HOW do I get the Mirtazapine INTO the cat?

GracieAllen

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Our 13-14 year old cat is now on kidney diet because she has early stage kidney disease. She's been taking Cisapride for over a decade, and still is.

Prior to the switch, she wasn’t eating a lot, and was losing weight so we were prescribed Mirtazapine. We started with pills… That did NOT work. Broke the small pills into even smaller pieces and tried to get her to take them.

In food, no. In treats, ONE time. In other treats, ONE time. We tried a piller, we tried blowing it in, we tried manually giving them. NOTHING. I could almost guarantee if we got it in at all, 15 minutes later I’d find a tiny, pink piece of pill sitting in her cat bad or somewhere. She would not take the pills.

We switched to the liquid. She hates the stuff with a PASSION. We’ve tried EVERY flavor – beef, chicken, salmon (if I recall) and most recently tuna – she HATES them all.

The normal dose is supposed to be .37ml. Giving her ANYTHING more than .1 – we tried .15 - and she vomits it up within a minute. Like clockwork – hold cat, give her liquid, hold cat, 60 seconds, vomits – always vomits twice. Usually clear or milk liquid. Usually no food in it, usually no fur ball, though very occasionally a small one.

We always take up her food for at least 30 minutes, sometimes 60, BEFORE we give her the Mirtazapine.

SO, we gave her .1 ml every other day. She ate BETTER but not great. Still lost weight. Vet had us switch to .1 daily.

Now we’ve switched to the kidney diet and she WAS eating it pretty well. She recently had a bout of pancreatitis, but that SEEMS to be better – but she’s been to the vet multiple times over the last month to the tune of $500 and $700 because there are ALWAYS x-rays and tests and blood work and whatever. And we're NOT in the middle of a major metropolitan area, so there aren't a dozen vets to try... So vet shopping isn't going to be a big success.

Even on the .1 ml, she’s always vomited it up about 1 time in 5, but this week it’s been EVERY DAY. I changed to .05 ml, and for the last 2 days she’s thrown THAT up.

BUT, if I give her a dose and she throws it up, I can then go get ANOTHER dose and give it to her and she DOESN’T throw it up…

Needless to say, NOBODY, cat included, is enjoying having her mouth pried open and given something she hates, followed by vomiting.

We can take her back to the vet AGAIN, but so far they haven’t had any answers.

So, HOW do I get this stuff in her, in a large enough quantity to make her appetite significantly improve? Oh, and there’s a NEW bottle of the stuff on it’s way ‘cause we’re about at the time limit on keeping the stuff – our doses are so small we don’t use it all up. But if she won’t take a piece of a pill about the size of the head of a pin, I DON’T see being successful with a gelcap or whatever…

Ideas? 'Cause I'm out of 'em and I need a fix...
 

AbbysMom

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I know you have a bottle on the way, but can you try the transdermal Mirtazapine? My cat is awful to pill as well and my vet gave me the transdermal that you rub on their ear.
 
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GracieAllen

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I can call the vet when they open and see... CAN'T hurt to try - can't be much worse than the liquid.
 

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The transdermal is an ear gel you rub into the pinnae of the ear - the brand name is Mirataz. The 'typical' dose is 1.5" strip of the ointment, given every day with alternating ears. I do not give that dosage to Feeby - she gets half that amount and only every third day. You will likely need to experiment to see what dosage and frequency are good for your cat. It, too, has an expiration date - 30 days once the tube is opened. I used the first tube for 60 days and then got another one and threw out the old tube. It is pretty wasteful, but what can you do?

You will need gloves to apply it. I use the most basic plastic gloves and cut off a finger for each application so that I don't have to go through so many gloves. You will also need to clean your cat's ears in between applications as the ointment tends to create a sort of residue that can lessen the efficacy of subsequent doses. I simply use unscented hypo-allergenic wipes. Some folks like to use witch hazel.
 
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GracieAllen

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Two days now with the transdermal Mirtazapine. Gave about a half dose yesterday morning - she at less than three ounces in 24 hours.
Today I have close to a full dose about 6 a.m. So far, 5 hours later she's eaten a couple bites.

She WAS eating between 5 and 6 ounces a day when we started her on the kidney diet(s), and still slowly losing weight. Now she's eating half that but at least she's not vomiting every morning. This is all the same foods that she ate pretty well previously.

We also, at our vet's recommendation, started adding chicken gravy to the food. She'd eat the gravy. And he recommended putting down some chicken broth. She'd drink several ounces of THAT per day. Didn't eat the food but ate the gravy and drank the broth.

We're pretty much out of ideas - HOPEFULLY, it's just that the transdermal stuff takes a few days? 'Cause she's not showing any signs of wanting to eat.
 

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It is possible that she is also nauseous. While Mirataz/Mirtazapine has some anti-emetic properties, it might not be enough all by itself. So, you could be looking at administering an anti-nausea med in addition to the Mirataz - or lieu of it. I would ask the vet about this. I am not sure there is supposed to be a 'waiting period' or a 'build up' for the Mirataz to become effective.

Feeby has her good days on Mirataz where it seems to work well and other days when it does not. Even at first, it usually took almost 24 hours after administration to see a change in her eating. I have also found that if I give her a food she does not like, there is no amount of Mirataz in the world that will get her to eat it. I am going to talk to her vet about either giving her an anti-nausea med in place of or in addition to the Mirataz.
 
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GracieAllen

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We've been using full doses of the Mirataz for the last 5 days. It got worse. Monday I picked up a can of Hill's A/D and after eating .25 ounce for breakfast, between lunch and overnight she at the WHOLE 5 oz can. Picked up a couple more yesterday and did the same thing. Yesterday, eating A/D, she at a total of 1.9 oz.

I talked to the vet tech when picking up the A/D and got a call from my vet a couple hours later. He has a NEW appetite stimulant he says people are saying works really well. He hasn't used it but he's got some, so we're picking that up this morning.

BUT, watching her I started wondering if she has an oral problem. She drinks water, chicken broth and gravy. But she often goes to great effort to get the broth and/or gravy out of the food, then doesn't eat the food.

She's been in (I think) three times in the last month, complete with blood work, renal tests, x-rays, a test for pancreatitis (which she had), etc. BUT I don't KNOW if anybody did a good, detailed look at her mouth - bad tooth? Abscess? Sore gum? If it hurts to eat, even soft food, you don't eat. When we pick up the new stuff I'll ask about the mouth and maybe we need to get over there to have that checked. I'd hate to give her some kind of appetite stimulant so she eats with a sore mouth.
 

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Make sure you look up the new med to see what some of the side effects might be - just so you know. As far as the food and how she is eating it - it wouldn't hurt to have her mouth looked at, but it could also just be a matter of a change in texture. For example, Feeby will eat pates but only eats the gravy/broth off of any food that has a 'chunkier' texture.
 
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GracieAllen

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When picking up the new stuff, we talked to one of the people that worked on HRH the last couple times. She said they did a thorough exam of her mouth and teeth and throat 'cause they had the same question way before it hit me...

As for side effects, they don't list a lot, but it doesn't make a lot of difference 'cause if the cat doesn't start eating, she's going to die. This is the hail Mary. If this doesn't work, we're out of options.

The good news is, after giving her breakfast and having her eat .15 oz - which is probably the amount of moisture that evaporated, I gave her the first dose of Elura (the new stuff). It's 5 pm, she was fed at noon, and since then she's emptied two servings about 1.2 oz each. We'll be giving her dinner shortly. If she eats this, we can increase her servings...
 
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GracieAllen

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I forgot to mention, the vet also recommended 2.5mg/day of Pepcid. SO, we took one of the little tablets and cut it into 4 very small pieces. I wrapped it in a bit of Hill's A/D and proceeded to give it to the cat - I held the pea sized bit of food with the tiny piece buried in it. Cat looked at finger with food, looked at me, then turned around and ignore the food and me.

Held cat and tried again - NOT opening her mouth. Squeeze so she'd open like we do to give liquids and she opened, I thrust food in, cat spit a little out - the part with the pill in it. Reformed small amount and opened mouth again. Attempted to insert food, cat turned, food now on cat bed. ONE more try - cat is now TOTALLY disgusted with me, and POSITIVE I'm the WORST STAFF EVER.

Open mouth one more time and FINALLY get food and pill in. She swallows, I stroke ears and neck, and cat gets up and leaves cat bed. And SITTING THERE, in the corner of the bed, is a minuscule pink piece of PEPCID...

HRH HATES getting pills. And HATES being manhandled without her permission. This was BOTH!

If the Elura works, maybe we could grind it to powder and put it in her breakfast!

OR, we'll get some liquid, mix it with the Elura in the syringe, and do it that way - it's less traumatic than trying to give her a pill!
 

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I have never been able to use liquid. For pills,I dip it in churu or tiki tubes for taste and it slides down much easier down her throat. Tilt her head back,dip the pill in it,put it in,quickly close her mouth then wait for her to swallow. Tiki a small pet store may have it,churu you have to buy online. Almost 90% water which your cat needs
 
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