Cat won't eat - despite Cerenia and mirtazapine?

trishia42

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Quick recap; brought our 15 year old cat with CKD to the ER vet last Monday night due to a tail injury; was only seen the next afternoon but no fractures on x-rays, some inflammation consistent with some type of injury so we were sent home with gabapentin. Had an odd experience with the gabapentin where by Thursday evening he could barely walk and was very lethargic so the last dose we gave him (30 mg) was on Thursday morning - he was thankfully better by Friday morning. BUT he didn't eat very much on Wednesday, and pretty much nothing at all on Thursday, Friday and Saturday (if he tried a few bites, he threw up immediately after) - so we brought him back to the ER vet on Saturday; thoughts were perhaps pancreatitis due to elevated ALT/GGT values (blood tests link here; ) or perhaps something gastro-intestinal (vet could feel a lot of poop, but thought it was soft; he is usually on Miralax to help with that).

So he was given a shot of Cerenia and some mirtazapine before leaving and we were sent with Cerenia to give every 24 hours (8 mg) and mirtazapine every 3 days (2 mg); also suggested to give the gabapentin twice a day at a low dose of 10 mg. He seems relatively alert although he seems to prefer quiet spots away from us, which would seem to indicate he is not feeling 100% - BUT he is not eating. Every now and then I will present him with food (especially after he wakes up) and he will eat a few bites, stop and look confused, walk away, lick his lips excessively and gag a bit (no vomit) and then he has no interest in food at all. We don't know what to make of this! He's peeing still, but not pooping (he's not getting the Miralax in since he's not eating!). We're also concerned that it will start to affect his liver - this is why we took him in on Saturday since it was pretty much 3.5 days by then with almost no food - he's a bigger cat that's already on a low-protein diet due to the CKD. We don't know what to do at this point; anyone had a similar experience? Does it take a while for the Cerenia/mirtazapine to kick in for certain cats? The internet says 2-3 hours, so we are very confused.
 

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Our 16-year-old was prescribed Elura (capromorelin oral solution) and it worked very well for her. It's an appetite stimulant. It's liquid so easy to squirt into her mouth. It's similar to Entyse for dogs but tweaked for cats. She also had a heart murmur. Couldn't tolerate the Cerenia tablets but they gave her the injection and fluid the first time we brought her to the vet. The vet said not to change the diet. Said it's more important that she eats and keeps her fluids. Didn't need fluid or Cerenia anymore. Just the Elura twice daily.
 

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Hi
You will need to talk with the vet again, (maybe a different vet?). He may need fluids, and possibly handfeeding/syringe feeding or a feeding tube.
 

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Hi. Sorry to hear what is going on with your cat. Are you getting him to take the meds? If so, how are you getting him to take them? Cerenia doesn't taste the greatest, so he might be turned off to his food because he is wary about finding the med in them. Both meds can be prescribed in transdermal doses to avoid having to put them in their food.

I had to give Feeby Cerenia and I ended up using pill masker to wrap the pill in, and Feeby loves Party Mix so I would roll the pill/pill-masker in crumbles of this to get her to take it. Although, Feeby wasn't/isn't gagging, after 6 days we gave up on the Cerenia as it wasn't doing much to encourage her to eat. So, perhaps, Elura, as mentioned above, or another med your vet could recommend, might be worth trying.

The other thing to note with pancreatitis is that cats often need sub-Q fluids to help flush the pancreas as well as the entire system to speed up healing. I would ask the vet about that as well.

I couldn't see the blood work - how high is his phosphorus level? Most vets don't seem to worry when it is in 'range', but CKD cats shouldn't have phosphorus levels near the high end of the normal range. It might be that he needs a phosphorus binder even if he is on CKD food. High phosphorus levels can make a cat feel really bad.

If there are other foods/treats that he does like, I would try those instead of the CKD food at this point. Another thing to try is baby food meat (Gerber Stage 2 or Beechnut), many cats - even ones who are slightly nauseated - will eat it, and it can sometimes 'jump start' a cat to begin eating again.

2-3 hours might be a bit quick to expect results from the meds, but if they are going to work for him, after a couple of doses they should make a difference.

P.S. Also ask your vet about giving the Mirtazapine (or Mirataz) every day at half the dosage for a couple of days and see if that helps any.
 
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trishia42

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Thank you all for the comments. We actually just gave him 100 mL of subQ fluids now, and we will probably do it again tonight (vet's recommendation). We are offering every food we can think of that he use to like (Fancy Feast, Meow Mix, those lickable treats).

We haven't given him his first doses of Cerenia/mirtazapine yet since he was given them at the vet but since he's not really eating treats, we plan on encapsulating the Cerenia half in a capsule and using a pill popper. The gabapentin we were given is liquid and although that was easy to give when he was eating (mixed in a Churu), now we've had to basically syringe it in his mouth and there's a lot of spitup and salivating so I'm not sure how much he is getting of that, but we don't think it's as crucial as the two other meds.

His phosphorus is actually good (1.42 mmol/L) - in fact the values for creatinine/BUN on Tuesday's bloodwork were lower than at diagnostic a year ago. Maybe these imgur links work instead; , , .

We will call the vet again this afternoon if things don't start looking up (only the ER vet is open here on week-ends, and our regular vet will most likely not be able to see us until Thursday, which I feel is too far away). His next dose of Cerenia is at 2 pm this afternoon, so we are really hoping things will stabilize before the end of the afternoon. I'm just so heartbroken, and it's terribly difficult to know what is best to do; especially because when we called the ER vet last time to discuss things first it was just "bring him in" and the visit is honestly something that could have been done over the phone - we had been there just on Monday/Tuesday.
 

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So he was given a shot of Cerenia and some mirtazapine before leaving and we were sent with Cerenia to give every 24 hours (8 mg) and mirtazapine every 3 days (2 mg); also suggested to give the gabapentin twice a day at a low dose of 10 mg. He seems relatively alert although he seems to prefer quiet spots away from us, which would seem to indicate he is not feeling 100% - BUT he is not eating. Every now and then I will present him with food (especially after he wakes up) and he will eat a few bites, stop and look confused, walk away, lick his lips excessively and gag a bit (no vomit) and then he has no interest in food at all.
He's peeing still, but not pooping (he's not getting the Miralax in since he's not eating!). We're also concerned that it will start to affect his liver - this is why we took him in on Saturday since it was pretty much 3.5 days by then with almost no food - he's a bigger cat that's already on a low-protein diet due to the CKD.
Hi T trishia42 ...has your cat gone poop at all, since you posted?
You mentioned in your first post that the vet felt a lot of soft poop...but has your cat gone, since then?

Gabapentin is supposed to help with pain, and causes sedation,...but I'm not sure if it can add to constipation in cats.
From what I have read, on another thread, the OP mentioned that gabapentin is not advised in cats with CKD...so I'm not sure why the ER vet would have prescribed it, for pain.
Perhaps at a very low dose, it would be okay.

I would definitely ask about the lowest dose possible, for a ckd cat.
And take a look at this box, in this article, where it actually mentions starting a cat with renal problems on a very low dosage:
Gabapentin and Amantadine for Chronic Pain: Is Your Dose Right?

This article just lists some other info, which you probably already know, but it's overall info is useful.
The Ins and Outs of Managing Feline Chronic Kidney Disease
 
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trishia42

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No he hasn't. We brought him back to the ER vet around five and we just got the call from the vet. They will admit him for the night, put in a feeding tube and adjust dosages of cerenia and ondansetron, fluids, enema. I am so very worried! I can't lose him like this. : (
 

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No he hasn't. We brought him back to the ER vet around five and we just got the call from the vet. They will admit him for the night, put in a feeding tube and adjust dosages of cerenia and ondansetron, fluids, enema. I am so very worried! I can't lose him like this. : (
Sending you Mega Health Vibes, Health Thoughts, and prayers, for your guy cat.:vibes::vibes::tabbycat:

I don't think you'll lose him,...since you brought him to the only place that could help him, right now.
His bloodwork didn't really look so bad, and cats are very strong, at any age.

Plus cats never give up.
With the enema, and getting him to feel better, then I think he will recover quickly.

(I just kind of wish that we had Vets during normal hours, and then other Vets for weekends,...plus ER vets for off hours.)
(Basically we probably need three Vet places, total).

What is his name?
Sending your cat extra Health Vibes that they can get him quickly stabilized...at the Vets. :goodluck::heartshape::hugs::grouphug::alright:
 
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trishia42

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Thank you. His name is Mao - an odd one but originally his name was Van der Mews, which got shortened to Mews, but then it turned out he doesn't really 'meow', it just comes out as 'mao' so that affectionately became his name. We've had him since he was just a little wee kitten, adopted from the humane society here.
 

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Thank you. His name is Mao - an odd one but originally his name was Van der Mews, which got shortened to Mews, but then it turned out he doesn't really 'meow', it just comes out as 'mao' so that affectionately became his name. We've had him since he was just a little wee kitten, adopted from the humane society here.
That is so sweet, and a very fitting name. :thumbsup:
(Van der Mews...Mews...to finally....".Mao". :))

Sending your Mao...more Health Vibes, now. :vibes::vibes::caticon:

Will the ER Vet place call you with an update?
or do you have to be the one to call them?

You're going to be tired tonight, but can you update us, (whenever you can)...tomorrow.
Also, remember to take care of yourselves, too, with plenty of rest, proper food, and sleep.
Hoping for only the Best for your Mao. :goodluck:

You've probably already read Tanya's website, for CKD cat info...but in case others read this thread,...it's here::
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat
 
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trishia42

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We got an update from the vet this morning. Mao has not pooped yet, but she thinks the stool is soft and that the Miralax they are giving him along with the fluids and nutrition are likely to work; also hasn't urinated yet but she can feel a full bladder so she expects he should soon. He is still being fed through a nasal tube and has not shown interest in food yet; he is getting IV fluids as well as Cerenia (I mentioned ondansentron, but it's apparently very expensive here so they usually start with adjusting Cerenia dosage)

The plan right now is to redo the basic bloodwork to see if any values have changed; perhaps we will also move ahead with an abdominal ultrasound. The general thought is that we really need to find out what started the whole thing and caused this intense nausea/not-eating issue. Really hoping it's not something terrible; I can't help but imagine all the worst scenarios.

If things stabilize, they would remove the tube and send him home to see if he would start eating within a couple of days and if not, consider an esophageal, which is a little concerning given the anasthesia required for putting it in, given his CKD status. He's most definitely not out of the woods yet - I'm a total wreck.

Thank you so much for all your kind comments. They mean a lot.
 

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We got an update from the vet this morning. Mao has not pooped yet, but she thinks the stool is soft and that the Miralax they are giving him along with the fluids and nutrition are likely to work; also hasn't urinated yet but she can feel a full bladder so she expects he should soon. He is still being fed through a nasal tube and has not shown interest in food yet; he is getting IV fluids as well as Cerenia (I mentioned ondansentron, but it's apparently very expensive here so they usually start with adjusting Cerenia dosage)

The plan right now is to redo the basic bloodwork to see if any values have changed; perhaps we will also move ahead with an abdominal ultrasound. The general thought is that we really need to find out what started the whole thing and caused this intense nausea/not-eating issue. Really hoping it's not something terrible; I can't help but imagine all the worst scenarios.
Okay, I am going to be praying for poop for Mao.

(my 7yr old female dsh cat, at the age of 6, had a partial blockage and needed an Enema to clear it out. She just stopped eating, and her bloodwork was good,(first trip to Vet). Was also given cerenia and mirtazapine. At home, ate a small bit while using both meds, but did not poop at all, so after three days, went to Vet again, (2nd trip to Vet), and had x-ray done, which showed a lot of poop. Then given Enema...which revealed a piece of small green cleaning sponge, in the poop, which Vet thought was the cause.)

Perhaps, due to Mao's age,...the Vet wants to wait for the Miralax to work,...versus an Enema.
The Vet would know best.

Ask the Vet if they think the pain medication could have slowed down Mao's digestion, at all?
Especially the sedating effects of the gabapenti
n?

It definitely is good to repeat the bloodwork, to see if his GGT or other Liver values have risen, and how his Kidney values are, plus the electrolytes.
With the Ultrasound, too, they are probably trying to 'rule out'...specific causes...and worse case scenarios...(but naturally our own minds always jump to worse case scenarios...anyways).
If things stabilize, they would remove the tube and send him home to see if he would start eating within a couple of days and if not, consider an esophageal, which is a little concerning given the anasthesia required for putting it in, given his CKD status. He's most definitely not out of the woods yet - I'm a total wreck.

Thank you so much for all your kind comments. They mean a lot.
I think when he begins to poop, that things will get better.
My hope is that all this started due to constipation, and it somehow snowballed.

The only thing that was slightly worrying, was why Mao's Liver values were higher, and especially the GGT which may indicate some bile duct blockages.
But hopefully with the right nutrition, and hydration, that these Liver values return to normal.

Sending more Mega Health Vibes for your Mao, and only Thoughts of Getting Well, quickly, plus some more prayers. :vibes::vibes::tabbycat: 🙏
 
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trishia42

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They redid quick bloodwork yesterday afternoon and his creatinine had gone from 226 to 200, BUN from15 to 16 (he's been a CKD-diagnosed cat for 1.5 years) and ALT from 236 to 130 (no GGT measurement unfortunately). They said that was good news, but also said some of it was due to the fluids so I'm not really sure what to think of it? They also performed an abdominal ultrasound. We went to see him yesterday and he was really out of it because of the sedation for the ultrasound. He is still been fed through a nasal tube and getting IV fluids - he still has NOT had a bowel movement (now 5 days I think?!). They say that it looks all soft and at the end of the colon/anus on the x-ray they took yesterday afternoon and that the ultrasound showed he should have diarrhea follow-up; I was really hoping it would come out overnight but no. I feel he's stuffed from both ends at this point : (. He also still has shown NO interest in food (guy who usually LOVES food), so we're really not sure what to think of that or what the next steps will be at this point. A vet should be calling us back this morning, but I really don't know where we will go from here - nothing seems like it's going in the right direction and I feel so helpless and heartbroken.
 

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They keep saying it looks soft, but nothing's moving? I sure hope the vet has something more definitive for you when s/he calls! :vibes: :crossfingers:
 
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I know! They gave him cisapride too on top of things, so you think SOMETHING should be moving out.
 
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Just talked to the vet now; the ultrasound results came back. He has some evidence of kidney changes (not surprising and expected since he has CKD and is 15), the liver looks affected (could be because hepatic lipodosis started before treatment was started, or could be inflammation - unsure), the pancreas definitely shows signs of pancreatitis.

So the treatment with the fluids, anti-emetics, appetite stimulants and pain killers that we have been doing is the right treatment for pancreatitis. But they are not understanding why he is not responding; feel like things should be moving more normally through him and like he should have started eating by now.

The vet from last night thought we should take out the nasal tube and send him home to see how he does, but I wasn't comfortable with that and the vet from today seemed to agree, so he will be spending yet another night there. I really pushed and they will give him a couple of enemas to get the poop out (I REALLY feel that's not helping things, since if that's not moving out, the stomach contents can't move forward to be digested and stuff, and he surely wouldn't be hungry and it wouldn't help with his nausea). So I REALLY hope that will work as the first item of action.

They will continue the Cerenia, appetite stimulants, adjust pain killers (maybe switch from gabapentin to an opioid), continue the IV fluids, tube-feeding as needed, and will add Denosyl as a liver-supporting anti-oxidant. But again, the vet really wasn't sure why nothing seemed to be improving his condition. I asked him to be honest and what he thought his chances were and he said that at this point, it was very difficult to say given how he physically looked this morning, and that it was "50:50 to be honest, could go both ways - I'm not holding my breath". My heart just sank so much - I really think we are going to lose him this week.
 

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The vet from last night thought we should take out the nasal tube and send him home to see how he does, but I wasn't comfortable with that and the vet from today seemed to agree, so he will be spending yet another night there. I really pushed and they will give him a couple of enemas to get the poop out (I REALLY feel that's not helping things, since if that's not moving out, the stomach contents can't move forward to be digested and stuff, and he surely wouldn't be hungry and it wouldn't help with his nausea). So I REALLY hope that will work as the first item of action.
I'm so glad that you were assertive and very proactive with the Vet from last night.

Unbelievable that s/he would want to send a sick cat home,...and did nothing to relieve Mao's symptoms.

Doing diagnostics is one thing, for them to 'rule out', and to allow them to proceed with caution,...if they are worried about perforations or other things happening within the intestines,..(if they do any treatments),...but to not relieve Mao's symptoms...just makes me discouraged in last night's Vet's training, or his/her abilities. Wow.

How did they think that he would eat, if like you said, his digestive tract is not cleared.
And how is Mao supposed to eat, if he is too sedated, or given strong pain killers.
(I don't know how vets balance the need for pain meds...with the sedating qualities of those pain meds, and the side effects...that they may cause our animals.)

Hoping and praying...for only the Best for today...for your Mao cat. 🙏 🍀
They will continue the Cerenia, appetite stimulants, adjust pain killers (maybe switch from gabapentin to an opioid), continue the IV fluids, tube-feeding as needed, and will add Denosyl as a liver-supporting anti-oxidant. But again, the vet really wasn't sure why nothing seemed to be improving his condition. I asked him to be honest and what he thought his chances were and he said that at this point, it was very difficult to say given how he physically looked this morning, and that it was "50:50 to be honest, could go both ways - I'm not holding my breath". My heart just sank so much - I really think we are going to lose him this week.
I am so sorry to hear this...50/50 chance.
I figured that if they did not see any 'gallstones' or inflamed bile ducts...with the ultrasound, that this would mean that Mao could overcome whatever is causing him to not being able to eat.

Plus, if they did get him to poop, that this too, would relieve his pain, and digestive symptoms.

Will still be saying many prayers for your Mao, and sending more Health Thoughts...for Mao to recover. :vibes::vibes::tabbycat: :alright: :hugs::grouphug::touched:🙏
Stay strong T trishia42 :hugs::grouphug:
 
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