Cat started prednisolone and vomiting has gotten worse. Any advice is appreciated

Canella

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13 years old F, spayed. She had bad bouts of vomitting maybe 2-3 times a week for the last month, she was diagnosed with IBD in September and been on omeprazole ever since, and added metronidazole about 2 weeks ago.

this past week she’s been vomitting everyday, I spoke to the vet and they put her on prednisolone 2.5mg twice a day. I gave her the first pill today at 7pm and her omeprazole at 10AM. around midnight she had a violent bout of vomitting, where she threw up clear liquid mainly (which is new, she always vomits food and/or bile). She’s sincevomited again around 2AM.

Is this because of the prednisolone, should I see about a lesser dose, or perhaps giving her more food with it? I gave her a bit of food when I gave her the pill but now I’m thinking maybe it wasn’t enough.

I’m so terrified for her, this hopeless feeling is gnawing away at me and I have no idea what to do. I don’t even know exactly what I’m looking for here, maybe if someone had a similar experience if they can share their solution or something I can try please I would be forever grateful.
 

Midget's Mom

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Possibly the steroid pill upset her stomach? I have an older cat with the same issue. She gets dexamethasone injections every 4 days, and Cerenia every couple of days. The Cerenia tablets are off-label for cats, but they improve her quality of life. I feed her Tiki cat velvet mousse cat food which seems to stay down better. The dry food that I offer the other cats is as grain-free as I can afford, and definitely no wheat, corn, or soy. I have to wach my IBD cat, though, or she'll tank up on dry and it comes up.
 

Astragal14

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I’m so terrified for her, this hopeless feeling is gnawing away at me and I have no idea what to do. I don’t even know exactly what I’m looking for here, maybe if someone had a similar experience if they can share their solution or something I can try please I would be forever grateful.
I completely understand the hopeless and terrified feelings. I have been in a similar situation with my 9 y.o. IBD cat (but without the steroids). There are a few things to definitely ask your vet about adding, as well as a few things to consider/keep in mind.

around midnight she had a violent bout of vomitting, where she threw up clear liquid mainly (which is new, she always vomits food and/or bile)
The prednisolone can cause stomach upset. Nausea can sometimes prompt cats to drink large amounts of water in an attempt to remedy the nausea, but it often backfires and they end up vomiting all that water soon after. This is my guess for what happened last night around midnight. Taking the prednisolone with larger amounts of food could help, but I also recommend asking your vet about other prescriptions.

These are the things I would definitely ask your vet about adding:

1. An anti-nausea drug
I agree with Midget's Mom Midget's Mom on the Cerenia. My cat took this daily for about 8 months and still takes it as needed during any IBD flares. It is an anti-nausea drug that also has some mild anti-inflammatory properties. There are stronger anti-nausea options, like ondansetron, but Cerenia is often strong enough and I really like the anti-inflammatory benefits.

2. B12 injections (cobalamin)
Every IBD treatment needs to begin with two steps: one, managing the inflammation (which you're doing with the prednisolone) and two, supplementing with B12 injections. The GI tract can't absorb any medication to its fullest effect until these two components are managed. Cats with IBD are almost always low in B12, even if blood work shows a normal range. You'll likely need a schedule of B12 injections that taper down over time. Many cats start with either weekly or bi-weekly injections. They're inexpensive and have almost no side effects or interactions. You can even give them at home if you feel comfortable (I don't, we still get monthly injections from our vet).

Ixnay on the IBD: An update on handling patients with chronic enteropathies
Cobalamin is only absorbed from the distal small intestine and is a very specific marker for distal ileal mucosal disease. Low cobalamin and folate concentrations are indicative of severe diffuse disease, and this will limit the efficacy of oral therapy for IIBD. Supplement with cobalamin and folate before instituting therapy.
The Importance of B12 – IBDKitties
A B12 deficiency can cause poor cell formation in the digestive tract and lead to nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and/or diarrhea. Absorption of B12 requires normal function of the stomach, pancreas and small intestine... Because a healthy liver is able to store many years worth of B12, signs of deficiency may not be obvious for a long time.

3. Add a probiotic
Cats with IBD usually need a daily probiotic, but they're essential when taking an antibiotic - and especially with metronidazole because it obliterates all the bacteria in the gut, good and bad. Separate the doses of the antibiotic and the probiotic by several hours (I usually wait about 3-4 hours). And continue the probiotic for a minimum of one week after the antibiotic is finished. But I would strongly recommend giving her a daily probiotic for her IBD anyway.

Why did your vet prescribe the metronidazole? For diarrhea? I wonder if the metronidazole led to your cat's increased vomiting the past week (due to an imbalance of bacteria in the gut), but that seems unlikely.

The absolute best probiotic is Visbiome (my cat took this for a few years). Two boxes is the minimum purchased online, it's also sold through some vet offices. Other good options are Proviable Forte and VetriScience Entero Flora Pro, both available through veterinarians.
Visbiome® Vet
Proviable®-Forte Kits For Cats - Proviable®
Entero Flora Pro

Here are a few things to consider:

1. My IBD cat had a huge flare up 3 years ago that kept him in the ER for a short while. He was discharged with 4 medications (3 Rx and 1 otc): metronidazole (for diarrhea), Cerenia (for nausea), Carafate (to help the esophagus heal after vomiting so much) and omeprazole (Prilosec for stomach acid).

I ended up switching him from Prilosec to Pepcid (famotidine). Some cats don't respond as well to Pepcid but it was fine for my cat. I prefer Pepcid because it doesn't have the rebound acid that Prilosec does when weaning the drug, and also Prilosec lowered my cat's white blood cell count (he took it for about 7 months). This is a rare side effect, but something to keep in mind if your cat takes it for a while.

2. Fecal transplant capsules are an option in place of a probiotic
This is a stronger option for more advanced IBD cases. I do not have any personal experience with this, but it is popular and many people on this site have discussed it in great detail. I know that probiotics should not be taken concurrently with this, but I don't know about interactions with other medications. Animal Biome is a good company that has conducted a ton of research on GI health for cats and dogs.
KittyBiome™ Gut Restore Supplement – AnimalBiome

3. Have you identified your cat's IBD triggers?
We're very fortunate to control my cat's IBD through diet and supplements (plus medications for any flares). It was a very long process of closely monitoring his diet in order to identify his triggers. We've eliminated all the big problems, and every now and then I notice a small trigger.

4. Dr. Adam Rudinsky is a veterinarian at Ohio State who specializes in feline GI diseases. He was featured on a veterinary podcast about chronic feline vomiting earlier this year. It's about 30 minutes long, they discuss diet and treatment options around halfway through. The language is very clinical since the audience is other veterinarians, but I still found it helpful and informative.
VetFolio
 
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PushPurrCatPaws

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13 years old F, spayed. She had bad bouts of vomitting maybe 2-3 times a week for the last month, she was diagnosed with IBD in September and been on omeprazole ever since, and added metronidazole about 2 weeks ago.

this past week she’s been vomitting everyday, I spoke to the vet and they put her on prednisolone 2.5mg twice a day. I gave her the first pill today at 7pm and her omeprazole at 10AM. around midnight she had a violent bout of vomitting, where she threw up clear liquid mainly (which is new, she always vomits food and/or bile). She’s sincevomited again around 2AM.

Is this because of the prednisolone, should I see about a lesser dose, or perhaps giving her more food with it? I gave her a bit of food when I gave her the pill but now I’m thinking maybe it wasn’t enough.

I’m so terrified for her, this hopeless feeling is gnawing away at me and I have no idea what to do. I don’t even know exactly what I’m looking for here, maybe if someone had a similar experience if they can share their solution or something I can try please I would be forever grateful.
...
Why did your vet prescribe the metronidazole? For diarrhea? I wonder if the metronidazole led to your cat's increased vomiting the past week (due to an imbalance of bacteria in the gut), but that seems unlikely.
...
So sorry your kitty is going through this!!

I, too, wonder about the metronidazole. Is she given it in liquid form, or pill form? Metronidazole tastes terrible, and, as a result, lead the cat into vomiting mode and/or nausea... so sometimes a cat may do better with it in pill form, with it deeply "hidden" inside of a tasty treat or in a pill pocket.
 

Sarthur2

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What was the pred prescribed to treat? That’s a high dose. My cats have never done well on pred (used for short periods of time, very low dose and tapered off, for allergies).

I definitely agree your cat needs a daily anti-nausea medicine — Cerenia or Ondansetron.

Is she finished with the Metronidazole now?
 
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