Does Mirataz stop working after a while on IBS cats?

[Shrimp's Mom]

My cat who has IBS and lost some weight was put on a regimen of

Budenoside (compounded liquid)
Metronidazole
Vitamin B12 injection
Mirataz transdermal gel

This all has made her feel a lot better, eat a lot of food and actually gain weight. No more vomiting and diarrhea.

She has been on this regimen for a month, last week we stopped giving her the mitronidazole based on what the vet said but continued the rest. Since yesterday she kind of went back to not wanting to eat as much anymore, she acts hungry and interested but does not seem to like any food we put in front of her and will eat little. But so far no vomiting or diarrhea though.

Question:

1) can mirataz stop working? Why? How? We do clean her ears with a warm cloth and baby soap the night before her dose to insure mirataz absorption.
2) Could the mitronidazole have been the thing holding it all together? We wonder if we should ask if we can put her back on it again
3) She has been getting Vitamin B-12 shots for at least a month now and i know the effect is cumulative. Could it be the shots make her feel better and which is why she no longer has that ravenous appetite making mirataz less effective or should mirataz make her hungry regardless?

 

[FeebysOwner]

Metronidazole is an antibiotic that helps with diarrhea, primarily due to an overabundance of 'bad' bacteria in the intestines. I would not think it would be wise to use it as a long-term solution and have never read it is beneficial in improving appetite. But it never hurts to ask the vet to try it again and see if it was somehow helping with your cat's appetite. However, some cats actually experience a lack of appetite with Metro, although at first blush it doesn't seem that would be the case with your cat. Perhaps, after use for a period of time, it could evoke it?

Is it possible that she is experiencing any nausea? Although, Mirataz has some anti-emetic properties to it, if a cat is truly nauseous, it probably would not be enough to override it entirely. Something like ondansetron might be another thing to discuss with your vet, just as another trial to see if it helps her eat better.

I don't think Mirataz would be any less effective because of B-12 shots. And, just from my own personal experience, Mirataz has not lost any of its effectiveness on my cat after having been on it nearly two years. There are some cats who do better with other appetite stimulants, such as Elura - so, another thing to ask your vet.

Budesonide is often used in lieu of Prednisolone because it has less impact on the rest of a cat's body since it is more focused on the digestive tract. But, perhaps in the case of your cat, it isn't as effective as Pred. Again, something to discuss with your vet.

 

[Shrimp's Mom]

Thank you. The vet did prescribe prednisonole but given that the above worked and she seemed to have a lot of appetite and eating well and gaining weight, we did not want to give her the pred since as a steroid it has more systemic effects on the body whereas budenoside, as you noted, acts more locally on the intestinal lining. I read that bud is actually 15 times stronger than pred but because it does not have the systemic effects as pred it is less "harmful."

I thought mirataz is supposed to address nausea. Are you saying it does not? I can certainly try asking my vet about the antinausea meds you recommended, thanks very much.

I know metro is not to be used long term but boy does it do wonders on her when she has diarrhea and maybe flare ups? She has been on the budenoside (0.6 ml every 12 hours) for a month now. Just today we reduced it to once a day based on what the vet said. I know it cannot be that since she has stopped having ravenous hunger before we changed her budenoside dosage. This is why I thought it was the metro.

Finally, would the steroids not reduce inflammation and with it eliminate nausea? I thought the whole reason cats with IBS have nausea is because of the inflammation. So what am i giving her the steroids for if they do not reduce inflammation and with it the associated nausea? I mean what is the nausea caused by if not the inflammation-associated IBS?
Thanks so much for your help again...

 

[FeebysOwner]

I have never actually heard that reducing inflammation will ensure an elimination/minimization of nausea. I see why you might think that, but I guess that is yet another question for the vet. Even if nausea remains, that doesn't mean the Budesonide is not helping with the inflammation. Has a probiotic been suggested to help with balancing bad gut bacteria, which might aide in one of the principal contributions of Metro? Maybe a pulse dosing of Metro?

Mirataz can help with nausea, but some cats sometimes need a bit more. I know numerous cats that are on both Miraraz and ondansetron, mine included - but most of these cats are dealing with kidney disease as their primary health issue. Nonetheless, I see no reason why it wouldn't work similarly on cats with other medical issues.

Is she on a new dietary regiment? That is almost always part of the equation with IBS/IBD.

As you can tell, I have probably gone beyond my element of knowledge regarding IBS.

 

[Shrimp's Mom]

She has been eating premium canned food all her life and we switched her over to small a couple of months ago which she loves. Probiotics were suggested but when we gave it to her it did not seem to do much. Or maybe it is a matter of it working cumulatively - i.e you wont see any results rightaway.

A cat has nausea for a reason, right? And i thought the nausea was the result of her IBS which in turn is because of inflammation. So I thought bringing the inflammation down = eliminate nausea. I mean why else would she have nausea? I can ask the vet but I always feel like I get more hands on info here.

I just am surprised the mirataz worked so well the first 2 weeks and just these past 2-3 days the intense hunger as a result has diminished. She still eats but just not like before. I worry about her losing weight again, in which case we may need to put her on pred. Appreciate your input and sharing your experiences...

 

[FeebysOwner]

Maybe she is just tiring of the new food - it happens. She must not love it as she did if she is not eating as much of it as she was originally, right? If a cat no longer favors a food, I am not sure Mirataz will override that entirely. I've seen that in my own cat. Mirataz will not make her eat great with food she doesn't care for.

I also have never given Feeby a full dose of Mirataz everyday, despite the directions. I have found that she does better with a half dose every 2-3 days. I can't explain why this would make a difference, but for her - and others I have seen on this site - it does. I think experimenting is the name of the game with this med.

I just cannot correlate Budesonide helping with inflammation to mean that there isn't residual nausea involved. But, in your case you may be dealing more with an aversion to the new food now.

All said, if you think that Metro is the key, get your vet to put her back on it and see what happens. With IBS there is no simple solution.

 

[ellen m]

You are correct that the nausea is from the disease, whatever it is, and the disease causes inflammation, and the steroid reduces inflammation. But it's not so simple. Your cat probably has IBD (inflammatory bowel disease - not IBS, irritable bowel syndrome, a different disease that humans get, not so much cats) or lymphoma, a mild form of cancer. If there was no biopsy, you can't know which one it is because the symptoms are similar. Even an ultrasound looks similar. The inflammation in the case of IBD is simple inflammation. But inflammation in the case of lymphoma is not really inflammation. It's uncontrolled growth of lymphocytes in the intestine, which only appears as inflammation on an ultrasound. Has your cat had an ultrasound? A steroid, either prednisolone or budesonide, will help by clearing out some of those lymphocytes in either case, IBD or lymphoma, but it will do that for only a limited amount of time if there is lymphoma. The "bandaid" meds for appetite and nausea will fail as well if the underlying disease is not being treated. Mirataz doesn't stop working. It's that the disease that's progressing.

Has your vet suggested a reason why your cat is not getting better? Was there any mention of further ways to diagnose the disease, such as a biopsy, perhaps?

As for prednisolone, it does work better for these diseases than budesonide, but as someone posted, budesonide can sometimes (not always) reduce systemic effects. The fact that budesonide is stronger doesn't matter. It just means you give a smaller dosage then pred to get a similar effect.

I would ask your vet for more details about your cat's disease, or possible diseases.

 

[ellen m]

Also is your cat on a nausea medication? As someone above posted, Mirataz is more of an appetite stimulant than a nausea med. I would ask your vet for a nausea med because very often, and especially in IBD and lymphoma, poor appetite is from nausea, even if the cat is not throwing up. A nausea med can help with that.

 

[daftcat75]

Haven't read all the responses yet. But s. boulardii is a much safer stand-in for metro that can be given twice a day for the rest of her life, if necessary. It has soothing qualities that can complement your other IBS treatments. And it has scavenging qualities that are specific to many bad actors while sparing the good ones. (Metro is not so particular.) It acts like a decoy gut. It's cell structure is very similar to the gut wall. And those bad actors that attack the gut wall bind to the s. boulardii instead and are pooped out. S. boulardii does not colonize like other probiotics. It has to be given regularly (twice a day) to keep a steady state in the gut.

My Cat Has Diarrhea - What Do I Do?

I found that Betty's appetite improved when I included s. boulardii in her IBD regimen. I give her approximately a 1/4 capsule twice a day. I have a size four capsule filling machine that lets me make up 50 cat-sized capsules out of about 10-12 human capsules. She gets one capsule in the morning and one at night. Some cats like the yeasty taste of s. boulardii and will not object to it being added to their food. Betty is not one of those cats. However, she is something of a unicorn cat in that she will happily scoop and swallow any capsules that I dip in Hills A/D and drop on the carpet for her.

It is possible that she may also be having nausea. You could ask your vet for a prescription of Zofran (ondansetron.)