Mirtazapine: Reaction during Second Dose?

For everyone who has given their kitties Mirtazapine (aka Remeron), I'm wondering if there was smooth sailing with the first dose, but then adverse side-effects upon the second dose. I've seen several anecdotes on other threads about this happening, but kind of want an aggregate thread here since the other threads are a little older, and the Mirtazapine second dose issue was not the main topic. 

Background if you're wondering:

• My kitty Blondie has polycystic kidneys and early stage CRF. Just to give an example of how bad the cysts are, the vet said during the ultrasound a few weeks ago, "Oh wow...God has really blessed you to have a fourteen-year old cat with this many cysts be with you this long," and began calling in other doctors, techs, even an intern to see how big and numerous the cysts are. Apparently, Blondie is an anomaly. 
• Last week we had a mini-crisis of him vomiting all night long and refusing to eat. This after having a wonderful week of eating regularly and more frequently. Vet gave him injections of Cerenia, B12, and Pepcid. He also got fluids, and I myself was taught how to give Sub Qs at home.
• Yesterday, we rushed him back to the vet after a day long bought of anorexia. He was given Mirtazapine. First dose was alright, no nasty or alarming side-effects and he was ravenous. Today, he's kind of back to not eating much. A second dose may be warranted in a couple days. Yet I'm reluctant on account of reading the second dose issues with Mirt. I have Cypro on my mind instead.

Thank you kindly in advance!

Emm

mfena0720 said:

 
For everyone who has given their kitties Mirtazapine (aka Remeron), I'm wondering if there was smooth sailing with the first dose, but then adverse side-effects upon the second dose. I've seen several anecdotes on other threads about this happening, but kind of want an aggregate thread here since the other threads are a little older, and the Mirtazapine second dose issue was not the main topic. 

Background if you're wondering:

• My kitty Blondie has polycystic kidneys and early stage CRF. Just to give an example of how bad the cysts are, the vet said during the ultrasound a few weeks ago, "Oh wow...God has really blessed you to have a fourteen-year old cat with this many cysts be with you this long," and began calling in other doctors, techs, even an intern to see how big and numerous the cysts are. Apparently, Blondie is an anomaly. 
• Last week we had a mini-crisis of him vomiting all night long and refusing to eat. This after having a wonderful week of eating regularly and more frequently. Vet gave him injections of Cerenia, B12, and Pepcid. He also got fluids, and I myself was taught how to give Sub Qs at home.
• Yesterday, we rushed him back to the vet after a day long bought of anorexia. He was given Mirtazapine. First dose was alright, no nasty or alarming side-effects and he was ravenous. Today, he's kind of back to not eating much. A second dose may be warranted in a couple days. Yet I'm reluctant on account of reading the second dose issues with Mirt. I have Cypro on my mind instead.

Thank you kindly in advance!

Emm

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I'm always a little worried about mirtazapine as an appetite stimulant, yes it can work but its really for short term use and better to get at the cause of the lazck of hunger, in your cat's case possibly nausea.  Cerenia is a wonder drug and can be given 4 or 5 days in a row with one day off, although many vets now give it 24/7 at a low dose.  If he won't take pills you could give it with fluids (to prevent stinging) at home.  My cat was on it, a combo of pikks, and sub q when in crisis daily for 15 months.

StephenQ said:

 
I'm always a little worried about mirtazapine as an appetite stimulant, yes it can work but its really for short term use and better to get at the cause of the lazck of hunger, in your cat's case possibly nausea.  Cerenia is a wonder drug and can be given 4 or 5 days in a row with one day off, although many vets now give it 24/7 at a low dose.  If he won't take pills you could give it with fluids (to prevent stinging) at home.  My cat was on it, a combo of pikks, and sub q when in crisis daily for 15 months.

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I agree with you on the short-term usage.

I personally do not like the fact that it's an antidepressant. I myself have taken antidepressant drugs, and sure as heck didn't like how it made me feel. I can only imagine how wacked out a kitty must feel. Blondie is back to eating at his regular pace, so I'm hoping that it was a one-time deal, and he will not need appetite stims permanently. 

I liked that the Cerenia helped with nausea, but unfortunately was not happy with the side-effects. He hid in the sick bay (my term for under the bed) for nearly the entire time, and hardly ate. He was non-responsive to my voice, didn't groom himself, and just seemed overall apathetic. The vet said Cerenia can sometimes cause anorexia and she thinks this, coupled with his illness-related anorexia, left him in a funk. But still, it's too bad because the Cerenia did it's job, for there was no vomiting. 

I have to ask, when you administered the Cerenia via Sub q, did you think it still worked well? I read somewhere that Cerenia injected into the Sub Q bubble tends to lose efficacy.