RINGWORM Nightmare + drug interaction.

Hi everyone, I'm literally at my whits end. This is going to be long, please bear with me.  Please any advice or personal experience stories are greatly appreciated!  

Here is my story: I have three long-haired indoor-only cats. About 4 months ago I took two of them to the groomer.  About a week later I noticed they were itching a lot especially around the head. So I put them on flea-treatment medicine. After a few weeks I noticed the itching had not stopped and in fact two of the cats had a lot of irritation on their temples and inside their ear on the skin.  So I took them to the vet.  The vet basically didn't know what was wrong but a cytology showed they had a bacterial infection on their skin so they were put on antibiotics.  The vet also did a test for fungus which came back negative a few weeks later.

In the meantime I personally developed several round, itchy lesions on my skin.  I also went to the doctor who did a fungal culture.  A few weeks went by and the culture came back negative! At this points the cats were done with the antibiotics and their skin looked better.  So I thought all was good. 

Boy was I wrong.  About three days after the antibiotics  were finished, the spots returned on the cats.  This time, the female cat started losing her hair around her chin and cheek.  The boy cat was bleeding and scratching furiously on his ear and temple.  Back to the vet, where even more antibiotics were given.  Again, this worked a little bit and the skin problem started to get better.  Meanwhile my skin was getting worse.  It was unbelievably stressful.  I went to three different doctors and was diagnosed with psoriasis and this other weird thing called  Pityriasis rosea.  The steroid cream I was given did NOTHING. But since the fungal came back negative they all assumed it was not ringworm.  

Fast forward a few more days and I noticed a lesion on my third cat.  This one looked a bit different than on the other two cats but I had enough.  I basically demanded that my vet do a skin biopsy.  I also personally went to a dermatologist and asked for a biopsy to be done on my own lesions.  

Two weeks later I got the results for both myself and my cats: RINGWORM!!!!!  Microsporum canis to be exact. The dermatologist gave me a special lotion for myself and within a few days I was finally feeling better!!  It was amazing. My husband also contracted ringworm during this nightmare, and he's also on the fungal lotion and getting better.  As far as my kitties, it's been more complicated...

One of my cats has Feline lower urinary tract disease (FLUTD). A few years ago he nearly died of a full urinary blockage and had to have emergency surgery.  Thankfully he survived and ever since I've had him on a special diet and on 5mg of a drug called Amitriptyline. He's been fine since that incident thank God.

Now fast forward to the present, and my vet is recommending that all three cats go on Itraconazole for the ringworm. Then I found out that Amitriptyline and itraconazole have major interaction with each other (just google or put the two drugs in a drug interaction checker). So my vet suggested cutting the Amitriptyline in half while I give the itroconazole for two months.  I just simply felt uncomfortable with this.  So I decided to try doing Lime Sulfer Dips only without oral meds and see what happened.

Well I did the dips for three weeks with very positive results.  However, during the forth week my cats got very sick and I had to take one of them to the hospital.  105 degree fever (VERY HIGH) diarrhea, vomiting, lethargy not eating, the works...They were treated for an overgrowth of a bacterial called clostridium perfringens which the vet said occurred from being stressed.  I really think the stress was the lime dips because I had to take them to the vet to do the dips (couldn't do it in my apt to smelly no ventilation). The vet would keep them there ALL DAY to do the dips and when they came home they were so upset. 

So I stopped the dips and then it came back.  And here we are again in the same situation.  The cats have the ringworm and I'm so afraid of the itraconazole.  I've decided I'm definitely giving two of the cats the oral itraconazole.  I already have started it in two of them today.   I've also given all three cats a bath today in some sort of anti-fungal shampoo the vet gave us.

But I'm hesitating to give the oral itraconazole to the cat who is on Amitriptyline, I just have a bad feeling about it.  Any thoughts? Advice?  HELP!!!!!!!!!!!!!! THIS IS SO STRESSFULL!!!!!

Talk to a pharmacist. They often have far more knowledge about the mechanics of drug interactions that doctors/vets. I speak as someone who's on a ton of meds long term (including amitriptyline), most of which are contraindicated. When looking at extra treatments, I first look to see how the two drugs affect each other.

Another alternative would be to find out if there's a topical version of the itraconazole. I had thrush a while back (sorry if too much info). It was decided that whilst the oral tablet wasn't a good idea, the pessary and cream were fine. It's to do with how the drug is absorbed. Hope that helps.

Agreed with Columbine. I also agree that if your gut is telling you to Not do it, then don't do it. Can I ask several questions? Firstly, is the current Vet treating him the one that prescribed the Amitriptyline? Secondly, why is he on that medication? its an anti-depressant in humans, so I was wondering why did they put him on it?

This is a link to Dr. Plotnick's blog,http://manhattancats.com/Articles/ringworm.html  he is a board-certified cat specialist and he has other shampoos and treatment ideas. I've not had to deal with ringworm in my cats. Very sorry this has happened. Also its advised that the cats be kept in a small, easily cleaned room, like a bathroom, to keep everything washed so they will not re-infect themselves or others. I'm also sorry it took this long to get a diagnoses.I am worried about the dips, I've not heard of cats being dipped for a very long time.

Hi Columbine, I did ask the pharmacist and he said something similar to the vet.  He said that the two taken together can cause two issues: the anti-fungal will cause the Amitriptyline to become more potent, which can cause an overdose in the cat.  Or, it can also cause an arrhythmia which can cause problems up to and including DEATH!  The pharmacist said he suggesting cutting the Amitriptyline in half, which is also what the vet suggested.  But I'm worried to do even that.  

nansiludie, Charlie is on Amitriptyline because FLUTD is often triggered by stress and the Amitriptyline is anti-anxiety.  Also, it is often used to treat FLUTD because for some reason it calms the bladder or something, honestly I don't remember exactly it was a few years ago that he was put on it.  And no the doc who originally prescribed the amitripatline is not the same vet that is prescribing the anti-fungal, however the current vet has been renewing the Amitriptyline for at least a year now. 

Right. I'm guessing the arrhythmia/death are rare complications. Itraconazole increasing the potency of amitriptyline is kind of what I figured. Arrhythmia and other cardiac issues are a possible side effect of amitriptyline anyway. It naturally follows that the itraconazole increasing amitriptyline's potency could also increase the likelihood/severity of the side effects.

I am not a doctor or vet - just someone all too experienced with psychiatric meds and their side effects /interactions. I do know that abruptly stopping the amitriptyline is a bad idea, and that it's equally important to effectively treat the ringworm. It might be worth asking about dropping the amitriptyline to a quarter dose rather than a half dose whilst giving the itraconazole. Also, find out if there's anything you can do to minimise the interaction issue(ie, would giving the drugs a certain number of hours apart be safer than giving both at he same time).

For what it's worth, I'd take the risk, but probably with a quarter dose rather than a half dose of amitriptyline. You don't say anything about looking at alternative administration methods for itraconazole (such as topiacally). It really is worth investigating, as the administration method really can affect the way drugs interact.

Topical treatment is very important to limit the release and spread of spores of the fungus.

Lyme Dips were actually one of the best things you could do.  Antifungal therapeutic baths at home with ketoconazole and miconazole based shampoos, such as KetoChlor and Malaseb, are very vital parts of ringworm therapy. Bathe once to twice weekly until no fungal growth occurs on fungal culture. Don't even bother having a fungal culture rechecked of each cats' skin until after 2 weeks of therapy.

Topical Conofite lotion and cream are also great veterinary products effective for ringworm. Applied twice daily. I used on myself after 2 different ringworm feline patients gave me ringworm, despite suiting up, and washing with antifungal soaks after our exams/restraint. I believe visiting one of the houses for the exam was the catalyst for the 2nd infection.

Which leads me to ask, what environmental treatment have you engaged thus far?

puck makes a very good point. There's little value in ridding the cats of ringworm if they're just going to reinfect themselves from their environment. Cats and house need to be treated to achieve eradication.