?Is lactulose and cisapride safe.

Hi, my Siamese was started on lactulose with cisapride  2 months ago after  fiber diet and reg. lactulose failed to work over time,so any other cat owners have any experience with lactulose with cisapride? I know that for humans cisapride was d/c due to arrhythmias. Please any feed back would be helpful.

cocostorm2 said:

 
Hi, my Siamese was started on lactulose with cisapride  2 months ago after  fiber diet and reg. lactulose failed to work over time,so any other cat owners have any experience with lactulose with cisapride? I know that for humans cisapride was d/c due to arrhythmias. Please any feed back would be helpful.

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 PushPurrCatPaws gives a good overview in Post #8 here:

http://www.thecatsite.com/t/311335/cat-on-lactulose-and-cisapride-still-not-pooping

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That's actually a good thread to read. I still hold with most of what I wrote then, but with some knowledge/experience gathered since -- that if the cat is not on a lot of other fibers (both soluble and insoluble), then pumpkin (a soluble fiber) as a single fiber source can help with controlling diarrhea, while insoluble fibers can help more with constipation. Problem is, when a cat is constipated, it's my view that they are "prescribed" TOO much fiber (a variety of both soluble and insoluble) and then the cat simply ends up feeling terrible, tummy cramps, pain, bloated -- don't forget that most commercial cat foods have fiber(s) added to them within all the fillers in the ingredients. On top of that, cat owners often give lactulose, cisapride, miralax, a whole cocktail of things to try to get the constipated cat to poop. Poor kitty! Sometimes starting with one thing to help a cat is better, (and giving that thing some time to work), rather than panicking and trying to give too many "solutions". You know?

@Molly92 also gives good comments in that particular thread and in this thread, in my view:
http://www.thecatsite.com/t/247733/alternative-for-propulsid-cisapride

She also brings up the use of probiotics. You could look into that. Maybe she can give some input in this thread, an update of sorts?


Regarding arrhythmias and cisapride, cocostorm2 , this source seems to connect the specific potential of "dangerous ventricular arrhythmias" with the concurrent use of cisapride and anti-fungals ("anti-fungal drugs such as ketoconazole, itraconazole, and miconazole"). These are things vets should be clearer on.


It's very, very important to work closely with your vet (and I'd recommend prompting them to give you detailed info, not just statements like, "it helps cats poop better") when using any and all drugs and supplements. I am not a vet, and you should always consult and work with your vet.

My own advice about cisapride and fiber derives from my own experiences with my last cat, and with what her vet told me about cisapride. We avoided using cisapride. (Again, finding a good dosage of Miralax can really help with problem kitties... but some cats are more sensitive to miralax than others, so use the lowest dosage you can to get results. Sometimes trying other things works better than miralax.) Cisapride is a colon motility drug, very powerful, and should never be used for a cat having diarrhea, for one thing, but also -- she (my last vet) said that once started on cisapride, it's often hard to get a cat off of it. Almost as if the cat's body gets too used to the drug-induced colon motility so that when off of the drug, the colon gets "lazy" in a way, and doesn't push poop out on its own (without the drug). That's what I gathered, anyway.

Hi,we had tried regular lactulose worked for about a year then after 2 emergency visits for enemas she wanted to try the lactulose with cisapride I was very hesitate,the vet assured me was safe but after doing research I'm not so sure .I will call my vet in the morning and ask to tritrate him off,and if the vet disagrees I will look for a new vet.  I have mentioned miralax before the cisapride she has never prescribed miralax for a laxative. So I'm praying I can take him off with no problems and look for another alternative,i have read about the arrhythmias when used in combination with certain meds. And as for pumpkin I have tried and he is so fussy he smelt it right away and refused to eat.  So I certainly do not want any harm to come to my baby,will be looking for different med asap.  And has any cat owners out there ever have any heart related side effects with cisapride? Thanks.

I'm going to send a page to one of our members who might better be of service here. 

@Geoffrey is a semi-retired Physician whose speciality is in Internal Medicine, who still practises as a consulting (Human) cardiologist, and who has an abiding interest in Siameses and their health, since he's been foolish fortunate enough to have had them for more than fifty years.  He's amiable, erudite and good-humoured - all the things which I am not - though I have it on good authority that he's less rather handsome.

I've dropped him a private message as well, asking him to have a look in here if chance and fortune permit.

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Great Thank You so much,  I am quite concerned.

cocostorm2 said:

 
Great Thank You so much,  I am quite concerned.

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You are, of course, entirely welcome.

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cocostorm2 said:

 
Hi,we had tried regular lactulose worked for about a year then after 2 emergency visits for enemas she wanted to try the lactulose with cisapride I was very hesitate,the vet assured me was safe but after doing research I'm not so sure .I will call my vet in the morning and ask to tritrate him off,and if the vet disagrees I will look for a new vet.  I have mentioned miralax before the cisapride she has never prescribed miralax for a laxative. So I'm praying I can take him off with no problems and look for another alternative,i have read about the arrhythmias when used in combination with certain meds. And as for pumpkin I have tried and he is so fussy he smelt it right away and refused to eat.  So I certainly do not want any harm to come to my baby,will be looking for different med asap.  And has any cat owners out there ever have any heart related side effects with cisapride? Thanks.

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Thank you, @1CatOverTheLine  for asking me to comment.   I am a human specialist in internal medicine and cardiology, not a vet, and my awareness of Cisapride has been because it affects the human electrocardiograph by prolonging the QT period, thus predisposing to potentially fatal arrhythmias.  It has been removed from the Australian Pharmaceutical Benefit Service because a number of cases of sudden death have been reported in humans whilst taking this drug. 

Human side effects are not necessarily the same in animals and, according to Patricia M. Dowling, DVM, MSc, DACVIM, DACVCP, Professor, Veterinary Clinical Pharmacology, Western College of Veterinary Medicine, University of Saskatchewan, in the MSD Veterinary Manual, adverse reactions to clinical use of cisapride have not been reported and It It has been shown to be very effective in feline megacolon.     Despite this, the use of cisapride in cats can cause  abdominal pain, nausea and vomiting and I would be cautious using it. 

Miralax is  Poly Ethylene Glycol and works in cats and humans by increasing water absorption, forming increased bulk in the lower intestine similarly to lactulose.  It may cause nausea and abdominal pain, it can do this in humans and may do so in cats, but seems otherwise safe.

Incidentally I have had Siamese cats since 1961 until 2014, but have never had any chronic  constipation disorders with any of them.  Maybe I am lucky but they have all been indoor/outdoor cats and have been fed moist food. 

My present cat, Sukie, who is a Blue cross Alley cat hardly ever drinks, only opens her bowels in the litter trays every few days, but appears well and has no obvious faecal impaction on examination of her abdomen. (However I have seen her on one occasion opening her bowels outdoors so that one cannot be definite about diagnosing constipation in indoor/outdoor cats just by looking for stools in the litter tray).

With all kind regards,

Geoffrey

Geoffrey said:

 
Thank you, @1CatOverTheLine  for asking me to comment.   I am a human doctor, not a vet, but my awareness of Cisapride has been because it affects the human electrocardiograph by prolonging the QT period, predisposing to potentially fatal arrhythmias.  It has been removed from the Australian Pharmaceutical Benefit Service because a number of cases of sudden death have been reported in humans whilst taking this drug. 

Human side effects are not necessarily the same in animals and, according to Patricia M. Dowling, DVM, MSc, DACVIM, DACVCP, Professor, Veterinary Clinical Pharmacology, Western College of Veterinary Medicine, University of Saskatchewan, in the MSD Veterinary Manual, adverse reactions to clinical use of cisapride have not been reported and It It has been shown to be very effective in feline megacolon.     Despite this, the use of cisapride in cats can cause  abdominal pain, nausea and vomiting and I would be cautious using it. 

Miralax is  Poly Ethylene Glycol and works in cats and humans and by increasing water absorption, forming increased bulk in the lower intestine similarly to lactulose.  It may cause nausea and abdominal pain, it can do this in humans and may do so in cats, but seems otherwise safe.

Incidentally I have had Siamese cats since 1961 but have never had any chronic  constipation disorders with any of them.  Maybe I am lucky but they have all been indoor/outdoor cats and have been fed moist food. 

My present cat, Sukie, who is a Blue cross Alley cat hardly ever drinks, only opens her bowels in the litter trays every few days, but appears well and has no obvious faecal impaction on examination of her abdomen. (However I have seen her on one occasion opening her bowels outdoors so that one cannot be definite about diagnosing constipation in indoor/outdoor cats just by looking for stools in the litter tray).

With all kind regards,

Geoffrey

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Geoffrey - for your kindness, courtesy and expertise, thank you.

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I have a cat on Cisapride. Booberry has been on it for 2 years. I also give him about 1/4 teasp of Miralax at each meal and have for as long. It doesn't seem to have adverse effects on him. He has a bit of nerve damage that affects his bowel and a slightly narrower passage. The combo makes him susceptible to constipation.

It was managed pretty well for a couple of years, and then he spent 5 days in an expensive emergency vet specialist hospital where they could monitor the drip of golyte (Miralax but higher dose) until he was cleared out. They avoided doing a manual extraction, but it was super expensive. 

For him the Cisapride is a life-saver and if it has been recommended and you choose not to use it, be sure to monitor your cat's litter box use very closely.  It also helps that he is a super easy cat and willingly takes the syringe of medication. I tell him its his appetizer and then he knows he gets his delicious meal soon after.

I avoid like the plague, any kind of fiber that has bulking properties. I'm pretty sure the last bout was in part brought on by an over-abundance of psyllium fiber in his freeze-dried raw diet. 

Thank You Geoffrey for your information, Ifeed both my Siamese moist and Storm the constipated one gets alittle hard cat food with fiber,maybe this is part of the problem?  I would rather try Miralax ask my vet today to titrate Storm off the lactulose/cisapride.  Your input has put my mind at ease.  Again thanks well wishes to you and Sukie.

Thanks Laura Mae,Storm takes his syringe very well, I give laxatone a few times a week as well. Plus a pediatric suppository when needed, he was born with a lax/slow bowel so I was told,I hate to give my babies meds but sometimes they are needed,A leave it alone and let nature take its course is not always the case. So thank You all.Have a great day!!!