Palliative care cat won't take gabapentin ... painkiller alternatives?

[hexevans]

Hi everyone!

I posted last year about Callie, the our then-15 year-old "foster fail." She has chronic pain from arthritis, her kidneys are at stage 3 1/2, and she possibly has cancer. The vet has recommended a palliative approach and I want her to be as comfortable as possible.

When I posted last, I asked about tricks for gabapentin administration. We eventually found a way the worked - dissolving the tablets or sprinkling the capsules in wet food. However, this no longer works. She's not feeling well, and if she even detects a mere hint of medication, she'll turn away the food and act distrustful for quite a while. But she needs to eat, and I don't want her to be in pain.

I got the transdermal gel gabapentin, but it's quite expensive, and a lot to administer to the ears twice a day - 0.5 ml each time! And it doesn't seem as effective? The vet said it could irritate her ears used regularly. But we'll budget and use it if we need to.

Anyway, I come here asking for your help in making her comfortable. If gabapentin won't fly with her, what are my options? I've heard of Solensia, but then there seems to be a lot of horror stories about it killing people's cats? Also, I'm wondering if there's other painkillers that don't taste horrible. Is buprenorphine an acceptable daily medication at this stage, and is it easier to administer?

I really don't want her last days/weeks/(months?) spent in pain and afraid that we are "poisoning" her.

Thanks for any and all advice. <3

 

[FeebysOwner]

Hi. I am in a somewhat similar situation with my 19+yo, 10 pound cat, Feeby. She has other health conditions besides arthritis, CKD Stage 3 and lymphoma - and is pretty much considered in palliative care. She will not take gabapentin, and she already gets transdermal Mirataz in her ears, although we clean them after every 2 application per ear and so far so good.

Anyway, we are using buprenorphine for pain. It is generally comprised of a very, very tiny dose given via oral syringe to be absorbed into the cheek. The dose right now for her is 0.1ml (twice a day) and she really has no issue with it. The way the drug is formulated is based on strength/potency and weight of the cat. So, even increases don't amount to a severe volume change. I am currently looking to increase Feeby's as I think she could benefit from a bit more than she is currently getting.

It isn't cheap, but it isn't terribly bad where I am located. I can get 28 pre-filled oral syringes of 0.1ml each for about $45. But, just know where you are located and who you use to get the meds might make it a bit more than I am paying.

Nonetheless, if I were you I'd look into buprenorphine.

 

[hexevans]

Hi FeebysOwner , thank you so much for your reply! It does indeed sound like we are in a similar situation.

Does the buprenorphine taste bad? Whenever I try to administer liquid medication, my cat froths at the mouth and hates it. I'm worried it wouldn't get absorbed.

I'm willing to pay for buprenorphine if it works. The transdermal gabapentin is very expensive anyway!

Thank you once again

 

[FeebysOwner]

Does the buprenorphine taste bad? Whenever I try to administer liquid medication, my cat froths at the mouth and hates it. I'm worried it wouldn't get absorbed.

Feeby has always gagged and foamed at the mouth with most liquid meds. She does not with buprenorphine, but the amount is ever so tiny there isn't even enough to try to swallow. I stick the syringe into her mouth, alongside her cheek and press the plunger. She looks like she is trying to swallow and then realizes there is nothing to swallow - and after 5 seconds, she acts like nothing happened.

I don't know what it tastes like as I have never tried to taste it due to the small amount of the overall dose. If you have any oral syringes in your home that measure in 0.1ml, you could see just how small the amount is. I, too, worry about its absorption/application, but I feel even if I didn't get it directly in her cheek, it would still be absorbed appropriately since all parts of the mouth are mucous membrane material which is how it is absorbed. I just wait a few minutes before letting her eat or drink anything, just in case.

I am not saying that bupe is right for Callie, or that it will work as you hope, but I don't think administration will be an issue.

 

[hexevans]

Hi FeebysOwner , thanks for the extra info! I think I will reach out to my vet and inquire about bupe.

With Feeby, do you notice any side effects with buprenorphine? Callie is prone to constipation these days - I'm wondering if it also causes extra drowsiness? My general impression of opioids is that they can cause some issues, but I really would like to use it if it's more effective as a painkiller and easier to administer.

 

[FeebysOwner]

I can't say if bupe has caused any constipation with Feeby since she is given Miralax due to her taking a phosphorus binder. However, because of the kind of partial opioid agonist that it is, I don't believe constipation is common ;ike it is for many of the full opioid agonists.

I also don't see drowsiness in her, but I am currently consulting with her vet to see if her dosage is adequate enough. Drowsiness ia a potential side effect, but I haven't read much about that happening either.

Let us know what the vet says!

 

[hexevans]

thanks FeebysOwner ! And sorry - one more semi-related question, since there's so much overlap! How often do you give your cat Miralax? I've been giving mine 1/4 teaspoon twice a day until she poops, then I stop (but then a week later, she's constipated again). Have you found a dosage amount and daily rate that helps Feeby stay regular? I'm wondering if I should be more continuous - I guess I'm cautious because I know Miralax can cause dehydration, which isn't good for CDK cats. Luckily mine drinks water fairly frequently.

I'm glad to hear Bupe isn't causing drowsiness! I'm hoping it will be a good alternative.

 

[FeebysOwner]

Because Feeby gets a phosphorus binder daily, I give her Miralax daily - 1/8 tsp. She never actually stopped going but did back off from going every day to every other day - it was then that I started the Miralax. She still doesn't go every day all the time. I would rather give it to her daily and as long as she doesn't have soft stools which she doesn't, I think the consistent dosing is - at least for her - more appropriate.

Do you give Callie sub-Q fluids? Feeby gets 100ml daily. I suspect if Miralax would contribute to dehydration, the sub-Q fluids would help with that too.

 

[hexevans]

Callie is not on sub-Q fluids, but I think I'm going to bring it up with the vet, when I ask about buprenorphine.

I'll try reducing the amount of Miralax I give her as well. She's not on a phosphorus binder because her phosphorus is at a good level, apparently ... somehow!

I will provide updates as they come, thank you once again for you wisdom!