Cisapride - regular vet vs. holistic vet

abbyntim · Mar 10, 2014

For more of Tim's history, see these two posts.

http://www.thecatsite.com/t/272867/...ion-urinary-crystals-food-sensitivites-asthma

http://www.thecatsite.com/t/274087/...e-weaning-off-cisapride-should-i-be-concerned

When Tim had his second and most recent severe constipation episode in June 2013, our regular vet put Tim on Cisapride and indicated we could eventually decrease the dose and maybe even stop. Each time I refilled, I asked if we could reduce the dose and the answer was "no". Finally, in January, they relented to one capsule (5mg) every other day - his original dose was one per day. Tim had a lot of other things happen (see other posts) and I decided to keep him on his full dose until those settled down.

Meanwhile, because our regular vet couldn't really help us with Tim's other issues, except to prescribe more medications, which did not help, I researched holistic vets and took Tim to one last week. She said we should wean him off Cisapride and to give him one capsule every other day for a week. If he continues to do fine, then stop.

In general, Tim has been fine and regular, though he's not yet had a BM this morning. Neither has his sister, though she climbed in the box some time ago and scratched like she was going to, then jumped out (weird for her, possibly another issue?). Both cats urinated just fine this morning. Even on daily Cisapride, Tim might go up to 36 hours between BMs, so even though nothing has happened this morning, I would expect to see something by this evening. Neither cat ate a tremendous amount of food this weekend; it was unseasonably warm and I notice appetite changes with sudden weather changes. It could be neither cat has significant waste to eliminate, due to reduced food intake and higher quality food that produces less stool.

Anyway, because Tim's been on Cisapride for 9 months, I wanted to make sure to properly taper. And to let the regular vet know that we're doing it now. I just called the office and spoke with one of the office staff, who relayed messages between the doctor and me. I was told to go ahead and give him the half-dose, but to keep him on it, that it will likely be for life! A cat with constipation is usually on Cisapride for life, they said.

So I really want to get him off the Cisapride if I can. But I am terrified of him becoming constipated again, though no one could tell me if Tim actually has megacolon. I would really like to hear from others who have successfully taken their cats off Cisapride - whether the cat actually had megacolon or just constipation, how long the cat was on Cisapride and how you tapered the dose, whether you did this with or without the support of your vet, and so on. I'm not looking for veterinary advice, just what others did. I'm not convinced I need to keep him on Cisapride for life, but I can see I won't get any help from my regular vet in tapering the dose. I think I will follow up with the holistic vet, though.

Thanks!

cocheezie · Mar 10, 2014

I have a 16-year-old cat on cisapride (1 tab 2x daily) for severe constipation. She does not have megacolon (three different vets looked at the X-rays). She does have an inoperable tumour on or near her liver that is pushing her internal organs around. We don't know if the constipation is the result of the tumour or if the constipation is a result of her age. She has been on cisipride for about 2 months now. I tried weaning her off about a month ago (with vet's recommendation - he didn't want to keep her on cisapride any longer than necessary), but without the cisipride, she went right back to vomiting when having a bowel movement. I immediately started the cisipride again because at the time she was not eating or drinking enough to keep her out of a crisis situation.

A month later, we finally have the constipation under control with cisipride, pepcid ac, and mirilax. (Many thanks to the people on this forum.) Stools are regular and soft. She won't touch slippery elm bark in any form and will voluntarily vomit if it is forced on her. She is eating (wet food only), drinking, and re-gaining weight. The occasional missed dose (i.e., cat spat it out and it wasn't noticed) hasn't seemed to affect her at all. I have started by decreasing her dosage to 1 tab daily (no vet consultation). However, this will be my last attempt to wean her off cisapride. At the first sign of constipation and its many issues and torments, she will be right back on and stay on. She's old, and the tumour will eventually win. I just want to make sure that she has no unnecessary discomfort.

oneandahalfcats · Mar 10, 2014

AbbyNTim said:
For more of Tim's history, see these two posts.

http://www.thecatsite.com/t/272867/...ion-urinary-crystals-food-sensitivites-asthma

http://www.thecatsite.com/t/274087/...e-weaning-off-cisapride-should-i-be-concerned

When Tim had his second and most recent severe constipation episode in June 2013, our regular vet put Tim on Cisapride and indicated we could eventually decrease the dose and maybe even stop. Each time I refilled, I asked if we could reduce the dose and the answer was "no". Finally, in January, they relented to one capsule (5mg) every other day - his original dose was one per day. Tim had a lot of other things happen (see other posts) and I decided to keep him on his full dose until those settled down.

Meanwhile, because our regular vet couldn't really help us with Tim's other issues, except to prescribe more medications, which did not help, I researched holistic vets and took Tim to one last week. She said we should wean him off Cisapride and to give him one capsule every other day for a week. If he continues to do fine, then stop.

In general, Tim has been fine and regular, though he's not yet had a BM this morning. Neither has his sister, though she climbed in the box some time ago and scratched like she was going to, then jumped out (weird for her, possibly another issue?). Both cats urinated just fine this morning. Even on daily Cisapride, Tim might go up to 36 hours between BMs, so even though nothing has happened this morning, I would expect to see something by this evening. Neither cat ate a tremendous amount of food this weekend; it was unseasonably warm and I notice appetite changes with sudden weather changes. It could be neither cat has significant waste to eliminate, due to reduced food intake and higher quality food that produces less stool.

Anyway, because Tim's been on Cisapride for 9 months, I wanted to make sure to properly taper. And to let the regular vet know that we're doing it now. I just called the office and spoke with one of the office staff, who relayed messages between the doctor and me. I was told to go ahead and give him the half-dose, but to keep him on it, that it will likely be for life! A cat with constipation is usually on Cisapride for life, they said.

So I really want to get him off the Cisapride if I can. But I am terrified of him becoming constipated again, though no one could tell me if Tim actually has megacolon. I would really like to hear from others who have successfully taken their cats off Cisapride - whether the cat actually had megacolon or just constipation, how long the cat was on Cisapride and how you tapered the dose, whether you did this with or without the support of your vet, and so on. I'm not looking for veterinary advice, just what others did. I'm not convinced I need to keep him on Cisapride for life, but I can see I won't get any help from my regular vet in tapering the dose. I think I will follow up with the holistic vet, though.

Thanks!

You should follow up with the holistic vet. It sounds like you could use some support and reassurance. He/She should be working with you and advising you if they have given their opinion that Tim can be weaned off of cisapride. Tim has been doing really well based on your reports and there is no reason why this shouldn't continue.

I know how big of a deal this is for you in taking the steps to wean Tim off of the cisapride, I've been there and had the same doubts at the time. In my opinion your conventional vet should be supporting you in this move, instead of discouraging you and suggesting that the cisapride is for life. It doesn't have to be that way. Worse case scenario is that if things don't work out, Tim can always return to the cisapride. Best case scenario is that Tim can be constipation-free through good diet and probiotics.

abbyntim · Mar 10, 2014

oneandahalfcats · Mar 11, 2014

Glad to hear that you have come to a decision you can be comfortable with.

As you said, Tim may (but not necessarily) run into some trouble with constipation, but nothing as serious as before as he is on the right kind of diet. You are more knowledgeable and aware now in knowing what you are dealing with, having gone through the episodes from before. These experiences should help you to know when and how to intervene if necessary.

Positive vibes that things continue to go well for Tim

cocheezie · Mar 11, 2014

Thanks for the update. Hope all goes well.

cocheezie · Mar 12, 2014

For AbbyNTim - update:

Was awake most of the night. Woke up repeatedly, hearing one "huc" sound, but when I checked on Cocheezie, she was resting or sleeping comfortably in the window. Around 5 a.m., there was a terrible smell (litter box near my nose between bed and window - stool was normal, if a tiny bit smeary). This was followed by a mad scramble out of the litter box and under the bed for a mass vomiting gala. Multiple paper towels worth of food came back up. Didn't notice any stomach acid. She had had her 1 tab of cisapride and miralax in the morning, but only her pepcid AC and miralax in the evening. After the event, she went to her feeding area for food. In true cat fashion, she wanted a certain cat food and refused to eat first offering, refused 2nd offering, howled the entire house awake and then accepted a plate of duck pate. The old girl had no interest in the morning pet ritual or anything else, and has just recently felt recovered enough to be social and have a bit of a wash.

She'll be staying on cisapride.

Hope Tim's cisapride weaning is going better.

abbyntim · Mar 13, 2014

cocheezie said:
For AbbyNTim - update:

Was awake most of the night. Woke up repeatedly, hearing one "huc" sound, but when I checked on Cocheezie, she was resting or sleeping comfortably in the window. Around 5 a.m., there was a terrible smell (litter box near my nose between bed and window - stool was normal, if a tiny bit smeary). This was followed by a mad scramble out of the litter box and under the bed for a mass vomiting gala. Multiple paper towels worth of food came back up. Didn't notice any stomach acid. She had had her 1 tab of cisapride and miralax in the morning, but only her pepcid AC and miralax in the evening. After the event, she went to her feeding area for food. In true cat fashion, she wanted a certain cat food and refused to eat first offering, refused 2nd offering, howled the entire house awake and then accepted a plate of duck pate. The old girl had no interest in the morning pet ritual or anything else, and has just recently felt recovered enough to be social and have a bit of a wash.

She'll be staying on cisapride.

Hope Tim's cisapride weaning is going better.

Oh, no! Something like this is my biggest fear. All we can do is closely watch and adjust.

So far, so good. Tim was a little off schedule a few days this week, but as of yesterday is back on his regular schedule. I am going to continue him on his half-dose until I am feeling comfortable with his progress. I really do think his constipation was due to dehydration and hope our major dietary adjustments have resolved this. No megacolon diagnosis, nothing internal that could cause things to get "stuck". I just need to be patient and wean him slowly, as I don't know to what extent, if any, he may already be dependent on Cisapride.

In your situation, I would do the same. I hope keeping her on Cisapride ends these episodes.

cocheezie · Mar 14, 2014

Glad Tim is making the adjustment. If Cocheesie was younger and did not have other issues, I'd be doing the same as you.

In Cocheesie's case, it might be the tumour that is making the cisapride necessary. I don't think 2 months on cisapride is long enough to make her dependent (could be wrong about this though). I think the tumour which has moved her organs around is the problem, and the cisapride helps the food get through the squished areas. Like Tim, dietary adjustments have helped tremendously as well.

Continued good luck to you and Tim.

abbyntim · Mar 14, 2014

Originally Posted by cocheezie

In Cocheesie's case, it might be the tumour that is making the cisapride necessary. I don't think 2 months on cisapride is long enough to make her dependent (could be wrong about this though). I think the tumour which has moved her organs around is the problem, and the cisapride helps the food get through the squished areas. Like Tim, dietary adjustments have helped tremendously as well.

This is what I thought when reading about Cocheesie. She's got other things going on internally that are causing problems. And, unfortunately, as the tumor grows, it may become worse. I agree Cisapride is good for this type of situation. I do hope it continues to help her!

Was doing some reading on constipation and probiotics, and read some more about the link between constipation and hairballs. It seems some of the more enlightened vets see hairballs as a motility problem. Tim continued to hack up hairballs while on Cisapride, suggesting that 1) Cispride really wasn't making any difference and 2) Tim's constipation was much more than motility problems. Tim hasn't had a hairball in over a month, which is a record for him. I've greatly reduced his Laxatone doses, as I'm trying to get him off that, too. Makes both my husband and me more comfortable with our decision to wean Tim off Cisapride. I think our dietary changes resolved the "other" problems. And I think our dietary changes plus the new addition of the probiotic will help with motility.

cocheezie · Mar 14, 2014

Cochise only started semi-actively grooming herself again two weeks ago. She coughed up a hairball half the size that she usually coughs up last week - the first one in a long time (this was before I tried weaning the cisapride). She wasn't grooming at all for the longest time. Even though she's an indoor cat, because it's been a bad winter and because we keep our thermostat fairly low, I've only been washing her face (laxatives are sticky), brushing lightly, and working on the occasional mat. Since she's now re-gaining some of the weight she lost, once the temperature looks like it will be staying above the freezing mark (maybe next week), I'll have a good go at her undercoat. I figured since she wasn't grooming, with the weight loss, she needed all the insulation she had. She's a small, fine-haired, semi-long haired cat.

Her mass on the x-rays, however, was definitely not a hairball in the three vets' opinions, and nothing that looked like it contained a lot of hair came out after her enema.

Regarding no hairball for a month: has Tim been grooming less? and have you been grooming more?

abbyntim · Mar 15, 2014

Tim was obsessively grooming earlier in February, but that has slowed. I'm grooming him about the same. I should add, possibly the most important bit, that I am seeing the hair is passing through in his stools. This is something new for him and why I'm excited - I don't think it's due to him ingesting less hair; rather, the hair is passing through as it should instead of getting stuck then barfed up.

oneandahalfcats · Mar 16, 2014

My holistic vet and I have been talking quite a bit about hairballs lately, in relation to Max's hacking that was producing nothing. Since the last visit, he has had one episode versus a few episodes per week. No hairballs were found in this or the previous visit, but something clearly has changed for the better. Max has been on both probiotics and alaskan wild salmon oil. He is looking, and seems to be feeling, a whole lot better. And the best news is that he has had back-to-back BMs this week!

I read somewhere that hair can definitely cause constipation problems when it gets balled up in the digestive tract instead of getting pooped out as it should. It may not be enough to cause an obstruction, but it can result in fecal matter not being able to pass as readily and you can end up with constipation or delayed BMs, as the result. I have to think it is the probiotics (and salmon oil) that are making the difference in this respect.

@cocheezie: Sorry to hear about the recent episode .. Hope she is feeling better ..

abbyntim · Mar 22, 2014

Tim has continued to lick his lips on occasion, and even shake his head quickly and jump up while licking his lips. Then his lower lip swelled again, which prompted a follow-up visit to the holistic vet yesterday afternoon. She thinks Tim is dealing with some acid reflux or indigestion and the head shaking may be acid in his mouth. She also thinks the acid in the mouth may have caused the lip swell, which makes sense as he'd started drooling again. We're making another minor diet tweak - reducing the fat a bit - and adding a very low dose of famotidine (basically, pepcid ac) to give him some relief as we continue to work on this naturally and with diet.

In other news, he's doing fantastic on his half-dose of cisapride and continues to be very regular. Discussing with the holistic vet, next week we will shift him to cisapride two times per week. We'll continue that for two to three weeks. If he continues to do well, then we can stop. The holistic vet did agree with our vet who had prescribed cisapride originally that some cats do need to stay on it for life, usually those with a physical problem or those who continue to eat dry. Because Tim has no physical problems and we successfully transitioned him from dry to wet, there is no reason he shouldn't do fine without cisapride. Here's hoping!

The holistic vet does want us to wait until Tim is off cisapride before beginning raw. Apparently, cats digest raw much more quickly, and if he's on cisapride while eating raw, it may move through him too quickly. So I am stopping even the raw treats for now. One step at a time. The important thing is to successfully wean him off cisapride.

cocheezie · Mar 22, 2014

Great news. Glad it's working for you. Cocheesie became a totally different-for-the-better cat when pepcid ac was added to her regiment.

abbyntim · Mar 28, 2014

Tim has continued to do well with cisapride every other day, so we decided to lengthen the interval between doses to two days. Today was his first "second day" (in other words, his last dose was Wednesday and his next dose will be tomorrow). He had a very nice bowel movement this morning, right on schedule. I'm excited that he's doing well, and at the same time a little nervous but we won't know if he can manage without cisapride unless we try!

In other news, Tim's lip swelling is pretty much gone. He's not licking his lips as much, and we're not noticing much drooling. I've not noticed any of the head shaking and jumping since Monday morning. He's been a relaxed and playful cat in the evenings, just the way he should be. We forgot his pepcid ac last night and he seemed fine, so we are reducing that to once per day to see how he does. I also took a long, hard look at my own behavior. I've been such a nervous wreck that I think I am contributing to what looks like stress (he's done other unusual things consistent with acute stress in a cat). So I am doing some behavior modification on my part in order to help him. Finally, because I had reason to suspect a mild thiamine deficiency after reading an article on Wednesday, I stopped picking the peas out of the canned food and split one Pet Natural calming chew (includes thiamine) between both cats Wednesday and Thursday evenings. I'll continue until the package is gone, then see how the cats do (our female, Abby, had also started slight drooling).

The one bad thing that happened this week is that Tim had one of his "asthma" coughs one evening. The interesting thing is that I fed him a bit of Tiki Cat chicken the night before and that morning. He'd not had a bite of chicken since February 6, when he had his last vomit episode. He continued to cough for a few days after that, then we never heard another cough. So I will go another two months without chicken and try again, but I continue to believe I cannot feed chicken to Tim.

abbyntim · Mar 31, 2014

We experienced a moderate earthquake the night of my last post. We were close enough to the epicenter that it shook us very good. Thankfully, a few things got knocked over but no damage or injuries. However, it was the first earthquake for Abby and Tim and they did not like it. Both ran under the bed, and the larger aftershocks also sent them under the bed. No one slept very well Friday night and aftershocks on Saturday continued to send them under the bed.

I mention this this because I think the stress of the earthquake and aftershocks has thrown both cats off schedule somewhat in terms of box habits. Tim possibly a bit more than Abby, but I'm trying to not worry. Both cats went Friday morning, then neither went until Saturday night. Abby went last night, about 24 hours later. Tim went some time during the night after 11:00pm and before 4:30am, from 30 to 34 hours later. Tim's quantity is better than Abby's, and both cats' BMs included a "pellet" or two. We're watching closely and continuing to administer laxatone until both are back on schedule. I'm ready to call the vet if either cat goes 48 hours without a BM; I've been told the general rule is three days, but I want to make sure I have professional guidance by that time, whether it's over-the-phone advice or a visit.

We are continuing with the next step of Tim's cisapride weaning, which is skipping two days between doses. So he had doses on Wednesday and Saturday, then he'll have one tomorrow. If he hadn't had a BM by the time I left for work this morning, or if his schedule was wildly different from Abby's, I would have gone back to every other day until he stabilized, then tried every two days again. This is still in the back of my mind, just in case.

Both cats have good appetites and energy levels. They are playing with each other and engaging with us. We've rolled them over to rub their tummies and check for bloating and discomfort, neither of which we see. I worked at home yesterday and the litter box is in the office. I did not see any unusual box behavior, no signs of wanting to go, straining, etc., but unable to. So hopefully this is just them being a little stressed and off schedule, and not clogged.

cocheezie · Mar 31, 2014

Glad cats and humans are doing well and the earthquake was not a big one. Being (and using) in a litter box is being in a place where you are temporarily vulnerable. I wouldn't want to take a chance of using my litter box when the whole world is shaking and might shake again.

The only earthquakes I get here are rare and small. Barely enough to swing a lamp shade. In a way, I miss being on the west coast.

abbyntim · Mar 31, 2014

Thanks, Cocheezie! That's kind of what I'm thinking about the litterbox. The box itself is in a very quiet and out-of-the way location and they've been peeing fine. But both cats have been very quick in and out. And both have been a little more jumpy than normal since Friday night. They both slept quite a bit after dinner and I think they both slept pretty soundly most of last night, so I believe they are finally settling down and their box habits should get back on schedule real soon. Both are pretty much every 24 hours. Abby has some 12-hour intervals, perhaps once per week or so, while Tim has a few 36-hour stretches on occasion. So it was a little unusual for Tim to have two 36-hour stretches back-to-back. I hope he returns to his 24-hour schedule by tomorrow morning. He also gets cisapride tomorrow morning.

It's funny you mention missing the west coast. My husband and I were commenting, after the earthquake two weeks ago, that we haven't felt a good one in a while. There have been a few small shakers here and there. But the one on Friday night really rattled both of us, and the cats! When the house wouldn't stop shaking and we heard things falling, we wondered if it's the "big one" that we always hear about in Southern California. Thankfully not yet, but a good reminder to check in on our earthquake kit and make sure it's well-stocked.

tdonline · Mar 31, 2014

Is cisapride a drug that usually results in long-term use? If a cat starts on it, does that mean he/she will have to depend on it? I've been dealing with a constipated cat for the last 4 months and even with the vet's recommended remedies, she will only go every 4 or 5 days. The waste is formed but soft and she doesn't seem to be in any pain when she actually goes. She isn't as peppy of course after 4 days or so, but she doesn't seem to be suffering during the act of going. The vet said if the remedies do not work, we would consider prescription medication. I'm leaning towards it as I'm concerned about my cat's schedule. She may not be in pain, but this can't go on long term. I agree with my vet that the constipation is a psychological reaction to the stress of redirected aggression and subsequent separation from her sister. We've worked on this issue and they are on the road to reconciliation. But still the constipation persists. It may have started out as psychological but I'm afraid it's going to a mechanical issue soon or it already is.

Can cisapride be used to jumpstart a stagnated stool schedule and thereafter be discontinued?

Cisapride - regular vet vs. holistic vet

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