Cerenia Nearly Killed My Cat

CaydensDad

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Dramatic title, I know, but it's true. I'm not here to bash on Cerenia or to say that everyone's experience will be the same; I imagine the drug has passed clinical trials, so was found to be safe and effective for a majority of cats. But safe it was not for Cayden, my 14 year old baby boy. This is not a request for help or guidance, this is sharing of an experience, since there are very few references online of Cerenia harming a cat.

Cayden was diagnosed with small cell lymphoma around April 2022 and we've been trying, desperately, to manage his disease and stabilize him on a cocktail of Chlorambucil, Prednisolone, Cerenia (8mg pill for assumed nausea due to lip-licking and periodic inappetence), Mirtazapine (to counteract inappetence), Lactulose (to attempt to resolve constipation), and a handful of other meds that did little to nothing to resolve the symptoms they were meant to target. Our oncologist (let's call him Dr. Bob) believed that Cerenia was the best option to resolve Cayden's nausea (even though it didn't seem to be having an effect), so Dr. Bob instructed us to start giving Cayden a daily dose of Cerenia, which we did, leaving out a few days here and there to give him a rest (since he hated being pilled). Over time we noticed his daily intake of calories was gradually reducing, but we assumed this was related to his lymphoma not being controlled well.

In August/September, we had a medical emergency - Cayden had mostly stopped eating - and rushed to the ER. The ER Vet provided a small supply of Omeprazole and Metoclopramide and instructed us to lay off the Cerenia for a few days since the Metoclopramide also acted as an antinauseant. Within a couple days, Cayden's appetite started to come back. I had a debate with Dr. Bob, insisting that the Cerenia was keeping Cayden from vomiting, but not dealing with his symptoms of nausea (Cerenia is advertised as an anti-emetic) and that we had more luck with Metoclopramide. Dr. Bob wouldn't hear it and insisted we continue with the Cerenia (would not provide more Metoclopramide). So we continue to give him the Cerenia.

October 20th, we start to see something scary: not only is Cayden's appetite extremely low, the Mirtazapine, which was giving him 3 day boosts to keep him eating, was doing nothing. Cayden was eating next to nothing and the only tools in our belt weren't helping. We moved up our appointment with Dr. Bob, but it was still a week away (the earliest he was available). We tried desperately to get some Metoclopramide from one of our vets, but no one would provide it. So we watched, day by day, as my sweet baby shriveled up on himself: he ate next to nothing, he did nothing but sleep, he had no interest in giving or receiving love. The only way he'd eat is to lick wet food off of our fingers and even that wasn't always successful. We took him to our primary vet on October 25th and had a very difficult talk about putting Cayden to sleep. We were devastated. We decided to schedule an in-home euthanasia for October 28th... and we grieved. We told the people around us what was happening and that we were going to need time to mourn.

On the morning of the 27th, when I was about to make the call to book the appointment, I was pouring through Cayden's health tracking sheet, trying to see any sort of pattern... and I spotted something. The loss of appetite in August/September and again in October, each coincided with a period of time when Cayden had Cerenia on a daily basis for over a week, with no rest days. I Googled like a madman and found a small handful of people online claiming that Cerenia was having an effect on their cats appetite and I decided: I needed to run one last experiment. Friday morning, Cayden did not receive a Cerenia and I went out to get as many different types of enticing wet foods as I could. Friday night, Cayden began eating, a little. Saturday morning, Cayden ate a bit on his own - the first time in days. Each day since Friday, Cayden has been eating a little bit more. This morning, I gave Cayden some Mirtazapine, again, and he's been eating like a champ now that the Cerenia isn't counteracting the Mirtazapine.

We're still on high-alert here. Through trial and error some months ago, we discovered Cayden requires roughly 110-130 calories a day to maintain his weight. For the past nine days, he's had below 100 calories, eating as little as 45 calories one day. But our tracking sheet shows that he's eating a little more every day since Friday. We're also seeing him slowly come back to his personality. He still sleeps a lot, as he should with his low caloric intake, but he's more interested and curious about the world and last night he snuggled with me for the first time in weeks. We're cautiously optimistic, but we know that there are so many ill effects that could come from the hardship his body just went through. We're getting him a little more stable, then we'll take him back to our primary vet for another assessment.

I break a little, on the inside, thinking about how close I came to putting my baby to sleep because I didn't see this pattern sooner. But I finally have confirmation that Cerenia was killing my cat and it no longer has a place in this house.
 

fionasmom

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Any pet can have a drug reaction, even if the odds of it happening are slim. In the case of Cayden, your instincts possibly saved his life. We have a number of members who have faced SCL, including my Chelsea; hopefully, your boy will recover from this episode and go on to better health, despite his diagnosis.
Please let us know how he does.
 

Astragal14

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I am so glad that Cayden is doing better. I don't want to overstep my bounds since you haven't asked for help or guidance, I just want to mention a few things that stand out to me.

First, is Cayden getting B12 injections (cobalamin)? It wasn't mentioned with his other medications and it will go along way towards improving his appetite and helping his body absorb medications and supplements. GI issues will deplete a cat's B12 faster than they can build it back up, making supplementation a necessity.

The Importance of B12 – IBDKitties
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... Because a healthy liver is able to store many years worth of B12, signs of deficiency may not be obvious for a long time.
Second, was 8 mg his daily dose of Cerenia? I know many cats on Cerenia and that's twice as high as the standard 4 mg dose. Some vets think a double dose is warranted, but I feel like there are more vets that would caution against this. There are a few anecdotal reports of Cerenia causing lethargy, so I don't think it's just speculation to ask your vet if a double dose could cause extreme lethargy.

Third, use of Cerenia is cautioned in animals with certain liver and heart conditions. It sounds like this doesn't pertain to Cayden's condition, it's just something to be aware of.

https://www.ema.europa.eu/en/documents/overview/cerenia-epar-summary-public_en.pdf
The active substance in Cerenia, maropitant, is broken down in the liver and therefore it is recommended to be used with caution in animals with liver disease. Since maropitant could affect heart activity, Cerenia should be used with caution in animals with certain heart conditions.
Contra-indications, warnings, etc
Maropitant is metabolised in the liver and therefore should be used with caution in dogs with liver disease. As maropitant is accumulated in the body during a 14 day treatment period due to metabolic saturation, careful monitoring of liver function in addition to any adverse events should be implemented during long term treatment.
Cerenia should be used with caution in animals suffering from or with a predisposition for heart diseases. Cerenia should not be used concomitantly with Ca-channel antagonists as maropitant has affinity to Ca-channels.
Maropitant is highly bound to plasma proteins and may compete with other highly bound drugs.
 
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CaydensDad

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First, is Cayden getting B12 injections (cobalamin)?
I missed mentioning this since he has a long list of meds, but yes... though it seems like a low dose to me. 250mcg injection once a month. By contrast, I personally take 100mcg daily.

Second, was 8 mg his daily dose of Cerenia?
Yes, 8mg daily. Dr. Bob mentioned it should be 2mg per kilo and, at the time, Cayden was over 4kg. I tried very hard to get Dr. Bob to give Cayden Metoclopramide instead of Cerenia as I suspected he had a motility issue. Instead I was told to keep him on Cerenia and add Lactulose.

There are a few anecdotal reports of Cerenia causing lethargy, so I don't think it's just speculation to ask your vet if a double dose could cause extreme lethargy.
Cayden didn't really show signs of lethargy until a few days after he stopped eating. I firmly believe his lethargy was related to insufficient calories (he was starving to death).

Third, use of Cerenia is cautioned in animals with certain liver and heart conditions. It sounds like this doesn't pertain to Cayden's condition, it's just something to be aware of.
I'm not aware of any liver disease, though he does have a heart murmur.
 

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Any pet can have a drug reaction, even if the odds of it happening are slim.

:yeah:

If you feel that Cerenia caused an adverse reaction, you should report it to Zoetis, the manufacturer of the drug. The box of Cerenia should have a folded piece of paper inside with the prescribing info in teeny tiny print. There's info there on common side effects, known adverse reactions, and how to report adverse reactions. If you don't have the piece of paper, it's online: https://www2.zoetisus.com/content/_assets/docs/vmips/package-inserts/cerenia_tablets.pdf
 
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CaydensDad

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If you feel that Cerenia caused an adverse reaction, you should report it to Zoetis, the manufacturer of the drug.
Thank you, others have suggested the same via private message. I attempted to submit a report via online form, but it's gated and requires a login. Their registration is geared towards professionals in the industry (and I also really don't want an account with them). I may phone them, if I can muster the time and energy, but I'm burned out after this past week+ and have plenty to do.
 

LTS3

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Your vet can probably file an adverse reaction report on your behalf. There's probably some veterinary credentials required to create an account anyways. Otherwise just give Zoetis a call.
 

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Inappetence is listed as a 2% incidence of adverse events in the drug data sheet. Of 107 dogs in the trial, two were found to have this adverse event. Cerenia hasn’t been approved for use in cats. It is used off-label for cats though. I am not certain if adverse event studies have been performed with cats. But I think inappetence or reduced appetite is a more common side effect among cats than 2% simply from the number of reports I’ve read in these forums.

I would definitely engage the prescribing physician (Dr Bob?) and let him know if he doesn’t already. And have him file the adverse event report with Zoetis. It’s possible because Cerenia is only approved in dogs and off-label for cats that both the vets and the manufacturer don’t have enough data to know that inappetence appears to be a far more common adverse event in cats.
 

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I am so sorry you and your baby had to go through this, but I'm glad he's back on the path to health. I have had 2 different cats given Convenia at 2 separate times and both responded the same way. They were very lethargic, zombie-like, and had very little to no appetite for about 10 days. They have both passed away now after very long lives. I have it (and Metacam) on all my cats' do not give list at the vet.
 

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I'm glad he's finally starting to recover, I hope none of our animals have to go through this experience
 

CeilidhCat

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Dramatic title, I know, but it's true. I'm not here to bash on Cerenia or to say that everyone's experience will be the same; I imagine the drug has passed clinical trials, so was found to be safe and effective for a majority of cats. But safe it was not for Cayden, my 14 year old baby boy. This is not a request for help or guidance, this is sharing of an experience, since there are very few references online of Cerenia harming a cat.

Cayden was diagnosed with small cell lymphoma around April 2022 and we've been trying, desperately, to manage his disease and stabilize him on a cocktail of Chlorambucil, Prednisolone, Cerenia (8mg pill for assumed nausea due to lip-licking and periodic inappetence), Mirtazapine (to counteract inappetence), Lactulose (to attempt to resolve constipation), and a handful of other meds that did little to nothing to resolve the symptoms they were meant to target. Our oncologist (let's call him Dr. Bob) believed that Cerenia was the best option to resolve Cayden's nausea (even though it didn't seem to be having an effect), so Dr. Bob instructed us to start giving Cayden a daily dose of Cerenia, which we did, leaving out a few days here and there to give him a rest (since he hated being pilled). Over time we noticed his daily intake of calories was gradually reducing, but we assumed this was related to his lymphoma not being controlled well.

In August/September, we had a medical emergency - Cayden had mostly stopped eating - and rushed to the ER. The ER Vet provided a small supply of Omeprazole and Metoclopramide and instructed us to lay off the Cerenia for a few days since the Metoclopramide also acted as an antinauseant. Within a couple days, Cayden's appetite started to come back. I had a debate with Dr. Bob, insisting that the Cerenia was keeping Cayden from vomiting, but not dealing with his symptoms of nausea (Cerenia is advertised as an anti-emetic) and that we had more luck with Metoclopramide. Dr. Bob wouldn't hear it and insisted we continue with the Cerenia (would not provide more Metoclopramide). So we continue to give him the Cerenia.

October 20th, we start to see something scary: not only is Cayden's appetite extremely low, the Mirtazapine, which was giving him 3 day boosts to keep him eating, was doing nothing. Cayden was eating next to nothing and the only tools in our belt weren't helping. We moved up our appointment with Dr. Bob, but it was still a week away (the earliest he was available). We tried desperately to get some Metoclopramide from one of our vets, but no one would provide it. So we watched, day by day, as my sweet baby shriveled up on himself: he ate next to nothing, he did nothing but sleep, he had no interest in giving or receiving love. The only way he'd eat is to lick wet food off of our fingers and even that wasn't always successful. We took him to our primary vet on October 25th and had a very difficult talk about putting Cayden to sleep. We were devastated. We decided to schedule an in-home euthanasia for October 28th... and we grieved. We told the people around us what was happening and that we were going to need time to mourn.

On the morning of the 27th, when I was about to make the call to book the appointment, I was pouring through Cayden's health tracking sheet, trying to see any sort of pattern... and I spotted something. The loss of appetite in August/September and again in October, each coincided with a period of time when Cayden had Cerenia on a daily basis for over a week, with no rest days. I Googled like a madman and found a small handful of people online claiming that Cerenia was having an effect on their cats appetite and I decided: I needed to run one last experiment. Friday morning, Cayden did not receive a Cerenia and I went out to get as many different types of enticing wet foods as I could. Friday night, Cayden began eating, a little. Saturday morning, Cayden ate a bit on his own - the first time in days. Each day since Friday, Cayden has been eating a little bit more. This morning, I gave Cayden some Mirtazapine, again, and he's been eating like a champ now that the Cerenia isn't counteracting the Mirtazapine.

We're still on high-alert here. Through trial and error some months ago, we discovered Cayden requires roughly 110-130 calories a day to maintain his weight. For the past nine days, he's had below 100 calories, eating as little as 45 calories one day. But our tracking sheet shows that he's eating a little more every day since Friday. We're also seeing him slowly come back to his personality. He still sleeps a lot, as he should with his low caloric intake, but he's more interested and curious about the world and last night he snuggled with me for the first time in weeks. We're cautiously optimistic, but we know that there are so many ill effects that could come from the hardship his body just went through. We're getting him a little more stable, then we'll take him back to our primary vet for another assessment.

I break a little, on the inside, thinking about how close I came to putting my baby to sleep because I didn't see this pattern sooner. But I finally have confirmation that Cerenia was killing my cat and it no longer has a place in this house.

THANK YOU TO CAYDEN'S DAD. It pays to keep notes and cross reference to see patterns. You did a marvellous thing and anyone who read your post will be a little wiser :)
 

Zenix

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Cerenia DID kill my cat. Last year I took my cat to the vet for gastrointestinal upset, she had vomited frequently through the night. The vet gave her some without even asking me as she was performing the exam. (I was not allowed in the room because of coronavirus regulations). She had complications with fluid in her lungs and she lost her appetite. I was advised to keep giving it to her even if she fought me. Stupid me, I did. I found out that she died from complications of cerenia... it lead to organ failure.

She was just three years old. I was there for her birth and raised her every day since she was born. I found her mom as a stray and she was pregnant. I fell in love with all of them and adopted them.

My life has never been the same. There's a hole inside. I can't help but feel I killed my baby. She was telling me she didn't want it but the vet said it would make her better.
 
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