Medical management of FLUTD: What do we really know? (Proceedings)
Review of therapies
The difficulty in evaluating the efficacy of therapies for iFLUTD is that this disease is self-limiting, resolving within 5-10 days regardless of therapy used. Several goals of therapy have been identified and various therapies addressing each aim have been investigated to one degree or another.
Alleviate pain and inflammation• Amitriptyline [10 mg tabs] 5-10 mg/cat/day: a tricyclic anti-depressant drug that also has numerous other effects including anticholinergic, antihistamine, anti-alpha-adrenergic, anti-inflammatory and analgesic. In one study, 9 of 15 chronic iFLUTD cats had decreased clinical signs with long-term use of amitriptyline. However, another study found no short-term improvement in clinical signs in acute cases. Amitriptyline can cause somnolence, decreased grooming and weight gain.
• NSAIDS: ketoprofen, piroxicam and meloxicam have been used with some anecdotal success, but few controlled prospective studies have been performed. Prior to use of any NSAID, careful attention must be given to the hydration status and renal function in the patient.
• Glucocorticoids: Showed no difference in clinical signs or recurrence in control cats versus those receiving glucocorticoids and are therefore not recommended, especially if given in concurrence with NSAIDs.
• Antispasmodics (Valium, phenoxybenzamine, propantheline): The few available studies showed no significant differences in outcome in cats administered these various antispasmodics. Phenoxybenzamine (2.5-10 mg [total dose] PO q24h) did show some decreased pre-prostatic urethral pressures suggesting some benefit of this drug for acute cases.
• Buprenorphine: Has not been prospectively studied, but likely helps with short-term pain.
Supplement GAGs (optional)
• Pentosan polysulfate (2 to 16 mg/kg BID. or 8 mg/kg BID PO): as a GAG replacement. The treatment has been shown to be helpful in some human patients and a veterinary product (Cartrophen) has been used successfully in some cats. Elmiron is the human product available in the United States, but does need to be formulated to smaller capsule sizes. Side effects can include bleeding/bruising as it is a heparin-like compound, though this has not specifically been reported in cats.
• Multimodal Environmental Modification (MEMO): Provide multiple litter boxes for multiple cat households; be fastidious about keeping the litter boxes clean; limit stressful events if the cat is prone to episodes of iFLUTD. One study showed significant improvement in fear, nervousness, URIs and a trend to decreased aggression in cats for which MEMO was implemented. There was no recurrence of clinical signs in 70-75% of cats in this 10-month study.
Increase water intake
Several studies that were evaluating dietary and or other supplementations in the treatment of iFLUTD in cats concluded that the main correlation between improvement in clinical signs and/or recurrences was a canned diet. Therefore, canned diets, because of their increased water content, and encouraging water consumption, is one of the advocated therapies for iFLUTD.