Liquid famotidine - OTC? Compounded?

[FeebysOwner]

I cannot get my vet to agree on treating Feeby's potential nausea with anything other than famotidine to start with. Does anyone use an OTC liquid version? If not, have you had it compounded/flavored into liquid through a pharmacy?

Feeby (17+ yo) has H-T (currently being treated with Felimazole) and CKD (currently on Mirataz). As of late, the Mirataz doesn't seem to be as effective for her appetite, even though it does increase her restlessness/howling. So, I figure she must need some sort of anti-nausea meds. The vet won't prescribe Cerenia or Ondansetron - the most common nausea meds given to CKD cats - before trying famotidine.

Just to ward off the typical comments/questions:
She cannot be pilled via things like pill pockets or capsules (using any of the various tips/tricks/techniques).
Her dose of Mirataz likely does not need to be increased because she already demonstrates restlessness at her current dose.
I am not going to get another vet...just yet (she has already seen three since she lost her long-time vet last year).
I cannot force oral-syringe meds on her as she will automatically vomit them back up and/or foam/froth at the mouth.

Really just looking at famotidine and how any of you may have administered it successfully, without forcing the meds down your cat's throat.

Thanks.

 

[daftcat75]

I don't think famotidine is the right drug to give here. But if you like this vet, you may have to try A first to get to B and C.

Famotidine can definitely be compounded into a liquid. That was the form I gave to Krista in her short-lived time with it. I had to force it on her but she didn't seem to hate it as much as other meds. I believe it was fairly flavor neutral if I remember correctly (back when I would taste her liquid meds before forcing them on her to understand what I was asking of her.) Since famotidine had to be given thirty minutes prior to food and because I used the timer on the microwave, the only thing it did for Krista was Pavlov train her to associate the microwave timer with meal time. For the last three years of her life, if I didn't want her running into the kitchen looking for food, I had to stop the microwave a second early before it beep beep beeped her learned dinner bell. On the flip side, sometimes I intentionally set a timer just to see if I could trigger a hunger in her when we were having issues in that department.

I would try a chew treat if she likes treats or a flavored oil, especially if you can get it concentrated. Less oil to eat will be easier for compliance. With Krista's chemo, I got it compounded as anchovy-flavored 10x oil. Her dose came out to 0.1 mL instead of a full 1 mL. That 0.1 mL got mixed with a small amount of salmon oil to make a puddle about the size of a dime or nickel. Krista cleaned it every time.

I recommend working with Wedgewood for the compounding. They will work with you if Feeby isn't crazy about the form or flavor you chose and get a replacement out to you quickly.

Famotidine Medication & Information for Animals

You could try it as a transdermal. But I don't know how effective transdermal famotidine is. You are also running out of ears since you are encouraged to alternate ears with the Mirtaz. If you wanted to try transdermal, you could ask your vet to shave a small landing strip on her neck or another alternate to her ear that she won't be able to lick off.

 

[FeebysOwner]

I don't think famotidine is the right drug to give here. But if you like this vet, you may have to try A first to get to B and C.

I agree it probably isn't the right drug, And, I am beginning to like this vet less and less, but for now she will have to do.

famotidine had to be given thirty minutes prior to food.

Won't happen unless she loves it all by itself. The best I might be able to do is get my husband to give it to her in some baby food meat she routinely gets about 2-3 hours before her breakfast. If that is too long of a time frame, she will have to get it right before her breakfast.

I would try a chew treat if she likes treats or a flavored oil, especially if you can get it concentrated. Less oil to eat will be easier for compliance..With Krista's chemo, I got it compounded as anchovy-flavored 10x oil. Her dose came out to 0.1 mL instead of a full 1 mL.

She doesn't eat any soft treats, so not sure this is an option. But I do like the compounding with oil in concentrated form, if possible.

Feeby's likely first preference would be the beef/bacon compound (saw if offered on Wedgewood). Now, I know this vet works with some compounding pharmacy, what one I don't know. It will be my luck that she will want to go with 'her' pharmacy first - and, who knows what they offer. Bucking me every step of the way seems to be her preferred MO.

BTW, the vet's supposed logic is that because Feeby willingly eats a bit first thing in the morning and then stops thereafter nearly all day long, that the food is causing an over-production of acids - which she feels will be resolved with famotidine. I was stymied by this response, as I kind of thought acid over-production was pretty much a 24/7 thing and wouldn't just start after she ate something in the AM. But, hey what do I know...

 

[daftcat75]

It's your prescription. You should be able to take it to any pharmacy. You are already humoring her by trying the famotidine first. She needs to accommodate you and let you choose the compounding pharmacy and the form. Otherwise it's just a waste of yours and Feeby's time and money to try to administer a medicine she won't take.

Acid production occurs before meals. Dawn and dusk being prime hunting times, just before dawn and dusk is when acid tends to be highest. This is why cats who spit up white foam (stomach acid) usually do it just before breakfast. Smaller meals fed more often helps with this. It reduces the amount of acid needed for meals, and the time between meals to accumulate acid in anticipation of the next meal.

I don't think this is a stomach acid issue. It really could be anything else: her HT, her CKD, her 17-year old gut which doesn't perform like a 7 year old gut did, or side effects from any of the meds she might be taking.

 

[FeebysOwner]

It's your prescription. You should be able to take it to any pharmacy. You are already humoring her by trying the famotidine first. She needs to accommodate you and let you choose the compounding pharmacy and the form. Otherwise it's just a waste of yours and Feeby's time and money to try to administer a medicine she won't take.
Acid production occurs before meals. Dawn and dusk being prime hunting times, just before dawn and dusk is when acid tends to be highest. This is why cats who spit up white foam (stomach acid) usually do it just before breakfast. Smaller meals fed more often helps with this. It reduces the amount of acid needed for meals, and the time between meals to accumulate acid in anticipation of the next meal.
I don't think this is a stomach acid issue. It really could be anything else: her HT, her CKD, her 17-year old gut which doesn't perform like a 7 year old gut did, or side effects from any of the meds she might be taking.

I guess we will see just how accommodating this vet will be...

I am not sure domesticated pets work off the same 'dusk and dawn regimen' as animals in the wild - for generations now, their whole lives have been 'adjusted' away from that 'thanks' to humans. Regardless, Feeby has food to her avail all day long, and can eat when she wants - which does tend to be a bite or two at a time with long bouts in between (after her first meal).

All said, she rarely vomits - mostly due to the occasional hair ball, her stools are near perfect every time, her tummy doesn't gurgle, she doesn't burp or pass gas, she doesn't drool or show other obvious signs of nausea - you get the picture. Her primary issue is lack of appetite, and I suspect more likely due to the CKD itself, rather than any of her meds - add the age factor of course because she is pretty sedentary!!

 

[MissClouseau]

BTW, the vet's supposed logic is that because Feeby willingly eats a bit first thing in the morning and then stops thereafter nearly all day long, that the food is causing an over-production of acids - which she feels will be resolved with famotidine. I was stymied by this response, as I kind of thought acid over-production was pretty much a 24/7 thing and wouldn't just start after she ate something in the AM. But, hey what do I know

You know we are monitoring my Hima’s liver-gallbladder enzymes frequently. Her Bile Acid level is always well within the normal range when the test is done after fasting. But it gets elevated sometimes when the test is done 2 hours after eating.

 

[FeebysOwner]

You know we are monitoring my Hima’s liver-gallbladder enzymes frequently. Her Bile Acid level is always well within the normal range when the test is done after fasting. But it gets elevated sometimes when the test is done 2 hours after eating.

I think the testing you have done on Hima must be something above and beyond the standard Super Chem panel. While I can see the results of Feeby's liver enzyme values, I don't have a clue if bile acid level or gallbladder enzymes are within the liver enzyme counts. But I can tell you her liver enzyme values stay within the same range whether or not she fasted before the blood work.

 

[MissClouseau]

I think the testing you have done on Hima must be something above and beyond the standard Super Chem panel. While I can see the results of Feeby's liver enzyme values, I don't have a clue if bile acid level or gallbladder enzymes are within the liver enzyme counts. But I can tell you her liver enzyme values stay within the same range whether or not she fasted before the blood work.

Bile Acid appears as “BA” in the blood test. You are right it’s not usually a part of the routine biochemistry test. Hima gets Liver Finction Test which includes Bile Acid.

Hima’s liver enzymes don’t really change between the fasting vs non-fasting. Not that I noticed at least. Bile Acid does though. The normal range is given to be 0-25. She gets 0-2 when the test is done after fasting. Minimum
25 when it’s done 2 hours after eating, sometimes it goes up to 26-27.

 

[MissClouseau]

And note when Hima gets nauseous, it’s also usually after eating. In fact sometimes she only gets nauseous before her evening and night meals although she eats the same food every day. I don’t know if it’s any related to what Feeby might be experiencing of course.

 

[FeebysOwner]

And note when Hima gets nauseous, it’s also usually after eating. In fact sometimes she only gets nauseous before her evening and night meals although she eats the same food every day. I don’t know if it’s any related to what Feeby might be experiencing of course.

It could be. Feeby does eat baby food meat very early in the AM, 2-3 hours later I give her breakfast and that is when she eats best. After that, it tapers off exponentially, but she will take a bite or two off and on throughout the day/evening. Sometimes, she will eat some 'leftover' food late in the evening and never is opposed to more baby food meat as a 'midnight snack'. So, I am not sure. But, besides the baby food meat, it does seem to be that she is 'off' eating her food after breakfast.

 

[MissClouseau]

It could be. Feeby does eat baby food meat very early in the AM, 2-3 hours later I give her breakfast and that is when she eats best. After that, it tapers off exponentially, but she will take a bite or two off and on throughout the day/evening. Sometimes, she will eat some 'leftover' food late in the evening and never is opposed to more baby food meat as a 'midnight snack'. So, I am not sure. But, besides the baby food meat, it does seem to be that she is 'off' eating her food after breakfast.

maybe you can discuss with the vet testing BA. Especially for a non-fasting test. If it gives any answers. They are strict about the rules like I was told Hima needs to fast for 8 hours, then eat about quarter of her meals or close, then no eating for 2 hours.

 

[rvf4uk]

What type of baby food meat do you give? My cat went off his usual small packs so trying chicken in broth but when his cancer gets worse I know his appetite will so looking for other things to have in, thx

 

[FeebysOwner]

I have used both Gerber Stage 2 and Beechnut. Feeby prefers Gerber, especially the chicken and ham flavors. Gerber also has beef and turkey. Beechnut has chicken, beef, and turkey. There is another brand, named Goya, but I have never tried that.

Good luck to you.

 

[maggie101]

I cannot get my vet to agree on treating Feeby's potential nausea with anything other than famotidine to start with. Does anyone use an OTC liquid version? If not, have you had it compounded/flavored into liquid through a pharmacy?

Feeby (17+ yo) has H-T (currently being treated with Felimazole) and CKD (currently on Mirataz). As of late, the Mirataz doesn't seem to be as effective for her appetite, even though it does increase her restlessness/howling. So, I figure she must need some sort of anti-nausea meds. The vet won't prescribe Cerenia or Ondansetron - the most common nausea meds given to CKD cats - before trying famotidine.

Just to ward off the typical comments/questions:
She cannot be pilled via things like pill pockets or capsules (using any of the various tips/tricks/techniques).
Her dose of Mirataz likely does not need to be increased because she already demonstrates restlessness at her current dose.
I am not going to get another vet...just yet (she has already seen three since she lost her long-time vet last year).
I cannot force oral-syringe meds on her as she will automatically vomit them back up and/or foam/froth at the mouth.

Really just looking at famotidine and how any of you may have administered it successfully, without forcing the meds down your cat's throat.
Thanks.

I have not read through everything but my vet recommended Elura for weight management. Something new in liquid form. I can give her a pill but not liquid. only can be prescribed,not otc
FDA Approves Elura for Weight Loss in Cats with Chronic Kidney Disease

 

[FeebysOwner]

I have not read through everything but my vet recommended Elura for weight management. Something new in liquid form. I can give her a pill but not liquid. only can be prescribed,not otc

I have read about Elura. But, as you say it is prescription. So if I can't get the vet to prescribe Cerenia, ondansetron, or even metoclopramide, the odds are not good she would be willing to prescribe that one either.