Vetmedin Dosage Advice

[AnnaYeti]

Hi,

We have a 5 year old boar who has had a heart problem for two years. Just recently he has got worse, shortness of breath, and also the effects of arthiritis in his joints.

He doesn't have any fluid on his lungs, but his breathing is a little laboured and there is a slight weeze occasionally. He's lost quite a bit of weight and is now off his food, being fed critical care (he is struggling to eat despite wanting to; we're not sure if this is arthiritis or lack of energy.)

His current meds are as follows:

1/4 of 1.25 mg Vetmedin tablet twice a day.
1/4 Ronaxan tablet once a day.
1/4 Fortekor tablet once a day.
1/4 Rhymadil tablet twice a day.
Nutraquin (just started giving him this today).

He is about 700g, maybe a little more.

I was wondering if anyone has any advice or, specifically, what the maximum dosage of Vetmedin we can give is?

We're quite worried about him now and he seems to be getting weaker, so anything we can do we'd like to do of course.

Many thanks in advance.

 

[AnnaYeti]

Oh, also to add, he does have a little lasix when he's weezy. But having some yesterday has resulted in soft poo today. Not diarreha, but soft. And with no real fluid around, I don't think there is any benefit in continuing to give it to him.

 

[Pebble]

Hi Anna

It sounds like you have a good vet - he has everything he should have given your description.

Can you please give the actual content of ALL the tablets before i comment please? e.g There are many different tablets of vet-medin of differing dosages.

Vet-medin is frusepmide - a diuretic - so a good thing to give in conjunction with forte-kor for heart meds. The diuretic dose however needs to be adjusted to suit over a period of months. Normally it is higher to begin with to "kick-start" (i.e. get rid of) the removal any excess fluid that has already accumulated. Then it is a question of tweaking it to get the lowest dose that still ensures the lungs remain clear of fluid.

The dose of fruse-amide i have been instructed to give my piggies over the years can vary from 10mg/kg intial "purging dose" for a max of 3 days down to 2mg/kg twice daily maintenance dose for life. This medication is dangerous and can dehydrate (and possibly kill) a guinea pig if not used properly under vet supervision so any changes to dosage need to be discussed thoroughly with your vet first.. every guine is different in terms of the dose it needs depending also upon its particular condition and clinical symptoms.


I would be wary of nutra-quin in view of the supplemental zinc content - there are other glucos-amine supplements including cyst-aid and cyst-ese without the extra zinc

Rona-xan is the antibiotic doxy-clycine - could explain why he has loose poos as it affects the balance of gut flora. Are you giving a probiotic? Why is he having an antibiotic as this is only given in the case of suspected bacterial infection? I'm assuming they are covering all the causes and giving him this to combat any possible URI ref the breathing?

Forte-kor is normally 2.5mg tablets - the standard dose is 1mg/kg and if your guinea wieghs 700g then that is about right.

Finally rhima-dyl is car-profen - a non-steroidal anti-inflammatory. Good for arthritis and pain management (equivalent of meta-cam)

Once you have posted the tablet content I can go on to comment further. Given all the (entirely appropriate) meds he is on he shouldn;t be getting weaker and this needs to be explored further.

Does he still look as though he is in pain (hunched up fluffed fur?). Are his poos normal size/consistency? Is he weeing normally?

At the moment his food intake is the most important thing ref the weight loss issue- he needs at least 120ml of mushed pellets every 24 hours - in 20-30 ml doses spaced 2 hours apart.

HTH
x

Edit - sorry have to hyphenate all the drug names as otherwise this software won;t permit me to post

xx

 

[AnnaYeti]

Hi Pebble,

Thanks for the reply.

He has been on Vetmedin for about 12 months and Ronaxan and Fortekor for about 18 months.

I didn't think that Vetmedin is a diuretic. We've got Lasix as our diuretic, but rarely give it to him.

He's been responding well to his mix of medicines for a long time and has only just started to get worse. I think a lot is down to the arthiritis, which has got worse too, stiffening him up and making sitting in anything other than a hunched up position to relieve the stress on the hind legs, difficult.

The Vetmedin tablets we have are the 1.25mg kind.

Do you know what the maximum dose he can have of this is?

One other thing to mention is we just saw some blood when we took him off his blanket. He had had a wee, but the blood did not look as if it was in the wee and instead some was conjealed on his willy. We don't know where this came from.

Mostly we're worried about his weakness and shortness of breath, hence wanting to know if we can give more Vetmedin.

Getting that much critical care down him would be great, but he is struggling to chew and finding every chew an effort, so it's proving impossible. We'll be lucky if he manages to eat half that today.

Many thanks for the reply btw.

 

[Pebble]

Hi Anna
Many thanx - you have given some great info and I need to make sure I have considered everything properly before giving a reply.

Are you based in the UK or abroad? The meds names and permitted dosages are dfferent either side of the Atlantic.....and i want to make sure my reply is relevant to your situation.

Will be back on tomorrow
x

 

[AnnaYeti]

Hi Pebble,

We're from the UK.

Thanks!

 

[Pebble]

Hi Anna

Sorry - my mistake. You;re quite right. Vetmedin is another heart drug called pimobenden and is often given with or as an alternative to fortekor. I have never had this prescribed for my heart pigs so I'm afraid I can;t give you any idea on max dosages but I do know from guinea lynx that the dose you are giving appears to be commonly used.


The shortness of breath and difficulty chewing would suggest that he now requires to be seen as an emergency....this may be due to build up of fluid or just progression of heart disease and it may indicate there are now other problems developing with other organs such as his kidneys (hence the blood) which is a common factor in progressive heart disease.

Please ring your vet today and discuss whether he needs to be seen today and whether any of his dosages need to be adjusted.

HTH
x

 

[AnnaYeti]

Hi Everyone,

We've spoken to the vet and been assured we're doing everything we can in terms of medicine. We've noticed some fluid come out of his nose today - not a lot, but some - and so have treated with diuretic. It's definitely pointing towards heart failure problems.

What we really want to know is what we can increase the vetmedin dosage to. Our vet only recommends a small dose, which he has been having much more than for a while. As it is not licensed for piggie use, vets are wary of perscribing too high a dose.

He has been on 1/4 twice daily (of 1.25mg strength tablet) for about 12 months at least.

Does anyone know what level we can increase to? It is our only weapon left I feel in combating the heart problem.

As it stands he can't go to the vets as he is too weak. There is also no reason to take him as they wouldn't do anything differently - perhaps even drop his dosage.

I thought I read on some threads here that some piggies got 1 vetmedin tablet a day and another got 2. I have PMd the people who wrote that, but so far had no reply.

Any advice is really appreciated!

 

[Pebble]

Hi Anna

Really glad you rang the vet to get reassurance.

I regret to say that increasing Vetmedin will NOT help your boy at this moment given his current symptoms

Nasal discharge on top of the breathing issues and problems eating are all indicative of fluid build up - not necessarily inside the lungs (although the nasal discharge/eating issues indicates this could be the case for your boy) but it can also occur outside the lungs or around the heart.

Fluid build up is the main "episodic" issue with congestive heart failure - which can also occur in the abdomen and around the chin as well - and the diuretic frusemide is the main weapon to alleviate the symptoms at this moment. Just upping any heart meds (such as vetmedin) will not cure the current clinical symptoms - you need to get the fluid down, get the breathing more normal and get him able to eat - and only frusamide can do that.

It is a sad fact that regardless of giving a piggie heart meds - (and your dosages are fine) - it does not cure the problem - it just enables the pig to live a longer happy life. However these fluid flare-ups can and will occur. I have had many such incidents with my heart pigs over the years and it just means upping the diuretic for a time to stabilise the symptoms.

You do also have to be aware however that at any time it will no longer be possible to stabilise the symptoms - especially if they have been on heart meds for some time. A heart pig can suddenly develop an overwhelming congestive "end-stage failure" involving respiratory distress/fluid build up at any time regardless of the medication so you have to be vigilant and be prepared to take them to an emergency vet who may say that even large doses of diuretic cannot help the piggie any further. Unfortunately you also have to monitor for kidney problems because these will start to appear with a heart pig as the condition progresses...and the diuretic frusemide can affect the (possibly already compromised) kidneys so the dose of the drug is a balancing act that only your vet can decide upon based upon the individual piggie concerned.

I think both you and your vet are a wonderful team and are doning everything you can to manage this condition in your piggie. The only info I can offer in your current situation to help is as follows:

How much frusemaide are you giving?With these types of "episodes" my vet recomends giving up to 10mg/kg twice daily for up to 3 days of frusemide (lasix) to kick start getting rid of the fluid and then gradullay reducing the dose over a two week period. It's a high starting dose and not many vets are willing to give it. We have also found with some heart pigs that they respond better to injections of frusemide rather than the oral dose when they are having an "episode". If you are giving oral meds that are not having much efffect then consider upping the dose. If you are already at the max oral dose then consider instead giving injections over the next few days.

Finally - please be vigilant in monitoring for dehydration if you are giving the max diuretic dose.

Happy to talk further - but I do think this should now come "off-line". Do you have tablets of lasix or an oral solution? What is the strength of the tablets?

Hugs - it's a complete balancing act regarding symptoms/drugs/contraindications for heart pigs. I truly believe you and your vet are spot on - and increasing vetmedin is not the answer at this moment.

HTH
x

 

[helen105281]

My friend's heart pig is on a mix of vetmedin, Fortekor and diuretic and is doing really well. She is happy to speak to you if you'd like to know what doses he is on. You don't have enough posts to PM but if you are happy to post your email address I will ask her to contact you.

Hugs too, I had a heart pig Nigel and it was such a balancing act with his meds. My Star has just been diagnosed with a heart condition too.