Long-term Management of Arthritis: Onsior, Buprenex, Tramadol, or Adequan?

sarahhalen

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Hi, 

My girl is almost 15yrs old and was diagnosed with arthritis at 12.  Upon diagnosis, I made the usual lifestyle adjustments:  pet stairs everywhere, laser therapy, Cosequin supplementation, etc.  Unfortunately I just took her into the vet because she was unable to walk properly.  After x-rays were taken, it appears her arthritis has worsened over the past year (we x-ray yearly to monitor the arthritis), mostly in her back hips and tail.  

The doctor prescribed Onsior, only to be given for 3 days. She showed improvement.  Now that the Onsior has "worn off", I've had to watch her go back to being in discomfort. I'm investigating other therapies simply because seeing her so improved on the drug makes it seem cruel to allow her to continue living in pain.  I read one reviewer who has been giving her cat Onsior 3x per week for the past 2 years with no side effects (yearly bloodwork performed to ensure kidney/liver values remained normal).

I investigated long-term use of Onsior but the host of potential complications (kidney and liver disease, primarily) makes me nervous. My doctor never mentioned Adequan or Tramadol, only Buprenex or Onsior. 

Could anyone share any long-term treatment options available for kitty arthritis?  Thank you in advance!
 

tinybash

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My vet has just prescribed my 15 yr old girl with metacam. I'm interested in other views too. I'm worried about side effects of these drugs.
 

denice

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Which medication is your vet recommending?  I used to be in the no metacam ever camp but I have kind of changed my view.  Metacam is often used for arthritis.  Precautions need to be taken as far as dosage and keeping an eye on kidney function.  A kitties liver isn't able to metabolize metacam so the kidneys do all the  work. 

I really think any pain  medication long terms will probably have negative side effects, just as it would in humans.  It's really  a quality  of life issue.

I know Buprenex is often used short term, my kitties had it after teeth extractions, I don't know about long term use though.   It is an opiate so I would think there would also be possible side effects with long term use.
 

jdollprincess

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My 16 year old cat Cali has severe arthritis in her lower back. For the past year or so I've had her on weekly adequan injections and a daily dose of gabapentin. Last week I spoke with the vet about her having trouble lying down and getting up and she prescribed Onsior. We're starting out with the 3 day course then going to every other day long term and we're going to check her kidney and liver values in 2 weeks then every 3 months. It's a quality of life issue with her and she definitely seems more perky on the Onsior. I'm curious to know if anyone else has used it long term. We discussed buprenorphine also but it makes her really constipated.
 

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My Boo, also 15 years old, has IVDD and arthritis.

Regarding pain management...  Buprenorphine (Buprenex) and Amantadine made him listless. We never tried Tramadol and my vet was irresolute about having to order Adequan, as if it was some huge inconvenience to them.  
  Anyway, we ended up putting Boo on Gabapentin. It is not traditionally used for arthritis, but vets are using it more and more for arthritic pain because it seems to really help some cats. It's been great for Boo and it doesn't make him lethargic. He's also on a Chinese herbal blend for pain, which was prescribed by a vet who specializes in Traditional Chinese Veterinary Medicine.

For joint support...  I use a glucosamine/MSM/hyalauronic acid supplement and omega-3s. Others have used curcumin and krill oil with success, but neither of these agree with Boo, unfortunately.

This thread has some good information and discussions: http://www.thecatsite.com/t/265881/best-remedy-for-feline-arthritis
 
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sarahhalen

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Hi, thank you for the info!  My vet isn't prescribing anything right now.  She gave me 3 doses of Onsior and that's it.  She never mentioned the Adequan and stated that Buprenex wasn't appropriate to treat arthritis pain (which makes sense since it doesn't really address the inflammation which is the cause the pain).

When she was on the Onsior for 3 days, I was giving her a very mild dose (1/4 of the standard 6mg dose) because she's quite sensitive to meds.  Even that small dose enabled her to move around a bit better.  She actually did the kitty stretch (where they stretch their front paws in front, then walk forward and stretch their back legs behind them)!  I haven't seen her do that in a year!  You could tell when watching her do it, that she was a little tentative, like "I kinda want to stretch, but I'm not sure if it'll hurt.." but she did it.  It was so nice to see her feeling better, but when the drugs wore off, I sadly watched her revert back to walking stiffly around the house, tail tucked under, sitting in a hunched position.  Just seems so cruel to do that to her.  It made me sad that I'd given her 3 days of relief, only to be left with no option by my vet for further meds. 

I've just recently read about "Duralactin" which appears to act like an NSAID, but isn't. I may try to incorporate this into her diet simply because the Cosequin is no longer working.  

Her latest xrays revealed arthritis in her back hips and tail.  She actually has no disc left between 2 of her lower back vertebrae, so they're rubbing against each other which I understand is quite painful.  

I'm very encouraged by the recent posts of using Onsior potentially long-term.  I understand that it may have side effects but as you said, it's a quality of life issue.  I want her to live as long of a life as she can, but I also want to balance that by being a responsible parent and making sure she's not in serious discomfort. 
 
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sarahhalen

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Thank you JDollPrincess for your feedback.  I completely agree it's a quality of life issue and I'm happy your vet is open to considering a long-term option.  I read on another site that someone had used Onsior 3x per week on her (now 15yr old) cat for the past 3 years with no problems.   

Also, I'd posted on another thread yesterday afternoon regarding Adequan usage, and CatPack provided her experience using Adequan but also using Onsior long-term.  She's used it on both of her cats for 3yrs (weekly) with normal blood panels.  Here's the link and I believe her comment is Post #12: http://www.thecatsite.com/t/275664/drug-for-arthritis-atiquan-sp
My 16 year old cat Cali has severe arthritis in her lower back. For the past year or so I've had her on weekly adequan injections and a daily dose of gabapentin. Last week I spoke with the vet about her having trouble lying down and getting up and she prescribed Onsior. We're starting out with the 3 day course then going to every other day long term and we're going to check her kidney and liver values in 2 weeks then every 3 months. It's a quality of life issue with her and she definitely seems more perky on the Onsior. I'm curious to know if anyone else has used it long term. We discussed buprenorphine also but it makes her really constipated.
 

char1963

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Hi I just saw your post and since it was fairly recent would love to know what you came up with. I am having the same issues with my kitty. I have him on gabapentin sometimes twice a day, and I have a transdermal buprenorphine for when it gets bad. I also use a joint supplement drops that I'm not sure if it works or not. He also has been prescribed tramadol but I only gave it to him for a few days because i believe it was making him nauseated, so I stopped.  I am going back to the vet for some updated x-rays this week I hope--i believe his condition is worse. Anyway would love to know what's going on for you because the couple of times he has been on onsior (for other reasons) he was like a new cat and it's very sad that i can't keep him on that. Thanks ...
 
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sarahhalen

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Hi Char1963,  I actually haven't made much headway towards improving her arthritis :(  You could try looking into the Assisi Loop with is a targeted PEMF (pulsed electromagnetic frequency) device.  She may have slightly improved on it.  

Laser therapy is also something that people have had good success with..  I tried a couple times but honestly the 2x per week vet visits to get the treatment were too stressful for her. I'm looking into purchasing one of the hand-held laser therapy devices to try using on her at home.  

I agree with you about the tramadol.  I really hate the idea of putting her on the tramadol (can cause nausea) or buprenex (can cause constipation).  Buprenex is one I especially would like to avoid just because most cats that have severe arthritis get constipated on their own for a couple of reasons:  1) age-related (dehydration, loss of motility, etc); 2) squatting actually hurts so they try not to do it if they absolutely don't have to; and 3) the pelvic nerve bundle at the base of the tail is commonly affected by arthritis. This nerve loses sensitivity so they don't get the 'trigger' that they need to defecate, which causes them to become backed up. 

I completely agree with you about Onsior.  I put my girl on it for 3 days and she was like a new kitty.  It's heartbreaking and cruel to watch them decline again after feeling so good.  There have been a couple of studies done where some cats have been on a lower dose (1/4 - 1/2 tablet) of Onsior 2-3x per week for 2 or 3 years, with no issues.   Try googling long-term use of Onsior.  

My vet actually prescribed me the long-term dosage but to be honest, I've been quite nervous to administer it simply because of the kidney/liver issues associated with it's use... so I'm on the fence about it. 

Some people have tried Adequan and had good success.  When I asked my vet, though, she said that she hadn't had any success with adequan in cats.  So I guess it's a question of who you ask :-/

Hopefully some others will reply with their feedback as well.  I'm in the same boat as you (and probably every other person who loves their kitty and hates to see them decline), so if someone finds a way to improve or manage arthritis, let us know! :)
 

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Adequan provided a lot of relief for my Lucky in his last year of life (died due to antibiotic-resistant pneumonia.)

I used Onsior off-label for about a year with him. I gave it whenever I felt he needed it...sometimes everyday, sometimes every other day, sometimes twice a week.

I never felt Tramadol worked well. And, while he was easy to medicate, he HATED the taste of the pill.

In the end, Adequan with Buprenex for breakthrough pain worked the best for us.
 

musicinthesun

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Hi everyone. I thought I'd chime in, too, since my baby guy has been battling arthritis the last 2 months. He is 16 or 17 (I found him as a baby when I was a teenager but not sure which age). Needless to say we are super duper close, as you all know! I feel terrible that I just noticed he was having trouble lying down and jumping recently, as it seems like it came out of nowhere but as I keep hearing from pet parents like yourself and my vet, cats are very good at hiding pain till it is out of hand. So, I got him to the vet who gave me Adequan (glucosamine/chondroiton) and Onsior. But not in that order. We first tried Adequan for a month but no improvement so I brought him back in for x-rays as I could tell he was having trouble still. I guess he got sore after the x-ray and started crouching while he was eating and drinking (his bottom wouldn't touch the floor) so I got freaked out that something happened during the x-ray (but know it didn't he just really got sore) so that is when they gave me Onsior. Now, my vet said that although he can take the 6mg table for 3 days in a row that a lot of vets give it for 6 days in a row. BUT, this morning he puked a little (maybe hairball trying to come up but now I am not sure) and I am thinking I should just stop for now (he had the 3 day dosage). Like you all have noticed, the change is REMARKABLE! He is doing SO much better now and of course, I am elated. I have researched like you all have and so far have to agree with the group consensus, it seems that the positives are outweighing the negatives. I will call my vet tomorrow (Monday) and see what she says but I think I feel most comfortable with 3 day dose for now, especially since his belly got upset today. 

What I am most interested in seeing at this point is if his pain will come right back to where it was in a week :/ I guess I'll cross that bridge when we get there. Lastly, I have been sprinkling turmeric, ginger, omega 3 oil, and some msm-glucosamine-chondroiton (all in 1) capsule on his food for the last week. I just do a little because he was on to me and wouldn't touch it, of course, but I have dome a lot of research before doing this and asked a couple of vets and it is VERY safe for those things to be administered to him. Maybe some of you might want to try it?

Thanks for letting me share and I appreciate any feedback and also hope this may have helped others!

Last question  before I post - what do you guys think on Onsior longterm? I haven't read about it yet but has it shown to cause kidney issues? Thanks so much!
 

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Our Missy is 16 and has been on Metacam for 8 months. I've quizzed our vet over the side effects as this also can be attributed to kidney disease. In the end we agreed with the vet that at her age pain management was the most important thing. She does have her bloods done on a monthly basis just to make sure everything is normal. She is a new cat - running and jumping etc. Good luck with your kitty.
 

musicinthesun

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Hi, that is so great she is feeling good again! Well, truth is I am still shocked I am here with this issue, as really for the first time in 16-17 years I realize my baby is old! But yes, I wholeheartedly agree at this point we need to keep our cats comfortable as much as we can. And good for you for checking her blood monthly, if we end having to go a similar route, I'll do the same thing. This is definitely an example of the pros outweighing the cons. Thanks for your reply :)
 

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M musicinthesun Onsior is the equivalent of us taking Aleve. So, it is just about guaranteed that your kitty's pain will return once off the medication.

When using Onsior off-label, I typically dose every-other-day or twice weekly. This may be a Bette option for your cat. It's really trial and error to figure out what works for each cat.

I often use Buprenex for breakthrough pain.

I also started using Adequan, which is a joint supplement, given via injection, and can be used in conjunction with Onsior/Metacam and Buprenex.
 

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Hi @CatPack  , you're right. I guess that seems to be the case. Good idea on experimenting how I can use it. With the 2 ways you dose your kitty, are the tablets 6mg? Also, do you think we will need to do periodic bloodwork if we use it regularly?

You know what, I just started using Adequan too. My vet said to give him .1mg 2x a week for now, he is 9 lbs, but I am realizing it is a very low dosage and I don't see much improvement yet. I had another vet say that with his weight he could get .2mg (2x as much) twice weekly. Would you mind if I ask how much you give your kitty? I think I need to up his dose ....

Also, they gave me Buprenex too. I haven't used it yet but like you will use for breakthrough pain so I am glad I have it on hand.

Last question (I know I am asking a lot), yesterday was my kitty's 3rd day on the 6mg daily tablet. The vet said I should give it to him for 6 days (I bought 2 packs) but he threw up today. Think it is Ok if I stop for a bit? I read that nauseous is a common side effect so I am trying not to freak myself out. I get too nervous!!

Thanks so much.
 

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First, I can't speak on the issue of nausea. I've not ever had that problem with Onsior. But, if you feel that the medication caused the issue, there isn't any harm in skipping a dose. Onsior doesn't require a "loading" period, really.

As for Adequan, the cat I gave it to weighted 13 lbs and his dose was 0.25 mL.

And, yes, I used the 6 mg tablets.

The main cats I have used the medication with were my oldest who had horrible arthritis (I lost him last May at the age of 17 due to pneumonia) and my now 4.5 yr old (he started on the medication when he was about 1) who has a mild form of hip dysplasia and mild arthritis. Max doesn't take meds on a regular basis now; but, I keep it on hand and use as needed.

As for blood work...
I personally think having a senior cat's blood work checked every 3-4 months is a great idea, regardless of medication taken.

Lucky (the kitty I lost) developed a severe case of pancreatitis 2 wks prior to the pneumonia. I was so happy to have had blood work done on him just a few weeks prior for reference. It didn't change the fact that he was so sick, but gave me some peace of mind knowing that he hadn't dealt with a low-grade pancreatitis for months. His sickness did happen fairly acutely.
 

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Thank you for the Onsior and Adequan info.  Good to know. I will just miss the 4th dose tonight and see how he is doing tomorrow. He jumped on the kitchen counter today 3 times so obviously the med is truly helping. I'm gonna up the Adequan tomorrow.

I am very very sorry to hear of your loss of Lucky :( That must have been and probably is pretty difficult, but I can see how having the knowledge of what was going on provided peace of mind. I am 33 and this is my first cat really... found him as a teenager and we've been together since. I feel like I am a "first time" mom but you're totally accurate - blood work every few months. I know it is so hard for owners when they suddenly find out about an illness by bringing the cat in for not eating and then the bloodwork is run and they realize something catastrophic has been going on for who knows how long. I promise I will check my kitty regularly. Glad to hear Max's conditions are mild and controlled. 

Out of curiosity, did they say what caused/causes the pancreatitis? Do they think it made him susceptible to the pneumonia? Or was it just age related?
 

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Hi @CatPack  , you're right. I guess that seems to be the case. Good idea on experimenting how I can use it. With the 2 ways you dose your kitty, are the tablets 6mg? Also, do you think we will need to do periodic bloodwork if we use it regularly?

You know what, I just started using Adequan too. My vet said to give him .1mg 2x a week for now, he is 9 lbs, but I am realizing it is a very low dosage and I don't see much improvement yet. I had another vet say that with his weight he could get .2mg (2x as much) twice weekly. Would you mind if I ask how much you give your kitty? I think I need to up his dose ....

Also, they gave me Buprenex too. I haven't used it yet but like you will use for breakthrough pain so I am glad I have it on hand.

Last question (I know I am asking a lot), yesterday was my kitty's 3rd day on the 6mg daily tablet. The vet said I should give it to him for 6 days (I bought 2 packs) but he threw up today. Think it is Ok if I stop for a bit? I read that nauseous is a common side effect so I am trying not to freak myself out. I get too nervous!!

Thanks so much.
Hi,

My 18 year old cat, Sandra, is on Adequan.  She is 9 ibs and is on a dose of .18 ml twice a week.  She just started her third week.  She has advanced arthritis in her lower spine and has difficulty walking.  I have not noticed improvement yet, but the vet wants to give the Adequan a few more weeks to see if there is improvement.  Most of the information I read online says an improvement is seen after a one month loading phase.  So I'm praying that she gets better.  

Sandra is currently not on any pain medication.  I am going to talk to my vet about possibly getting her on medication for pain, specifically Onsior.  I can tell she is very uncomfortable. She is always changing position while laying down and walks slow and wobbly.  The problem is she has stage 3 kidney disease so I don't want the pain medication to cause further deterioration of her kidneys.  I just want her to be comfortable.  It breaks my heart to see her going through this.
 

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As for Lucky's health issues...a little background.
He had IBD with known intolerances to grains, glutens and pork. He had also developed some cardiac issues over the last 12 months. He also had an autoimmune issue that caused swelling in one of his front paw pads, in addition to the severe arthritis.

I think IBD played into his pancreatitis.

He had spent some time at the overnight clinic getting meds/fluids with the pancreatitis and developed symptoms of a URI just a few days after coming home. He seemed to be recovering from the pancreatitis well, eating good, using the litter box; but, the URI slowly got worse over about a 5 days.

I think the fact that his body was already drained from the pancreatitis, paired with a heart issue, allowed the URI to run rampant.

Long story short, despite high doses of antibiotics and antivirals, his body just couldn't fight off the infection.

He spent nearly 5 days in and out of oxygen to give his body the best chance to fight, and the last 2.5 days were spent completely in oxygen, with the exception of the 5 min drive from my regular clinic to the emergency/overnight clinic. He showed some improvement that gave us hope to continue treatment until his last day, at which time he really began to deteroriate.

Blood work showed 98% infection the day it was decided to PTS.
 

musicinthesun

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It sounds like a very difficult time, no doubt. And based on this info, I think you are right - the URI couldn't be fended off well due to the pancreatitis and heart issue. It was Lucky's time to go but in all of this, you must feel a sense of peace knowing you LITERALLY did everything you could do for Lucky. It was your kitty's time to go. 98% infection, yeah, what more can one do? You are a very good cat mom. I am convinced cats are little angels here to make us and the world a better place.
 
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