Mirtazapine Losing Its Effect

WeHave4

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I've used Mirtazapine, (also Mirataz, but only the past couple of months) occasionally for our cat Alice, who is also taking low-dose prednisolone. The mirtazapine was used sporadically, as needed, and at what I call micro-dose levels - as low as 1/200th of a 15 mg pill. It worked fine for about 3 years, then last year, I seemed to need to use it more often, and then about a month ago, needed larger doses. I even gave her 1/4 tablet recently, with very little effect. So, the vet had me stop giving her the mirtazapine (or mirataz), cold turkey. I have a bottle of CBD oil - Innovet PURCBD, which I got a couple months or so ago, but haven't really dared use it because it was another variable, but now I am trying it out. Today is Day 2, and so far, so good. I am giving her 3 drops at the same time as her pred. If I think she needs it, I'll give her a second dose at lunch time.
She is actually overweight (16 lbs.), which is a separate issue, and I am addressing that by cutting down her food intake from about 6 tablespoons total (both canned and dry) to 5 tablespoons, roughly a 17% decrease. I don't agree with the vets' opinion that her going without food, or eating very little for a day or so is fine. It most certainly is not. He's too stuck on the issue of her weight. This is a failing I have seen of other vets. I will get her weight down, but I want to see her continuing to eat.
 

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I won't ask why your cat needed Mirtazapine since most of the time that means a cat isn't eating adequately and most therefore lose weight - and unless she weighed a lot more before, her weight would indicate she has eaten just fine. The pred normally causes increased hunger, but perhaps that was not the case for your cat?

However, your approach for cutting her calories is, IMO, on target. Even a 17% reduction could be seen as a bit high to start off with, but if she is doing well with that reduction then for her it is fine. One of the main concerns in cutting down calories is to ensure it is done slowly enough that the cat has a chance to adapt - physically and mentally - to the lower amount of food, which makes the transition much more comfortable. And, just as is professed for humans, a slow weight loss is by far better and healthier than losing it quickly.
 
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WeHave4

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She was on pred. basically for the same reason as the mirt. - to help keep her appetite at least somewhat on an even keel. Otherwise, there were days when she would barely eat anything at all. They never discovered why. Unexplained anorexia. The weight gain was an unintentional side effect, and I can deal with that.
 
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WeHave4

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I would love to be able to wean her off of the pred., and have tried to before, but it always seems to backfire sooner or later. Perhaps the CBD oil will allow me to do so eventually.
 
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WeHave4

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Yes. She loses her appetite. I have looked at other appetite stimulants. They don't interest me. Anything like "toppers" or special "treats" are useless with her. Other drugs? Why replace one drug with another? The CBD seems to be working anyway, so far.
 

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My experience with the appetite stimulants has been that, as listed in order in the article, Elura (capromorelin) was more effective than the first two.
 
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I hadn't heard of that, so looked into it a bit. It sounds promising, if the cbd oil doesn't work out, although I noticed one side effect is that it raises glucose levels and since hers tested high (but not quite reaching diabetic levels), the vet probably would not prescribe it for Alice.
 

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The FDA document on Elura and elevated glucose levels said that was a transient side effect. Looking further, it seems the glucose level is increased for several hours after dosing and then apparently decreases. So, that might be what you would want to talk about with your vet if you should have to consider Elura. Maybe the vet would find it acceptable since the elevation is temporary?
 
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Possibly. And that's only if I can convince him that she needs to have her appetite increased. Vets, and people generally seem to confuse and conflate the issues of weight and inappetance. You would think that vets would know better. Although certainly connected, they are not the same thing. Yes, she is overweight. And the way to approach that safely is a reduced food intake, not a crash diet. Therefore, I still need to see her eat, and when she refuses to, it is a problem.
 

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If your vet thinks the best way to get your cat to lose weight is to let her stop eating, then it is probably time to find another vet. Any vet that would tell me that would soon be my cat's ex-vet. Any friends/family/neighbors/co-workers that could provide you with a name of a vet they use and like? Next Door Neighbor web site is an excellent place to get recommendations for another vet. All of her records are yours, so you get copies of them (and any tests) to share them with a new vet - helps to reduce redundant costs and gets a new vet up-to-speed more quickly.
 
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WeHave4

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Unfortunately, it is extremely difficult finding vets in the area willing to take new patients. And, I have seen that idea before, that, well, she's overweight, so tell me again why she needs to have her appetite increased? Yes, it is retarded. It's their training, I guess.
 
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