Dosing with liquid buprenorphine (Vetergesic/Buprenex)

tinnly · Dec 21, 2016

I've been supplied with 1mL tuberculin syringes pre-filled with ~0.2mL. I'm supposed to deposit this liquid between the cat's gums and cheek, but this is proving very difficult. She trashes her head around so much that I have been getting most of the liquid down her throat, and I read this medication is ineffective if eaten.

Anyone have a trick for getting the syringe into the right spot? I feel like I'm getting the dry outside of the syringe caught on her lips or something..

LTS3 · Dec 22, 2016

If you can, kneel on the floor and tuck the cat between your legs. Doing this in the bathroom and facing a corner works well. No where in the bathroom for a cat to hide if she wiggles away

Hold the cat firmly with your knees while you hold the head still with one hand and slide the syringe with the other hand into the mouth between the cheek and teeth to squirt the Burprenex in. I typically aim downward between the bottom gums and cheek. Another set of hands may be helpful. Do you have a friend or relative who may be able to help hold the cat?

stephenq · Dec 22, 2016

tinnly said:
I've been supplied with 1mL tuberculin syringes pre-filled with ~0.2mL. I'm supposed to deposit this liquid between the cat's gums and cheek, but this is proving very difficult. She trashes her head around so much that I have been getting most of the liquid down her throat, and I read this medication is ineffective if eaten.

Anyone have a trick for getting the syringe into the right spot? I feel like I'm getting the dry outside of the syringe caught on her lips or something..

Some vets may be willing to give you the sub q inject-able version which is very easy to give, they won't feel it and the vet can do a demo. alternatively, the vet can also give a long acting (3 day) version.

white shadow · Dec 22, 2016

StephenQ said:
then, .2ml will 'excrete' ~6 droplets with slow and careful depression of the plunger.

Your goal should be to only insert a drop or two at a time, withdraw the syringe, then repeat. That way, the drug is much more likely to stay in the buccal area longer and to be absorbed by the oral tissue.

This isn't easy....I've had to do it....I suggest you do 'practice runs' - both away from the cat and with the cat, using plain warm water. LTS3's suggestions for positioning yourself and the cat are helpful and serve as a starting point for your own practice.

Buprenorphine is not pleasant-tasting....in my experience with 5 cats, some cats find it more unpleasant than others. Also - some of the reluctance to accept the oral medicating is the cat's unfamiliarity - and, therefore fear - of/with the whole process...so, 'desensitizing' the cat to the process and thereby alleviating fear - by practicing with plain water - can go a long way toward successful buccal administration of anything.

Now, on the second part of the quote (in red, marked 2): while 'ordinary' Buprenorphine (common brand is Buprenex) is readily available from Vets, the long-acting version isn't so easily available...and, it is significantly more expensive. It's only available from a different manufacturer...website: http://www.srvet.net/index.php/other/buprenorphine-sr NOTE: This product IS EFFECTIVE USED SUB-Q

I know I've been quite 'anal' in describing all this. I also know just how critical is the need to effectively supress/eliminate pain in our little ones.

'Hope something there helps.

stephenq · Dec 22, 2016

White Shadow said:

Thanks for the correction....my bad memory!

that guy · Dec 22, 2016

There are two parts to this, getting the syringe in there and getting the drugs into the cat. Find out if the cat is less bothered having the syringe in one side opposed to the other. My cat hated the syringe in the left side of his mouth but could tolerate it on the right. You can also practice this with water as well which does not have the bad taste but also gets the cat used to it. As mentioned above just small amounts of liquid at a time and I give it bit and then let the cat go and then repeat it 3 or so times until I get it all in there. I can take 10 - 20 minutes to get the drugs in there so just work at it slowly. I always kneel with the cat sitting between my legs and put one hand under the cats chin to keep the head under control and then slip the syringe in parallel to his jaws and let a little of the fluid out and pull the syringe. You don't want to push the syringe back too far either which can make it uncomfortable and get them moving around. Practice with a little water to work on the technique and be calm and if it is just water you can also give treats. My last cat had arthritis and it did not take long for him to realize it made him feel better and this really helped dosing him.

tinnly · Dec 22, 2016

White Shadow said:
Correction is needed on the first part of that quote (in blue, marked 1): 'Ordinary' Buprenorphine is NOT effective when given "sub q" ( "sub q" means sub-cutaneous...under the skin injection, versus intramuscular [IM] injection).....

There are only three effective routes for Buprenorphine: buccal ("transmucosal"), intramuscular (IM) or intravenous (IV). "Sub-Q" doesn't 'work'.

White Shadow said:
Now, tinnly, if this is the type of syringe you've been given {...} then, .2ml will 'excrete' ~6 droplets with slow and careful depression of the plunger.

Yes, that's the type.

Originally Posted by White Shadow

Your goal should be to only insert a drop or two at a time, withdraw the syringe, then repeat. That way, the drug is much more likely to stay in the buccal area longer and to be absorbed by the oral tissue.

This isn't easy....I've had to do it....I suggest you do 'practice runs' - both away from the cat and with the cat, using plain warm water. LTS3's suggestions for positioning yourself and the cat are helpful and serve as a starting point for your own practice.

This is very valuable advice, thank you!. I don't know why I didn't think of practising with water. The vet "showed me what to do" and the cat responded very well, I've been disappointed that I haven't been able to get the same results. I was able to successfully "pill her" today using the same position.

White Shadow said:
Buprenorphine is not pleasant-tasting....in my experience with 5 cats, some cats find it more unpleasant than others. Also - some of the reluctance to accept the oral medicating is the cat's unfamiliarity - and, therefore fear - of/with the whole process...so, 'desensitizing' the cat to the process and thereby alleviating fear - by practicing with plain water - can go a long way toward successful buccal administration of anything.

She's never really been dosed with anything, so there some fear - and some indignation

. She's been in excellent health heretofore, but our previous vet wasn't concerned about the arthritis.

White Shadow said:
I know I've been quite 'anal' in describing all this. I also know just how critical is the need to effectively supress/eliminate pain in our little ones.

'Hope something there helps.

Thanks for the detail, its definitely helpful.

stephenq · Dec 29, 2016

White Shadow said:
Correction is needed on the first part of that quote (in blue, marked 1): 'Ordinary' Buprenorphine is NOT effective when given "sub q" ( "sub q" means sub-cutaneous...under the skin injection, versus intramuscular [IM] injection).....

There are only three effective routes for Buprenorphine: buccal ("transmucosal"), intramuscular (IM) or intravenous (IV). "Sub-Q" doesn't 'work'.

@WhiteShadow

My vet is giving me Buprenorphine sub Q for my post surgical cat and this NIH study says its effective in that route....

https://www.ncbi.nlm.nih.gov/m/pubmed/16379630/

Thoughts?

catmom marcia · Dec 29, 2016

The easiest way I have found is to put the cat on a counter with her butt firmly planted into your armpit and her body against your chest (bend over to do this). (If you are right handed) wrap your left arm around kitty and place your hand under her chin and gently lift her head while firmly holding her head against your chest. Tuck the syringe between her gum and cheek and depress quickly.

feral lover · Dec 29, 2016

Ugh. I just completed five days of this with Evander. He was a stray/feral who has been living in my house for two years. He is terrified of people, but really trusts me, which made this so traumatic for both of us. I am hoping he continues to pee because I don't know if either of us can go through this again.

white shadow · Jan 1, 2017

StephenQ said:
@WhiteShadow

My vet is giving me Buprenorphine sub Q for my post surgical cat and this NIH study says its effective in that route....

https://www.ncbi.nlm.nih.gov/m/pubmed/16379630/

Thoughts?

Frankly, I'm very surprised at that (your Vet's prescribing, that is). Everything I've seen indicates only 3 routes of administration...SC not being one. That information has long been available.

A review of studies using buprenorphine

Nov 25, 2014

The subcutaneous (SC) route of administration is considered unreliable; at typical clinical dosages (0.02 mg/kg), SC buprenorphine has not been shown to provide adequate analgesia. The results of a clinical trial using SC sustained release buprenorphine was published in 2011, but additional PK and PD studies of this formulation need to be done.

http://www.winnfelinefoundation.org...+Health+News+from+the+Winn+Feline+Foundation)

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

In cats, the subcutaneous route of opioid administration is not recommended. IM and IV routes are preferred both pre and post-operatively. The oral transmucosal or buccal route of administration for buprenorphine may also have clinical efficacy as well

https://www.aaha.org/public_documen...n_management_guidelines_for_dogs_and_cats.pdf

[p. 71]

Perioperative Pain Management - Part II
Bob Stein

October 2005

Buprenorphine has a delayed onset, even when given IV, that needs to be taken into account for best effect. Given IV, peak effect occurs in about 30 minutes. Given IM, peak effect occurs in 45 to 60 minutes[xii]. Data from Dr. Robertson’s feline hydromorphone studies have shown SQ administration to be the least effective route, even in healthy cats[xiii]. Therefore, subcutaneous administration is not recommended.

Veterinary Anesthesia & Analgesia Support Group

http://www.vasg.org/perioperative_pain_management_part_ii.htm

[my emphasis]

stephenq · Jan 1, 2017

White Shadow said:
Frankly, I'm very surprised at that (your Vet's prescribing, that is). Everything I've seen indicates only 3 routes of administration...SC not being one. That information has long been available.

Very interesting, i will discuss with vet. For the record, she got sub Q bupe and it worked well.... She was calm, didn't appear in pain, was fully ambulatory. A little loopy but that's it.

white shadow · Jan 1, 2017

StephenQ said:
Very interesting, i will discuss with vet. For the record, she got sub Q bupe and it worked well.... She was calm, didn't appear in pain, was fully ambulatory. A little loopy but that's it.

Did you medicate her yourself.....did you give the Bup sub-Q ?

stephenq · Jan 1, 2017

White Shadow said:
Did you medicate her yourself.....did you give the Bup sub-Q ?

Yes 2 days in a row. Perhaps my vet gave into my request because my cat is so incredibly difficult to treat orally.

Dosing with liquid buprenorphine (Vetergesic/Buprenex)

tinnly

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LTS3

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that guy

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catmom marcia

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A review of studies using buprenorphine

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