• Remeron
• Tablet, dissolvable tablet

What is Mirtazapine used for?
Mirtazapine is used to stimulate the appetite and prevent vomiting.

What is Mirtazapine?
Mirtazapine is a human antidepressant that works in the brain to increase norepinephrine and serotonin activity stimulating appetite centers in the brain as a side effect.

How is Mirtazapine given and what if a dose is missed?
Mirtazapine is typically prescribed for once daily dosing in dogs and a twice weekly dosing in cats. If a dose is missed and it is less than 12 hours late, go ahead and give missed dose. If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose. If using dissolvable tablet formulation, place it under the tongue and hold mouth shut for several seconds. Follow with a swallow of water.

Are there any common adverse effects with the use of Mirtazapine?
Reported side effects include increased vocalization and affection in cats, drowsiness, and elevated heart rate.

Who should not take Mirtazapine?
Use with caution in patients that have heart disease. Patients with liver or kidney disease may require a lower dose.

What drugs should not be given with Mirtazapine?
Mirtazapine should not be used in pets that have taken selegiline or amitraz in the last fourteen days. Use with care in patients taking tramadol or fluoxetine.

What follow up is necessary with Mirtazapine use?
Withdrawal signs with discontinuation of mirtazapine can occur in humans after longterm use.

• Metronidazole (generic)
• Flagyl (brand name)
• Tablets, Capsules, and Injectable

What is Metronidazole?
Metronidazole’s mechanism of action is not fully understood. Common uses include the treatment of Giardia, a variety of anaerobic bacteria including Clostridia, and in the treatment of intestinal inflammation/diarrhea. Metronidazole is also effective in the treatment of nervous system disease unlike many other antibiotics.

How is Metronidazole given and what if a dose is missed?
Metronidazole is typically prescribed for twice daily dosing. If a dose is missed and it is less than 12 hours late, go ahead and give missed dose. If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose. Metronidazole have a bitter somewhat unpleasant taste and may be easier to administer in capsule form.

How should Metronidazole be stored?
Store at room temperature and protected from light.

What side effects are associated with Metronidazole?
Metronidazole may cause nausea and vomiting in some dogs. Giving on a full stomach may help with these signs. Neurologic side effects (walking as if drunk, rapid eye movements, depression, seizures) can occur in particular with higher doses or longer duration therapy. Some cats will develop a fever in response to metronidazole therapy. Animals with liver disease may require dose reduction when being given metronidazole.

What drugs should not be given with Metronidazole?
Efficacy of metronidazole may be effected by concurrent use of phenobarbital.

What follow up is necessary with Metronidazole use?
Medication should be used for some time after signs of illness or disease are gone. Notify us if a refill is necessary.

• Cerenia
• Tablets and Injectable

What is Cerenia used for?

Cerenia is labeled for the treatment and prevention of vomiting and motion sickness. Recently Cerenia has also been found to be effective in treating a variety of inflammatory diseases and in the management of pain.

What is Cerenia?
Cerenia works in the brain by blocking Substance P, a neurotransmitter involved in vomiting. It also has some effect on small intestine contractions and inflammation peripherally.

How is Cerenia given and what if a dose is missed?
Cerenia is typically prescribed for once daily dosing. If a dose is missed and it is less than 12 hours late, go ahead and give missed dose. If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose. After use for five days a two day rest period is required before redosing Cerenia. While giving with a small amount of food is recommended, avoid giving with treats that are fatty as this may affect efficacy. Cerenia works on average within one hour of administration.

Are there any common adverse effects with the use of Cerenia?
Drooling, loss of appetite, diarrhea, and sedation may be seen at higher doses. Pain at site of injection is seen in some patients.

Who should not take Cerenia?
Caution should be used in patients with liver disease or puppies younger than 11 weeks of age.

What drugs should not be given with Cerenia?
Side effects may be more common when used in conjunction with phenobarbital, thyroid hormone, and non-steroidal anti-inflammatories.

What follow up is necessary with Cerenia use?
No specific follow up is necessary with the use of Cerenia.

• Neurontin and generic
• Tablets, Capsules
• Do not use human oral solution in pets as it contains xylitol (toxic in dogs)

What is gabapentin used for?
Gabapentin is used for the treatment of pain in dogs and cats. While not good for sudden or acute pain, gabapentin is often prescribed to preempt pain or to treat general signs of chronic pain such as arthritis. Gabapentin can also be used in the treatment of refractory seizures.

What is gabapentin?
Gabapentin’s method of action is not truly understood but it is believed to be related to blockage of pain directly at the nerve cell.

How is gabapentin given and what if a dose is missed?
Gabapentin is prescribed to be used typically every twelve hours but as often as every six hours. Tolerance may develop over time necessitating dose increases. The safe dose range is quite wide and therefore the latitude in dosing interval is wide. If a dose is missed, go ahead and give the missed dose. Use should not be abruptly stopped if gabapentin has been used for a long period.

What side effects are associated with gabapentin?
The most common side effect of gabapentin is drowsiness. Some may notice ataxia similar to what is seen in inebriated individuals. Often these signs will improve over time. Urine testing for protein may be affected by gabapentin use.

What drugs should not be given with gabapentin?
Caution should be used when using gabapentin in conjunction morphine or hydrocodone. Antacids may affect the absorption of gabapentin, allow two hours between use of these drugs simultaneously.

What pets should not take gabapentin?
Caution should be taken in using gabapentin in patients with kidney disease.

What follow up is necessary with gabapentin use?
Dosing is variable for gabapentin, if benefits are not observed at a particular dose, consult with Dr. Burgess for further recommendations.

Fenbendazole (Panacur)

Fenbendazole

Antiparasitic
(Panacur)
By Dr. Karen Burgess

• Fenbendazole (generic formula)
• Panacur (brand name animal formula)
• Powder, Liquid

What is Panacur?
Fenbendazole is an antiparasitic known for its efficacy against roundworms, hookworms, lungworm, flukes, Giardia, and tapeworm.

How is fenbendazole given?
Fenbendazole is typically prescribed daily for three to five consecutive days.

How should fenbendazole be stored?
Store at room temperature.

What side effects are associated with fenbendazole?
Vomiting, diarrhea, and excessive salivation may be associated with the use of fenbendazole.

What drugs should not be given with fenbendazole?
There are no specific drug interactions of major concern.

What follow up is necessary with fenbendazole use?
Follow up dosing may be recommended. Prevention of future re-exposure is recommended via monthly heartworm preventative administration. Follow up fecal examination is recommended a week after treatment is completed.