Sileo Dose In Cats

1. Sileo In Cats
2. Sileo Side Effects
3. Sileo Dosing Chart For Dogs
4. Sileo Dose In Cats For Adoption
5. Sileo Dog Dose

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I have a quick question for you about the use of alendronate for treatment of cats with idiopathic hypercalcemia. First of all, I wanted to find out if you recommend this treatment, and what your experience is with the drug.

The protocol that I've been using is to start with an oral dose of 10 mg once weekly, and then increase the dose to 20 mg once weekly if needed. In a few cats, I've had to go as high as 30 mg per week to lower the total and ionized calcium concentrations.

Have you ever done twice weekly dosing? I was recently referred a hypercalcemic cat whose dose was changed from 20 mg once a week to 10 mg twice a week by the veterinarian in the hopes that twice weekly dosing would be more effective. I know it theoretically can be given twice weekly, but was wondering if you've found that twice weekly dosing was more effective.

Thank you for your help.
My Response:
As you know, treatment for idiopathic hypercalcemia in cat is currently empiric, since the cause of the disorder remains unknown. I generally start with a change in diet as a first step in treatment (1), since normocalcemia is sometimes restored after a change to a different diet. However, even in cats that show an initial response to dietary intervention, the duration of normocalcemia may be short-lived and the hypercalcemia can relapse. In these cats, I then turn to medical therapy (i.e., glucocorticoids or bisphosphonates) to help control the hypercalcemia.
Even though not extensively reported, I consider bisphosphonate therapy with alendronate (i.e, Fosamax, Merck; generic formulations also available)to be a better alternative than prednisolone for most cats with idiopathic hypercalcemia that fail dietary intervention (2-4). The complications I commonly see with chronic high-dose glucocorticoid treatment include muscle wasting and iatrogenic diabetes. Remember that steroids are catabolic for muscle tissue (5,6) and will produce insulin-resistance that can lead to hyperglycemia and overt diabetes mellitus (7).

Sileo In Cats

Alendronate dosing protocol

Sileo Side Effects

Most cats with idiopathic hypercalcemia will respond to oral alendronate, at a dose range of 10-40 mg once weekly. Like you, I start with an initial oral dose of 10 mg per week, and then gradually increase the dose based on ionized calcium concentrations monitored at 4-6 week intervals (4).

This treatment protocol will restore normocalcemia in over two-thirds of the hypercalcemic cats treated with an average weekly dose of 15 mg (4). As with dietary therapy, many will eventually show relapse and will require an increase in alendronate dosage or the addition of glucocorticoid therapy. In a few cats, the serum ionized calcium will drop too far, and the dose can be decreased to 5 mg per week or 10 mg given every other week (2,4).
Alendronate is poorly absorbed from the GI tract
The oral bioavailability of alendronate in cats is poor. In one study, the percentage of the drug that was actually absorbed when administered to cats was found be only 3% (8). This percentage fell about 10-fold when alendronate was formulated in tuna juice.
To maximize intestinal absorption of this drug, we recommend that the cats be fasted overnight (12-18 hour fast) prior to the administration of the alendronate. The medication should then be given with 6-ml of plain water (to ensure passage of the tablet into the stomach), and the fast continued for at least 2-4 additional hours (4). We do not recommend any kind of alendronate that has been formulated by compounding pharmacies in flavored solution or suspension because that will likely lead to a marked decrease in the intestinal absorption.

Sileo Dosing Chart For Dogs

Twice weekly dosing of alendronate?
I don't see any problem with twice-weekly dosing of the alendronate. However, based on the pharmacokinetics of the drug, it's unlikely to be any more effective than once-weekly dosing. In humans, the original treatment protocols recommended a dosage of 10 mg once a day, but this was subsequently changed to 70 mg per week based on pharmacokinetic studies (9).
Remember, however, that the biggest issue with the use of this drug in cats is the need for prolonged fasting in order to even achieve 3% absorption. If the owners are giving the drug with food, less than 0.5% of the drug will be absorbed, if it's going to be absorbed at all.
Because of the issues associated with the prolonged fasting, I would not recommend twice-weekly dosing in my feline patients. We know that once-weekly dosing works in most cats, and the 'stress' associated with twice-weekly prolonged fasting (as well tablet administration followed by a 6-ml flush of water) is just too much for the cat or the owner.
References:

1. Peterson ME. Nutritional management of endocrine disease in cats. Proceedings of the Royal Canin Feline Medicine Symposium 2013;23-28.
2. Hostutler RA, Chew DJ, Jaeger JQ, et al. Uses and effectiveness of pamidronate disodium for treatment of dogs and cats with hypercalcemia. J Vet Intern Med. 2005;19:29-33.
3. Whitney JL, Barrs VR, Wilkinson MR, et al. Use of bisphosphonates to treat severe idiopathic hypercalcaemia in a young Ragdoll cat. J Feline Med Surg. 2011;13:129-134.
4. de Brito Galvao JF, Chew DJ, Parker VJ. Management of idiopathic hypercalcemia. In: Little SE, ed. August's Consultations in Feline Internal Medicine: Elsevier, in press.
5. Horber FF, Scheidegger JR, Grunig BE, et al. Thigh muscle mass and function in patients treated with glucocorticoids. Eur J Clin Invest 1985;15:302-307.
6. Menconi M, Fareed M, O'Neal P, et al. Role of glucocorticoids in the molecular regulation of muscle wasting. Crit Care Med 2007;35:S602-608.
7. Lowe AD, Graves TK, Campbell KL, et al. A pilot study comparing the diabetogenic effects of dexamethasone and prednisolone in cats. J Am Anim Hosp Assoc 2009;45:215-224.
8. Mohn KL, Jacks TM, Schleim KD, et al. Alendronate binds to tooth root surfaces and inhibits progression of feline tooth resorption: a pilot proof-of-concept study. J Vet Dent. 2009;26:74-81.
9. Fosamax (Alendronate sodium). Product insert. www.merck.com.

What is methimazole used for in cats

Methimazole (the active ingredient in Tapazole) is an effective veterinary medication used for the management of hyperthyroidism in pets, a condition that causes an excessive production of thyroid hormone in the body ^{[1, 2]}. While there are two drugs available, methimazole and propylthiouracil, for medical therapy of feline hyperthyroidism, the former is more commonly used because it has a lower rate of adverse side effects compared to the latter ^[3].

Piecing me together summary. Aside from its use for lowering the thyroid hormone concentration in blood, the medicine may also be administered before a radioactive iodine therapy or surgery of the thyroid gland ^[5].

Quick Information
Crypt of the necrodancer crack. Methimazole for Cats	Generic name Methimazole Brand name Tapazole® [2] Type Thioureylene anti-thyroid agent [1] Does FDA approve it Yes [1] Availability Prescription medication [2] Who can take it Cats, dogs, humans [2] Forms 5 mg and 10 mg white round tablets, transdermal gel, cream, or liquid [1, 2] Cost $0.46 – $0.47 per 5mg tablet

Mechanism of action: how does it work

The production of thyroid hormones, including triiodothyronine (T3) and thyroxine (T4), is initiated by the peroxidase enzyme through the oxidation reaction of tyrosyl groups of thyroglobulin protein and iodide ion. Methimazole interferes with the regular interaction of peroxidase and iodine with thyroglobulin and reduces the formation of thyroid hormones ^{[6, 10]}.

Methimazole dosage for cats

Talk to a vet to determine your cat's daily dosage requirements and the best time to administer.

The usually recommended initial dose for cats of all weight is 2.5 mg, given twice at an interval of 8 to 12 hours per day ^[11]. The maximal daily dosage varies depending on the severity of the condition, from 2.5 mg for a mild case to 5 mg for a moderate case, and 10-15 mg for a severe chronic condition ^[11].

Blood tests are usually repeated every 28 days until the hormone level reaches a steady state, and the maintenance dosage is achieved ^[7].

How to give methimazole to your cat

Give the medication as instructed by the vet. As a tablet, it can be administered with or without food. However, you need to check with the vet before dividing the tablet or crushing it to mix with your cat's food ^[12]. Make sure you give your pet plenty of water to drink ^[8].

It may also be provided as an oral liquid ^[4]. Since methimazole tastes bitter, you may choose the flavored varieties that are compounded in some pharmacies ^[22].

How to apply topical methimazole to cats

For the transdermal cream or gel, wear gloves and measure the dose onto your finger before gently applying it on your cat's skin (usually to the pinna) ^[4]. Clean the site using a small piece of moist cloth before giving the next dose.

Do not stop applying the cream unless the vet advises you to do so ^[4].

What to do if you miss giving a dose

If you have missed a scheduled dose, give it as soon as you can. However, it is best to skip the dose if the next dose is due within a few hours. Make sure never to provide a double dose ^[4].

Symptoms of an overdose

• Easy bruising and bleeding
• Headache (your cat pushing its head against the floor or other objects, hiding its face in its paws, becoming sluggish, sleeping longer, and/or being hyper-reactive to touch specifically on its head or neck) ^[13]
• Fever (watch for signs like decreased drinking, loss of appetite, shivering, rapid breathing, and lack of activity) ^[14]
• Itching or increased scratching
• Swelling
• Nausea
• Upset stomach (look for signs like loss of appetite, diarrhea, or vomiting) ^{[9, 15]}

If your cat shows any of the abovementioned signs of overdose, urgently call your vet or the ASPCA Animal Poison Center at 1-888-426-4435.

How long does it take for methimazole to work

Although studies have revealed that methimazole can effectively work for 2.3 hours in hyperthyroid cats and 4.7 hours in normal cats, a single dose can actually suppress thyroid hormone levels for about 24 hours ^{[10, 11, 20]}.

Methimazole (Tapazole) side effects

The following common side effects may occur within the first one to three months of treatment:

• Vomiting
• Headache
• Dizziness
• Drowsiness
• Hair loss
• Joint, nerve, or muscle pain (difficulty jumping, reluctance to move, licking a specific body part, or abnormal gait) ^[19]

Other serious side effects may include:

• Difficulty breathing (the cat opening its mouth, sticking its elbows out from its body, flaring up its nostrils, extending its head and neck out in front while breathing) ^[17]
• Fever
• Swelling of the face, lips, tongue
• Loss of appetite
• Bloody stool or urine
• Vomiting
• Depression (losing appetite, becoming less active, displaying abnormal behavior, or disturbed sleep patterns) ^[18]
• Autoimmune disease like jaundice ^[8]

Contact your veterinarian if your cat has any of the above side effects.

When should it not be given to cats

Make sure to discuss with your vet of any existing health conditions in your cat. Methimazole is not prescribed for cats that have:

• Anemia
• Kidney disorders
• Liver disease
• Lymphopenia
• Neutropenia
• Thrombocytopenia

Its use is also not recommended for pregnant and nursing cats because it may be toxic to an embryo and cause birth defects ^[1].

Potential drug interactions

Be sure to inform the vet if your cat is on any of the following medications:

• Warfarin (Coumadin)
• Beta blockers like atenolol (Tenormin)
• Propranolol (Inderal)
• Metoprolol (Lopressor)
• Digoxin (Lanoxin)
• Theophylline (Theo-Dur) ^{[8, 9]}

Sileo Dose In Cats For Adoption

Homeopathic and herbal remedies, as well as acupuncture, are considered alternatives for a methimazole treatment. However, there is not enough evidence to prove their effectiveness ^[21].

References

Sileo Dog Dose

1. Focus On Pharmacology: Methimazole: Management of Feline Hyperthyroidism – Todaysveterinarypractice.navc.com
2. Methimazole – Petmd.com
3. Clinical efficacy and safety of transdermal methimazole in the treatment of feline hyperthyroidism – Ncbi.nlm.nih.gov
4. Methimazole – Vcahospitals.com
5. Methimazole – 1800petmeds.com
6. Methimazole, Tapazole – Medicinenet.com
7. About Tapazole Tablets for Hyperthyroidism in Cats – Petcarerx.com
8. Tapazole – 1800petmeds.com
9. Tapazole for Cats – Vetinfo.com
10. How to Dose and Monitor Hyperthyroid Cats on Methimazole – Animalendocrine.blogspot.in
11. Methimazole (Veterinary – Systemic) – Aavpt.org
12. Getting Your Cat to Take Medication – Thecatvet.co.uk
13. Cat Headaches – Cats.lovetoknow.com
14. Fevers in Cats – Pets.webmd.com
15. Remedy for an Upset Stomach in a Cat – Pets.thenest.com
16. Methimazole for Cats – Wedgewoodpetrx.com
17. Breathing Difficulties in Cats – Petmd.com
18. Can Cats Get Depressed? – Petmd.com
19. 25 Red Flags That Spell Pain – Healthypets.mercola.com
20. Optimal testing for thyroid hormone concentration after treatment with methimazole in healthy and hyperthyroid cats – Ncbi.nlm.nih.gov
21. Feline Hyperthyroidism – Healthypets.mercola.com
22. Methimazole for Cats and Vomiting – Pets.thenest.com