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The failure of oral stomach acid suppressants in cats

MT18-004.   Comparative analysis of the effect of orally administered acid suppressants on gastric pH in cats. (A Winn- funded final research grant progress report)

Principal Investigators: M. Katherine Tolbert, DVM, PhD, DACVIM; Texas A&M University; Adesola Odunayo, DVM, MS, DACVECC; University of Tennessee

A sustained increase in stomach pH is central to the successful treatment of esophageal, stomach, and intestinal ulcers in cats. Thus, drugs that suppress the production of stomach acid, such as proton pump inhibitors (PPI; e.g. omeprazole, prilosec) and histamine-2 receptor antagonists (e.g. famotidine, pepcid) are commonly prescribed.

The requirement for frequent administration and the need to give omeprazole before a meal in cats likely leads to disruption of the human-animal bond, inability to consistently get the medication into the cat, and treatment failure. Thus, veterinarians are increasingly prescribing newer PPIs that are longer acting and can be given with food. The efficacy of these novel drugs has heretofore not been comparatively evaluated and described.

Accordingly, the investigators central objective was to evaluate the efficacy of these newer orally administered drugs, including esomeprazole, lansoprazole, and dexlansoprazole, in helping to decrease stomach acidity in cats. In this study, they determined that these newer PPIs do not perform as well in cats as they do in dogs or humans. Indeed, only esomeprazole achieved the pH goal for the treatment of stomach and intestinal ulcers and this effect was not observed until treatment day 4. The difference between cats and dogs in their response to oral acid suppressants might be explained by differences in feline GI pH and motility and their impact on drug delivery.

Their results highlight the need for veterinary clinician scientists and pharmaceutical companies to explore and design drugs such as acid suppressants specifically for use in cats.

Publication: A manuscript has been prepared and submitted for publication.

See also:

Marks SL, Kook PH, et al.  ACVIM Consensus Statement: Support for Rational Administration of Gastrointestinal Protectants to Dogs and Cats. J Vet Intern Med. 2018 Nov;32(6):1823-1840.