Veterinary Medicine - February 2008 - (Page MV11) Twedt: Our hospital uses it extensively now for vomiting dogs. In fact, it’s replaced the other antiemetics for our critical care cases and chemotherapeutic patients. I’ve followed up on a number of these cases, and I have not identi ed any side e ects. And the once-a-day administration is very user friendly. Jergens: I would also add that Reto Niger from the European College of Veterinary Internal Medicine did an overview of antiemetics at the 2007 ECVIM Congress. In this lecture, he reported that the European experience with Cerenia has been uniformly positive. He reported no adverse e ects with the use of the drug and the clinical data presented were very promising. Simpson: We have been impressed. A dog whose vomiting was not controlled with metoclopramide or ondansetron comes to mind. The dog had severe neutrophilic enteropathy and Cerenia was the only drug that controlled the vomiting. Leib: The drug is approved for both the prevention of motion sickness and treatment and prevention of acute vomiting. Can someone comment on its labeling for puppies greater than 16 weeks of age? Twedt: In P zer’s initial study researchers studied dogs as young as 8 weeks old.2 Some of these puppies were not healthy and had problems such as parasitim or gastroenteritis. They were given either a placebo or Cerenia. Following the treatment period, bone marrow hypoplasia was identi ed in some of the Cerenia-treated dogs and some of the placebotreated dogs. Many of these dogs were stressed and not acclimated when entering the study which could explain the bone marrow changes. P zer is reevaluating the drug in young, healthy dogs. In our hospital, puppies with parvovirus are the prime cases for Cerenia use, and we have treated many cases without identifying adverse e ects. (Sponsor’s note: Cerenia is recommended for use in dogs 16 weeks or older.) Simpson: We have some potential questions—one is how hypoproteinemia might a ect the kinetics of the drug because it is heavily protein bound. Then in extremely azotemic animals, do we have to adjust the dose based on the decreased glomerular ltration rate. The other issue is administration with other antiemetics, such as ondansetron or metoclopramide. Are there any interactions with other antiemetics if Cerenia is used in combination? (Sponsor’s note: The concurrent use of Cerenia with other antiemetics has not been evaluated.) Twedt: It is also metabolized by the liver. So the other concern would be liver failure cases. Does the dose need to be adjusted in those cases? We typically adjust dosages of drugs that are metabolized by the liver in liver failure patients. I think you probably need to make educated judgments based on the hepatic function of each patient and decrease the dose or frequency of administration accordingly. The same is true with a severely hypoproteinemic animal, which actually might make more of the active drug available due to decreased binding, though this is probably not that important in most cases. (Sponsor’s note: Cerenia should be used with caution in dogs with hepatic dysfunction.) Take note • The use of anticholinergics to treat vomiting animals with abnormal gastrointestinal motility is not recommended because this may promote ileus and worsen the vomiting. • Maropitant citrate has a different mode of action than the other antiemetics—it blocks neurokinin1 receptors and, therefore, works both peripherally and centrally. • Maropitant citrate is approved for both the prevention of motion sickness and the treatment and prevention of acute vomiting. Leib: There have also been concerns about benign electrocardiogram changes. Can anyone comment on those? Williams: I understand that slight prolongation of the QT interval was observed in some dogs.2 Apparently because of innate electrophysiologic di erences between the myocardium of people and dogs, such relatively minor prolongations of the QT interval may predispose people to life-threatening arrhythmias but are of no consequence in dogs. Leib: I am pleased that we have a new product that is preceded by at least three peer-reviewed, published articles in the veterinary literature.3-5 It certainly gives us a lot more con dence to use a new drug. Those articles cover several causes of acute vomiting, including chemotherapy-induced vomiting. These publications are commendable because there are few publications concerning e cacy in clinical patients for most of the other drugs we’ve discussed today. 11
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