drug for liver kidney semintra? vet calling me about it in 10 minutes

Hi. Called vet clinic to re-order sub-q. Receptionist called back. Said vet has new drug he wants to add - symetra? symentra? Would benefit liver and kidneys.

Waiting for vet to call me about it. Anyone have any experience with it?

Does he mean silmarin (milk thistle)? Receptionist definitely said something ending in "mentra".

Cymetra?  That's a derm med, so I don't think that's it.

I can't wait to hear what it is!

Maybe Denamarin? 

I don't know anything about the drug, but a Google search turned up Semintra.
New treatment for cats with chronic kidney disease: Boehringer Ingelheim launches Semintra[emoji]174[/emoji]

A new treatment option for cats diagnosed with chronic kidney disease has been launched in Europe by Boehringer Ingelheim Animal Health. Semintra[emoji]174[/emoji] is the first ever angiotensin receptor blocker to receive a marketing authorisation in veterinary medicine, and contains the active ingredient telmisartan1. It is licensed for the reduction of proteinuria (i.e. the unwanted loss of proteins via the urine) associated with chronic kidney disease (CKD) in cats.

Click to expand...

It's included in this list: Best New Veterinary Products Of 2013 As Voted By UK Vets

That must be it!

Oh, good find, @jcat! That might be it. 

Thank you all so much! I ended up playing phone tag with the vet all day and still haven't talked to him. I'll do some reading and hopefully contact him tomorrow.

Edit: I must have tried every spelling but that one. Thanks again.

Oh, so I guess Semintra is a little different than an ACE inhibitor like lisinopril and enalapril? My vet recommends an ACE inhibitor for proteinuria. Do we know why one of these treatments might be preferred over the other? Tanya's site touches base at little on both: http://www.felinecrf.org/treatments_fluid_and_urinary_issues.htm#proteinuria

GoHolistic said:

 
Oh, so I guess Semintra is a little different than an ACE inhibitor like lisinopril and enalapril? My vet recommends an ACE inhibitor for proteinuria. Do we know why one of these treatments might be preferred over the other? 

Click to expand...

Thinking out loud here. Apologies in advance for the long post.

Why? Because it's new.

Cocheezie, according to her last blood work, has Stage 3 renal failure (liver lymphoma affecting kidneys). BUN 27.4 mmol/L. Range 5.7-13.2. Creatine 338 umol/L. Range 80-221. This bloodwork was done 24 May. The last time the vet saw Cocheezie except for one visit for a B12 shot was the 23 of May. There has been no new bloodwork done. Since she has a terminal illness, we felt that there was no point. She has been feeling great. We had another great outing along the riverbank tonight. She even stuck her nose in a few holes that she optimistically thought might contain mice. Only recently have we started to see minor signs. A twitch in a front leg which messes up her jump from time to time. For the last week, her appetite has decreased. After a week of trying this food and that combination, it turns out she is holding out for fishy wet food. Obviously fish is not good for her (although she gets 1 tsp 2x with 2 meds mixed in). We've started putting tiny little dabs of fish on top of her k/d wet. It's becoming a balancing act. Nutro Soft Loaf Cod seems to be one of the lowest phosphorus-wise. And at some point soon she can eat whatever she bloody well wants to. Her current weight is 6.2 pounds. This is after a week of holding out. She has lost 0.6 pounds in the last month. Other than that once for a B12 shot, there has been no major reason to take her for a vet visit.

She has never had a protein/creatine ratio test. Her bloodwork in May showed a Total Protein level of 76 (range 63-88 g/L).  I have not tested her urine for protein. I don't think I could unless I bought litter box crystals. She won't go unless she has complete privacy. I'm sure that being in Stage 3 kidney failure means she is losing protein, but she doesn't have the symptoms of proteinuria mentioned in the tanya site except for weight loss (and that could be due to the liver problems and/or the lymphoma). No foamy urine. No swelling.

I did not talk to the vet today. He called while I was out this afternoon. He's away on Wednesday. I have a doctor's appointment Thursday morning that I've waited 5 long months for; and that doctor's appointment will make me sicker than a dog for the rest of the day, and possibly the next day as well. We may not connect until next week. The vet receptionist said that the vet thought that semintra would help her liver and kidneys. Is it on his mind because he just read about it? or a drug rep visited? Will it truly help her? Our goal has been to keep Cochise comfortable. She's getting sub-q daily. A vitamin b/iron/amino acid tincture + miralax mixed in her forbidden food. Cisipride to keep constipation at bay + Pepcid AC for stomach acid. She's eating k/d wet with other low phosphorus food mixed in because she won't eat k/d straight up. The exception being the fishy wet that makes giving the tincture and the miralax easier, and the exception of the last few days when it have been used as a topper. Proper toppers or treats or ground up kibble on top of wet she won't touch. She gets k/d and thyroid dry left out at night but is eating less than 1/8 cup total. We've been seeing a bit of stomach acid some mornings. Her squished digestive system does not want to process hair at all. It comes up as a mix of foam and strands of hair usually in the early morning. Not even formed into a hairball. Once it comes up, she happily eats 1st, then 2nd breakfast.

This is the first time that the vet has suggested a drug other than RX food for Cocheezie's kidneys. Why wouldn't he have mentioned using ace inhibitors before now? Because he just read about this new drug recently approved, or was visited by a drug rep.

The drug might buy some time kidney-wise. It should help with her rapid heart beat (slightly high T4 is a contributing factor). My partner thinks that since Cocheezie continues to be well, we should leave well enough alone. I don't know what to do. I know she's going to die. I know she will go to a good place and that her original owner of her 12 years is waiting most impatiently for her. I love this old girl to bits, but her original owner (my mother-in-law) loved her too. Because of this, I haven't felt the desperation that some owners feel when their cat is sick and dying. I know she's going to see her beloved owner. I can tell that Cocheezie still misses her. Instead of despairing, I'm concentrating on keeping her comfortable and happy, and concentrating on being with her and enjoying her. I'll cry after. We both work from home and she is being spoilt rotten. 

I have no idea what it will cost. In the UK, a month's supply costs between £20-30 (which is about $30-40 CDN). Price may be higher in Canada because it is a new drug.

Are there any UK members out there who have used this drug?

For now, these are my thoughts. I will be doing more reading tomorrow and get my partner to do the reading as well.

Thinking that we are going to try the semintra (unless it is over the top expensive). 

cocheezie said:

 
Thinking that we are going to try the semintra (unless it is over the top expensive). 

Click to expand...

i'll be very interested to hear your experiences with that drug for your cocheezie. my snick has CKD, so i think it'll be good to learn about this new medication that might help my girl at some point. not sure what stage snick's CKD is currently, but we caught hers early at the "beginnings of kidney issues" stage and have been treating it since then.

Just started last night. I gave it to her around dinner time so that there would be time to see if there was a reaction. I'll type out the notes that came with the meds later today. It's easy to give, and doesn't seem to have a bad taste. If hidden in food, you have to make sure all the food is eaten at once.

Since we are not doing before/after blood testing because Cocheezie's problems are terminal, and the cat is currently feeling great, I'm not sure how much I'll be able to tell you. I did find out that in May, her protein was +2. If we end up doing bloodwork, I'll let you know the results.

GoHolistic said:

 
Oh, so I guess Semintra is a little different than an ACE inhibitor like lisinopril and enalapril? My vet recommends an ACE inhibitor for proteinuria. Do we know why one of these treatments might be preferred over the other? Tanya's site touches base at little on both: http://www.felinecrf.org/treatments_fluid_and_urinary_issues.htm#proteinuria

Click to expand...

This is the most comprehensive document I could find on Semintra.

Scroll down to p 15. 

http://www.ema.europa.eu/docs/en_GB...ment_report/veterinary/002436/WC500139277.pdf

 
The second was a good quality, multicentre non-inferiority GCP study of two parallel-group design, conducted at centres in Belgium, Germany, France, Italy, the Netherlands and the United Kingdom.The study was designed to show that telmisartan is as efficacious as an authorised ACE inhibitor containing benazepril to reduce proteinuria in CKD in the cat ...

Click to expand...

I experimented and gave Cocheezie her dose tonight mixed into a tsp of food. She ate it without hesitation. It is necessary that the dosage be given all at once. If the cat is a snacker, giving the med in food will not work.

Important: You do have to use the syringe provided to measure out the dosage.

The scale on the side of the syringe is based on and scaled to weight, not in mls or units. Therefore, I fill the syringe to just under the 3 mark as she weighs almost 3 kilograms.

You insert the tip of the syringe into the bottle then turn the bottle upside down like an insulin vial, and suck out the dose. The syringe is not interchangeable with any other. When the bottle is almost empty, I shall measure the 3kg dose to see what it is in mils, then see if I can pry off the special top of the semintra bottle, in case, one day, the special syringe gets misplaced or stops pulling the med properly.

Would be good if they put "kg" somewhere on the syringe. Between (a) measuring out insulin in units for my other cat, and for Cocheezie (b) sucking up miralax with a 3cc syringe, (c) measuring her b complex tincture with accompanying 1 ml dropper, and (d) eyeballing 100 ml of fluid sub-q -- there are too many measurement variables coming into play.

Update.

Yesterday, I spent most of the day trying to entice Cocheezie to eat. The fridge is full of opened cans. She barely touched fishy pates (her favourite), and then that came back up again within an hour. Because it is more important right now that she eats, I have taken her off Semintra, and will be calling the vet Monday morning to discuss. While on the Semintra, she was vomiting more and eating less which does not fall into the quality of life category for a terminal cat. When I gave her Semintra straight from a syringe, it would come back almost immediately. When I mixed Semintra in a little bit of food (Semintra has to be taken all at once), she would still vomit an hour or more afterwards.

According to this website, there are no adverse withdrawal effects: http://ec.europa.eu/health/documents/community-register/2013/20130213125268/anx_125268_en.pdf

Already, I'm seeing a totally different old girl who is asking for food. While she is still being finicky about k/d (I've always had to mix it into other food anyway on a 50/50 and sometimes 30/70 basis), she is willing to eat.

I used the special syringe to measure, then syringed into a shot glass and picked up the med in a separate syringe, so that if the Semintra didn't work out for Cocheezie, the special syringe would not be contaminated and I could give the remainder of the bottle to the animal shelter. I hope some kitty there can benefit from it.

@cocheezie, I'm so sorry for two things: 1) That you quoted me twice and I never responded!     I wasn't sure if you were expecting a response, but that's besides the point. And 2) That poor Cocheezie didn't do well on Semintra. I saw your question in the expert forum with Dr. Kris and it prompted me to check back here.

Thank you for providing that information on Semintra. It's interesting that it seemed to affect Cocheezie negatively. Certainly vomiting more and eating less since starting the drug is not what you want! I'm glad that she was willing to eat again since stopping the drug as of your last post.

Sending lots of vibes that she remains comfortable...  

@GoHolistic  Thank you. I wasn't expecting a response. I was just passing on information since it is a new drug, and you had shown an interest in the drug earlier in the thread.

Haven't taken her in yet. Cocheezie's vet is on holidays, and I refuse to let the other vets look at her.

That sounds like a reaction alright.  I think you were right in stopping it, especially since she's eating again now that she's off of it. 

cocheezie said:

 
@GoHolistic  Thank you. I wasn't expecting a response. I was just passing on information since it is a new drug, and you had shown an interest in the drug earlier in the thread.

Haven't taken her in yet. Cocheezie's vet is on holidays, and I refuse to let the other vets look at her.

Click to expand...

Yes, thank you, I was interested. And Dr. Kris' take on it was interesting, too. I didn't realize that the drug had become available before the published studies were out. Since the drug is so new, I wonder if there is a protocol to report to the manufacturer the side effects you observed. 

Hope so. I plan on asking my vet to report the side effect.