Question about giving Pepcid/Mirtazapine together

donutte

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I normally would just ask my vet this question but it's Sunday, and Lucky gets the Mirtazapine today.

I've been giving my Lucky Pepcid to help with his tummy troubles (he has stage 4 acute renal failure) and Mirtazapine every 2-3 days. I have had such a hard time getting these meds into him, and the best thing I could think of to do was to crush them up, mix them with water, and give them to him with a syringe. I tried tuna juice before - bad idea, he hated tuna juice after that. So sticking with water.

My question - can I crush the two up and put them into the same little syringe-full of water I give him? I know I'm supposed to wait a certain amount of time before giving him the Pepcid after the antibiotic he's on (I try to give it two hours or so). I just know how much he hates both and having to do it twice breaks my heart. He always feels so much better after a little while though and is more of himself.

 

On a side note - if anyone has any idea for giving sub-q's to a cat that will not calm down, I'll be willing to listen. He HATES getting it. It's not the needle either, I think it's the fluids because he starts getting very unruly after about 75 ml go in (he's supposed to get 200 ml a day). I've tried Feliway spray, treats, putting away the other critters... treats helped temporarily yesterday. Of course he probably should be eating THAT many treats but you know, I don't know what else to do.
 
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stephenq

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I normally would just ask my vet this question but it's Sunday, and Lucky gets the Mirtazapine today.

I've been giving my Lucky Pepcid to help with his tummy troubles (he has stage 4 acute renal failure) and Mirtazapine every 2-3 days. I have had such a hard time getting these meds into him, and the best thing I could think of to do was to crush them up, mix them with water, and give them to him with a syringe. I tried tuna juice before - bad idea, he hated tuna juice after that. So sticking with water.

My question - can I crush the two up and put them into the same little syringe-full of water I give him? I know I'm supposed to wait a certain amount of time before giving him the Pepcid after the antibiotic he's on (I try to give it two hours or so). I just know how much he hates both and having to do it twice breaks my heart. He always feels so much better after a little while though and is more of himself.

 

On a side note - if anyone has any idea for giving sub-q's to a cat that will not calm down, I'll be willing to listen. He HATES getting it. It's not the needle either, I think it's the fluids because he starts getting very unruly after about 75 ml go in (he's supposed to get 200 ml a day). I've tried Feliway spray, treats, putting away the other critters... treats helped temporarily yesterday. Of course he probably should be eating THAT many treats but you know, I don't know what else to do.
Have you tried pill pockets for the pills?  And have you tried warming up the fluids close to body temp?
 
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donutte

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Have you tried pill pockets for the pills?  And have you tried warming up the fluids close to body temp?
He was on pill pockets for the last 2.5 months for his thyroid pill (he has hyperthyroidism also). Last Sunday, he just decided not to take it anymore (that was the 'final straw' of many things that happened last weekend that spurred me to take him to the vet the next day). I DID find a "pill wrap" yesterday that he seemed to do well with. I'm almost afraid to try it with these though for fear he'll stop liking the new wrap. It almost killed tuna juice for him.

I might try cutting the Pepcid into even tinier pieces. The mirtazapine is already pretty small. Then maybe I can sneak it in there.

Edit: Will try warming the fluid again. Didn't work yesterday, but thinking it may have not been enough. Already watered him today, it seemed to go a bit better. Maybe I need to do it earlier in the day from now on.
 
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As a suggestion, I have purchased empty gel capsules. I put pills in them. I use a pill gun an follow it with a bit of water. Artie is very hard to medicate, but this is the best for him.

I heard that Pepcid is a very bitter tasting medication. I tried tasting it myself. It is gross. Cutting it up makes the taste more pronounced.

I know it is Sunday, so you are limited in your immediate options. You could just try to pick up a pill gun and see how that works. Make sure your kitty does not spit it out. I hold my guy's mouth closed until he swallows.

I wish you luck.

I do not have any thoughts on the combo of drugs together. Sorry
 
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donutte

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I have to give him a 1/2 Pepcid so no choice in cutting it up (they don't make one that is 5mg it seems). The mirtazapine is given to me by the vet already cut into quarters - that is actually worse than Pepcid in the bitterness department. I went to Petsmart yesterday and bought a pill gun, and it sucked! The plunger never even reached the pill. So glad I tried it out to see how it would work before trying it on Lucky. I think for future reference, need to do some research on a good pill gun and go through Amazon.

I sucked it up and put these in the pill "wraps" I bought yesterday. I cut the Pepcid into fourths and put each one into a treat. The wraps are not very big unfortunately, but he eats them. So I tried on with 1/4 Pepcid, and he ate it! I gave him the other one after that, and he ate that. Finally got brave enough to try the mirtazapine. And he ate that.

I'm beyond elated right now. I dread having to give him that syringe of bitter liquid way more than the sub-q. 
 

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Getting the sub-q up to temp is pretty key I think.  If the bag is pretty full it can take a while sitting in hot water.  It's been too long now though so I can't remember if we had to change out the bowl of hot water to get it hot enough or if one fill was enough.  I know you don't want to heat it any other way.  I always tested a drop on my skin to see if I basically didn't feel it.  That was close enough.  Cat body temp is a couple degrees higher than ours.

Pretty sure I gave Pepcid and mirtazapine together on occasion.  It was gel caps by then.  I used the plunger with those, coated them in butter and chased them with some water.  Still very difficult!  The sub-q was cake in comparison (actually the sub-q from the very beginning went a whole lot easier than I ever thought it would be, but pilling was difficult).  I had about 3 easy YEARS of pilling with Pill Pockets on methimazole, and then one day she bit it wrong and it became all over very quickly.  I bought any halfway soft cat treat I could get my hands on and tried them to varying degrees of success.  Even Pounce worked sometimes.  But that was before she needed multiple meds with the CKD.  At that point I gave up everything except trying to combine them in the gel cap.  You want really small gel caps if you try that, I forget the size, I think #3.  Probably have to order them; I never found them in a store.

Also for the sub-q, one of the things that happened by accident but turned out to be great is that Amber started sleeping in a rectangular basket that was lined with a fleece blanket.  This meant we could carry her to the easiest place to do the sub-q (where we hung the bag from a curtain rod and left the bed on the floor for best gravity effect) without disturbance.  She just lay in there and got the fluids in before she was really too aware of what was happening.  We faced her away from the fluid tubing of course.  Heh.  So my thought is if you can get Lucky to sleep in something rigid like that, it might also help you.

Caring for a renal cat involves a lot of tough things to keep up. Takes its toll on you as well as the cat. Hang in there.
 
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donutte

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If I do end up having to resort to the pill popper, definitely need a different one than the one I got yesterday. I think it was capsule #3, or at least I've seen that on other things. For now though, he seems to like it with the pill wraps so I'll take that as a small success.

Lucky sleeps on my bed, for the most part. Sometimes he comes out during the day to lay in the sunshine (if there is any). He gets quite agitated nowadays if he's picked up. I think it's because his tummy doesn't feel good. He never minded before last weekend. That would be great if I could get him to sleep in something like that though! Unfortunately, I don't think it's just the coolness of the fluid that bothers him. He's growling at me before the needle even gets inserted. He probably knows it's coming. I give him treats beforehand and then while he's eating, insert the needle. We managed to get about 160 ml today though - more than the last two days combined! It may not be ideal but I think we're finally onto something here.

I've also made a little "clinical area". I don't want to do it in his "safe havens", so turned the living room table into the clinic. Put a little towel on there, and it's ready to go. I need to figure out the best way to warm the fluid though. I even bought a digital infrared thermometer because I'm paranoid I'd accidentally make it too hot for him.

You're right about it taking a toll. Although, I think it's more my emotions getting to me at this point, and coming to grips with the fact that he probably won't be around much longer. Oh no, the tears again.... :(
 

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In human medicine a PPI like Pepcid slows digestion and causes malabsorption of certain medications including antibotics, heart meds and thyroid meds. The recommendation is to take the other medications at least one hour prior to the PPI or 4 hours after to make sure their systems absorb the medication.
 
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donutte

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In human medicine a PPI like Pepcid slows digestion and causes malabsorption of certain medications including antibotics, heart meds and thyroid meds. The recommendation is to take the other medications at least one hour prior to the PPI or 4 hours after to make sure their systems absorb the medication.
Thank you for the input. It's hard managing so many meds with Lucky (I have to do so with myself as well). Today he decided he didn't like the pill wrap. I tried to drop it into his mouth and he just swallowed it whole *shock*. Did NOT expect that. But, regardless, I only got half of the Pepcid into him that he's supposed to get. Will try the other half before leaving for work. The other meds and fluids will have to wait till I get back home from work.

I'm happy to have discovered that he will happily eat Fancy Feast gravy-type foods with gusto (in very small doses though). I'm sad to hear it's high in phosphorus though. I just want him to eat anything at this point. So between that and home-made boiled chicken, that's what his food will be I guess.
 

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My three younger cats will eat the pill pockets happily. I have a special tin box I keep the package of pill pockets in and they all think they are getting a special treat. My oldest boy I have to use a pill gun. He is picky and will not fall for the pill pocket.
 
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He used to take the pill pockets for his thyroid pill, but that stopped last Sunday. He just wouldn't take it. Even tried putting cream cheese on it (he loves that). Sara is still quite happy to have the pill pocket. 

Not so good today. I think I nicked something during sub-q and he just had a lot of blood - not gushing, but a lot more than a few drops. Going to the vet to have a tech watch me do it on Wednesday. They said let's give him a break tomorrow since he's freaking out. Hopefully can get him to eat later.
 

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Hi Donutte.

I'm sorry your baby is struggling.yes I know about pepcid & ckd.Have you read about pepcid on Tanya's ? Do you belong to Tanya's site?I see no sign of any anti nausea meds used.Pepcid is not for nausea.Nor is mirt.Odanestron is the chosen  & some kitties do well on Cerenia.Both can be used in conjunction as they stimulate differrnt receptors in the body.Pepcid only stops excess tummy acid from forming .That's it.Nothing for nauseau.If you don't belong to a group pls join right away.You are obviously giving phos binders being stage 4 correct?.Tanya's group in the UK superb is www.felinecrf.org  yahoo's group of over 14,000 members where i belong also superb https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info Also dosing of pepcid (famitodine) I have only seen max doses of 1/4 of a 10 mg tab per dosing.So I don't know if your vet advised this.Pls join one of these groups right away.Saying new member big letters.Need help stage 4.They will help you honey help your baby.Some people resort to pepcid injectable.If you are giving nothing for nauseau you have to be.It is must.These groups either one will walk you through all that you can do to help your baby feel way more comfortable.That is what they do.And have dealt with people all over the world.Pls join you will have no regrets. And yes they are used to dealing with a multitude of ailments in one kitty.They've all been there where you are today.If you have your most current test results for Bloodwork they will want to see everything you have & walk you through it.Hugs to you  & your Baby.C
 
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donutte

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Hi Donutte.

I'm sorry your baby is struggling.yes I know about pepcid & ckd.Have you read about pepcid on Tanya's ? Do you belong to Tanya's site?I see no sign of any anti nausea meds used.Pepcid is not for nausea.Nor is mirt.Odanestron is the chosen  & some kitties do well on Cerenia.Both can be used in conjunction as they stimulate differrnt receptors in the body.Pepcid only stops excess tummy acid from forming .That's it.Nothing for nauseau.If you don't belong to a group pls join right away.You are obviously giving phos binders being stage 4 correct?.Tanya's group in the UK superb is www.felinecrf.org  yahoo's group of over 14,000 members where i belong also superb https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info Also dosing of pepcid (famitodine) I have only seen max doses of 1/4 of a 10 mg tab per dosing.So I don't know if your vet advised this.Pls join one of these groups right away.Saying new member big letters.Need help stage 4.They will help you honey help your baby.Some people resort to pepcid injectable.If you are giving nothing for nauseau you have to be.It is must.These groups either one will walk you through all that you can do to help your baby feel way more comfortable.That is what they do.And have dealt with people all over the world.Pls join you will have no regrets. And yes they are used to dealing with a multitude of ailments in one kitty.They've all been there where you are today.If you have your most current test results for Bloodwork they will want to see everything you have & walk you through it.Hugs to you  & your Baby.C
I definitely have heard of Tanya's site, and also joined the support group. It's really great knowing that people not only face these issues so much, but also manage to work through them. It gives me some hope.

Lucky was prescribed 1/2 of a 10mg Pepcid tab per day, so that is why I've been giving that much. My vet has been on a family emergency, so not in the clinic since the day Lucky was diagnosed. He's supposed to be in next week but even at this point, that is a maybe. 

I had gone in yesterday to have the tech watch me give fluids to make sure I do it right. While there, I had asked if she could as the doctor about something for nausea. She came back and said the doctor had said it's probably from the kidney disease and there was nothing she could do. I was VERY upset, called again this morning and talked to someone else. I didn't feel great after that conversation either, felt worse actually, but the doctor from yesterday called me back 40 minutes later. I ended up bringing Lucky in for a shot of Pepcid and shot of Cerenia. He had the dry heaves pretty bad last night so I was terribly worried about him today, and glad she listened and gave him the Cerenia. 

He still hasn't eaten much. Not sure how long it takes for that kinda thing to kick in. He's having his "nap" right now (he likes to burrow under my blanket and sleep around this time every day), so will give him some more stuff to try later on. If he doesn't eat enough on his own, will go to the syringe feeding.
 

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Hi Donutte.I understand completely about HOPE.WE all need it for our Babes.Great that you joined & great that you asked about the nausea.I am so pleased!!! I also can elate to feeling upset from no answer.At least your vet did call or a  vet did call.I believe that vet office & this is my opinion only, just loves pepcid.

Donutte as per nauseau.Can you tell me about your baby & eating? Does he walk up to food smell it maybe a munch, then walk away? These are classic nausea signs.You can find them on Tanya's.Depending on what your kitties blood numbers are & what stage you are dealing with ,hydration etc all can affect the ability for them to want to eat or not.

Cerenia works well with some kitties and others it doesn't .You should know by tonight if not now if your kitty improves.What that vet thinks one shot is gonna do I have no idea.maybe just a test.Cerenia is dosed daily.You can read that on Tanya's as well.

Pepcid is only for preventing excess tummy acid from forming.And Man imo you sure have enough in there although it all get's excreted out of the body.Nothing stays.I'm hoping he picks up as food is life but you must understand & make sure Tanyas's is well aware you are new & make a big posting to get attention.

Helen is a wealth & will want to see all documentation to see just how much the kidneys are struggling.So if you have no documents of tests pls call the vet's office & see if they can scan & email them over to you.They are yours.You are privy, like I have said many times,privy to all test results ,xrays,scans,you name it.

If you haven't posted yet pls do so as time is going by and inappetance is nothing to wait around for.By the sounds of another member posts were not being seen for days or hrs.i forget.If your boy improves as per eating you will have to get on the horn tomorrow as cerenia will have left the body.I have used both injection and pills.Pills are what most vets prescribe.Can you pill your kitty?

Can you learn subq fluid therapy.You said you watched.your vet actually getting you to do it on your kitty while visiting is crucial in learning.Tanyas' will help you with that as well.A prescription from your vet & they will have a link for supplies exactly the same as what your vet is using but much more affordable.

It all helps.Maxwell was on fluids nightly for 6 yrs.Did very well my angel Trooper.You can do this!!!! You have made huge progress today!Your kitty is so proud.Let's hope the cerenia gets working to making him feel a whole lot better.Do you try different foods Donutte? Helen works with Yahoo groups all the time as well and you have their link.in case you end up waiting forever for your posting to show up.Which is not good IMO.

Pls keep us posted as WE all care here very much!!! Hugs Honey & Good Job!! Cindy

Hopefully this post will make it through to you as i mention meds but i want you to know we care & you made huge progress!!!! Are you Donutte or what is your babies name?I'm sorry I am so used to names.LOL But gotta Love that Donutte.
 
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donutte

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Haha, Donutte is my handle (has been the last ten years or so). Lucky is my kitty that is having problems. 

Regarding the Cerenia... he got a shot of it today because he was up half the night with dry heaves. The vet just decided it would be better for today at least to give it to him via injection (to avoid risk of him throwing up the pill). Vet asked me to call her again tomorrow morning to see how he's doing, and then we'll do it every day after that if it worked. It worked in the sense that he is no longer heaving and doesn't seem nauseous like yesterday. He just doesn't seem interested in the food for the most part today though.

Regarding the nausea... the dry heaving last night was a pretty good sign it's nausea. He keeps making these noises like he's trying to keep from puking, and at night I can even feel his stomach heaving on top of me. It's a rather disconcerting thing to feel. He does have the acidic tummy also though, and with that he really doesn't like having his stomach touched in any way, shape or manner. Yesterday, he seemed interested in food - very much so, and would take a few licks, but that was it. Today though, he hasn't seemed interested at all, and just wanted to go under my blanket in my bedroom. I've been syringe feeding him a bit today, so that might be part of why he's turned off to eating (it is different than the food I offer him though).

Regarding the food... I have a smorgasbord of things for him! Ranging from the kidney food, to gravy fancy feast (he seems to like that) to baby food to boiled chicken. Think we'll try the chicken again tomorrow. He really seems to fancy chicken. And maybe egg yolks... At this point, anything to get food into him. Losing 3.5 oz was not a good thing to have happen.

Regarding the fluids... most definitely been doing those! I had a couple of days where I had trouble controlling the needle and it would come up after less than 100 ml. Today I managed to not have too much trouble with him (limited growling and squirming), but not sure if that was because he was used to it, or because he was weak. 

Regarding pilling... I'm getting a handle on that. Had it rough last week as he bit me. I don't mean a small bite, I mean "tooth in thumb" and "blood gushing" bit me. It's all healed by now but I remember it quite well, lol. I got some gel caps and a pill popper that just came in the mail today. Will be trying it out tomorrow.

I think I'll start keeping a journal of his eating habits vs how he seems to feel. What he likes, what he doesn't (there are some things he makes me very well aware that he doesn't like - like trying to bury it). He also seems to like to eat more in the morning than in the evening. He almost seems ravenous - if attacking a spoonful of cat food can be called "ravenous". But then after he has this look of, "Oh man, I shouldn't have eaten that."
 

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Hi Donutte & Lucky.you know pepcid is really bitter right? it will very likely make him foam at the mouth or puke.Did your vet recommend more of it today even after having a shot?Pepcid can delay absorption of some meds but I don't see mirt.But that doesn't mean it won't.I always when dosing pepcid waited 2 hrs.Where you buy pill pockets at the petstore they also make capsules made by the same company .Greenies.

I'm afraid if you mix the two together he will puke with the bitterness & will not get the needed mirt to try to get him to eat.Great you did fluids.I have had blood before.Don't fret.You attempted it which was great.Here are the links as per mixing the two & understand what pepcid is really for.I used a pce of the pill pocket dough.not the whole  pill pocket & down the hatch then a 3-5 ml syringe of room temp water to get it down their very long esophagus.

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5.4pt;mso-para-margin:0cm;mso-para-margin-bottom:.0001pt;mso-pagination:widow-orphan;font-size:11.0pt;font-family:"Calibri","sans-serif";mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:"Times New Roman";mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;}</style><![endif]http://r.search.yahoo.com/_ylt=A86....605.html/RK=0/RS=VrQpj43U6Y24swOTLY_PpVSWNgE-

Also a video on subq .There is one here a the group.I can't find it.So I'll send you mine

Sophia gets her sub-Q

Hugs Honey C.
 

momofmaxwell

TCS Member
Alpha Cat
Joined
Oct 5, 2014
Messages
388
Purraise
61
Location
BC CANADA
Donutte You are still giving him his thyroid med right? I would not give that near pepcid.I'd wait at least 2 hrs.How are you giving it? You may have posted that already & I missed it.Thyroid meds cannot be stopped period.When was the last blood draw to check his thyroid levels Donutte? LMK Hugs C.
 

momofmaxwell

TCS Member
Alpha Cat
Joined
Oct 5, 2014
Messages
388
Purraise
61
Location
BC CANADA
Hi Donutte.I like it BTW :) & yes your Boy is lucky.And he truly is to have a parent like you to love him so.I'm all screwed up with  my postings to you.I'm sorry i am having a computer nightmare here i think.Usually Donutte nausea is addressed and then if still inappetant mirt or cyproheptadine is introduced.

For some reason I was  responding to you in regard to a posting you made mixing mirt & pepcid.But I think that was many moons ago.Yep I'm losing it sorry.When I gave Maxwell his pepcid my Internist had me give  it right before bed.Very late after all meals.I didn't realize he was hyper T.My late bunny was too.

How have the thyroid levels been?Low being hypo will make him lethargic.Hyper he will eat like a horse.I'm glad you got gelcaps excellent as they are used highly in veterinary care.You will get the hang of it.I feel for everyone who cannot pill buy gelcaps.They are cheap.Fill with just water & practice with baby.

Then when the time comes they will at least have some idea.Great about the vet Donutte he seems like he is on the ball.You need that now.I know with cerenia I just had them fill the needles & I brought them home & kept them in the fridge.But had pills as well.But if going there does not stress him out than go for it.

You're doing a great job BTW.Hats off to you for having to deal with all these things.You deserve a lot of credit.You have taken the bull by the horns.It bit.LOL And now you are forging forward.You are an inspiration to all of us.

Food is life now Donutte as you well know.Just do your best.Your Boy loves you for all that you give.Keep in touch & disregard my haywire thread to you somewhere floating around.

Hugs to you & Your Boy To Chicago from Canada.Cindy
 
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