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Medications

General

At some point, your cat will almost certainly need medication. The following is a summary of the more common medications prescribed for CRF cats. The list is by no means complete nor is the information given complete. Other medications are available and your veterinarian will be able to recommend what is needed for your cat.

Some of the medications are available as tablets, liquids and powders. Tablets may be ground up and put in food if your cat has a difficult time swallowing pills. Liquids may be given with a syringe. Many of these medications are made for humans with doses that are much too large for cats. Pharmacies can compound the drug to the dosage needed for your cat. Links to compounding pharmacies are on our links page under the category CRF Supplies. NEVER give your cat a pill made for humans without checking with your veterinarian first. Always ask your veterinarian about side effects for each medication prescribed.

Side Effects

Be advised that there is NO drug that is entirely free of side effects. In some cases the side effects may be so serious that the primary effect is not worth the risk. The severity of side effects vary by patient. In one patient, a given drug may work as planned and side effects are not noticed, while the same drug, in another patient, may cause serious side effects.

When you start a cat on any medication, watch carefully for indications of problems related to the medication. If you notice any negative changes in your cat after starting a new prescription, bring them to your vet's attention and ask if the dosage should be stopped, decreased or the frequency of adminstration should be changed.


Condition/Medication Detail

Anemia

  Epogen, Eprex or Procrit (erythropoietin)

Epogen and Procrit recalled
September, 2010

Used to stimulate red blood cell production. Your veterinarian can train you to administer erythropoietin at home. Only the human form of erythropoietin is currently available for treatment of felines.
Advisory - March, 2007: The FDA issued a Public Health Advisory on March 9, 2007 regarding a higher chance of serious and life-threatening side effects and a greater number of deaths in human patients being treated with Epoetin alfa (marketed as Procrit, Epogen) and Darbepoetin alfa (marketed as Aranesp).

Although the human version has been proven effective, some cats may develop antibodies against it, in which case the PCV (packed cell volume) falls even lower and the erythropoietin must be stopped immediately. A weekly blood test to monitor PCV is crucial when administering this drug. Because of the risk of antibody formation, veterinarians often wait until the hematocrit (PCV) falls below 20 before introducing this drug.

Check with your veterinarian about the need for iron supplements when using erythropoietin.

  Recombinant erythropoietin Clinical trials (at the Baker Institute for Animal Health - Cornell University) for a feline version of recombinant erythropoietin have ended and research findings were published in late 2004. Feline recombinant erythropoietin is not commercially available at this time. 
  Winstrol-V (stanozolol)

An anabolic steroid that is used to improve appetite, well-being and quality of life. It can be used as an adjunct in the treatment of anemia. Winstrol-V can be administered by shots or tablets. As noted below in red, you might have difficulty finding Winstrol-V, but veterinary compounding pharmacies may be able to help you.  Click here for a list of some compounding pharmacies:    
Advisory - June 29, 2004: According to the manufacturer, Pfizer Animal Health, Winstrol-V is still on back order status at this time. It is unknown when it is expected to be back on the market but it has not been discontinued. If you are having a problem obtaining Winstrol-V for your cat, ask your vet to find out if the human version is available and if it can be compounded in a form and dosage suitable for a cat.
Advisory - September 11, 2000: A recently published study indicates that Winstrol has a high potential to cause liver damage in both CRF and non-CRF cats. Please consult with your veterinarian if your cat is currently taking Winstrol. Together, you can assess the risk/benefits ratio. We can only judge in hindsight through our experience with Avatar who was dosed with Winstrol daily for more than two years. In his case, the benefit was obviously worth the risk as Winstrol definitely improved his well-being with no evidence of liver damage.

 

Calcium Imbalance

  Rocaltrol (calcitriol)

Calcitriol is the active form of vitamin D (D3). An excess of phosphorus suppresses the production of calcitriol. Calcitriol is instrumental in absorbing calcium through the gut into the system. The lack of calcitriol prevents calcium from being absorbed in the alimentary canal which leads to hypocalcemia. A parathyroid hormone test can be done to determine if a CRF cat is a candidate for calcitriol. If the phosphorus level is too high (very common in CRF cats), calcitriol should not be given until the phosphorus level is reduced by administering a phosphorus binder. Close monitoring of calcitriol, phosphorus and calcium is crucial when giving calcitriol since it is a fine balancing act and complicated interrelationships exist between the three of them. There are varying opinions as to the correct dosage and also how beneficial calcitriol replacement therapy is to a CRF cat. For more detailed information on Calcitriol, see Calcitriol for Cats and Dogs - Reference Page. Also see our Links Page for additional links and a Feline Calcitriol User Group mail list.

 

Hyperphosphatemia (excess phosphorus)

 

 

In order to bind phosphorus (lower absorption of phosphorus in intestines), phosphorus binders must be given immediately before, immediately after, or with food as they are otherwise useless. Your veterinarian can advise you on which phosphorus binder is right for your cat.
Alu-Cap (Aluminum hydroxide dried gel antacid capsules) Manufactured by 3M Pharmaceuticals. This product has been discontinued by the manufacturer in March, 2005 and is difficult to find.
AlternaGEL (Alumina and Simethicone) Over-the-counter liquid suspension. Probably the easiest way to give this medication to your cat is to measure it, by syringe, into a gelcap. You must pill the cat quickly, though, because the gelcap will rapidly dissolve. If you can't find it over-the-counter, your pharmacy may be able to order it for you. Manufactured by Johnson & Johnson Merck.
Amphojel (Aluminum hydroxide) This product has been discontinued by the manufacturer, Wyeth-Ayerst. Both tablets and the liquid version are difficult to find.
Basaljel (Aluminum carbonate) This product has been discontinued by the manufacturer, Wyeth-Ayerst, and is difficult to find. However, Island Pharmacy will prepare this compound in 500mg doses in #000 gelcaps. These gelcaps are too large for cats, but you can open them and transfer the substance to smaller gelcaps or sprinkle it on food.
Basaljel/Canada (Dried Aluminum hydroxide gel powder and sucrose) Gelcaps Sources indicate that this product is marketed by Axcan Pharma in Canada, though their website does not reflect this information. Their website does, however, indicate that they market Amphojel (we are not sure if this is the same compound as was marketed in the United States under the Amphojel name) in Canada. We suggest contacting PetPharm in Ontario for current information and availability on either of these products.
Renagel (Sevelamer Hydrochloride) Prescription only. Both tablets and capsules. Manufactured by Genzyme.
Epakitin and Ipakitine (Calcium Carbonate and Chitosan)

A nutritional supplement in powder form marketed in Europe as Ipakitine and in the United States as Epakitin.
As this product is calcium-based, ask your vet about any risk involved if your cat's calcium number is high or if your cat is taking Calcitriol.
More information here.

For more detailed information on the above medications and other phosphorus binders, we highly recommend this link About Phosphorus Binders
 

Hypertension (high blood pressure)

  Norvasc (Amlodipine, calcium channel blocker) The most common medication prescribed for CRF cats with hypertension.
     
  LoTensin or Fortekor (Benazepril hydrochloride  ACE Angiotension-Converting Enzyme inhibitor)

There are current research projects targeted at slowing the progression of CRF with ACE inhibitors and calcium channel blockers which are normally used to treat heart conditions and high blood pressure in both feline and human patients. These medications may be helpful in treating CRF since they dilate the blood vessels thereby increasing blood flow to the kidneys. Study results so far have been encouraging, but the research is not yet complete. In Europe, especially England, Benazepril is frequently prescribed as the primary treatment for CRF cats. As of March 9, 2006, it has not been approved for use in the United States.
Warning: Caution must be used because ACE inhibitors carry some risk for CRF cats, such as hyperkalemia. Cats on ACE inhibitors must be monitored closely.

For more detailed information on ACE Inhibitors, see ACE Inhibitors and CRF Cats

 

Hypokalemia (potassium depletion)

  Tumil-K and RenaKare (potassium gluconate)

Available in tablets, gel, and powder form. Also, check with your veterinarian regarding sub-Q solutions containing potassium.
Warning: Hyperkalemia (excess potassium). Potassium supplementation combined with the inability of the kidneys of end-stage CRF cats to sufficiently rid their bodies of excess potassium can stress the heart and could potentially cause heart failure and/or other associated problems. It is crucial to always consult your veterinarian when supplementing potassium, whether your cat is in the early, middle, or end-stage of CRF.

For more detailed information on potassium supplements, see About Potassium Supplements

 

Inappetence (loss of appetite)

  Periactin (cyproheptadine) An antihistamine used for human medication. For some reason, Periactin works to stimulate the appetite in cats. Periactin does not work equally well for all cats, but since it has fewer and less serious side effects than the family of tranquilizers more commonly used for appetite stimulation, it's worth a try. Many people have had great success with Periactin. Our cat seemed lethargic, depressed, meowed and cried constantly and would not or could not sleep, no matter what dose we gave him. His food intake was less than impressive. Another side effect is dryness of mucous membranes.
     
  Valium (diazepam) and Serax (oxazepam) When giving these tranquilizers to cats, it is extremely important to always keep a close watch on them when the drug takes effect to make sure they don't fall off anything. They may be a bit unsteady, wobbly and uncoordinated as their central nervous system is affected by these drugs. By experimentation you may find a dose small enough not to cause noticeable CNS depression while still stimulating appetite.
Warning: Some cats cannot tolerate diazepam. In these cats the drug causes massive liver and kidney damage and death within a short time. While the percentage of cats that are susceptible to this reaction is extremely small, the reaction is so serious that it must be a factor in the decision to use diazepam to treat inappetence.
 

Stomach irritation (Uremic gastritis)

  Pepcid AC Acid Controller (famotidine) A systemic gastric acid production inhibitor, that is, it inhibits the production of acid rather than neutralizing it. It is not an appetite stimulant. It simply eliminates one of the disturbances that can cause a cat not to eat and, therefore, may improve appetite. It is available over-the-counter (ask your veterinarian for dosage - cats cannot take an entire Pepcid AC and the tablet must be broken into tiny pieces) or can be compounded to cat-size portions by a pharmacy. We observed no side effects, and Pepcid AC seemed to be really helpful for our cat, but as the CRF progressed, it may have become less effective.
Warning - March 28, 2001: The FDA has warned that famotidine (Pepcid) has been linked to lethargy in (human) kidney patients. Famotidine takes a long time to clear from the system, which is what makes it so effective. However, in patients with reduced kidney function, the drug takes even longer to clear the system, leading to a possible build-up of the drug, increasing the risk of side effects. If your cat is taking Pepcid, contact your vet and ask about reducing the dosage or increasing the time between doses. If your vet prescribes Pepcid, make sure the vet knows about this warning.
 

Toxin reduction

  Covalzin
     Kremezin (AST-120)

This was marketed in Japan by Sankyo Lifetech Co., Ltd. under the name Covalzin® for treatment of chronic renal failure in cats.
Note
: Novartis purchased that part of Sankyo Lifetech. We have been unable to determine if Covalzin is available through Novartis at this time.

To our knowledge, this oral adsorbent has not been approved by the FDA for use in the USA at this time. Most of the available research documentation on Kremezin is in Japanese.

From the few English language abstracts (pertaining to human nephrology) we were able to find, Kremezin appears to lower the amount of a toxic dietary protein metabolite (indoxyl sulfate). One of the abstracts indicates that indoxyl sulfate, which builds up in the body of a CRF patient, is instrumental in accelerating the progression of renal failure. Another abstract indicates that Kremezin delays the progression of chronic renal failure in man through an "unknown mechanism".

 

Azodyl

Developed by Kibo Biotech, Inc., Azodyl is marketed by Vetoquinol. Azodyl is designed to lower BUN and creatinine by populating the patient's bowel with beneficial microorganisms that catabolize the urea toxins in the intestine.

This product is currently classified as a food supplement. The developer, Kibo Biotech, Inc. has plans to further develop the product for human patients into the medical food category (a prescription product).

Note: While Azodyl is available without prescription through a number of online veterinary and pet health sites, you should consult with your veterinarian before using this or any product to treat your CRF cat.

Note - January 5, 2008: The Veterinary Information Network (VIN) is conducting a trial of Azodyl in Renal Failure Trial (ART). ART is the first placebo-controlled clinical trial examining the efficacy of Azodyl ® in reducing azotemia and uremia in cats with chronic renal failure. This trial is being conducted by Dr. Mark Rishniw and Dr. Paul Pion at the Veterinary Information Network and has been largely funded by the VIN Foundation.

If you have a cat with CRF that might be eligible for the study, please discuss enrollment with your veterinarian and provide him/her with the link to the ART clinical trial page..


Antibiotics

Your veterinarian may, at some point, prescribe an antibiotic for your CRF cat. Antibiotics do not fight CRF, they fight infections that may be taking advantage of your cat's weakened condition. For more information on individual antibiotics, visit Mar Vista Animal Pharmacy Center.

Some Tips on Administering Medications Orally:

We found that a piller worked well with Avatar. These can be purchased through mail order pet supply catalogs or at local pet stores.

There is a new product called "Pill Pockets" which may be just the thing for easy pilling.  (Note:  We are not affiliated with Pill Pockets in any way)

Even a cat that is cooperating may have difficulty handling a pill. After Avatar became accustomed to being pilled twice a day, we noticed that he would open his mouth and give us about a quarter of a second before his tongue would start flailing around. If we got the pill in during the grace period, all was well. If we hesitated, the pill would often be expelled. After we learned this, we had very few problems pilling him. If we missed the 'insertion window', we would wait thirty seconds and try again.

For more information on how to give your cat a pill, visit these three Web sites:

Gelcaps

Warning: Please check with your vet before trying the following suggestion as some medications should not be mixed with others.

Two months before we lost Avatar, we found that administering his meds in gelcaps worked very well. Since we had to give Avatar three pills twice a day, we were now able to give him one gelcap twice a day instead. Not only was it easier on us, the important thing was that it seemed to be much easier and less stressful on him. We noticed an immediate change in him. He seemed to feel better, was more active and alert and vomited less. We tried to figure out what could be responsible for this incredible change. The best explanation we came up with was this: When we gave him his pills before we started packing them in gelcaps, one or more of them would inevitably end up partially dissolving in his mouth. We now believe that he was continually disgusted (and nauseated) by the medicine taste.

Gelcaps come in different sizes. We used Lilly size #1 and these may be the smallest size available. It may be necessary to crush or break larger pills if you use this size. We were sure Avatar could handle a larger size, but the #1 just held all of one dose of his three meds. If you have more medication than would fit in a single capsule, you could use two small gelcaps if you don't want to use a larger capsule. The point is to put something between the medicine and the cat's mouth. The process of filling the capsules can be made easier by investing in a pill cutter or a mortar and pestle for crushing tablets. Some pills can be mashed with the back of a spoon. A small funnel can be used to pour the powdered meds into the gelcap. Since it's difficult to locate such a tiny funnel, you may find it easier to roll up a small piece of paper in the form of a funnel and use that when loading the gelcaps with multiple medications. We prepared a dozen or so gelcaps in advance each time we made them.

For more detailed information about gelcaps and to find sources of gelcaps, visit About Gel Caps.


For additional information on some of the drugs listed above, see our Links page under the category Drugs and Other Related Information.