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Getting your kitty to take a tablet.. Need Help

post #1 of 15
Thread Starter 
I have been trying to get Simon to take a tablet because his third eyelid is still showing so I am treating him for tape worms and round worms aside from the normal worm treatment he got. He will not take it. This is what I have tried so far...

1. cover the tablet in vanilla yogurt (his fave). Didn't work

2. Break the tablet up and put it in his favorite wet food that he doesn't often get. Didn't work.. it's like he knew something was in there!

3. New tablet.. The Vet gave me a "syringe" like contraption that you can insert into the cats mouth and then release the pill. Sure, in theory this sounds like a good idea. Nope, he spits, and hacks the pill back up.. and he HATES the syringe! I feel so horrible trying to stick it down his throat.

I don't know what else to try Any tips for getting cats to take tablets ?

Any advice is much needed, the sooner the better for Simon's sake

If all else fails, when my boyfriend gets home we will have to tag team Simon and somehow force him to swallow the pill.. As horrible as it sounds
post #2 of 15
We use the pill popper around here.

But! If your cat is a cheese lover, try covering it in cheese, maybe little pieces of pill inside several bits of cheese.
That's how we pilled the Siamese that raised me.

My old cat, thankfully would sit between my legs and let me pill him...rare to find one that easy to deal with.
post #3 of 15
This just arrived in my email bin- I haven't read through the entire article yet. Like Aryln, I use a pill gun, or the spray cheese


Pilling Cats (and Dogs) and Erosive Esophagitis

Compounded Flavored Liquid Alternatives

Transdermal Medications

Lisa A. Pierson, DVM


--------------------------------------------------------------------------



Think about the last time you swallowed a pill or a capsule. You most likely took it with several swallows of something liquid to help move the pill along its journey through the esophagus and into the stomach. Most people would never dream of 'dry swallowing' pills, having felt that awful sensation of a pill not 'going down' very smoothly. When this happens, the human usually reacts by drinking more water. It would be nice if cats and dogs reacted this way, but they don't.

For this article, a "dry swallow" refers to the administration of a pill or capsule to a cat or dog without immediately following up with several milliliters (cc's) of water, or tuna juice or meat broth given orally via a syringe, or the consumption of some canned food by the patient. Offering tuna juice or a meat broth for them to lap up on their own is also a very good option and one that is less stressful than syringing. Some people use butter or oil to coat the pill and that may make swallowing the pill easier, but it is unlikely that this method results in a more timely entry into the stomach. This is where the swallowing of some liquid or canned food helps keep the esophagus healthy by moving the pills or capsules immediately into the stomach.

The best size of syringe to use for a cat is a 1 cc ("TB") syringe. The larger syringes do not fit comfortably inside of a cat's mouth. Also, you do not want to administer any more than 1 cc at a time. If liquid medications, such as some of the commonly used antibiotics, are dispensed with an eyedropper, ask your veterinarian for a 1cc syringe. Not only is this a more accurate way to measure the dose, but your cat will be more agreeable to this small syringe entering the side of his mouth rather than the larger eyedropper.

Before you get ready to administer the pill, have a bowl of water (or tuna juice or broth) readily available. See if your cat is interested in drinking it. If not, you will then have to use your syringe. To administer a liquid using a syringe, it is best to approach the cat from the side, not from the front. Cats tend to be a bit worried when approached head on. Slip the syringe into the side of the mouth at about a 45-degree angle being careful not to insert the syringe too far down the back of the throat. You don't want the cat to panic, nor have him aspirate the liquid. Do not hold your pet's head up! This is something that I commonly see people do. Try it yourself. Lift your chin up and you will see how much harder it is for you to swallow. You can hold his head level or his mouth slightly down, but never raise his head upward.

Believe me when I say I fully understand that some of the readers will be saying "oh sure...I can barely get the pill down my cat and now I am supposed to follow up with the syringing of some liquid?!!?" I realize that none of this will be easy with some cats, but my goal is to get people to start thinking about this issue and not take the dry pilling of an animal lightly. For those hard-to-pill cats, please see below for other alternatives such as compounded, flavored liquid medications and transdermal preparations.

Another option is to see if the cat or dog will consume the pill if it is hidden in canned food. This is obviously the least stressful for all concerned but it usually works better with dogs. Cats are notoriously picky eaters and are suspicious of anything out of the ordinary in their food. Some drugs such as Baytril TasteTabs are formulated to be fairly palatable and can be crushed and put in the food and this is a great way to go....if the cat will eat it. Unfortunately, I have tried this trick with several cats and most of them have refused to eat the TasteTabs.

Note: When I use the word "pill", I am also referring to capsules which can cause even more problems than pills, as shown in the study below.

Given the facts regarding how humans take their medications and vitamins, why do we ask our cats and dogs to do something we would never do? Why do we ask them to dry swallow a pill which quite often ends up lodged in the esophagus with the real potential to cause a very painful condition called erosive esophagitis?

The lining of the esophagus is very delicate and it is not designed to have irritating medications in contact with it for more than the short amount of time it should take for the pill to pass from the mouth to the stomach when swallowed with an adequate amount of liquid or food. When a pill is in contact with this tissue for a prolonged period of time, a painful irritation or ulcer has the potential to develop. Some medications are worse than others. For instance, doxycycline is a well-known antibiotic that is extremely irritating. (More on that below from a human who experienced very painful erosive esophagitis from taking this medication without enough water.)

Please note this excerpt from the study quoted below:

"After 5 minutes 84% of capsules and 64% of tablets are still sitting in the esophagus." This is referring to pills and capsules that were dry swallowed.

It really is amazing that cats and dogs are as good as they are about pilling but one has to wonder about the pets that panic and/or gag when their owners try to pill them. I know that I would not be very happy about being asked to dry swallow a pill.

A Very Interesting Study

The following is a summary of a very interesting article that appeared in a veterinary journal entitled Evaluation of the Passage of Tablets and Capsules Through the Esophagus of the Cat. It is from a paper presented at the 2001 American College of Veterinary Internal Medicine Forum. (They do note at the end of the paper that the principles outlined also make good sense for dogs.) This paper was submitted to one of the lesser-read journals so a lot of veterinarians may not have seen it. This is extremely unfortunate for all cats and dogs.

Purpose of the study:
The goal of the study was to determine the length of time that it took for pills or capsules to enter the stomach after 1) dry pilling and 2) pilling and then giving a 6 cc water chaser immediately following the administration of the pill or capsule - referred to as a "wet swallow".

Study design:
30 cats were used. Fluoroscopy was used to evaluate the pill/capsule passage at 30, 60, 90, 120, 180, 300 seconds.

Study results:
For the dry swallows:
No pills were in the stomach at 30 and 60 seconds. Only 6% of the pills were in the stomach at 90 seconds. Only 13% of the pills were in the stomach at 120 seconds. And at 5 minutes only 36% of the pills were in the stomach.

For the wet swallows: (i.e., the pill was followed by 6 cc of water)
At 30 seconds, 90% of the pills were in the stomach. All pills were in the stomach by 120 seconds.

The statistics were even worse for capsules when dry swallowed. By 5 minutes, only 16% of the capsules had made it to the stomach. 100% of capsules followed by water chasers, were in the stomach by 60 seconds - faster than for pills probably due to the smoother surface of a capsule versus a pill.

Commentary:
"This is an interesting study that has considerable practical impact. Although veterinarians have a huge arsenal of mediations and treatments available to us, we still have a very poor understanding of some of the most basic aspects of everyday practice. We routinely prescribe oral medications in the form of tablets or capsules to cats.

It has been our assumption that when it was possible for the owner to actually give the pills or capsule to the cat, it would make it into the stomach reasonably rapidly. It turns out that this is inaccurate. After 5 minutes 84% of capsules and 64% of tablets are still sitting in the esophagus. Similar results were published in another study by JP Graham (American Journal of Veterinary Research 2000).

Practical outcome:
The main concern with this information is that if tablets and capsules sit in the esophagus for a prolonged period of time, this can cause damage to the tissues in this area. This damage can lead to esophagitis, which can lead to nausea, vomiting and megaesophagus. At times, the esophagus can also respond by developing an ulcer or stricture. The latter is a very serious complication requiring aggressive therapy, preferably with balloon dilatation.

In addition, we probably have all had that uncomfortable feeling when a tablet we have taken has gotten stuck on the way down. This could be the cause of vomiting in some cats that are medicated. It is quite frustrating to win the battle to get the pill or capsule down a cat and then have it vomited up several minutes later.

Both this abstract as well as the study published by Graham et al. clearly point to the need to administer either water or food after a cat has been pilled with a tablet or a capsule. This will hasten the movement into the stomach and cut down on the chances of the tablet or capsule remaining in the esophagus for a prolonged period of time. Although comparable studies have not been done in dogs, this advice is sound in dogs, as well."
(End of quoted study)


The following is an anecdotal report from a person who ended up with a very painful case of an ulcerated esophagus after a capsule became lodged in her esophagus:

"I know the pain of an ulcerated esophagus personally and it is a living hell. I was on doxycycline capsules (due to a cat bite) last year and one got stuck in my esophagus. I did not think it was a big deal and went to bed figuring it would eventually work it's way down. Several days later I had suffered so much that I took myself to the ER. I had to drink this horrible tasting cocktail with liquid lidocaine to get relief. It worked, temporarily, but I had to drink a tsp of the lidocaine 3x a day just to be able to swallow for about 30 minutes each time. Forget eating. I lost 10+ lbs in less than 2 weeks. I couldn't eat at all and could not swallow without the lidocaine. I laid in the bed with a cup to spit in because it was too painful to swallow. It was a great diet, but not one I'd recommend. Please take every precaution you can to make sure this does not happen to your pet."



Compounded Flavored Liquid Medications

As an alternative to using pills and capsules to administer medications, certain pharmacies can compound the medications into flavored liquids. Please be aware that compounded medications may be more expensive than medications dispensed by your veterinarian, but the use of these liquid medications can alleviate a great deal of stress for both the pet and the human. I am very involved in rescue work and often deal with extremely frightened and painful animals whose trust I am trying to gain. Pilling a sick cat/kitten who is feral or traumatized/frightened/painful, or has severe upper respiratory disease and can hardly breathe as it is, does not exactly make for a fast friendship and development of trust.

When an animal is ill or injured, the last thing we want to do is add more stress to the situation. I adopted a 9 year old cat out to a really nice woman 4 years ago. She recently called me in tears because Caliban was now in congestive heart failure and she was having a hard time pilling him and was going to put him to sleep since he could no longer receive his necessary medications. She felt so guilty for failing Caliban by not giving him the medications that he desperately needed but was also feeling guilty for stressing the heck out of him in his final days with the pilling. This stress was alleviated by using compounded, flavored liquid medications.

The most common flavor used for cats is 'triple fish' and if dealing with a very bitter medication, this flavor is the best one to use. Another flavor that is used is chicken and some cats do better with this milder flavor than the very strong triple fish.

Please note that some drugs are so bitter that even compounding will not hide the awful taste. An example of this type of drug is amitriptyline which is often used for anxiety and inappropriate elimination problems. Fortunately, this medication is formulated into a small, coated pill but a food or liquid chaser still needs to be administered if the cat is pilled. Or, because this pill is small and coated, another option is to hide it in canned food.

Since we all know that every cat is different, I will mention that some people state that they have had much better luck pilling their cats than trying to get liquids into them. Some cats throw a fit if given liquid medications. The problem with these cats, however, is that if you do pill them successfully, they are not apt to take the water chaser very well. This presents a bit of a problem and the hope is that they will eat some canned food or drink some tuna juice or meat broth after being pilled.

Another favorable aspect of using a compounding pharmacy is that you can pick the drug concentration so that the necessary dosage volume is not over 1cc. I try to have the medication mixed in a concentration that enables me to give 1/2 - 3/4 of a cc or 1cc at the most. This is an easy volume to administer to a cat.

Occasionally you may run across a drug that can't be compounded but I have yet to run into this situation.


Transdermal Medications


Transdermal preparations are medications that are formulated into a gel or ointment that can be applied to the inner ear of the cat. After application, the medicine is then absorbed through the skin. There is some controversy regarding the efficacy of this route so please discuss this issue with your vet and pharmacist for each individual medication considered. Some medications cannot be compounded into transdermal preparations.

One medication that is often used with this route of administration is methimazole (Tapazole) which is a commonly prescribed hyperthyroid medication. Studies here and here have shown that the use of transdermal methimazole is a very effective way to administer this drug and results in fewer gastrointestinal upsets.

Another medication that has been formulated into a transdermal preparation is amitriptyline but I do not know of any studies showing the efficacy of this route of administration for this particular drug.


Conclusion

The goal of this article is to prevent the silent suffering that our pets often go through when medications are administered without appropriate precautions. I have outlined several options above:


1) Administer the pill or capsule and follow up immediately with a chaser of a liquid

using a syringe.

2) Administer the pill or capsule and follow up with the feeding of canned food, tuna

juice or a meat broth.

3) Use compounded, flavored liquid medications.

4) Use transdermal preparations.

5) Or...be lucky enough to have your cat eat the medication in canned food.

Please pass this information on to anyone whose pets may benefit from the information. It is my hope that the information will help to save some of our non-speaking friends from a painful esophagitis and their caretakers from the stress of pilling some hard-to-pill cats.
--------------------------------------------------------------------------

April, 2005

Lisa A. Pierson, DVM
post #4 of 15
That is a great article. I had no idea how much damage dry pills could cause. Thanks for the info.
post #5 of 15
Thread Starter 
Thanks very much for the information

I tried the cheese idea, which almost worked, he ate the piece of cheese without the pill inside, but then must have smelled the pill in the other which he sniffed at then walked away

I think what I will do is wait until I have another set of hands (ie. boyfriend) and then attempt the "pill popper" again making sure to hydrate him right afterwards.

Simon is now hiding under the couch poor fella!
post #6 of 15
Jane, I have ferals, and they are hard to pill. Boy howdy are they!

I have a system, perhaps it will work for you as well- it is using the spray cheese in a can? You know, the kind in the cracker section of your grocery store?

This is what I do. I have the pill with me, but hidden. I have the spray can of cheese. The kitty is at rest. I spray a tiny bit of cheese on the underside of my finger. I let kitty smell the cheese on my finger and get her to raise her head. Once her throat is extended, I lower the cheese finger and let her lick it. I don't use a lot of cheese the first time. Then I spray my finger again, this time with the pill being covered in the cheese. Again using my finger to tease the neck upward, I let her throat become fully extended and then lower the finger. The cat will eat the cheese quickly including the pill.

Worming pills are tricky because they taste horrible. They carry enough chemicals in them to kill worms so you can imagine it would be like a poison taste the cat is experiencing. I only hope that the pills you are giving your cat were given to you by a vet, and not something over the counter (which can potentially harm, even fatally hurt your cat) Worming pills are given out by vets because it depends on the weight of the cat as well as the health factors.
post #7 of 15
Thread Starter 
Thanks for the spray cheese idea, I will go buy some and give that a try.

The pill was given to me by the Vet, Simon get's one full pill because he is 10lbs and my younger cat got half a pill (4lbs).

Now that you mention it, I am sure those pills must taste awful I never really thought of it that way, I wouldn't want to eat one either!
post #8 of 15
I've been giving Jazz 1/2 a pill twice a day for almost 3 weeks now. She has gotten wise to the cheese, ham and just about everything else. This morning I rolled it into a little cream cheese ball and she ate it! Try that or peanut butter!
Good luck!
post #9 of 15
i am a trainee vet nurse so i spend quite a lot of time giving awkward cats thier tablet , kind of comes with the job lol
we have pill poppers at work and many people seem to find them great because you can fill them with water too so that the cat gets the tablet and water at the same time,,,however i have the problem where the cats just seem to eat them then i usually get moaned at for breaking the last pill popper
i find it easier to just give it myself with my fingers....you hold the cats head in your left hand with your fingers each side of the cats top jaw and extend thier head upwards. with the pill between your index finger and thumb of your right hand you gently open the cats mouth with another free finger on your right hand then drop the pill right down at the back of the cats throat. i usually have a syringe of water handy and while you are still extending the cats head and holding the mouth closed, gently squirt the water down the side of its mouth, as the cat swallows the water in theory it should also swallow the tablet.....works most times anyway lol
post #10 of 15
I have pilled hundreds of cats.. and have scars to prove it.
I just grab the scruff of the neck, gently, but firm enough that the cat can't turn around and tear me a new hole. Hold pill in index and thumb fingers, pry mouth open with middle or ring finger, push the pull down as far as you can. Shut cats mouth, blow on its face and rub its neck to help it swallow.
post #11 of 15
Since it tastes terrible, you can put it in an empty capsule or disguise it in some bread (I have bread-loving kitties at my house). That might help keep them from foaming when the pill enters their mouth. Place the kitty on your lap with their legs out (so the cat faces the same direction you do). This keeps them from getting as much leverage. Open the mouth and shove the pill as far back as possible. Quickly close the mouth and hold it gently but firmly shut. Don't let the cat fake you out with pretend swallows. Watch until the cat licks its nose. Then give him or her a treat, and your done.
post #12 of 15
Do you keep their mouth close after giving it?

other than that, all I can say is PRAY!!!

I can't pill CJ either!
post #13 of 15
Thread Starter 
UPDATE:

Well I tried the spray cheese idea, turns out Simon is not a fan!

I then waited until my boyfriend got home and he held Simon while I tried to pop the pill in his mouth with my fingers, I am not sure why this didn't work, but we tried several times and Simon just got more and more agitated.

Then I crushed the pill up into a fine powder, mixed it with a bit of water and sucked it up into a cat syringe. Then Charles held him while I shot the liquid in, and then held his mouth closed. Lets just say he was NOT pleased, but I think most of the liquid got in his mouth!

Lets hope so anyways

Thanks for all the comments!
post #14 of 15
Pilling Cats (and Dogs) and Erosive Esophagitis

Compounded Flavored Liquid Alternatives

Transdermal Medications

Lisa A. Pierson, DVM

Dr. Pierson thank you so much for posting this information it is something I learned a while ago but know that not many cat owners had any idea that pilling can cause harmful health issues. I read an abstract about this exact same subject that an associate passed on to me and realized even though I had been pilling Lulu for a while (Tapazole) although very difficult I did manage somehow. But as soon as I read this and thought just how horrible this would be to swallow a large pill without any liquid and the heartburn I get when taking a tablet with a full glass of water, I stopped. I saw an ad in Cat Fancy from a company called Apothepet stating that this what they specialize in. So I gave them a call and tried both the liquid in Salmon and Tuna and also tried the transdermal gel. I still have questions about transdermals because Lulu would try to get it off her ear with her paw and I don't know how well it was absorbed into the system so I went back to the liquids. She really loves the Salmon flavored Tapazole and will actually lap it up of of a paper plate. Treatment turned into TREATment. I hope others out there understand this and realize that serious health damage can be done due to pilling. I have even heard of a case where a cat had formed so many strictures and scar tissue the vet needed to do a balloon dialation of the esophagus just so the cat could eat again.

Again thanks for this terrific info.

--------------------------------------------------------------------------



Think about the last time you swallowed a pill or a capsule. You most likely took it with several swallows of something liquid to help move the pill along its journey through the esophagus and into the stomach. Most people would never dream of 'dry swallowing' pills, having felt that awful sensation of a pill not 'going down' very smoothly. When this happens, the human usually reacts by drinking more water. It would be nice if cats and dogs reacted this way, but they don't.

For this article, a "dry swallow" refers to the administration of a pill or capsule to a cat or dog without immediately following up with several milliliters (cc's) of water, or tuna juice or meat broth given orally via a syringe, or the consumption of some canned food by the patient. Offering tuna juice or a meat broth for them to lap up on their own is also a very good option and one that is less stressful than syringing. Some people use butter or oil to coat the pill and that may make swallowing the pill easier, but it is unlikely that this method results in a more timely entry into the stomach. This is where the swallowing of some liquid or canned food helps keep the esophagus healthy by moving the pills or capsules immediately into the stomach.

The best size of syringe to use for a cat is a 1 cc ("TB") syringe. The larger syringes do not fit comfortably inside of a cat's mouth. Also, you do not want to administer any more than 1 cc at a time. If liquid medications, such as some of the commonly used antibiotics, are dispensed with an eyedropper, ask your veterinarian for a 1cc syringe. Not only is this a more accurate way to measure the dose, but your cat will be more agreeable to this small syringe entering the side of his mouth rather than the larger eyedropper.

Before you get ready to administer the pill, have a bowl of water (or tuna juice or broth) readily available. See if your cat is interested in drinking it. If not, you will then have to use your syringe. To administer a liquid using a syringe, it is best to approach the cat from the side, not from the front. Cats tend to be a bit worried when approached head on. Slip the syringe into the side of the mouth at about a 45-degree angle being careful not to insert the syringe too far down the back of the throat. You don't want the cat to panic, nor have him aspirate the liquid. Do not hold your pet's head up! This is something that I commonly see people do. Try it yourself. Lift your chin up and you will see how much harder it is for you to swallow. You can hold his head level or his mouth slightly down, but never raise his head upward.

Believe me when I say I fully understand that some of the readers will be saying "oh sure...I can barely get the pill down my cat and now I am supposed to follow up with the syringing of some liquid?!!?" I realize that none of this will be easy with some cats, but my goal is to get people to start thinking about this issue and not take the dry pilling of an animal lightly. For those hard-to-pill cats, please see below for other alternatives such as compounded, flavored liquid medications and transdermal preparations.

Another option is to see if the cat or dog will consume the pill if it is hidden in canned food. This is obviously the least stressful for all concerned but it usually works better with dogs. Cats are notoriously picky eaters and are suspicious of anything out of the ordinary in their food. Some drugs such as Baytril TasteTabs are formulated to be fairly palatable and can be crushed and put in the food and this is a great way to go....if the cat will eat it. Unfortunately, I have tried this trick with several cats and most of them have refused to eat the TasteTabs.

Note: When I use the word "pill", I am also referring to capsules which can cause even more problems than pills, as shown in the study below.

Given the facts regarding how humans take their medications and vitamins, why do we ask our cats and dogs to do something we would never do? Why do we ask them to dry swallow a pill which quite often ends up lodged in the esophagus with the real potential to cause a very painful condition called erosive esophagitis?

The lining of the esophagus is very delicate and it is not designed to have irritating medications in contact with it for more than the short amount of time it should take for the pill to pass from the mouth to the stomach when swallowed with an adequate amount of liquid or food. When a pill is in contact with this tissue for a prolonged period of time, a painful irritation or ulcer has the potential to develop. Some medications are worse than others. For instance, doxycycline is a well-known antibiotic that is extremely irritating. (More on that below from a human who experienced very painful erosive esophagitis from taking this medication without enough water.)

Please note this excerpt from the study quoted below:

"After 5 minutes 84% of capsules and 64% of tablets are still sitting in the esophagus." This is referring to pills and capsules that were dry swallowed.

It really is amazing that cats and dogs are as good as they are about pilling but one has to wonder about the pets that panic and/or gag when their owners try to pill them. I know that I would not be very happy about being asked to dry swallow a pill.

A Very Interesting Study

The following is a summary of a very interesting article that appeared in a veterinary journal entitled Evaluation of the Passage of Tablets and Capsules Through the Esophagus of the Cat. It is from a paper presented at the 2001 American College of Veterinary Internal Medicine Forum. (They do note at the end of the paper that the principles outlined also make good sense for dogs.) This paper was submitted to one of the lesser-read journals so a lot of veterinarians may not have seen it. This is extremely unfortunate for all cats and dogs.

Purpose of the study:
The goal of the study was to determine the length of time that it took for pills or capsules to enter the stomach after 1) dry pilling and 2) pilling and then giving a 6 cc water chaser immediately following the administration of the pill or capsule - referred to as a "wet swallow".

Study design:
30 cats were used. Fluoroscopy was used to evaluate the pill/capsule passage at 30, 60, 90, 120, 180, 300 seconds.

Study results:
For the dry swallows:
No pills were in the stomach at 30 and 60 seconds. Only 6% of the pills were in the stomach at 90 seconds. Only 13% of the pills were in the stomach at 120 seconds. And at 5 minutes only 36% of the pills were in the stomach.

For the wet swallows: (i.e., the pill was followed by 6 cc of water)
At 30 seconds, 90% of the pills were in the stomach. All pills were in the stomach by 120 seconds.

The statistics were even worse for capsules when dry swallowed. By 5 minutes, only 16% of the capsules had made it to the stomach. 100% of capsules followed by water chasers, were in the stomach by 60 seconds - faster than for pills probably due to the smoother surface of a capsule versus a pill.

Commentary:
"This is an interesting study that has considerable practical impact. Although veterinarians have a huge arsenal of mediations and treatments available to us, we still have a very poor understanding of some of the most basic aspects of everyday practice. We routinely prescribe oral medications in the form of tablets or capsules to cats.

It has been our assumption that when it was possible for the owner to actually give the pills or capsule to the cat, it would make it into the stomach reasonably rapidly. It turns out that this is inaccurate. After 5 minutes 84% of capsules and 64% of tablets are still sitting in the esophagus. Similar results were published in another study by JP Graham (American Journal of Veterinary Research 2000).

Practical outcome:
The main concern with this information is that if tablets and capsules sit in the esophagus for a prolonged period of time, this can cause damage to the tissues in this area. This damage can lead to esophagitis, which can lead to nausea, vomiting and megaesophagus. At times, the esophagus can also respond by developing an ulcer or stricture. The latter is a very serious complication requiring aggressive therapy, preferably with balloon dilatation.

In addition, we probably have all had that uncomfortable feeling when a tablet we have taken has gotten stuck on the way down. This could be the cause of vomiting in some cats that are medicated. It is quite frustrating to win the battle to get the pill or capsule down a cat and then have it vomited up several minutes later.

Both this abstract as well as the study published by Graham et al. clearly point to the need to administer either water or food after a cat has been pilled with a tablet or a capsule. This will hasten the movement into the stomach and cut down on the chances of the tablet or capsule remaining in the esophagus for a prolonged period of time. Although comparable studies have not been done in dogs, this advice is sound in dogs, as well."
(End of quoted study)


The following is an anecdotal report from a person who ended up with a very painful case of an ulcerated esophagus after a capsule became lodged in her esophagus:

"I know the pain of an ulcerated esophagus personally and it is a living hell. I was on doxycycline capsules (due to a cat bite) last year and one got stuck in my esophagus. I did not think it was a big deal and went to bed figuring it would eventually work it's way down. Several days later I had suffered so much that I took myself to the ER. I had to drink this horrible tasting cocktail with liquid lidocaine to get relief. It worked, temporarily, but I had to drink a tsp of the lidocaine 3x a day just to be able to swallow for about 30 minutes each time. Forget eating. I lost 10+ lbs in less than 2 weeks. I couldn't eat at all and could not swallow without the lidocaine. I laid in the bed with a cup to spit in because it was too painful to swallow. It was a great diet, but not one I'd recommend. Please take every precaution you can to make sure this does not happen to your pet."



Compounded Flavored Liquid Medications

As an alternative to using pills and capsules to administer medications, certain pharmacies can compound the medications into flavored liquids. Please be aware that compounded medications may be more expensive than medications dispensed by your veterinarian, but the use of these liquid medications can alleviate a great deal of stress for both the pet and the human. I am very involved in rescue work and often deal with extremely frightened and painful animals whose trust I am trying to gain. Pilling a sick cat/kitten who is feral or traumatized/frightened/painful, or has severe upper respiratory disease and can hardly breathe as it is, does not exactly make for a fast friendship and development of trust.

When an animal is ill or injured, the last thing we want to do is add more stress to the situation. I adopted a 9 year old cat out to a really nice woman 4 years ago. She recently called me in tears because Caliban was now in congestive heart failure and she was having a hard time pilling him and was going to put him to sleep since he could no longer receive his necessary medications. She felt so guilty for failing Caliban by not giving him the medications that he desperately needed but was also feeling guilty for stressing the heck out of him in his final days with the pilling. This stress was alleviated by using compounded, flavored liquid medications.

The most common flavor used for cats is 'triple fish' and if dealing with a very bitter medication, this flavor is the best one to use. Another flavor that is used is chicken and some cats do better with this milder flavor than the very strong triple fish.

Please note that some drugs are so bitter that even compounding will not hide the awful taste. An example of this type of drug is amitriptyline which is often used for anxiety and inappropriate elimination problems. Fortunately, this medication is formulated into a small, coated pill but a food or liquid chaser still needs to be administered if the cat is pilled. Or, because this pill is small and coated, another option is to hide it in canned food.

Since we all know that every cat is different, I will mention that some people state that they have had much better luck pilling their cats than trying to get liquids into them. Some cats throw a fit if given liquid medications. The problem with these cats, however, is that if you do pill them successfully, they are not apt to take the water chaser very well. This presents a bit of a problem and the hope is that they will eat some canned food or drink some tuna juice or meat broth after being pilled.

Another favorable aspect of using a compounding pharmacy is that you can pick the drug concentration so that the necessary dosage volume is not over 1cc. I try to have the medication mixed in a concentration that enables me to give 1/2 - 3/4 of a cc or 1cc at the most. This is an easy volume to administer to a cat.

Occasionally you may run across a drug that can't be compounded but I have yet to run into this situation.


Transdermal Medications


Transdermal preparations are medications that are formulated into a gel or ointment that can be applied to the inner ear of the cat. After application, the medicine is then absorbed through the skin. There is some controversy regarding the efficacy of this route so please discuss this issue with your vet and pharmacist for each individual medication considered. Some medications cannot be compounded into transdermal preparations.

One medication that is often used with this route of administration is methimazole (Tapazole) which is a commonly prescribed hyperthyroid medication. Studies here and here have shown that the use of transdermal methimazole is a very effective way to administer this drug and results in fewer gastrointestinal upsets.

Another medication that has been formulated into a transdermal preparation is amitriptyline but I do not know of any studies showing the efficacy of this route of administration for this particular drug.


Conclusion

The goal of this article is to prevent the silent suffering that our pets often go through when medications are administered without appropriate precautions. I have outlined several options above:


1) Administer the pill or capsule and follow up immediately with a chaser of a liquid

using a syringe.

2) Administer the pill or capsule and follow up with the feeding of canned food, tuna

juice or a meat broth.

3) Use compounded, flavored liquid medications.

4) Use transdermal preparations.

5) Or...be lucky enough to have your cat eat the medication in canned food.

Please pass this information on to anyone whose pets may benefit from the information. It is my hope that the information will help to save some of our non-speaking friends from a painful esophagitis and their caretakers from the stress of pilling some hard-to-pill cats.
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April, 2005

Lisa A. Pierson, DVM
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post #15 of 15
Dr. Pierson thank you so much for posting this information it is something I learned a while ago but know that not many cat owners had any idea that pilling can cause harmful health issues. I read an abstract about this exact same subject that an associate passed on to me and realized even though I had been pilling Lulu for a while (Tapazole) although very difficult I did manage somehow. But as soon as I read this and thought just how horrible this would be to swallow a large pill without any liquid and the heartburn I get when taking a tablet with a full glass of water, I stopped. I saw an ad in Cat Fancy from a company called Apothepet stating that this what they specialize in. So I gave them a call and tried both the liquid in Salmon and Tuna and also tried the transdermal gel. I still have questions about transdermals because Lulu would try to get it off her ear with her paw and I don't know how well it was absorbed into the system so I went back to the liquids. She really loves the Salmon flavored Tapazole and will actually lap it up of of a paper plate. Treatment turned into TREATment. I hope others out there understand this and realize that serious health damage can be done due to pilling. I have even heard of a case where a cat had formed so many strictures and scar tissue the vet needed to do a balloon dialation of the esophagus just so the cat could eat again.

Again thanks for this terrific info.
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