Prozac and Mirtazapine?

[katiekat89]

Hello all,


I started my cat Theo on 5mg of Prozac on Thursday of last week for inappropriate urination per the advice of my vet. He seemed to be fine the first few days, but his appetite had decreased a bit and on Sunday I noticed he did not go to the bathroom at all. Finally he ended up pooping and peeing in the middle of the night (Sunday night going into Monday), then didn’t go pee again until Tuesday morning around 8am. He then didn’t go pee again until today at 1pm, and only had one very small poop in the middle of the night last night. I ended up taking him back to the vet today because I was concerned about him going over 24 hours between peeing (especially as he’s had some issues in the past with cystitis). They did a physical exam and said his bladder seemed fine but that he may be a little dehydrated, so they gave him some fluids. We are also going to stop the Prozac for now and I didn’t give him his dose today. She suggested that maybe if he wasn’t eating as much that could be causing him to not be drinking as much (he’s on a special prescription urinary health food) and that could be why he’s not going to the bathroom as much. He actually seemed to be eating better today and yesterday but she ended up giving him an appetite stimulant, Mirtazapine.

Since we’ve been home, he has been acting weird. He’s being very vocal and seems like he can’t relax. When I go over to him to pet him he meows and then walks away from me to lay down somewhere else. It seemed like he was breathing a little quickly too. I looked online and apparently mirtazapine shouldn’t be combined with Prozac because it can cause serotonin syndrome, so now I’m freaking out that that’s going to happen to him. The side effects of Mirtazapine seem to be very similar to serotonin syndrome so I’m also just really unsure of what’s happening. I called the vet and they said these are normal side effects of the mirtazapine and to just monitor, but the effects could last up to 3 days. I didn’t mention that I had read the two medicines shouldn’t be combined because I was talking with a receptionist and she was relaying info back and forth and honestly I just felt like maybe I was being over concerned and I should trust my vet. I have only been to this vet twice now so I don’t have that trust built yet though.

Anyone familiar with this and know if I should be worried or not? There is an emergency vet somewhat near me but they’re only open til 11 and I don’t even know what would constitute an emergency right now.

 

[librarycat2022]

I can't help you out that much. My cat is on Mirtazapine and doesn't like it. I do the ear dose. But it does help him eat- as does Entyce.
With the Mirtazapine I put it in his ear- he bucks- even though I am gentle or try to be and then jumps away runs away and looks at me blinking his eyes rapidly. So all I can say is that my cat acts much different to personality on this. But it seems to do the job. Best to you both!

 

[katiekat89]

I can't help you out that much. My cat is on Mirtazapine and doesn't like it. I do the ear dose. But it does help him eat- as does Entyce.
With the Mirtazapine I put it in his ear- he bucks- even though I am gentle or try to be and then jumps away runs away and looks at me blinking his eyes rapidly. So all I can say is that my cat acts much different to personality on this. But it seems to do the job. Best to you both!

Thanks for responding, does it make him meow like crazy? I could barely sleep last night and now this morning he had some diarrhea. I am glad he went to the bathroom, but the diarrhea makes me nervous. I’m not sure if it’s from the meds or just from eating so much.

 

[AbbysMom]

My cat has never been on prozac, but mirtazipine definitely makes her restless.

 

[silent meowlook]

Recognizing and treating serotonin syndrome (dvm360.com)

 

[katiekat89]

My cat has never been on prozac, but mirtazipine definitely makes her restless.

Okay yeah, the vet said that was normal so glad to hear it from someone else. It was awful last night

 

[katiekat89]

Recognizing and treating serotonin syndrome (dvm360.com)

Thanks - I’ve read through that and it’s so hard because some of the symptoms overlap with side effects from the Mirtazapine. Although it did mention diarrhea which he had this morning and is not a side effect of mirtazapine, but could be just from eating so much more than he had been. Maybe I will call the vet again today.

 

[daftcat75]

I've had two cats on mirtazapine now. What I've come to learn is that the recommended dose is too high for many cats. I would not change the dose without your vet's guidance. But certainly bring that up and ask if you can try either a lower dose and/or alternate dosing days.

My Betty is getting used to taking daily mirtazapine. She doesn't like the wet willy in the ear. But she seems to understand that it's necessary and doesn't struggle too hard against it like she used to. As far as the side effects, when we first started, she would get a bad case of the meows if I left her to it. Or if I was there to hold her and stroke her, it would be a lesser case of the chirps. Krista was the same way. There seems to be a mirtazapine rush that I need to be there to support them through it. But as long as I'm there, they trill (Krista) or chirp (Betty) and purr their head off until the rush has passed. That seems to be the normal case. I cannot comment on serotonin syndrome.

My unprofessional opinion is that if he seems to have autonomic disturbances (breathing or heartbeat is "off") or hypothermia (not sure how you would determine this other than a thermometer up his butt), take him to the vet or the ER vet. If he's simply restless and vocal, monitor him and see if he wants comfort from you. Otherwise, you may just need to let him ride it out and discuss lowering his dose with your vet.

 

[katiekat89]

I've had two cats on mirtazapine now. What I've come to learn is that the recommended dose is too high for many cats. I would not change the dose without your vet's guidance. But certainly bring that up and ask if you can try either a lower dose and/or alternate dosing days.

My Betty is getting used to taking daily mirtazapine. She doesn't like the wet willy in the ear. But she seems to understand that it's necessary and doesn't struggle too hard against it like she used to. As far as the side effects, when we first started, she would get a bad case of the meows if I left her to it. Or if I was there to hold her and stroke her, it would be a lesser case of the chirps. Krista was the same way. There seems to be a mirtazapine rush that I need to be there to support them through it. But as long as I'm there, they trill (Krista) or chirp (Betty) and purr their head off until the rush has passed. That seems to be the normal case. I cannot comment on serotonin syndrome.

My unprofessional opinion is that if he seems to have autonomic disturbances (breathing or heartbeat is "off") or hypothermia (not sure how you would determine this other than a thermometer up his butt), take him to the vet or the ER vet. If he's simply restless and vocal, monitor him and see if he wants comfort from you. Otherwise, you may just need to let him ride it out and discuss lowering his dose with your vet.

Thanks for your response - he seemed to be just restless and VERY vocal (we barely slept last night) but today he seems better. Still a little chatty, but seems to be able to relax, and not breathing so quickly. Thankfully this was just a one time dose while he was at the vet (which is also a little frustrating - they didn’t tell me what type of appetite stimulant they were giving him or the dose - I only found out it was mirtazapine after calling) and hopefully he won’t need it again. He is having some diarrhea today, but I think it’s mostly just from eating so much more than he had been. Fingers crossed he keeps getting back to normal. Thank you!

 

[librarycat2022]

Sorry I am just coming on now. Glad to hear he is doing better! My cat Odin was chatty in the beginning but that changed. In any case, to me- it does not sound like Theo tolerates it well so I hope the vet can come up with something else in the future. I know Odin is on Entyce but that causes drooling in him and others but still easier for me to see rather than seeing an issue with breathing. Best Health to Theo!

 

[katiekat89]

Sorry I am just coming on now. Glad to hear he is doing better! My cat Odin was chatty in the beginning but that changed. In any case, to me- it does not sound like Theo tolerates it well so I hope the vet can come up with something else in the future. I know Odin is on Entyce but that causes drooling in him and others but still easier for me to see rather than seeing an issue with breathing. Best Health to Theo!

Thank you! Hopefully this is not a regular thing - his appetite had just been down due to the Prozac so hopefully won’t need this going forward. He seems to be doing a lot better today but I do think he is just extra sensitive to medications. Appreciate your input!

 

[silent meowlook]

I think it is important to note that Prozac and mirtazipine should not be given together due to the increased risk of sick serotonin syndrome. It is frustrating. I hope your cat feels better.

 

[katiekat89]

I think it is important to note that Prozac and mirtazipine should not be given together due to the increased risk of sick serotonin syndrome. It is frustrating. I hope your cat feels better.

That’s what I’ve read everywhere! So I’m really confused why my vet would give the Mirtazapine to him when he had been on Prozac?

 

[silent meowlook]

Vets can’t know everything. Sometimes they mess up.

 

[katiekat89]

Theo had 3 bouts of diarrhea yesterday (the day after his vet visit where they gave him mirtazapine and sub q fluids) and once today so far. They’ve been pretty bad - the last one yesterday he didn’t even try to cover up and it was straight liquid. He’s still eating and I actually heard him drinking some water last night (he hasn’t been drinking much lately). I gave him a little pumpkin this evening so I’m hoping that helps but worried about the reason behind the diarrhea. I’m probably going to call the vet in the morning to update them and hopefully get some guidance. I don’t want to traumatize him again by taking him to the vet again in such a short period of time but it would be good to see if there is something else going on.

 

[daftcat75]

How are the other symptoms? Is his breathing still irregular? I don’t know how to measure a cat’s heart rate but that is something you should be able to do at home too. Google or YouTube can probably tell you how. Is he hypothermic? Probably the only way to tell is to stick a rectal thermometer up his butt. I would say if his temperature, heart rate, or breathing are abnormal, take him to the ER vet. If he just has diarrhea now, feed him less for a few days or a bland diet.

You can also add saccharomyces boulardii to his diet for a few days. That could help greatly.

My Cat Has Diarrhea - What Do I Do?

 

[librarycat2022]

Checking in to see how you and Theo are doing. I hope things are going better.

 

[katiekat89]

Checking in to see how you and Theo are doing. I hope things are going better.

Thanks for checking in. Now that the Prozac and Mirtazapine are out of his system, he seems to be back to normal. I also took the advice to give him S Boullardi for the diarrhea and that helped so much. Now back to figuring out the initial issues that had me start him on Prozac to begin with.

 

[daftcat75]

This might sound random. But how is his teeth? My Krista peed the walls for months with me trying to figure out why. I mentioned it to the vet on an unrelated visit (I wasn’t a very responsible cat dad at the time ) and he popped her mouth open and said, “thought so. She’s trying to get your attention.” We had the problem teeth removed and the inappropriate urination stopped. Worth looking into if his teeth haven’t been checked out under X-ray for some time.

 

[katiekat89]

This might sound random. But how is his teeth? My Krista peed the walls for months with me trying to figure out why. I mentioned it to the vet on an unrelated visit (I wasn’t a very responsible cat dad at the time ) and he popped her mouth open and said, “thought so. She’s trying to get your attention.” We had the problem teeth removed and the inappropriate urination stopped. Worth looking into if his teeth haven’t been checked out under X-ray for some time.

Actually, the last time I took him in, the vet said his mouth/teeth looked great - she actually said it was one of the healthiest cat mouths she had ever seen!