Drug therapy in cats: a systems approach

In the second part of this 4-part series, drug therapy in cats is discussed by use of a systems approach. Specifically, drugs that can be used safely for treatment of disorders affecting the feline gastrointestinal, central nervous, respiratory, cardiovascular, and urogenital systems are described. Many drugs that are used in dogs can be safely used in cats according to the same or similar dosing regimens. Several drugs that have traditionally been considered inappropriate (eg, morphine derivatives, primidone) can probably also be used, if cautiously, in cats. In contrast, use of several drugs that are safely used in other species should be avoided in cats (eg, selected emetics and antiemetics, phosphate salt enemas, and selected urinary antiseptics). Cats are more sensitive than dogs to the adverse side effects of a variety of drugs (eg, aspirin, digoxin, selected antiarrhythmics), and extra precautions must be taken when these drugs are used in cats. Finally, several drugs are used for the treatment of illnesses that tend to be unique to cats (eg, taurine and calcium-channel blockers in selected feline cardiovascular disorders).     

Nonsteroidal anti-inflammatory drugs in cats: a review

OBJECTIVE: To review the evidence regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in cats. DATABASES USED: PubMed, CAB abstracts. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs should be used with caution in cats because of their low capacity for hepatic glucuronidation, which is the major mechanism of metabolism and excretion for this category of drugs. However, the evidence presented supports the short-term use of carprofen, flunixin, ketoprofen, meloxicam and tolfenamic acid as analgesics in cats. There were no data to support the safe chronic use of NSAIDs in cats.     

Psychotropic drugs and behavioral therapy

Psychotropic drugs often are helpful in the treatment of selected behavior problems in dogs and cats. Drug therapy is rarely curative by itself and in most cases is only indicated as ancillary therapy in a behavior modification program. Very few of the psychoactive drugs are approved for use in companion animals, and owners should be made aware that their use is considered experimental. Before prescribing any of the psychotropic drugs, veterinarians should be thoroughly familiar with dosages, side effects, and contraindications. Some of the more common behavior problems in which drug therapy may be useful are reviewed.     

Anaesthesia and analgesia for dogs and cats in South Africa undergoing sterilisation and with osteoarthritis--an update from 2000

A survey was conducted in 2000 into the use of analgesic drugs by veterinarians in South Africa. This survey was repeated in 2005 to establish whether the use of analgesic drugs has increased and which analgesic drugs are being used for acute pain and osteoarthritis. The number of sterilisations performed and the number of new cases of osteoarthritis in dogs and cats was estimated. It is estimated that approximately 260000 cats are operated on each year in South Africa and that 150000 cats are sterilised. Five hundred thousand dogs undergo surgery, of which 242000 are sterilised. It appears that the number of surgical procedures performed in South Africa has decreased. The estimated death rate following anaesthesia has remained unchanged at 1:1004. Overall, the use of analgesics by South African veterinarians has increased significantly. Fifty-six per cent of cats and 74% of dogs were given peri-operative analgesics but this increased to 94% and 84% after including pre-anaesthetic medications with analgesic properties. The use of opioids (morphine and buprenorphine) and propofol has increased significantly. Approximately 253000 dogs and 33000 cats with osteoarthritis are seen by veterinarians in South Africa annually. The recognition by veterinarians of osteoarthritis in cats appears to be poor and is in need of attention. Carprofen and glucosamine/chondroitin are the most commonly used agents for the treatment of osteoarthritis. Details of the drugs used by veterinarians are given. Knowledge of analgesic drugs has increased significantly over the last 5 years. Continuing education is thought to have played an important role in the changes reported in this study.     

Recent developments in nonsteroidal antiinflammatory drugs in cats

Pain, particularly chronic pain, is an underestimated ailment in cats. Veterinarians tend to under-diagnose and under-treat pain in this aloof and stoic species. Until recently, there was only one analgesic (i.e., butorphanol) approved in the United States for use in cats; but many analgesics, particularly opioids, have been used extra-label for this purpose. Nonsteroidal antiinflammatory drugs (NSAIDs) have been used sparingly in cats because of safety concerns, which are less of an issue with the newer agents. Meloxicam is the only NSAID labeled for use in cats in the United States, but other agents are available in this country and are labeled for use in cats in other countries.     

抗菌药在犬、猫临床上的合理应用

菌药在犬、猫临床上使用最广泛和最重要的抗感染药物,对控制犬、猫疾病起着巨大的作用,但目前不合理使用尤其是滥用的现象较为严重,不仅造成药品的浪费,而且导致犬、猫的不良反应增多,产生细菌耐药性,对动物造成伤害,甚至导致医疗事故的发生等。作者针对犬、猫疾病特点,结合犬、猫临床疾病防治经验和体会,对用于犬、猫临床上的常见抗菌药物进行了概括与总结,为在犬、猫临床上正确使用抗菌药物提供一个参考。     

Oral medications for treating diabetes mellitus in dogs and cats

Five classes of oral hypoglycaemic drugs and two trace minerals used to treat diabetes mellitus in humans are reviewed and current knowledge on the use of these drugs in diabetic dogs and cats is presented. Oral sulphonylurea drugs stimulate insulin secretion and have been used successfully to treat diabetes in cats but not dogs. Preliminary studies evaluating the efficacy of the biguanide, metformin, in diabetic cats have not been promising. Pharmacokinetic studies have been performed in healthy cats, but clinical studies evaluating the efficacy of the insulin-sensitising drugs, thiazolidinediones, have not been reported. Treatment with the alpha-glucosidase inhibitor, acarbose, improved control of glycaemia in diabetic dogs; similar studies have not been reported in cats. Although chromium picolinate did not improve control of glycaemia in diabetic dogs, vanadium has improved control of the abnormality in diabetic cats.     

非甾体抗炎药在猫临床疼痛管理中的应用

疼痛是猫常见且多发的问题,诱发原因很多。近几年,随着国内外兽医对宠物猫的慢性疼痛问题以及临床中疼痛管理日益重视,疼痛管理已成为临床兽医必须面对的重要课题之一。非甾体抗炎药因其解热、抗炎和镇痛的特性而逐渐被广泛应用于动物医学。国内有关非甾体类抗炎药在猫临床疼痛管理中的应用少见报道。主要就国外发表的一些关于猫长期使用非甾体抗炎药的相关文献进行综述,以期为非甾体抗炎药在猫临床疼痛管理中的进一步应用提供参考。     

Gastroprotectants in small animal veterinary practice – a review of the evidence. Part 1: cyto‐protective drugs

Diverse drugs with presumed cytoprotective effect have been used therapeutically in small animal veterinary practice for various gastro‐intestinal conditions such as oesophagitis, gastric ulceration, gastritis or chronic gastro‐enteropathies. Their efficacy has been doubted in human medicine, raising similar questions in the veterinary field. The aim of this review was to assess the current evidence on the efficacy and safety of these drugs in dogs and cats. Through a systematic review of the literature, we identified 37 articles on the use of misoprostol, sucralfate and other gastroprotectants in dogs and cats. There was evidence to support use of misoprostol in the prevention of aspirin‐induced gastroduodenal mucosal injury in dogs, and for use of sucralfate in the prevention of acid‐induced oesophagitis in cats. However, the overall quality of evidence supporting the use of these drugs in small animal patients was poor. In contrast, there was evidence of important adverse effects, especially drug interaction and gastro‐intestinal signs. We therefore recommend prescribing these drugs with caution until further well‐conducted studies reveal a useful gastroprotectant effect.     

Management of acute renal failure in cats using peritoneal dialysis: a retrospective study of six cases (2003-2007)

Information regarding the use and success of peritoneal dialysis (PD) in the management of acute renal failure (ARF) in cats is lacking. The purpose of this retrospective study is to describe the indications, efficacy, complications and outcome of cats undergoing PD for ARF. Six cats that underwent PD for treatment of ARF of various etiologies were included. PD effectively replaced renal function in all cats and allowed renal recovery in 5/6 cats. Five cats were discharged and one cat died. Complications were reported in all cats and included subcutaneous edema (n=5), hyperglycemia (n=4), dialysate retention (n=3), and hypoalbuminemia (n=3). A novel technique consisting of a Blake surgical drain and an intermittent closed suction system was used, which appears to be a viable option for PD in cats. Although complications are common, PD is an effective renal replacement therapy for ARF in cats and carries a reasonable prognosis in selected cases.     

Reported adverse reactions of veterinary drugs and vaccines in 2005

We received 105 reports of suspected adverse events (SARs) following the use of veterinary drugs for the year 2005. This corresponds to a 35% increase compared to 2004. Practicing veterinarians sent most of these declarations. 73% of these concerned drugs used on companion animals. Antiparasitic drugs approved for topical use were the most frequently represented group with 48%, followed by drugs used to treat gastrointestinal disorders (11%) and drugs used off-label (14%; other target species or other indication). For the first time 2 declarations concerning the application of permethrin containing spot-on preparations used by mistake on cats were received. An overview of 20 declarations about adverse reactions following application of different vaccines is also presented with emphasis on the problem of fibrosarcoma in cats. We are pleased by the growing interest shown by practicing veterinarians for the vigilance system and hope to further develop this collaboration in the future.     

Pharmacology and therapeutics of non-steroidal anti-inflammatory drugs in the dog and cat: 2 Individual agents

The general pharmacology of the non-steroidal anti-inflammatory drugs (NSAIDs) used in dogs and cats has been described in part 1 of this review (Lees and others 1991). This paper outlines the properties of the individual agents as they are used in small animal practice. The NSAIDs which have been used extensively in small animals include the older agents such as Aspirin, cinchophen and phenylbutazone. These agents have previously been used empirically by extrapolation of dosages from other species and by clinical experience. Studies are now available which provide a scientific rationale for the dosage rate recommended. A number of new drugs have recently been licensed for use in the dog or may be licensed in the near future. These include flunixin, carprofen and tolfenamic acid and the data generated from these products provides very useful information for formulating I effective dosage regimens. There are also some NSAIDs such as piroxicam which have been investigated in the dog because they have particular properties which may be of use in common clinical conditions and others, such as Paracetamol and Ibuprofen, which are readily available to the public and which owners may administer to dogs or cats at toxic doses.     

Use of anti-inflammatory and analgesic drugs in dogs and cats

SUMMARY: Responses (486) were collated from a survey of 5054 Australian veterinarians on their use of anti-inflammatory and analgesic drugs in dogs and cats. Almost all respondents used glucocorticoids (usually prednisolone) to treat allergic, pruritic dermatoses in dogs, while two-thirds also gave fatty acid supplements and one-half used antihistamines. Almost 60% of respondents initially injected a glucocorticoid (frequently a long-acting preparation) when treating inflammatory skin diseases in dogs. More than 90% of respondents used glucocorticoids to treat immunemediated haemolytic anaemia or thrombocytopenia, and about one-third also gave cytotoxic drugs. Administration of prednisolone on alternate days was generally favoured for long-term enteral steroid therapy. Phenylbutazone was the most preferred treatment for painful or inflammatory musculoskeletal disorders of dogs, but aspirin and pentosan polysulphate were also used widely. Regarding the use of analgesics drugs generally, both narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were used more widely in dogs than in cats, but alpha-2 agonists were used similarly in both species. The most commonly used narcotic analgesics were pethidine and buprenorphine in both species, while the NSAIDs used most often were flunixin and dipyrone in dogs and ketoprofen in cats. More than 80% of respondents generally used analgesic drugs with potentially painful surgical procedures, with doses given usually before anaesthetic recovery. Analgesic use rates varied with the condition, ranging from 94% for patients with acute severe trauma, through 60% for cruciate ligament repair and 29% for perineal herniorrhaphy, to about 5% for ovariohysterectomy and dog castration. The three clinical signs most frequently nominated as indicators of pain in dogs and cats were (in descending order) vocalisation, response to handling or palpating the affected area, and mental depression. Other items mentioned frequently were behavioural changes and immobility (in both species), inappetence/anorexia in cats, and altered respiration in dogs.     

Feline heartworm infection: serological survey of asymptomatic cats living in northern Italy.

Heartworm infection is now recognized as a potential cause of serious disease in cats. Epidemiological studies indicate that in locations where the infection is endemic in the dog, cats are at risk. The aim of this work was to carry out a serological survey for the presence of anti-Dirofilaria immitis antibodies in privately owned, predominantly asymptomatic cats living in different areas of northern Italy in order to determine the distribution of the parasite and the risk of infection in this species. Serum samples from 1045 cats were evaluated using a commercial antibody (Ab) detection kit (Heska Solo Step Filariosi Felina, Heska Corporation) and results were analyzed together with information obtained by questionnaire. Results showed that 16% of all tested cats were positive for anti-D. immitis antibodies, with values ranging from 9 to 27%, depending on location. Male cats and outdoor cats appeared to be at greater risk, with a significantly higher number of positive antibody tests. The results of this study suggest that the risk of exposure with D. immitis in cats is high in northern Italy and suggest that the use of preventive drugs would be advisable in this area endemic for canine heartworm disease.     

Feline heartworm disease: a clinical review

Feline heartworm disease is caused by the filarial nematode Dirofilaria immitis, and is transmitted by mosquitoes in heartworm-endemic areas worldwide. While dogs are the definitive hosts for this parasite, cats can also be infected, and the overall prevalence in cats is between 5% and 10% of that in dogs in any given area. The spectrum of feline presentations varies from asymptomatic infections to chronic respiratory signs, sometimes accompanied by chronic vomiting to acute death with no premonitory signs. Ante-mortem diagnosis can be challenging and relies on a combination of tests, including antigen and antibody serology, thoracic radiography and echocardiography. As treatment with heartworm adulticidal drugs can be life-threatening and heartworm infection in cats is often self-limiting, infected cats are frequently managed with supportive treatment (corticosteroids, bronchodilators, and anti-emetics). Surgical removal of filariae using extraction devices may be considered in some acute cases where immediate curative treatment is necessary, but filarial breakage during the procedure may result in an acute fatal shock-like reaction. Necropsy findings are mainly pulmonary and include muscular hypertrophy of the pulmonary arteries and arterioles on histopathology. A number of safe and effective macrocytic lactone drugs are available for prophylaxis in cats. These drugs can kill a range of larval and adult life-cycle stage heartworms, which may be advantageous in cases of owner compliance failure or when heartworm infection status is undetermined at the time prophylaxis is commenced. An index of suspicion for feline heartworm disease is warranted in unprotected cats with respiratory signs, and perhaps chronic vomiting, in areas where canine heartworm disease is endemic. Many cats, once diagnosed and with appropriate supportive care and monitoring, will resolve their infection and be free of clinical signs.     

Prospective open pilot study on the use of ciclosporin for feline allergic skin disease

OBJECTIVES: To evaluate the efficacy of ciclosporin in cats with allergic skin disease. METHODS: Ten cats with signs of allergic skin disease were administered ciclosporin daily at a dose of 3.6 to 8.3 mg/kg for one month. None of these cats had previously responded to a hypoallergenic diet trial, and all animals had previously been treated with endectoparasiticidal drugs, with no improvement two weeks before entering the trial. On days 0 and 30, owners assessed pruritus with a visual analogue scale, and veterinarians evaluated cutaneous lesions. RESULTS: All the cats had pruritus and erythema, five had alopecia, two had an eosinophilic plaque, one had miliary dermatitis and two had both alopecia and an eosinophilic plaque. Good or excellent improvement was observed in 40 per cent of cats for pruritus, 57 per cent of cats for alopecia and 60 per cent of cats for erythema. A significant decrease in mean scores was observed for pruritus only, while for erythema and alopecia, it was close to being significant (P < 0.052). CLINICAL SIGNIFICANCE: Ciclosporin may be helpful in symptomatically treating signs of feline allergic skin disease. However, it is important to remember that ciclosporin is not licensed for use in cats.