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Improving appetite and nausea control in cats with chronic kidney disease

Quimby JM, Lunn KF. Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: A masked placebo-controlled crossover clinical trial. Vet J. 2013 Sep; 197(3):651-655. 

One common condition in elderly cats is chronic kidney disease (CKD). At least 30% of the population is affected by 15 years of age.  Medical management is an important part of treatment and one goal of treatment is to help improve the quality of life in cat patients. In the area of improving quality of life, treatments that focus on nausea and appetite are most beneficial because nutrition affects prognosis. Studies have shown that a poor body condition score is correlated with decreased survival. Mirtazpazine has been utilized in veterinary patients due to its significant beneficial side effects, primarily its anti-nausea, anti-emetic, and appetite stimulating properties.

A previous study (W08-020) funded by the Winn Feline Foundation on the pharmacodynamic and pharmacokinetic aspects of mirtazapine demonstrated the appetite stimulating properties of mirtazapine and also determined the appropriate dose rates and intervals for cats that are healthy and cats with CKD. The investigators in that study followed with this placebo-controlled, double-masked crossover clinical trial to evaluate the effects mirtazapine on bodyweight, appetite, and vomiting in cats with CKD. In a randomized trial, eleven cats with stable CKD received 1.88 mg mirtazapine or placebo orally every other day for three weeks. Weight gain was noted in 91% of the cats with CKD during the mirtazapine phase, while 82% of the cats lost weight during the placebo phase. The appetite score and activity score were both significantly increased when the cats received mirtazapine. The appetite score was found to be increased in 91% of cats and the activity score was increased in 55%. A statistically significant decrease in vomiting was also noted.

The authors concluded that mirtazapine is an effective appetite stimulant and anti-emetic for cats with CKD. Mirtazapine can aid in the nutritional management of these cases and, therefore, potentially improve their quality of life. (VT)

See also:
Quimby JM, Gustafson DL, Lunn KF. The pharmacokinetics of mirtazapine in cats with chronic kidney disease and in age-matched control cats. J Vet Intern Med. 2011 Sep-Oct; 25(5):985-989.