Meds/Supplements

Medications for Cats with Heart Disease

For more information regarding the following medications, Drugs.com and Wikipedia and PetMD are just some excellent online resources.  

Medications can be purchased either at a regular pharmacy-Target and Kroger offer $4.00 generics for many of those listed below-or from the vet (but usually more expensive than a regular pharmacy), and the online pet pharmacy Road Runner.  Many pet stores and online pet stores carry supplements and medicines.  Call your local pharmacy and shop online to compare prices and to find what is affordable and convenient for you.

What Meds and Supplements Did Myrna Take?

Myrna’s medication needs changed over the course of the six years and nine months that she lived with the disease.  At first, she began with a couple meds and then after two months, was up to five.  Three years later, she was up to six, then seven.  About 2012 we added Valium to help her use the litter box because she was going out of the box-probably due to the frequent need to urinate due to the diuretic medication Lasix.  Eventually, she was on Pepcid for stomach acid.  We added sucralfate for stomach ulcers.  Then at times she needed Mirtazapine and Cerenia to help her eat.  She took a variety of vitamins, minerals, and supplements to improve her body condition, help the heart, replace what the heart meds removed, and to give her additional kidney support.  She put up with a lot; she endured a lot.  But all of it helped her live a long, healthy life and her kidneys stayed strong until the end despite the high levels of Lasix and then Torsemide that she took to better manage CHF. 

Medications for Cats with Heart Disease

For more information regarding the following medications, Drugs.com and Wikipedia and PetMD are some of the excellent online resources.  Each medicine and supplement discussed below is linked to a page of information. Feel free to search the above sites for additional information.

Medications can be purchased either at a regular pharmacy-Target and Kroger offer $4.00 generics for many of those listed below-or some from the vet (but usually more expensive than a regular pharmacy), and at online pet pharmacies such as Road Runner.  Call your local pharmacy and shop online to compare prices and to find what is affordable and convenient for you.

*Please remember that HCM or cats with heart disease cannot have any form of steroid medication. Steroids retain fluids and dangerously so for HCM cats-which is the opposite of what you want.

WHAT DID MYRNA TAKE?

These following meds (other than Valium) are what you should consider for your heart diseased/HCM cat. Depending on the extent of the heart disease, a cat may not need every medication that Myrna receives.  They may receive something such as lasix and atenolol at first, then have others added as the disease progresses or as symptoms appear.    

 1) Valium was given to Myrna for litter box use and can be safely used by heart diseased cats to help solve any anxiety issues as long as the cat can tolerate it.   It is the only medication that as far as studies have shown, is not contraindicated with Plavix.  A cat on Plavix should not take psychotropics such as Prozac or stomach medications such as Prilosec.  The FDA issued a warning a few years ago that psychotropics and anti-acid stomach medications interfere with the blood clotting properties of Plavix.  A cat with heart disease needs to take Plavix to prevent clots from forming.  She received Valium four times a day for a total of almost 2 mg.

2) Myrna took baby buffered aspirin 81 mg once a day on Wednesdays and Saturdays because, in general, cats cannot take and tolerate aspirin well.  Therefore, they need to space the aspirin 72 hours apart.  Your cat may or may not be able to tolerate aspirin and blood work is needed constantly at first to monitor liver and kidney function. If the cat begins to vomit each time you give aspirin, then the aspirin needs to be stopped.  And of course, any time a new med is introduced and your cat begins to have stomach upsets, it might be the new med and the cat needs to either be given time to adjust, or the med needs to be decreased until the regular dose can be tolerated, or the med suspended altogether.  Always discuss medication needs and changes with the vet.

3) Myrna Loy took a 1/4 tab once a day of Plavix, the blood thinner, to prevent clots.  Clots form as blood pools in the heart because the heart cannot sufficiently pump out all the fluid it takes in. Thinner blood is also easier for the heart to circulate.  An article that discusses how Plavix is contraindicated with stomach anti-acid meds and psychotropics. (The article is a few years old and is outdated regarding generic Plavix which does exist now in the U.S.) Here is an article discussing that Plavix has been shown to be effective in cats. 

4) She took a 1/4 tab of Atenolol BID or twice a day-a beta blocker-which slows the heart rate, lowers the blood pressure which helps the heart not work so hard.  For four years, Myrna took 1/4 tab once a day.  This was adjusted to 1/4 BID (twice a day) as of 9/8/14 since her heart rate was becoming higher and she developed afib (abnormal heart beat.)

5)  She took a 1/2 tab twice a day of Enalapril-an ACE inhibitor-it keeps veins opened and from being restricted, aids in reducing sodium retention and therefore fluid in the body, and thereby lowers blood pressure. ACE inhibitors are also Fortekor (Europe) or benazepril.

6) Diuretic information:  There are three main diurectics-Lasix, Torasemide, and Thiazide. Myrna began with Lasix and used it for five years before switching to Torsemide in January, 2015.   We were going to add Thiazide in addition to Torasemide due to Torasemide’s inability to get rid of all of the congestion in her lungs.  Congestion or CHF was difficult to get rid of due to the damage to her lungs by the chylothorax fluid that created pits within the lungs.  This condition meant the lungs were unable to expand and take in oxygen, get rid of carbon dioxide, and get rid of fluid sufficiently.  Instead, the damaged pits held fluid.  Her kidneys-while the values were great-had seemed to hit a tolerance for Torasemide, meaning, they seemed oblivious to the medication’s diuretic properties and were not assisting the body in drawing fluid from the lungs to the kidney system. 

Lasix is a diuretic, a fluid reducer, therefore also aids in lowering blood pressure, helps the heart by having less fluid volume to circulate, prevents congestive heart failure and aids in getting rid of fluid.  If the cat develops CHF, or if the heart condition decreases so that CHF is a threat, then typically a cat should receive at least 5 mg twice a day.  More will be needed as the disease progresses or as congestion becomes a constant problem.

She took the following amount of Lasix (furosemide) as of November 2014 to December 2015: 25mg QID-four times a day.  From summer of 2014-November of 2014: 15mg in the a.m., 18mg at lunch, 15mg at 7p.m., 18mg at 11:30 p.m.  The cardiologist did not want to overload her kidneys with heavy hits of Lasix. But as CHF became constant, she needed a more consistent dose. Hence, the 25mg QID. 

We also injected Lasix when she needed it because the effect on congestion is quicker. Talk to your vet about this option.  (Myrna could not withstand multiple, daily injections because she developed horrible skin lesions. When had to stop during the summer of 2013 and use it only when needed. She needed it more in the last few months and we simply had to deal with the horrible lesions when they developed.We could never mitigate them. We used new needles each time; we cleaned the area before and after the injection with sterile meds; we even tried a new brand of injectable lasix to no avail.)

Torasemide-As of December 2014 she took Torsemide after developing pleural effusion.  She took 7.5mg once a day.  But that only until January when she developed congestion again, this time when lymphatic fluid or chylothorax developed in the pleural cavity.  The Torsemide was increased to 5mg in the a.m., 2.5mg around 3 p.m., and 5mg at 11 p.m.   By May she took 7.5mg QID.   Torsemide quickly depletes the body of potassium and can damage or decrease kidney function.  Because of this, a good vitamin source is necessary; additional potassium is necessary (Renal K gel and powder, Sundown Potassium tablets for example), and vitamins for kidney support (see the information below.)

Thiazide-Is good at reducing hypertension and decreasing fluid retention. While they can work alone, they are often given in small doses in addition to a loop diuretic Lasix or Torsemide to help the loop diuretic.  Loop refers to the part of a cell in the kidney that a loop diuretic affects while Thiazide affects the proximal portion of the distal convoluted tubule to prevent sodium resorption and promote potassium excretion in the diuresis process. 

7) She took 1/4  of a tab twice a day of Spironolactone-a potassium sparing diuretic.  Spironolactone competes with aldosterone at its receptor site, causing a mild diuresis and potassium retention.

8) She took a 1/4 tab of Isosorbide once a day in the evening.  It's a nitrate. It helps increase oxygen and blood to the heart by keeping blood veins opened; and the open veins reduce blood pressure.  It also redistributes the load from the heart (this one is difficult to explain and she was put on it to reduce the cardiovascular load to help ease her congestion. Your cat may not yet need this.) 

There are other meds some vets choose to prescribe which Myrna's vet does not:  

One is Carvedilol, a beta blocker like atenolol. The vet prefers Atenolol.  

Nattokinase, a soy based enzyme, which is used as a blood thinner but with limited results.  Plavix or aspirin is best.   

Aminophylline, a bronchodialator that opens up airways in the lungs when there is congestion.  This is an old method and should no longer be given to fight congestion in the lungs. It also raises the heart rate which is not what a cat with heart disease needs. Lasix should be used instead.  Aminophylline is best used for cats with asthma.

Pimobedan or Vetmedin was created for use in dogs with heart disease.  It was not approved by the FDA for use in cat but some vets do use it as does Myrna's.  We chose not to give it to Myrna. It improves the contractility of the heart but has potential side effects. 

Myrna took Albuterol for Asthma during the summer of 2014 until December 2014.  Once she developed chylothorax, she seemed not to need the inhaler.  During the summer of 2015, we kept the windows closed, thereby controlling air quality by decreasing irritants she could inhale; and by decreasing the heat and humidity that would come in from the outside. The mobile air conditioners were set on 72-74 (but not lower) in order to control air quality.  Hand held humidity and temperature control devices helped me monitor room air quality. 

Asthma is not common in heart diseased cats but can happen due to inflammation in the lungs.  And it can occur in cats which do not have heart disease.  For more information, check the website called Feline Asthma with Fritz the Brave.  Remember: cats with heart disease CANNOT use steroid based inhalers such as Flovent.  Use Flovent only with cats without heart disease. 

Supplements

Supplements are necessary to replenish electrolytes and other vitamins and minerals that are removed due to the diuretics and to improve the condition of the body and heart function.  These are necessary for survival, for strength, for endurance against heart disease. Without replenishment, the body grows weak and is unable to handle the effects of heart disease. 

Many of these can be purchased at the grocery store, the pharmacy, pet stores, vets' offices, online pet stores, and Amazon.  That many of these links are linked to Amazon is in no way a support or an ad for Amazon.  Whether it is medicines or supplements or cat supplies, shop around at online stores, Amazon, and local stores and compare prices to find the most convenient to buy and affordable for you. 

1) To fight the chylothorax, she was taking 1/2 tab three times a day of 500mg of Rutin.  I should have tried other forms of Rutin. I did not comprehend the extent of damage the fluid could do to the lungs nor the ensuing complications of getting rid of congestion. Or perhaps there were other things that could have reduced the effects of chylothorax.  But I never concentrated on the chylorthorax enough and it was a contributing factor to her death.  Chylothorax is a lymphatic fluid that drains from the intestinal tract to the vena cava but due to heart disease, backs into the pleural cavity.  Rutin is thought to change the triclycerides in the lymphatic fluid so that it flows more easily to the vena cava and does not back into the pleural cavity.  It was suppose to change the makeup of the fluid so that it does not cause fibrosis-or scarring-in the pleural cavity. 

2) COQ10 is needed for heart health. Myrna received 200mg a day of Nature Made COQ10 which I mixed into her food after piercing the gel cap and squeezing out the oil.  I administered it this way for four years before adding it to the mixture for kidney support (see notes below.)  COQ10 improved her heart function.

3) Potassium is necessary for kidney, heart, and overall health. Being hyper (too high) or hypokalemia (too low) in potassium can often cause the same symptoms-lethargy, nervousness, vomiting, etc.  Potassium is mobilized to run the heart and is needed to create strong kidneys. The kidneys run the diuresis process and when a cat is on lasix, the cat needs more potassium. Diuretics promote excretion of fluid but in the fluid are electrolytes the body needs to properly function. One of these electrolytes is potassium.  A potassium supplement must always be given when the cat is on lasix and increased as the need for a diuretic increases. Myrna received four or more tabs a day of 595mg tabs of Sundown Potassium Gluconate that were cut into pieces and given by mouth.  We also tried to give her some of the 485mg tabs of Tumil-k potassium a day. But then her potassium level decreased and we resumed using Sundown.  In the summer of 2015, we began to also use Renal K powder in her food which worked when she was eating; or Renal K gel by mouth when she wasn’t eating.  I had also previously mixed a bit of banana into her food. When she stopped eating bananas, I mixed in sweet potato baby food until I began to use that as the base for the kidney support mixture. (See note below.) 

4) She received an inch of Petco cat vitamin gel.  (No link available.) A cat on diuretics loses electrolytes in the fluid that is excreted. Those are: magnesium, potassium, sodium, glucose, chloride, bicarb. A good overall vitamin paste will help get the nutrients it needs. A normally healthy cat should be able to get the nutrients it needs by eating regular cat food. But this is not the case for a cat on medications and diuretics.

5) She received one ml a day of Viralys brand lysine, an amino acid, to help fight the herpes virus she was exposed to as a kitten.  It is also good for the heart.   

5) To improve kidney function, to decrease BUN and creatinine, (two links about improving kidneys as they decline) I created a mixture that I gave to Myrna by mouth three times a day of one 3ml syringe.  This was a mixture of vitamins and supplements that she would not eat when mixed into her food and was easier to administer when mixed together as a solution. This recipe is per day. If you mix up more than one day's worth at a time, then multiple these amounts by number of days: one Solgar 100mg vitamin E oil, (any vitamin E you can pierce and that you trust will work); one Nature Made 200mg COQ10 (or any COQ10 you prefer); 2 tsp (or 10ml) of Gerber Baby's First Foods Sweet Potatoes;1/2 ml of water; a smidge of Halo vitamin C for cats; and some drops of Sundown Krill oil.  All gel caps were pierced and squeezed into a container, mixed, and syringed, and given orally. Later, I added in the dry Renal k powder. I found it easier if I mixed dry powders first, then added the water and mixed to dissolve, then added the baby food, then added the pierced gels and oils. Mix well each time you administer the solution.

6) She received 1/2 of a 500mg Nature Made B12 a day. Use any good B12 you trust. Vets often recommend injecting B12 but Myrna had issues with injections due to lesions.

7) She received 1/2 of a 325mg Nature Made Iron three times a day and I believe this was key to improving her kidneys once she was on Torsemide.  Torsemide is an incredibly strong diuretic but very difficult for the kidneys to handle. I believe that her kidney values remained stable after she began taking iron in the fall of 2014. But it creates a messy bowel movement. You may need to adjust the dose based on if it causes diarrhea or not; may also cause constipation. Give extra water by mouth if it causes constipation; decrease dose or use rice or bananas or rice water to stop diarrhea. 

8) She received 1/4 of a 250mg Nature Made magnesium twice a week.

For stomach issues I tried giving her 1ml of club soda twice a day.  Then I tried 1ml of apple cider vinegar, cut with water, by mouth each day. (Apple cider helps with both digestion/stomach acid and helps the kidneys.)  This worked until September 2014 when I had to switch to 1/4 a day of Pepcid because the stomach acid became too much for her to handle.  She began not eating well and had some vomiting issues. 

What About Pain Meds?

If your cat needs a pain medication, Buprenex or Valium are safe choices depending on the cat's heart health.  All other medications may not be safe because they may lower the breathing rate too far.   Cats with poor hearts cannot tolerate typical surgical anesthesia.  If your cat needs surgery, discuss with the cardiologist what the cat may be able to tolerate before proceeding with any surgery. 

Remember-HCM cats CANNOT have any form of steroids.