Veterinary Medicine - February 2009 - (Page 90) Nonobstructive iFLUTD PEER-REVIEWED TABLE 2 Proposed Causes of iFLUTD and Their Respective Treatments and Efficacies Proposed Cause Treatment Investigated Treatment Efficacy Antimicrobials are unlikely to be of benefit unless there is a positive culture result. Only amitriptyline has been shown to be beneficial in chronic, recurrent cases of iFLUTD. Glucosamine may be beneficial in chronic, recurrent cases of iFLUTD. Both measures have shown benefit in cats with iFLUTD. Bacterial infection Antimicrobial administration Neurogenic inflammation Administration of amitriptyline, NSAIDs, glucocorticoids, or antispasmodics Administration of pentosan polysulfate sodium or glucosamine Feed canned food, and ensure adequate and optimal exposure to water sources. Apply feline facial pheromone in the cat’s environment, and incorporate MEMO (client education, environmental enrichment, and husbandry changes that reduce a cat’s stress level). Deficient glycosaminoglycan layer Inadequate water intake Stress Both measures have shown benefit in cats with iFLUTD. Address infections Theory. Infectious agents, including stealth organisms, are responsible for iFLUTD. Evidence. Most studies, including those investigating interstitial cystitis in women, indicate little evidence to support an infectious cause of iFLUTD.1,4,6,8 Despite recent reports of increased percentages of UTIs and the identi cation of novel feline caliciviruses with iFLUTD, further investigation is needed before antimicrobials or antivirals can be recommended (see the discussion regarding causes of iFLUTD). Bottom line. Do not administer antimicrobials unless the urine bacterial culture results are positive. Alleviate pain and inflammation Theory. Pain and in ammation are due to neurogenic stimulation and increases in mast cells and substance P. Evidence. The ef cacy of amitriptyline, nonsteroidal anti-in ammatory drugs (NSAIDs), glucocorticoids, and antispasmodics in cats with iFLUTD has been investigated. •Amitriptyline (2.5 to 10 mg/cat/day given orally37): This tricyclic antidepressant is an anticholinergic, antihistamine, anti-alpha-adrenergic, anti-in ammatory, and analgesic. In one study, nine of 15 cats with chronic iFLUTD had decreased clinical signs after amitriptyline administration for 12 months.36 However, in another study in which cats with iFLUTD received either a placebo or amitriptyline for seven days, no differences in clinical signs between the two groups were found.38 This nding was also con rmed in a separate study of short-term amitriptyline use.39 The disappointing results in these studies may have been due to the short-term drug administration. Amitriptyline can cause somnolence, decreased grooming, and weight gain.36 •NSAIDS: Piroxicam and meloxicam have been used in cats with LUTS with some anecdotal success, but no controlled prospective studies have been performed.5,40 Before using any NSAID, make sure the patient’s hydration status and renal function are adequate. I cannot make recommendations about their safe and effective use in cats with iFLUTD because controlled studies are lacking. • Glucocorticoids: A double-blind clinical study in cats with iFLUTD showed no difference in clinical signs or recurrence in control cats vs. those receiving glucocorticoids.41 Thus, glucocorticoid administration is not recommended, especially if NSAIDs are being administered concurrently. •Antispasmodics (e.g. diazepam, dantrolene, phenoxybenzamine, propantheline, acepromazine): Limited studies in cats with iFLUTD have shown some relief with a few of these drugs in the 90 February 2009 VETERINARY MEDICINE
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.