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Pharmaceutical Care of Felines: Practitioner Summary

Pharmaceutical Care of Felines

Disease State

Clinical Pearls
 Hyperthyroidism  Methimazole

  • Do not switch dosage forms without consulting veterinarian first
  • Counseling points for transdermal gel
    • WEAR GLOVES
    • Rotate ears with each dose
    • Clean ears regularly
    • Importance of recheck appointments
 Diabetes Mellitus
  • Administer insulin AFTER meals, not before
  • Spontaneous clinical remission is possible
  • Dispensing the correct syringe
    • U-40 vs U-100
  • Do not substitute insulins without veterinarian’s permission
  • Usually very small dose
    • Use insulin pens (3mL) to avoid waste instead of insulin vials (10mL).
 Cardiovascular  Enalapril

  • Dose reduction by 50% in cats with renal insufficiency

 Clopidogrel

  • DO NOT COMPOUND INTO TRANSDERMAL – contact irritant 

 Diltiazem

  • Human commercial XR capsules (certain NDCs only) have 60mg tablets inside which can be used to administer smaller dosage strengths.

 Pimobendan

  • Feline concerns: large, liver-flavored tablets
 Feline Asthma (Chronic Bronchitis)
  • Focus on non-pharmacological considerations to remove triggers
  • Use PREDNISOLONE instead of prednisone
    • Felines cannot metabolism prednisone 

 Inhalers

  • Fluticasone (Flovent) 
    • Currently 3 strengths available (44mcg, 110mcg, 220mcg) – study has shown that all 3 are similar in terms of efficacy1. Therefore, the 44mcg inhaler is usually recommended first for cost savings.
  • Best to use spacers – importance of acclimation routine

 Theophylline

  • Extended-release theophylline has poor PO bioavailability in cats
 Feline Lower Urinary Tract Disease (FLUTD)  Amitriptyline

  • Efficacy concerns
  • Transdermal form should be a last resort2

 Fluoxetine

  • Extremely long half-life (60+ hours)
  • Transdermal should be a last resort3
 Pain
  • NEVER give acetaminophen to cats

 Buprenorphine

  • Can be compounded into transmucosal formulation – needs to be given along the gumline

 Gabapentin

  • Prefer to compound into a suspension for felines
  • Strengths compounded above 100mg/mL are highly likely to crystalize

 Robenacoxib (Onsior)

  • Limited to 3 days of treatment
  • Significant decrease in bioavailability when given with food
 Infectious Disease  Itraconazole

  • SHOULD NOT BE COMPOUNDED – bulk powder is not bioavailable in mammalian species4
  • Use FDA approved products as source of API

 Ronidazole

  • Should not be compounded in oil-based suspensions- ronidazole is highly lipophilic and making an oil-based suspension could increase the risk of adverse effects/toxicity

 

References:

  1. Cohn LA, DeClue AE, Cohen RL, et al. Dose effects of fluticasone propionate in an experimental model of feline asthma. In: Proceedings from the American College of Veterinary Internal Medicine Forum; June 7, 2008; San Antonio, TX.
  2. Kruger JM, Conway TS, Kaneene JB, et al. Randomized controlled trial of the efficacy of short-term amitriptyline administration for treatment of acute, nonobstructive, idiopathic lower urinary tract disease in cats. J Am Vet Med Assoc. 2003;222(6):74758.
  3. Ciribassi J, Luescher A, Pasloske KS, Robertson-Plouch C, Zimmerman A, Kaloostian-Whittymore L. Am J Vet Res. 2003 Aug;64(8):994-8.
  4. Mawby DI, Whittemore JC, Fowler LE, Papich MG. Comparison of absorption characteristics of oral reference and compounded itraconazole formulations in healthy cats. J Am Vet Med Assoc. 2018;252(2):195-200.