An update on the cat on Prozac:
I know I said that this would be a blog about Myrna, our HCM cat. But I can't help noting important items about our other cats as well.
Jimmy, as I've mentioned before, is on Prozac for spraying/marking after trying amitriptyline and while his behavior improved radically, with no doped up effects such as with amitriptyline, it did however cause severe urine retention. Urine retention is the inability of the bladder to fully empty but in his case, it involved the bladder not being able to signal it was full until after he'd been holding it in for 12-18 hours. At first, Jimmy was going every 12 hours which worried me. But then he began going 15 hours and then this last week, 18 hours. Meanwhile, he was drinking water and sleeping his normal amount. But after a few hours, he was noticeably uncomfortable. Last week, I began to give him 12-15 ccs of water and bladder rubs after 12 hours to help stimulate his bladder. This would make him go in the next hour.
But here's the kicker-there is no on-line information regarding urine retention in cats other than a note that slight urine retention with amitriptyline or Prozac may occur. There is no on-line information regarding how severe this could become and what could possibly be the results except in cases where there is a disease, an infection, or physical damage. There is one study that showed urine retention with Clomincalm, a tricyclic like amitriptyline in one patient which was resolved when the cat was taken off of the meds, given sub q fluids, and hospitalized for a week until normal bladder elimination was achieved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539679/pdf/canvetj00137-0059.pdf
But neither his regular vet nor another vet we consulted had ever heard of urine retention in a cat with Prozac. The consulting vet said that since it was possibly caused by medication, that decreasing the Prozac might restore normal bladder function. His regular vet, however, disagreed with my findings-both the on-line report and my insights to my cat's behavior. That we had him on a bathroom schedule prior to any meds was unusual she said and therefore perhaps he had had an infection which is why he urinated 3 or more times a day. She said it was perfectly normal for him to go every 12 hours. Well, we had him tested twice during that time prior to meds and no UTI or other infection was found by her. She said if he's not going it's because he doesn't like the box, the litter, or the placement of the box. But we've been through all of this before and everything was working fine prior to putting him on any meds. She then said that he wasn't drinking enough water and that I just assumed he needed to go when he really didn't need to go. Except when I felt his bladder region, I could tell that it was extremely full not to mention that I saw him drink plenty of water during the day and had given him a few cc's of water by mouth. She said that perhaps he had an infection or a blockage except he was tested last week by the consulting doctor and no, he did not have either. He's been able to go such large amounts that I referred to them as lakes when normally he would go ponds. Not to mention that after his urine was withdrawn and tested for a UTI at the consulting vet's, he urinated a lake on their floor.
We are concerned for his bladder health so we've decided to take drastic measures into our own hands.. A bladder that remains full can create UTIs and other health related issues to the bladder and to the kidneys. A male's urethra can become blocked requiring surgery. The bladder could become stretched and weak and urine leakage could occur or lead to further inappropriate elimination issues if he couldn't hold it in before making it to the box. We want to restore normal bladder function before reinstating Prozac. We've withdrawn the Prozac for now and we are not weaning him off from it. He was only on it for a month so we doubt it will be too much of a shock or so we hope. We will give him a slight amount of amitriptyline if he gets overly anxious. If we do begin Prozac again, we have a compounded formula in a liquid form to try to adjust the dose between what would have been 1/8 to a 1/4 of a tab (and tabs are difficult to cut precisely.) We are monitoring his actions and reactions. We are spending time with him and engaging him and taking him on bathroom breaks-all which we were doing while he was on either of the meds. If spraying/marking begins, we will clean and watch and adjust. We are more concerned with his health at this time. I will continue to give 3 ccs of water with each meal and maybe more in the evening if it seems that he has not gone much during the day.
As for the vet, the consulting vet was an hour away, too far to go on a regular basis but his regular vet lacks experience and knowledge. We'll have to find a new vet if possible, preferably one who listens and understands that owners often have more insight into their cat's normal vs. sick behavior than what doctors have learned in vet school. As human patients go, animals are not always as straight forward as the text book cases one learns in vet school.
All I want is my little boy back, the one who played with toys, was happy and engaged, and used the litter box and wasn't afraid of anything.
I know I said that this would be a blog about Myrna, our HCM cat. But I can't help noting important items about our other cats as well.
Jimmy, as I've mentioned before, is on Prozac for spraying/marking after trying amitriptyline and while his behavior improved radically, with no doped up effects such as with amitriptyline, it did however cause severe urine retention. Urine retention is the inability of the bladder to fully empty but in his case, it involved the bladder not being able to signal it was full until after he'd been holding it in for 12-18 hours. At first, Jimmy was going every 12 hours which worried me. But then he began going 15 hours and then this last week, 18 hours. Meanwhile, he was drinking water and sleeping his normal amount. But after a few hours, he was noticeably uncomfortable. Last week, I began to give him 12-15 ccs of water and bladder rubs after 12 hours to help stimulate his bladder. This would make him go in the next hour.
But here's the kicker-there is no on-line information regarding urine retention in cats other than a note that slight urine retention with amitriptyline or Prozac may occur. There is no on-line information regarding how severe this could become and what could possibly be the results except in cases where there is a disease, an infection, or physical damage. There is one study that showed urine retention with Clomincalm, a tricyclic like amitriptyline in one patient which was resolved when the cat was taken off of the meds, given sub q fluids, and hospitalized for a week until normal bladder elimination was achieved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539679/pdf/canvetj00137-0059.pdf
But neither his regular vet nor another vet we consulted had ever heard of urine retention in a cat with Prozac. The consulting vet said that since it was possibly caused by medication, that decreasing the Prozac might restore normal bladder function. His regular vet, however, disagreed with my findings-both the on-line report and my insights to my cat's behavior. That we had him on a bathroom schedule prior to any meds was unusual she said and therefore perhaps he had had an infection which is why he urinated 3 or more times a day. She said it was perfectly normal for him to go every 12 hours. Well, we had him tested twice during that time prior to meds and no UTI or other infection was found by her. She said if he's not going it's because he doesn't like the box, the litter, or the placement of the box. But we've been through all of this before and everything was working fine prior to putting him on any meds. She then said that he wasn't drinking enough water and that I just assumed he needed to go when he really didn't need to go. Except when I felt his bladder region, I could tell that it was extremely full not to mention that I saw him drink plenty of water during the day and had given him a few cc's of water by mouth. She said that perhaps he had an infection or a blockage except he was tested last week by the consulting doctor and no, he did not have either. He's been able to go such large amounts that I referred to them as lakes when normally he would go ponds. Not to mention that after his urine was withdrawn and tested for a UTI at the consulting vet's, he urinated a lake on their floor.
We are concerned for his bladder health so we've decided to take drastic measures into our own hands.. A bladder that remains full can create UTIs and other health related issues to the bladder and to the kidneys. A male's urethra can become blocked requiring surgery. The bladder could become stretched and weak and urine leakage could occur or lead to further inappropriate elimination issues if he couldn't hold it in before making it to the box. We want to restore normal bladder function before reinstating Prozac. We've withdrawn the Prozac for now and we are not weaning him off from it. He was only on it for a month so we doubt it will be too much of a shock or so we hope. We will give him a slight amount of amitriptyline if he gets overly anxious. If we do begin Prozac again, we have a compounded formula in a liquid form to try to adjust the dose between what would have been 1/8 to a 1/4 of a tab (and tabs are difficult to cut precisely.) We are monitoring his actions and reactions. We are spending time with him and engaging him and taking him on bathroom breaks-all which we were doing while he was on either of the meds. If spraying/marking begins, we will clean and watch and adjust. We are more concerned with his health at this time. I will continue to give 3 ccs of water with each meal and maybe more in the evening if it seems that he has not gone much during the day.
As for the vet, the consulting vet was an hour away, too far to go on a regular basis but his regular vet lacks experience and knowledge. We'll have to find a new vet if possible, preferably one who listens and understands that owners often have more insight into their cat's normal vs. sick behavior than what doctors have learned in vet school. As human patients go, animals are not always as straight forward as the text book cases one learns in vet school.
All I want is my little boy back, the one who played with toys, was happy and engaged, and used the litter box and wasn't afraid of anything.
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| Jimmy at 10 weeks |
Thank you for your Post. I know its a few years past your original Post and I hope Jimmy is good. I've just returned from Afghanistan and adopted a cat. Understandably its been an enormous change and just last week I and the vet decided to put him on a small amount of Prozac every other day.But he's not urinating and I'm scared and worried. You were the 1st to make this connection and to acknowledge there there's not much on the net to help
ReplyDeleteDon't give up on the Prozac. It's been better for our Jimmy than the amitriptyline he first tried. But yes, we couldn't adjust Prozac in pill form because of the way it's shaped. We have it compounded and I can make adjustments as necessary. I'd start with a lower dose and work your way up from there. When you see him able to go for a few days then slowly work your way up. We took about a year starting at .120 down to .1 then back up again. Good luck!
ReplyDeleteCompounded-into liquid form.
ReplyDeleteJust don't give any antidepressant to your cats. They all induce urinary retention and this will damage their bladder beyond repair. I know it because I had to find a way to treat severe hyperesthesia in my cat which made her attack savagely her own tail and cry in pain for hours each day. It is a very difficult illness to treat as it is a kind of phantom pain in the lower back. I gave her gabapentin which helped a bit, but to really avoid these horrible crisis I had to add antidepressants. As she went out in the garden to urinate, I didn't notice immediately that she had severe urinary retention, but when I had to put her in a room of the house for another problem, I realised with much despair that she didn't urinate for 37 hours... without even trying to go to the litterbox. She was just unaware that she had to go.... long story short, I had to hospitalize her with a catheter in the bladder for one week and stop immediately the antidepressants to try to save her enlarged and damaged bladder. It worked. After that, I will never give antidepressants to any cat. Just find another way to treat them. It is much too dangerous and not worth it. And certainly not worth it if your male cat is marking. They almost all do and you just have to live with it. I have 11 cats and I just clean after them.
ReplyDeleteIn later posts I say that we did return to Prozac but we used a compounded formula and began with .1ml which was far, far less than the amount originally prescribed. We eventually worked our way up to. .15 after a year or so; then in small increments until this year we began using .19ml which is still very low. He's doing well. Yes-it can and did lead to urine retention as I stated in the post. That is why we began Prozac with such a low dose and slowly worked our way up. No-I would not say anyone should "live with it" when cats mark or go out of the box. I would say to increase litter boxes, clean them frequently each day, put them where the cats need them most, use Prozac or such and take the time to find the smallest amount possible and then work your way up over time as needed, and develop a behavioral training method-which we did as well. And you can read about those in later posts.
DeleteWe have a very aggressive little orange boy so our vet put him on amitriptyline- it worked almost immediately. We had a new and sweet cat. Then two weeks later, he stopped peeing. He cried very hard all day so we took him to the hospital thinking he was blocked. He was not. They had to completely sedate him in order to massage bladder to express urine. He is 14 months old and we had never had this issue. We strongly believe it was the amitriptyline.So the hospital vet prescribed prazosin to facilitate urination. What to do about aggression because it came back a few days later. We started him on fluoxetine compounded (liquid) yesterday and are hoping this will work otherwise we cannot keep him. It breaks our hearts that he can be so loving one minute, then attack us the next. Giving him up would be devastating.
ReplyDeleteSo sorry to hear about the difficult, complex issue. First, urine retention is possible with psych drugs. I suggest starting with a dose much lower than the equivalent of what he was taking before. Then work your way up over time, monitoring for urine output. Write it down-how often he can go, how far apart, and if his bladder becomes so engorged before he can go. You can feel the bladder-or its effect. If you feel the underbelly at the back near the legs, you can feel the weight of a full bladder. It's not accurate but we feel it has always given us an idea of how much Jimmy might have and when he needed to go. By beginning a low dose and using behavioral methods, and monitoring when he went, we eventually worked it out. He went from .1 to .19 in seven years-a far lower dose than originally prescribed. Your issue is anger. A cat that is angry and bites is scary. But I suggest two things-the lowest dose possible of Prozac and then working your way up based first on his bladder (holding urine can lead to infections as well as pain) and then on anger. Prozac is given once a day. Perhaps you could give half doses twice a day to help with both the urine and anger. There's also valium to try which doesn't seem to have the urine retention affect but might help with his moods. The other thing is anger management and behavioral training techniques. Does he jump on you and attack? Or does he get instantly tired of you petting and then screams and swipes and bites? Either requires training and patience and the realization that you need time. Even on drugs, the cat needs training and you need training as well. Learn the signs and times he's aggressive: when hungry, with noise, change in schedule, too much play, too much roughness or rough play by any person, aggressive play as a kitten that taught him to be rough, being abandoned as a kitten or removed from mom at six weeks (no kitten should leave until 12 wks)-these lead to anger issues. Or is he mental? Let's assume he's naturally rough and naturally gets tired of being petted or held or brushed or having you invade his space. Learn the physical signs when he's about to strike-tail swishing suddenly, ears back, hissing, growling. Then let him go, turn away, put him down, walk away and ignore him. Don't squirt with water or hit him-that furthers aggression. Ignore him. If you must-and use it sparingly-clap your hands loudly twice to make a sharp noise , say NO, and then walk away. He might hiss but if the sharp noise makes him walk away, great. Ignoring him will train him to behave if he wants your attention-which he does. Not that it will curb his angry response. Don't use your hands for play, use only long objects to create distance. Let him have toys that move and let him run off his energy. Give him many tall scratching posts throughout the house. Give him two or more tall cat condos to climb. With age, he'll settle down but still be angry. In a few months, if he's swiping and hissing and hitting but not using teeth or claws, that's a great sign of a cat learning to be less aggressive. Claws-don't declaw but have the vet trim them every two weeks if you are not able to do so. Cats tend to be quiet at the vet. Don't give up on him but he and you need training. Read up on it. Find a local person-call your humane society-although trainers charge a lot but maybe someone can give you pointed advice after observing the cat's behavior and asking you how you treat him and play with him. Again, start a lower dose and monitor and then build up to a higher dose as he can tolerate. Good luck!
ReplyDeleteI just found this post and my kitty is experiencing a near similar situation. He had a urinary blockage in May 2017 which required PU surgery. It was successful and he was doing so well. This past year was a bit stressful. Our dog who was his buddy, passed away. He went kind of crazy. He went from sweet and docile to aggressive attacking 2 of our other cats. Nothing I tried helped so after a few months, he went on 2.5 mg of Prozac. This was in late October. In January 2019, I started to notice large pees. I have 6 cats so was unsure at first who it was. I finally saw it was Cisco. I watched this for a few weeks as he was still urinating at least once a day. Then in March he started to go longer between urinations. I took him to the vet and asked if it could be the Prozac as I did see some reference to it. He said maybe, but wanted to check urine and blood first. It came back he had a UTI and a few crystals. Hmmmm. So clavamox and prescription cat food. After a few days, he was no better. We decided to wean him off Prozac. After 5 days, still no better. We made a trip to ER vet. He had an ultra sound to check for stones. He was clear. She said it could be Prozac and to stop weaning and just get him off. He was giving a medication to help with bladder spasms and then told to try gabapentin a few days later. Nothing helped. Now on April 2, 2019 I had to rush him back to ER vet as it had been 48 hours since he peed. My regular vet could not express any urine.
ReplyDeleteER vet says he is not blocked, but he is "choosing" not to urinate. What??? I think he cannot urinate. I truly believe the Prozac has messed with his bladder. He is at the ER vet now, with a catheter inserted, fluids and pain meds. One of the ER vets doesn't think he will live. She said she suspects that when the catheter is removed he will block again.
So just another story that Prozac can truly cause urinary retention and it can be very serious.
Are they finding urine in the bladder when they exam him? A lot or normal amount? "Couldn't express urine"-because he didn't have any or it wouldn't come out but it was there? Did they do a needle aspiration of urine or they tried to get him to go in a box? If they couldn't express any but it's there, then there is a problem and further echos or such are needed to examine the system on the inside. If they couldn't express because it wasn't there, then he's going out of the box. Check for that around your house including cool surfaces-sinks, appliances, floors, walls, furniture, bedding, windows, etc. Urine retention can lead to a UTI. Prozac can lead to retention. I'd suggest getting him back to normal somehow and stop all behavioral meds (tough it out) then either try Valium and see if that helps keep him calm, and see if it causes any issues; or get compounded Prozac and start him on .05 ml and see how he responds both with behavior and urine; and work your way up slowly over time from there. Jimmy began slowly and after eight years, went up to .1, .15, .2, etc. and this winter began taking .27 ml. Meanwhile, try Buprenex as an anti-inflammatory/pain med when he's at home. This may need to be compounded. We have cats with cystitis that take it compounded. Gaba can be too much. If your cat is as sensitive as mine, it doesn't take much and vets tend to give "normal" amounts which are too much. Did the echo to look for stones include the entire kidney/bladder system? If not, have one done. Continue the special food-we prefer CD, and feed wet and not dry (or a little dry CD with the wet); use Methigel to help acidify the urine (order on Amazon)-give two inches by mouth once a day. Make sure he drinks enough water, and add it to his wet food, and give 6ml by mouth (get a 3ml syringe from the vet) 2-3x a day; and if he drinks enough, then 3ml twice a day. Take into account what other meds or supplements he is on that may interfere with him and cut out all that you can for now if possible. And finally, if you can, find a vet school or animal hospital and call and ask what else they'd recommend and think about going there, especially a vet school/hospital. I'm so sorry to hear that he is having such a difficult time. Let me know if you have any questions. Good luck!
ReplyDeleteSo he is at the ER vet now. The internal medical vet called me just a bit ago. His bladder was full and bulging and they were unable to express it. They put in a catheter and out it all came. He was not ever urinating out of the box. I have wireless cameras on my litter boxes right now and also use a black light daily. He had an ultrasound on Saturday of the bladder. No stones were found. Tomorrow he will have a contrast dye x ray to determine if there is anything in the urethra.
ReplyDeleteThank you for all of the wonderful suggestions. I will look into Methigel and I love the suggestion to syringe him water. He was never a big water drinker. He did drink out of the fountain we had, but once our dog passed he stopped drinking out of it. I would add 1 T. of water to his wet food 3x a day. But I gather that is just not enough. He is now on S/O canned food. I do believe it has something in it to acidify the urine. So I might not need the Methigel. I am looking into a product called Uromaxx. I do believe an anti-inflammatory will be neded. He was on gaba once before and it helped him. Thank you so much for all of the helpful info.
Hi all, joining this thread now as my cat seems to have a very similar situation to Ann's cat. Our cat had PU surgery for supposed blocks, is on fluoxetine, and still can't urinate post-PU surgery. The same tests Ann had done for her cat (including contrast x ray) have been done in the past few days with no evidence of anything. Ann, I would be very curious to hear what happened with your kitty! I hope he made it through alright. Any information regarding this situation would be most helpful.
ReplyDeleteI suggest you lower the Prozac dose; get it compounded if you can-Google "comppounding pharmacies" near you, or use Wedgewood online pharmacy (vet would set that up.) A local one is easier for sure. If compounded, get sugar free base with chicken flavor and make sure they don't use a base that is spicey (yes, this actually happened and Jimmy hated it.) A liquid dose is easier to titrate than pill. Begin a lower dose, see if he passes urine, then slowly overtime increase the dose. So, if the vet says to use. 3ml, use .2 or .15ml. Monitor urine ability to go, then titrate up over time, and monitor urine again. This could take months. Jimmy began at .10ml in 2011 and by 2020 was up to .30ml where he remains which is still a low dose. We titrated up when accidents began or increased. He now has one every 4-7 weeks. We do what we can but at least he's able to go and we've not had issues with retention since 2011. Monitor going out of the box. Try to mitigate that by using calming spray-we love Feliway sprayed around boxes and where accidents happen; scoop boxes multiple times a day; wipe down box edges with a wet wipe that smells normal-not bleach, not floral; clean floor around box; clean accident sites really well then use a small amount of bleach kitchen spray on the area if at all possible or a "urine out" type of product, and cover it with plastic or a bed pad if it continues (we use Target bed pads or you can buy online from medical supplies cheaply.) Basically, you are trying to help him use the box and avoid areas outside of it. Treats given around boxes help him think this is a positive experience around the box. Make sure no cats bother him or dogs or kids when he's trying to go. Give him a calm spot to go and easy access. Take off covers of boxes or have one with a lid and others without; switch up litter-we use wheat litter in some boxes, and Cat Attract litter in others; have more than one box in one area and use more areas in the house. Try to monitor how often he does need to go as the medicine is changed-every four hours? Eight? 12? Then try to work with him when it's time to go use the box. Also, always monitor general health. Have urine tested from time to time for infections, glucose, proteins; check blood work for kidney function BUN, creatinine, etc. Check fructosamine occassionally to make sure he's not diabetic which causes accidents (Jimmy later became prediabetic and we also changed his diet twice. Now on diabetic diet with CD although not diabetic but fructosamine was increasing. And CD helps with bladder health and at his age, his kidneys and bladder are changing.) You can read more here at the blog. Good luck!
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