buprenorphine formulations and dosages

My 9-lb guy Matt had an IV of buprenorphine at 0.04 mg per 8 hours at the overnight vet clinic and then received 0.5 mL of injectable buprenorphine at his regular vet for a 10-hour hospitalization.

They released Matt to come home with me and prescribed 0.05 mL of liquid buprenorphine for me to administer in Matt's cheek pouch 3x daily for the next 6 days or until he stops showing signs of pain.

Whatever he was given at the vet's, it worked and it gave him back his appetite for a little while. The home prescription doesn't seem to be doing anything to help him. It has been three hours since his last dose of the 0.05 mL. He's curled on his chest, tensed up and purring. He'll drink a little water and get up to use the litter box, but he is not showing any interest in food. He ate well last night when he got home fresh from his vet stay. Nothing since then, so it's been 12 to 18 hours since he ate.

Is 0.05 mL of oral (cheek) buprenorphine a standard dose 3 times daily for a 9-pound cat? Can anyone tell me what's different about the injectable form, since without knowing anything about it it looks to me like 10 times as much medicine, and Matt definitely responded positively to the IV and injectable forms.

I want him to be comfortable, pain free, and he needs to eat. The vet is checking in with us later so I'll ask her, too, but I would really appreciate anyone responding. Did your cat respond to one kind of buprenorphine delivery better than another?

I would call the vet's office and explain what's going on and get their input.

Do you know what the strength/dilution ratio is for the Buprenex you are giving your cat is?  Anorexia can be a side effect of Buprenex.  The standard dose is 0.01-0.03mg/kg  He may have been given other drugs at the vet which increased his appetite.  I would recommend consulting your vet on this.

cprcheetah, thank you for mentioning strength/dilution. I didn't think of that. I'm so tired and worried, my mind is definitely not all there. I'll ask this morning.

Poor guy finally expressed interest in food. He licked up some tuna gravy. What he wanted to eat on Monday was the Science Diet a/d he got from the vet. He ate half a 5.5 oz can of that then. When I offered him the exact same a/d 8 hours later he had no interest. Come on, cat.

Back to the vet in a few hours.

How did the vet visit go?   I feel your frustration on the eating.  DeeJay my kitty is going through picky eating right now, what she eats at one meal she snubs at the next....it's getting expensive the stinker.

Hi, cheetah. Thank you for caring about my guy too. I've been reading your thread about DeeJay's pancreatitis and I really hope you can find some answers... I want DeeJay and Matt out of the woods and enthusiastic about eating again!

Vet visits plural for Matt since I last visited TCS. They thought it might be nausea more than pain keeping him down, but since he just wasn't eating enough, he now has a feeding tube and is receiving .4 mL Cerenia injection each morning. The constant purring has stopped and he is a little more mobile than he was, but he hasn't been interested in eating on his own at all. He tolerates tube feeding. However, he is only taking about 60ccs a day in 10-15cc increments and when I try to feed more than that he vomits.

He has no firm diagnosis. IDEXX (is that right?) pancreatitis test results came back negative. ALT is too high, bilirubin is too high and red blood cells are low. I don't want to think the C-word but very afraid it may be?

catclan said:

Hi, cheetah. Thank you for caring about my guy too. I've been reading your thread about DeeJay's pancreatitis and I really hope you can find some answers... I want DeeJay and Matt out of the woods and enthusiastic about eating again!

Vet visits plural for Matt since I last visited TCS. They thought it might be nausea more than pain keeping him down, but since he just wasn't eating enough, he now has a feeding tube and is receiving .4 mL Cerenia injection each morning. The constant purring has stopped and he is a little more mobile than he was, but he hasn't been interested in eating on his own at all. He tolerates tube feeding. However, he is only taking about 60ccs a day in 10-15cc increments and when I try to feed more than that he vomits.

He has no firm diagnosis. IDEXX (is that right?) pancreatitis test results came back negative. ALT is too high, bilirubin is too high and red blood cells are low. I don't want to think the C-word but very afraid it may be?

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I am so sorry you are dealing with this.  Yeah I started crying at work today when the Vet said the C word.  DeeJay is my heart baby and it tears my heart out even thinking that is a possibility.  Is your kitties HCT normal?  That is Hematocrit.  Has your vet mentioned Bile Duct Obstruction?  That can be the cause of the elevated ALT & Bilirubin.  Cholangiohepatitis can cause those elevations as well. 

Oh, no, Cheetah, I really hope it's not.

I know the vets are only human, but I'm pretty frustrated--ultrasound showed bile duct inflammation and pancreatitis, after the IDEXX pancreatitis test came back negative. That gives me no confidence there ever again... His HCT was 34.7, pretty normal I think?

He is now getting prednisone, cerenia, reglan, amoxicillin and his buprenorphine. A/D food intake is up to 100cc daily, which is better. I'm not sure what the long term lookout may be, since even when he wasn't acutely ill he couldn't eat more than about 35ccs or 1/3 of a 5.5 oz can every 4 hours without vomiting. He is showing zero interest in eating on his own yet. He's had the tube for 8 days.

I will start looking around other pancreatitis threads for more information on long-term care and what else might help him--assuming his diagnosis is really complete and correct :frusty: --I have been lucky enough in life not to have had to deal with this disease before, so I'm brand new to it and trying to keep my head above water so I can help my cat. Thank you so very much for offering your help to me and my little boy when you're going through so much right now.

My guy gets 0.20mg of Buprenorphine twice a day for arthritis and he is 6.2 pounds in weight. What is interesting is he gets almost the same drugs as your cat with the exception of amoxicillin. My cat is over 18.5 years old and suffers from renal failure, pancreatic issues. and IBD but the drugs he is getting is to treat the IBD. There are a lot of things that can cause the cat to throw up and it doesn't always show in the blood test numbers.

My guy will throw up large amounts of water with some food in it and he gets into these modes every few days to at most two weeks. It typically lasts for a day or two and then clears up and he stops throwing up. My guy always has a lot of stomach noise during these times and he will typically lick the roof of his mouth to force himself to throw up. Some days such as this morning he will just sit hunched up for 2 - 4 hours where his insides will make a lot of noise and he will eat nothing. The one he had today was pretty bad but it cleared up and he is back to eating again.

I don't know what other symptoms your cat may have but these issues can be really hard to diagnose. Some of the information here may help, I was reading this earlier today....http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm This is one of my guys issues so he gets Pepsin and Prednisolone to help control the acid build up to settle his stomach and stop him from throwing up. He was also B12 deficient so getting shots for this also made a big difference and he is now down to monthly shots (just had one B12 shot which was 0.25ml). My cats left kidney is almost half the size of the right so he was dehydrating and gets sub-q's which are now daily and 100ml each.

Even after all of this he stills has bouts where his insides are making a lot of noise and he is not comfortable but the gaps between them have grown so most of the time he is doing well. Keep on working at it and hopefully you can find something that works. You have to get the cat to start eating so try different cat foods or even baby food if possible. Fancy Feast is supposed to be the kitty crack of cat foods so try some different flavours and see if any work out. Hopefully you can find something that works that will help you increase the cats health.

I just have a question, I'm a little new to being the sole care taker of my cats so I'm not very knowledgeable on all of the common ailments and treatments used today for cats.

But I am somewhat knowledgeable on a lot of medication out there and what it is used for on humans, whether that is good or bad I'm not sure, but I am a little confused about why your cats are being prescribed buprenorphine. As far as I was aware, buprenorphine is a synthetic opioid, the active ingredient in medications such as suboxone and Subutex. Which are used mainly to treat opiate addiction such as heroin or prescription pain killers. It was created as an alternative to methadone.

Also as far as I know, side effects from this medication can be number one nausea, constipation, dehydration etc. But this is in people I guess it could be different in cats. And I also know some doctors do use it for pain management but it is rare and I don't see the logic in that for cats but I guess there is a reason. But this medication is stronger than most opiates and builds up longer in the body. And it is just as physically addicting, in humans anyway.

Just curious, like I said I don't know too much about medications in cats yet and how they effect animals differently than humans, I just found this interesting.

Is your question "why are cats prescribed Bupe?"

The only answer I know is that it is prescribed for pain and is well tolerated in cats.

Cats are more sensitive to medications than humans are and cannot tolerate NSAIDS like humans do.  Therefore Buprenorphine is used as an effective pain medication in cats.  http://www.petplace.com/drug-library/buprenorphine-buprenex/page1.aspx  Drugs like Morphine etc can have gastrointestinal effects in cats which is why Bup is preferred. 

Lol yes I guess that was my question, I was just confused why they prescribe cats a medication that is mainly used to treat heroin addiction. But I guess stranger things have happened and I know many medications can be used for different reasons. Cats and people are different so I guess the reaction to the medication would be different. But if someone who did not have an addiction to opiates took buprenorphine they would get violently ill. Usually it's only given for main management when someone has built up a high tolerance to other pain medication.

Again I guess cats and humans are different, it just kind of threw me through a loop and didn't make much sense to me that they would give this medication to a cat.

Pain management ***

Faythe said:

I just have a question, I'm a little new to being the sole care taker of my cats so I'm not very knowledgeable on all of the common ailments and treatments used today for cats.

But I am somewhat knowledgeable on a lot of medication out there and what it is used for on humans, whether that is good or bad I'm not sure, but I am a little confused about why your cats are being prescribed buprenorphine. As far as I was aware, buprenorphine is a synthetic opioid, the active ingredient in medications such as suboxone and Subutex. Which are used mainly to treat opiate addiction such as heroin or prescription pain killers. It was created as an alternative to methadone.

Also as far as I know, side effects from this medication can be number one nausea, constipation, dehydration etc. But this is in people I guess it could be different in cats. And I also know some doctors do use it for pain management but it is rare and I don't see the logic in that for cats but I guess there is a reason. But this medication is stronger than most opiates and builds up longer in the body. And it is just as physically addicting, in humans anyway.

Just curious, like I said I don't know too much about medications in cats yet and how they effect animals differently than humans, I just found this interesting.

Click to expand...

Faythe,

Buprenorphine, like methadone, is a synthetic opiate that was originally made as a pain medication and has been used as such for decades (I think it was created in the 40's). In the 90's it was discovered that it was also effective in treating opiate addiction and was eventually sold as Subutex and Suboxone, which also contains naloxone, to people recovering from opiate addiction. It is still a very effective pain medication for both people and animals. In the US it's used more in veterinary medicine but in other countries it's commonly used for people too, usually under the brand name Tamgesic. Cats don't normally do well on opiates as it tends to make them wired but buprenorphine is an exception (although it can cause cats to be wound up too) and is one of the most useful pain medications in cats. 

To the OP and other people who are interested -

Buprenorphine is a bit different than other drugs as it doesn't go through the stomach. If you swallow buprenorphine it's not going to do anything for you because it will be broken down by the liver and excreted in your urine as something the body doesn't want. It will not go out into the bloodstream which it has to do to do anything for you. In order for buprenorphine to got into the blood stream when taken orally it has to be absorbed into the mucus membranes in the mouth. Pills made for humans are absorbed under the tongue but that's not possible for cats, of course, so it's given in the cheek so that it's absorbed by the gums. However - and this is very important to know - very often when you inject the meds into the cat's cheek it will not stay there but is instead automatically swallowed by the cat. The meds that are swallowed will just be broken down by the liver. This is why you probably don't see much effect from the medicmation you give your cat - it never enters his bloodstream! For this reason, in my opinion, I think it's best to give cats buprenorphine sub-q instead of orally. I have two cats that take buprenorphine sub-q and it's much easier, more comfortable for them, and, most importantly, much more effective than giving it orally.

If you do give it orally you have to give it very, very slowly a little at a time. Just give a few drops on the gums between the gums and cheek and wait for it to absorb, then give a little more and so on. If you inject a bunch of liquid at once the cat's automatic reaction will be to just swallow it.

If your cat is prescribed buprenorphine to be given at home I highly recommend that you ask your vet to show you how to give sub-q shots. Some people thinks giving shots is scary but giving sub-q shots to cats, in the scruff of their neck, is really easy, painless and hard to screw up. I can give my cats shots when they're sleeping and they hardly wake up - that's how little it hurts. There are many good videos on youtube that shows how to give sub-q shots too.

Buprenorphine is expensive, sometimes as much as $10 per dose or more. It doesn't have to be. If you are going to give it for more than a couple of days it's worthwhile to get it from a compound pharmacy. I get mine from an animal compounding pharmacy called Roadrunner. I pay $43 for 30ml of injectable meds which adds up to 75 doses at 57 cents a dose. Even if you have to pay for overnight shipping it's still cheaper than getting it from the vet. If you get the oral version it's even cheaper.

Thanks for the clarification like I said I didn't know anything about it in cats and I knew some about in humans. I didn't know it was around that long but I knew pretty much everything else you said. Naloxone is mixed with it for suboxone, but Subutex is straight buprenorphine because naloxone is thought to be dangerous for an unborn fetus in pregnant women which is why Subutex was designed. I knew it was used as a pain medication but having taken Subutex before and getting violently ill because I did not have a tolerance to opiates I did not see how someone could tolerate it with out getting sick if they did not use opiates. I'm not a doctor or pharmacist, just know what I know from researching things and knowing people who have taking these drugs. I was just curious that's all.

Thanks cprcheetah for the link!

Hi There

Just checking if anyone is giving their cat Buprenorphine injections long term - is this dangerous or addictive to cats? Our cat has had all his teeth out due to FIV related Stomatitis 18 days ago and is currently on .5ml of sub q Buprenorphine injections - he seems to be still in pain as he had to go back a week ago in for a revision op to take out some bone fragments - yesterday he started vomiting up his syringe fed Hills A/D at least twice a day - not sure if it's the meds or if we should be feeding his less per session- he seems to throw up if we feed him more than a 1/4 of a can per feed and he is not actively pestering us for food which is worrying as he was previously always up for a feed.

 We were feeding him a whole can at once TWICE A DAY without incident up until last week and he was loving it!!

Cheers Narelle

I have been giving Scratchy Buprenophine orally for over a year now and no issues other than it loses effectiveness over time. He started at 020cc twice a day and then went to 0.25cc and is now at 0.30cc twice a day. He does not get injections though, he gets it orally in his cheek pouch twice a day for creaky joints and arthritis. I always check the side effects for all drugs and Google helps with this... http://www.vetinfo.com/buprenorphine-for-cats.html

Thanks so much for the reply - makes me feel a bit more confident!!

Cheers  (  :