The feline medicine cabinet: drug therapy for cats (Proceedings)
Cats handle drugs in a different fashion than dogs. While this is not a surprise, there are some drugs that every practitioner should be aware of that work really well for their feline patients. The focus of this discussion will be to highlight these drugs and their uses, showing why they deserve to be in the feline medicine cabinet. Case studies will be utilized.
Prednisone is converted to prednisolone in the liver. Prednisolone is the active form of the drug. While the cat can make this conversion from prednisone to prednisolone, the conversion varies from cat to cat. Some cats do not convert enough prednisone to prednisolone to effectively treat the disease, appearing to be treatment failures. Using prednisolone skips this extra step and often the cats respond more reliably to prednisolone. Lower doses of prednisolone may also be effective for long-term control of disease (asthma, inflammatory bowel disease, etc.). Cats handle corticosteriods much better than our canine patients, with fewer reported side effects.Dose: Varies widely depending on the disease being treated
• Neoplasia (lymphoma): 10 mg per cat daily, often used in conjunction with other drugs
• Immune-mediated diseases: 1-2 mg/kg q 12 hours to start, decreasing to lowest effective dose
• Inflammatory disease: 1–2 mg/kg once daily, decreasing to lowest effective dose
Budesonide is a potent glucocorticoid (15 times more potent than prednisolone). Its "topical" anti-inflammatory effects are particularly useful in controlling inflammatory bowel disease in cats. The drug is absorbed systemically, but steroid side-effects are minimized by the high first-pass metabolism effect through the liver. The drug usually needs to be compounded for our feline patients.
Dose: 1 mg PO once daily
This drug is a strong non-steroidal anti-inflammatory drug (NSAID) that can be used to control pain and swelling in a wide variety of diseases. It should never be combined with corticosteroids or other NSAIDs due to the risk of gastrointestinal ulceration. I will use this drug in cats to treat inflammation in the nose, lungs, and bladder. This drug also controls pain due to osteoarthritis and neoplasia in cats. It has also been used as adjunctive treatment of some cancers (transitional cell carcinoma, adenocarcinomas). This drug is not recommended for use in cats with kidney disease. Concurrent use of GI protectants is generally not needed. The long-term daily use of piroxicam is cats has been found to be well-tolerated.
Dose: 0.3 mg/kg PO q 24-48 hours with food
Tramadol is drug used for its analgesic effects. It is a centrally acting opiate agonist that is not a controlled substance. It can be used alone or in conjunction with other drugs (corticosteroids, NSAIDs). This drug can have some sedating effects, which can be minimized with lower doses. The drug is safe to use in cats with renal disease.
Dose: ⅛ to ¼ of a 50 mg tablet (6.25 – 12.5) PO q 12-24 hours; 4 mg/kg PO q 12-24 hours
This antibiotic is useful for treating a wide variety of bacterial and other unusual infections in cats. I particularly like to use this drug in cats with nasal disease (to treat secondary infections), possible Mycoplasma infections, anemias of unknown etiology (erythrocytic mycoplasmal infections, Ehrlichia spp.), Chlamydia psittaci, polyarthritis, Mycobacteria, L-form bacterial infections. This drug also seems to have some anti-inflammatory effects. It is important to make sure the drug is given with food or water, as significant ulceration and stricture of the esophagus have been reported. Alternatively, the drug can be compounded into a liquid suspension.
Dose: 5 mg/kg PO q 12-24 hours with food