Veterinary Medicine - February 2008 - (Page MV12) MANAGING VOMITING Dr. David Twedt prevalence of gastritis because the animals are stressed or sick and reducing stress-induced gastritis may reduce vomiting. True or not, famotidine is a very safe drug. Leib: If it were rational, would decreasing acid secretion potentially bene t some patients with gastritis and erosive disease? Williams: If they have gastritis and erosive disease, yes. But in most cases, it is pure speculation. I suspect famotidine probably doesn’t do a whole lot to reduce vomiting in many patients, but has become standard practice for some people to use. Twedt: Veterinarians carry those medications in their practice. They are easy to dispense. Clients can get many histamine blockers over the counter now. That’s probably why they’re so widely used. Simpson: If you review the human literature on gastric acid and pH in the stomach of people with renal failure, gastric acidity was actually reduced in most patients. I am usually happier if these patients get sucralfate rather than a histamine antagonist because sucralfate is less speci c in its mode of action. Jergens: Dr. Simpson, one of the problems using sucralfate is that it is an oral medication. Often these patients are being held NPO. You are contradicting one of your basic tenants of therapy if you use it. Simpson: We are starting to feed patients much earlier. At least we’re feeding through vomiting. After 12 to 24 hours of dietary rest, they need some nutrition. We are more concerned about trying to preserve some gastrointestinal barrier function early on “We rarely use metaclopramide anymore in our critical care unit cases.” Williams: The comparisons with the antiemetics that we formerly used are impressive. Twedt: I’ve been fortunate to to use maropitant for about ve months and three months before the drug launched. And it is our number one antiemetic now because of clinician experience. I recently reviewed the rst 50 cases in which we used it. Out of those cases, which included chemotherapy, parvovirus infection, renal failure, and pancreatitis, there were no clinically apparent adverse e ects other than minor stinging at the injection site in a few cases. There was a positive response in 49 out of 50 cases. The animal that didn’t respond had gastrointestinal neoplasia. Leib: How did you de ne positive response? Just a reduction in vomiting frequency? Twedt: A reduction or stopping of the vomiting. It was the clinician’s impression. We didn’t have any speci c criteria or scoring system. But those impressions have carried over into our clinicians’ continued use of the product. We rarely use metoclopramide anymore in our critical care unit cases. 12 Jergens: Our experience is similar. There was a tremendous acceptance of the drug by our group of clinicians. We initially ran out and the pharmacy couldn’t get it. My phone started ringing. They were saying, “Where is it? We want it. We need it.” It was a very positive response. Leib: That’s great. Other comments on maropitant before we move on? Williams: A European study showed similar e ectiveness and safety in cases of spontaneous vomiting due to a variety of causes. Other drugs used for vomiting Leib: Other drugs are used to treat vomiting. These drugs are not necessarily antiemetics, but they have pronounced gastrointestinal e ects. Let’s start with the histamine-2 receptor blockers that are commonly used in the vomiting patient. Dr. Williams, do you use famotidine and other histamine blockers? Williams: Some clinicians may think that there is a high
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