Veterinary Medicine - February 2009 - (Page 92) Nonobstructive iFLUTD PEER-REVIEWED treatment of urethral smooth muscle and skeletal muscle spasms. Because of possible side effects and a lack of studies in cats with iFLUTD for each drug, no single agent can be recommended.5,40 Bottom line. Amitriptyline may be useful when given long-term in chronic, recurrent cases but is not helpful in acute episodes. between the severity or duration of iFLUTD in client-owned cats receiving oral glucosamine vs. a placebo. Two cats in the placebo group, however, were euthanized because of severe, recurrent disease.43 Side effects can include minor gastrointestinal signs such as atulence and soft stool.44 Bottom line. Oral glucosamine supplementation has few side effects, and long-term therapy may be useful in conjunction with other therapies in cats with chronic, recurrent iFLUTD. Alleviate stress Theory. Stress has been associated with iFLUTD recurrence and may play a role in the disease’s pathophysiology, both systemically and locally in the bladder. Supplement glycosaminoglycans Theory. The glycosaminoglycan layer is de cient, allowing for toxic insult to the urothelium. Evidence. Pentosan polysulfate sodium and glucosamine are two agents that have been studied in cats with iFLUTD. •Pentosan polysulfate sodium (2 to 16 mg/kg b.i.d. or 8 mg/kg b.i.d. given Increase water intake Theory. A decreased urine concentration decreases the concentration of components that may be toxic to the urothelium. Evidence. Dilute urine may reduce the concentration of noxious urinary components that can be bladder wall Offer cats canned food choices, and then remove the dry food gradually. orally42): This particular glycosaminoglycan has been shown to be helpful in 28% to 68% of people with idiopathic cystitis and has been used anecdotally in some cats with success.43 Elmiron (Ortho-McNeil-Janssen Pharmaceuticals), the product approved in the United States for use in people, needs to be formulated to smaller capsule sizes. The drug is well-tolerated in cats, and though it can cause bleeding in any species because of its anticoagulant properties, this side effect has not speci cally been reported in cats.42 •Glucosamine (Cosequin for Cats—Nutramax Laboratories) (1 capsule [125 mg glucosamine, 100 mg chondroitin sulfate] daily for cats 10 lb given orally44): One study showed no signi cant difference irritants.12,43,45 Several studies evaluating dietary or other supplements in the treatment of iFLUTD in cats concluded that the main correlation between improvement in clinical signs or reduced recurrences was the feeding of a canned diet.43,46 Offer cats canned food choices, and then remove the dry food gradually. This measure establishes a constancy of the water content and diet composition, which appears to be important.5 Drinking water preferences, such as bowl type, water depth, and running vs. still water, should be determined to ensure adequate water intake. Bottom line. Transition to a consistent canned diet, and encourage water consumption by determining a cat’s drinking preferences. Evidence. Stress reduction measures that have been investigated in cats with iFLUTD include feline facial pheromones and environmental modi cation. •Pheromones, chemical substances that are found, for example, in sebaceous secretions in the cheeks, likely affect the limbic and hypothalamic regions.47,48 The F3 fraction of the ve facial pheromone fractions isolated in cats is deposited on objects by facial rubbing and serves to mark territory and decrease aggressive behavior. Feliway (Ceva Santé Animale), a synthetic analogue of the F3 fraction of feline facial pheromone, has been used for behavior modi cation, including urine spraying.47 In a clinical study, Feliway resulted in a trend (though no statistically signi cant difference was noted) toward fewer days of clinical signs of cystitis and a reduced number of episodes of iFLUTD.49 •Multimodal environmental modi cation: Implementation of a stress and environmental management protocol that uses client education, environmental enrichment, and husbandry changes appears to be an important aspect of therapy. Multimodal environmental modi cation (MEMO) involves making adjustments to litter boxes (number, location, size and shape, litter type), scratching posts (number, location, texture), sleeping and eating areas, perches, and toys.5,48,50 Client education includes providing information about cat behavior in relation to people and other cats, explaining the iFLUTD syndrome, empathizing with the owner’s frustrations and concerns, and encouraging the owner not to blame the cat for the disorder.50 Tailor MEMO to the speci c surroundings and interactions in a cat’s environment. A recent study in which owners used MEMO demonstrated a signi cant 92 February 2009 VETERINARY MEDICINE
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