Inappetence, anorexia, poor appetite, not eating, if you’ve had an elderly cat, a cat with renal failure, a fever, URI, or any condition that produced pain such as injuries or cancer, you’ve heard your vet describe part of your cat’s diagnosis in these words. On their own, lacking an appetite or not eating seem like a complaint rather than a condition, but healing and recovery, or simply maintenance of health, won’t happen without nourishment.
I’ve had a few cats suffer from chronic renal failure who needed regular treatment, but Peaches, above, suffered mightily from nausea and reflux. An acid reducer and an appetite stimulant and subcutaneous fluids kept her feeling well and eating and are likely the only reason she lived with the condition for as long as she did.
Simply not eating can endanger your cat’s life in just a few days even if she’s in good health and just refuses to eat a new food you’ve put in her bowl. But when a condition, illness or disease takes away the appetite, especially a chronic disease like renal failure which, even when treated, can cause acid reflux, nausea and vomiting, a cat will quickly lose ground because she no more wants to eat when she feels sick than you do. She will lose weight, deteriorate and may die for lack of appetite.
An appetite stimulant, mirtazapine, is often given to cats who aren’t eating in many situations: in treatment for renal failure, immediately after surgery with the pain of healing, while in treatment for diseases such as cancer or illnesses like upper respiratory infections or calici if congestion or pain makes eating uncomfortable or impossible.
When it works it’s like a miracle to see a cat who looked flat out ready to cross over instead perk up, eat and look alert again. A problem, however, is dosing the cat. Giving a cat a pill can be a challenge in the best of times, but stressing a sick cat with getting it to swallow a pill, or giving one to a cat who is regularly vomiting and will not digest it, will not help at all.
That’s where the transdermal dose, rubbed onto the skin, usually inside the ear, is especially helpful. The medication is absorbed into the skin and into the bloodstream. The common hyperthyroid medication methimazole or Tapazole, often given twice daily for the remainder of a cat’s life, was made into a transdermal dose several years ago when many cats simply didn’t get their medication because they could not be regularly given a pill.
But you can’t just give the same dose as a transdermal as you do with a pill. The medication and its application need to be studied to be sure it’s absorbed that way without side effects, and exactly what is the best dose, how frequently, and how to formulate the transdermal compound.
Dr. Jessica Quimby, DVM, PhD, DACVIM, associate professor at The Ohio State University and an affiliate professor at Colorado State University, has been working on just this application for the past 10 years. In her studies she has charted the effect of mirtazapine on cats’ appetites and the weight gain and recovery they’ve achieved from eating because of the medication’s effect, in each study perfecting the dose. In the studies, 91 percent of the cats given mirtazapine gained weight, and vomiting was greatly reduced. The studies she’s run of transdermal mirtazapine have moved the compound toward approval of a transdermal mirtazapine ointment for cats by the Food and Drug Administration in late 2017.
Participation in the studies
Clinical trials are underway at The Ohio State University and Colorado State University to learn more about the effectiveness of mirtazapine transdermal gel applied to the inner skin of the ear to stimulate appetite. Cats diagnosed with chronic kidney disease (CKD) may be eligible to participate.
Cats do need to visit the schools’ veterinary hospitals three times with a gel administered to the ear over six weeks. Cats will be divided into two groups, one which will receive treatments with mirtazapine transdermal gel and the other a placebo gel.
A Purina Veterinary Resident Research Grant funded Dr. Quimby’s first study in this dosing, and a Winn Feline Foundation grant is funding the current study. I learned of it through following The Winn Feline Foundation’s #Cures4Cats series of articles.
Learn more about Dr. Quimby, the studies and how to participate here.
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