all treatment.  Now with the mass confirmed, the new oncologist said we could try Onsior. He started out at the full tablet of 6mg and overnight he became a new cat. He displayed no side effects and showed unbelievable freedom in movement and started peeing better. We did monthly blood draws to watch kidney function, but switched to 1/2 tab after a few months when his kidney levels began to rise. At 9 months his creatinine spiked to 5.0 and we ceased using the Onsior. We began sub-q fluid therapy to aid the kidneys and he took Buprenex solely for pain. After four months off the Onsior, his creatinine settled back down at around 3.0, still high, but since he'd been in the upper 2's before starting Onsior not significantly worse. 

The point of his taking Onsior was primarily to control inflammation associated with cancer, to try to control the growth of the mass, and to provide pain relief. In our cat's case, taking Onsior made him feel better and gave him new life, but I can't say if it stopped the mass growth. He lived for about a year after stopping the Onsior. 

Throughout his treatment, I had many sole searching conversations with myself, the regular vet, the oncologist, and the surgeon about appropriate care. His health situation was terminal, chemo was not effective for this type of cancer, it was only a matter of time until the mass blocked his urethra, and we wanted to make his life as comfortable as possible. The mass itself was not removable by surgery, but should we do surgery anyway to put in a stent in his urethra (pushed through the mass) to allow him to void urine? That in itself was a decision...16 years old, hyperthyroid, elevated kidney function, and very expensive (we did and it worked beautifully). Do we give the Onsior despite risk to the kidneys (we did)? Should we try radiation (we did not)?

After my cat was gone, I reviewed his treatment to see if we should have done anything differently in retrospect. I would have kept everything the same except I would also give sub-q fluids while he took the Onsior. Ultimately my cat was far more comfortable when taking the Onsior than when only on Buprenex for pain. There was a discussion with a vet on The Cat Site awhile ago (after my cat passed) about the use of NSAID's and the vet had no qualms with NSAID use in terminal situations (even if the situation was kidney failure), but felt that the addition of sub-q fluids reduced the danger of their use. I honestly don't know if that would have kept my cat's creatinine from spiking, but the use of fluids makes sense. I made the suggestion later to our oncologist and regular vet for their future consideration. 

That's my experience with Onsior.  With respect to your cat, it seems you are asking if you should continue Onsior for the weekend. I can't tell you what to do. Obviously I continued it for a lot longer. Perhaps you could ask the vet if you could bring her in for sub-q fluids once over the weekend. When my cat was 11 pounds he got 100ml every other day (which we did at home). In the end, at 6ish pounds, he tolerated about 40ml most days. 

I sure hope you get a handle on where the mass is and wish you great luck in her treatment. 

 
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maggiemay

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So sorry to hear about your daughter's cat's situation. I had a cat, who at 16 years, was diagnosed with bladder cancer and took Onsior daily for about 9 months. His weight at the time was around 11 pounds. This was back in 2013 and using Onsior at all, let alone off-label was rather new.  Our oncologist had never prescribed it before, just read about it. With bladder cancer, the standard protocol was to give Piroxicam (another NSAID) but when we tried that under a different oncologist's care a couple years before, our cat had a similar reaction to Piroxicam as your cat to Onsior. He was a zombie and had an immediate creatinine increase. Since at the time we weren't absolutely positive he had cancer, we stopped all treatment.  Now with the mass confirmed, the new oncologist said we could try Onsior. He started out at the full tablet of 6mg and overnight he became a new cat. He displayed no side effects and showed unbelievable freedom in movement and started peeing better. We did monthly blood draws to watch kidney function, but switched to 1/2 tab after a few months when his kidney levels began to rise. At 9 months his creatinine spiked to 5.0 and we ceased using the Onsior. We began sub-q fluid therapy to aid the kidneys and he took Buprenex solely for pain. After four months off the Onsior, his creatinine settled back down at around 3.0, still high, but since he'd been in the upper 2's before starting Onsior not significantly worse. 

The point of his taking Onsior was primarily to control inflammation associated with cancer, to try to control the growth of the mass, and to provide pain relief. In our cat's case, taking Onsior made him feel better and gave him new life, but I can't say if it stopped the mass growth. He lived for about a year after stopping the Onsior. 

Throughout his treatment, I had many sole searching conversations with myself, the regular vet, the oncologist, and the surgeon about appropriate care. His health situation was terminal, chemo was not effective for this type of cancer, it was only a matter of time until the mass blocked his urethra, and we wanted to make his life as comfortable as possible. The mass itself was not removable by surgery, but should we do surgery anyway to put in a stent in his urethra (pushed through the mass) to allow him to void urine? That in itself was a decision...16 years old, hyperthyroid, elevated kidney function, and very expensive (we did and it worked beautifully). Do we give the Onsior despite risk to the kidneys (we did)? Should we try radiation (we did not)?

After my cat was gone, I reviewed his treatment to see if we should have done anything differently in retrospect. I would have kept everything the same except I would also give sub-q fluids while he took the Onsior. Ultimately my cat was far more comfortable when taking the Onsior than when only on Buprenex for pain. There was a discussion with a vet on The Cat Site awhile ago (after my cat passed) about the use of NSAID's and the vet had no qualms with NSAID use in terminal situations (even if the situation was kidney failure), but felt that the addition of sub-q fluids reduced the danger of their use. I honestly don't know if that would have kept my cat's creatinine from spiking, but the use of fluids makes sense. I made the suggestion later to our oncologist and regular vet for their future consideration. 

That's my experience with Onsior.  With respect to your cat, it seems you are asking if you should continue Onsior for the weekend. I can't tell you what to do. Obviously I continued it for a lot longer. Perhaps you could ask the vet if you could bring her in for sub-q fluids once over the weekend. When my cat was 11 pounds he got 100ml every other day (which we did at home). In the end, at 6ish pounds, he tolerated about 40ml most days. 

I sure hope you get a handle on where the mass is and wish you great luck in her treatment. 

These case histories are heartbreaking, but so very helpful.  Thank you so much for this detailed response!  The use of sub-Q's along with Onsior is a fabulous idea.  The cat who developed acute kidney failure that I mentioned in my original post was dehydrated, so this makes perfect sense.  I am going to pass this information along to my daughter.  It sounds like your baby got the very best of care and you made many difficult decisions.  I'm so sorry that you lost him, and I'm so appreciative of your sharing his story to help another.  Thanks again!
 
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maggiemay

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Thank you all for the information on Onsior.  Lexi Crossed the Bridge today, but she lived a long life filled with love, and battled the cancer with such courage.  They are such brave little creatures.  When she was examined today, the mass had wrapped around her spinal column and was invading the spinal cord itself.  And so the decision was made to help her let go with dignity and peace.  I have posted a tribute to Lexi on Crossing the Bridge.  You will be missed so very much, precious baby.
 
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