Remeron?

Precious is in chronic renal failure and doesn't like to eat.  I've had her on Remeron for a year and it seems like some days it makes her hungry and some days it doesn't.

Anyone else in the same boat?

Welcome to the forum!

You'll find others who have had this experience and some solutions too...right here http://pets.groups.yahoo.com/group/tanyas-crf-support/

WendyB said:

Precious is in chronic renal failure and doesn't like to eat. 

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What are you feeding Precious?

Precious eats Science Diet K/D wet and dry - I give her the option to eat either.

Remeron (Mirtazerpine) is used in humans as an antidepressant.  It is not considered a first line therapy, i.e., physicians usually try drugs in the SSRI class (Prozac, Zoloft, etc..).  I've never heard of it used in cats or dogs!  What I do know, however, is that one of its more undesirable side effects is weight gain.  It is also notorious for raising cholesterol and triglycerides to very high levels.  I can't imagine what it has to do with renal failure.  What did the vet say about why he/she was prescribing Remeron?  I would really like to hear about this, as it sounds like a very poor choice of drug for a cat - but again, maybe it's not.

Presto, In cats it stimulates the appetite.  She takes 3.75mg every 3rd day. 

Aside from the creatinine and bun issues, Precious really only has trouble maintaining weight because she doesn't eat.  This was the vet's suggestion after I had tried everything I could think of to make her eat.  She typically will eat 1 1/2 cans of wet food the first day (I put down a 1/4 can at a time and let her tell me when to refill it) + dry, she'll then eat 1 can + dry for the next two days.  Rinse and repeat.

For the past year it's been amazing.  She's gone from 7 lbs up to 8.2 lbs - pre-CRF she was at 12 lbs and wasted down like mad.

WendyB said:

Precious eats Science Diet K/D wet and dry - I give her the option to eat either.

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That might be part of the problem. K/D is such an unpalatable food with horrible ingredients that it's no wonder she doesn't want to eat it. I also think these super-low protein diets do more harm than good (cats start to catabolize their own muscle tissue, which is even harder on their kidneys), although of course most vets would tell you otherwise. I personally would feed a variety of good quality wet foods with half an eye on phosphorus levels and ditch the K/D. 

http://www.littlebigcat.com/health/kidney-disease-in-older-cats/

http://healthypets.mercola.com/site...you-could-destroy-their-kidney-and-liver.aspx

Presto said:

What did the vet say about why he/she was prescribing Remeron?  I would really like to hear about this, as it sounds like a very poor choice of drug for a cat - but again, maybe it's not.

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Some info on the use of mirtazapine as an appetite stimulant in cats: 

http://www.felinecrf.org/persuading_cat_to_eat.htm#mirtazapine

Thanks Sugarcatsmom.  I'd been feeding Precious Nutro and she LOVED it.  She'd dance around the cans when she wanted more and would turn into a rumblebox when I went near the cabinet where I stored them.  The look I got the first time she saw the K/D wet nearly broke my heart but since it was what my vet recommended, I went with it.

Tonight I'll run to the store and get some that I know she likes.

Sugarcatmom said:

Some info on the use of mirtazapine as an appetite stimulant in cats: 

http://www.felinecrf.org/persuading_cat_to_eat.htm#mirtazapine

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So, I guess it makes sense as an appetite stimulant, but, as your article states, .." Mirtazapine must be used with caution in anyone with renal problems..."  This is clearly a risk/benefit situation, but increasing appetite is actually a "side effect" of the drug.  Remeron is a psychotropic drug, so be careful, and keep an eye on any behavioral changes. Please read the link that Sugercatmom posted...
 

Presto, I'm well aware of the side effects; but with it, she's gained 3 pounds over the past two years. I'm willing to take the risk to keep her healthy (or at least stable). 

Wahoo!

I got 7 different flavors of the Nutro gourmet 3 oz cans.  I wanted to see which one she liked before I got more than one.  She ate almost the entire can (maybe two teaspoons were left) and I'll leave it down tonight. 

This is on day 3 of the Remeron, so tomorrow she will be scarfing it down.  It makes this meowmy warm inside to see her baby girl eat.

WendyB, I know what you are going through as I have a CRF cat. I am lucky in the sense that his appetite isn't down. However, he will not eat the same can twice in a row So I have to rotate foods. Many CRF cats tire of the rx foods for kidney disease because of the low protein. But it's a balance between your cat eating the proper diet and your cat eating and maintaining weight. Remeron (mirtazipine) obviously helping your cat and while there are side effects, there's a balance again between your cat eating and maintaining weight. Because they only take a quarter of a 15 mg tablet every three days, this reduces the effects on the liver. Any drug can have side effects but with a CRF cat, there is a lot to consider. The thing that makes me happiest is when my cat is eating.

Anyway, you want to look for foods with low phosphorus, more So than low protein. I feed the following in Schweppie's rotation:

Wellness turkey
Wellness chicken
Natural Balance limited ingredients diets (duck, chicken, venison, salmon)
Holistic selects - turkey & barley, duck & chicken, chicken & lamb
K/d
Royal Canin lp
Medi-cal Mature
Hills g/d (geriatric)

I don't care for the ingredients in the last 4 foods but it's the results we are looking for right? Well, Schweppie is really picky So I have to rotate all these foods. I feed him 1/2 can three times a day. If he is exceptionally picky, I will feed him almo nature or Weruva or nature's variety which are definitely not good for CRF cats but he has to eat.

You can also ask the vet about giving your cat a phosphorus binder (if he isn't already on one) So that the phosphorus doesn't get digested. This comes with side effects but it may allow you to feed different foods.

I think the issue is the K/D not loss of appetite.  This morning she came down the stairs in front of me and ploped in front of the spot where I feed her.  And, she's already cleaned the bowl.

I hate to be the contrarian here, but Hills products are JUNK.  Read the ingredients!  All by-products.  You may as well feed her Fancy Feast.  I was given a couple of cans of Hills from one of the biggest Veterinary hospital chains in the country, when my cat was discharged.  I couldn't believe my eyes when I read the ingredients.  The Hiils' people sponsor a whole lot of veterinary practices and activities - so THAT's why the vets give it out.  It's all about the $$$.  The same exact phenomenon exists with regular MDs and pharm reps pushing their latest pills!. 

WendyB said:

I think the issue is the K/D not loss of appetite.  This morning she came down the stairs in front of me and ploped in front of the spot where I feed her.  And, she's already cleaned the bowl.

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Yippeeeeeee!!!!!! So glad to hear it.

If you want to check out this chart, it lists the phosphorus levels of some of the more popular canned foods: http://binkyspage.tripod.com/CanFoodNew.html

You can aim to keep the amount below about 240mg/100Kcal, but I wouldn't be anal about it unless Precious is starting to get higher blood phosphorus levels.

Oh, and I personally think mirtazapine is a great appetite stimulant if you have to use one, especially in CRF cats because it also controls nausea, which none of the other stimulants do. That and having to give it only every 3 days is way less stressful than the twice a day ones.

If I don't have to give her the Remeron to eat, I'm not going to.  The Nutro bounces near the edge, but her phosphorus values are fine.  We only have issues with the Creatinine and BUN.  My vet is conintually amazed at how well she's doing.

Your original post asked about Remeron and now that you have received responses, you are not going to give Remeron unless necessary. it it's an appetite stimulant but you said your cat's issue is not lack of appetite. I gave you some alternatives to k/d because I thought that was part of what you were asking. So I am confused now .as to the question in this thread.

To the poste

I didn't mean to confuse anyone SweetPea.

I started the thread because with the 1/4 Remeron every three days Precious still barely ate anything. 

After just getting brave, I fed her Nutro and she's eating 2-3 3 oz cans/day right now with no Remeron.  I think the issue is she just couldn't stand the K/D any longer.  I had no idea that K/D was made with so much crap in it.  Precious may have finally had enough.

NEVER GIVE THIS DRUG TO YOUR CATS! This drug is given by vets for use in cats as an appetite stimulant. Mine had a horrible experience after taking this drug. He was sedated so much from Mirtazapine I thought he was going to die. He was foaming at the mouth for hours and crying out every 10 seconds or so. He would stare into space for long periods of time. This went on all night and he is still crying this morning. His appetite is no better. I REPEAT, NEVER GIVE THIS DRUG TO CATS! It is not approved by the FDA for use in cats and is used as an "off label" medication. I was stupid for not looking this up before I gave it to my beloved kitty