Possible Vidalta side-effects?

[jensuz]

Great to have your advice, Kay and Nicky, really appreciated.

Presently my instincts are to continue with the 2.5 mg and post the results of the blood test in three weeks.  Don't think the vet will be
very happy with this decision though so may keep it to myself and just get the result for advice on the forum again.

Kay: The advice given by the vet to increase dose to 5 mg was due to the fact that, as you've advised, fluctuations are caused in levels if not
given twice during the day so will try the 1.25 mg twice a day.   

Nicola: Regarding the scratching, this has started since Felimazole and is in the area where Flo had matted fur and got the fur out
herself gradually by persistent tugging.  It is sore and weeping at times and she nibbles at it.  Think it's mainly an irritation from
her pulling out the matted fur so may not be linked to the medication.

Thank you again, so much feel better for being able to discuss on this forum.

  Flossie and Jenny xx

[Nicola (RockysMum)]

It’s a great sign that she’s gaining weight. But as well as the signs you’re seeing, getting bloods done would tell you exactly what’s going on with her thyroid. If you’re continuing on the 2.5mg a day I would be asking for blood tests in the next few weeks just to keep an eye on things.

Re. her skin problems. Did this start after she went on the drug? Or before?

My Bailey scratched away all the hair round his neck before he was diagnosed with hyperT and would pull it out in clumps. It stopped as soon as he went on felimazole and his levels came down, so that can be a symptom of the hyperthyroidism

I’m just trying to figure out whether it’s a side effect of the HyperT or if it’s the meds causing it.

You mentioned her heart rate being up. That’s the big concern with this condition. It might be worth talking to your vet about medication for the heart if you’re keeping her on the lower dose of felimazole. I had Bailey on Atenolol short term for his heart until we could get him stabilised. It made a big difference for him.

Really glad she is doing OK and hope she continues to improve.

I’ve been lucky that with two of mine on felimazole I never had any problems – other than, like you, trying to find the right dose!

[Kay and Penny]

I'm sorry, but to double the dose when she is putting on weight, and seemingly more like herself, makes no sense at all - especially when her skin irritation may well be a side effect of the Felimazole

are you giving 2.5mg in one dose? it is better to cut the pills and give a half twice a day, as they work best if the dosage is kept even through 24 hours - personally I would not increase the dose just because her heart rate is high, as that could simply be down to the stress of a vet visit

I'd carry on with 2.5mg a day, preferably in two doses of 1.25mg, and monitor her weight yourself until you go back for the next vet visit

pity vets don't apparently do the research on feline HT that we can do at the flick of a cursor - but whatever you are told, you are the world expert on Flossie, and you should trust your own feelings about how she is doing

[Gill (sneakiefeline)]

Hope her weight keeps on going up 

[jensuz]

Really appreciate your thoughts.  I made the decision not to go ahead with the blood test as felt would then only have to put Flo
through one again after having the 5 mg for the three weeks.  She has actually put on a little weight, is now 2.35 kg having been
2.25 kg last time weighed.  Jenny and Flossie xx

[Gill (sneakiefeline)]

My thought is take control of your vet and tell him;her what you want.........if you want a blood test tell them!

They can recommend but you are the one that decides........yes or no, what they say is not obligatory on you 

[jensuz]

Hi Everyone,

Flossie has had vets appointment this morning. The vet decided not to do a blood test as I haven't been giving Flo 5 mg (only 2.5 mg per day), although suggested by vet to give her 5 mg.  It has been suggested to try her with 5 mg per day and the blood test will be done in three weeks.  Her heart is still beating very fast and a murmur can be detected.  Slightly off subject, Synulox 50 mg to be given at half a tablet twice daily has been also
prescribed  as Flo has been itching skin where fur was matted and is now gradually regrowing after she tugged it all out over a period of
several days.  Should anyone have experience of this medication, please could you respond.  I am doing my own research so if any
specific detail I think of interest to know, I will post.  Very best wishes, Jenny and  Flossie xx 

[jensuz]

Kay, Thanks a lot for the advice and I've now applied to join the Yahoo group.  Very best wishes, Jenny and  Flossie

[Kay and Penny]

I'd wait until the new results are in, to be  honest, as high T4 - and hers was high - can play havoc with other readings

now the T4 has, it would seem, come right down, any abnormal levels will be more significant - but it's something your vet should be able to advise you about - and posting the results on the Yahoo group for Hyper cats will get you some expert opinions from those who have been there and done that

[jensuz]

Hi Everyone,
Just wanted to update to present with Flossie and ask for advice re. blood tests.  Flossie started on Felimazole in mid October and has so far responded well to the 2.5 mg per day.  The vet had suggested 5 mg but I have kept to lowest dose so far and she is much improved.  We have another appointment with vet on Monday and I now have the results from previous vet.  These mean nothing to me and I would much appreciate advice regarding any information which can be gathered from same.  I believe at the moment it is intended to do another blood test on Monday.  The results are: alkp 187 HIGH(14-111) alt 715 (12-130) urea 14.7 (5.7-12.9) tt4 >90. Also states at another note-in house test: 90 nmol/L. Hope all well with all cats and their humans.  Flossie and Jenny

[Kay and Penny]

I see Jenny, who is based in the UK, has answered you, Ellarose

as all I know came from that site, I shall leave you in their capable hands

and now a response from Forrest, who is THE expert on there

[ellarose]

Hello Kay

Yes I have sent all the info to the Yahoo site and will be interested to see what they say. Thank you for pointing me in the right direction. With all the help and advice I have been given I am very hopeful I will be able to do the right thing for Dot Dot.

  ellarose

[Kay and Penny]

did you join the Yahoo Group, EllaRose?

if yes, I would ask what the advice is as to how long to wait before starting the Felimazole, basically giving the same info as in your post below - the most expert members are in the US, so you won't get an instant answer, but you should hear within 24 hours - ideally Dotdot should have another blood test in a couple of weeks, but it's not very fair on her to keep repeating what is a very uncomfortable experience (though I have to say my Trigger tolerates it very well after having had it done eight times)

and whatever the advice given by the Yahoo group,  I guarantee it will be sounder, and based on far more experience, than your vet can offer

[ellarose]

Hi Rosella
I was hoping to be able to say I had got Dot sorted out but can't.

After phoning surgery and receptionist telling me to stop medication I waited for the vet to ring back and explain. No phone call.
Phoned again this morning to see perhaps if there was a message...no message and no one knew what I was talking about....a vet would ring back ....no phone call. The vets are closed for the weekend now so won't be able to do anything until Monday.

Dot is comfortable and eating so will just wait until Monday, try phoning again and if no luck will go to the surgery myself.

I obviously have to change vets as this one is useless. Given half a chance they will kill poor Dot Dot. She is old but not ready to go yet and I won't have them hurry her on.

Facts: her T4 level is now 9.27 after three weeks on  Vidalta 10mg daily when it was 62.50 (range 13.00 - 50.00). I am then told to give her 2.5mg Felimazole twice a day. Common sense makes me ask why try to get the level down even more when she is now hypo? Or have I missed something?

I'm not doing her any harm am I?  I hate taking things into my own hands when I am paying a professional but knowing what a mess doctors can make of thyroid problems and how I've had to go it alone so many times to get good results then I feel I should do the same for Dot.
  ellarose

[Rosella moggy]

Am glad you have been told to stop the meds altogether. 

I read or was told that "normal" T4 range is lower for older cats.  You might want to query if that is true with vet.  The fact that Dot is lethargic though certainly points towards Hypo.   

If Dot shared our home, I would stop meds for maybe a week and try to get my hands on some 1.25mg pills and get money back for the ones prescribed so far.  If they don't have in stock (only recently made available), they can order but you can just contact manufacturers and ask for details of where you can buy them.  Your vet will of course need to give you a prescription though.  It's not fair that you should have to go through all this when you will already be so worried about Dot 

The matted fur which Flossie has they have stated will not be included on the HT claim as it isn't related ..........

Your vets are beginning to irritate me.  "A poor and unkempt hair coat" is certainly one of the more obvious symptoms of HyperT to Joe Public and I have little doubt this is what lead to her matted fur    Another link for you from a safe source of info.  http://www.icatcare.org/advice-centre/cat-health/hyperthyroidism-overactive-thyroid-gland

Actually I have gone back to your original post and I am not clear on Dot's original symptoms that led vet to test her initially for HyperT. 

Also was it just a T4 tests or was she also tested for kidneys, liver, diabetes etc.   I think some vets refer to it as a geriatric profile.

[ellarose]

That's it!  I've phoned the vet. Can't get in touch with one but have explained my worries to the receptionist who seems to know what I was talking about. She told me to "Stop the medication!" and she would discuss it with a vet and get back to me.

Thanks for the support on here, you stopped me dithering and hopefully will get a good result for Dot. If I hadn't asked for the results as you all suggested I would never have known what was going on.

The "cat fairy" obviously led me to this site!

Will let you know how I get on.
ellarose

[LouiseJ]

Ellarose
You know what it is like to be hypo and how sometimes you are have exaggerated symptoms no matter what you are told about optimal medication?
You also know Dot Dot better than anyone else in the world.
I would apply your knowledge here with Kay's advice and treat Dot Dot gradually and yes weight will play a part in her level of medication.
There is no one size fits all to this.
People respond to the various drugs differently so there is no reason why cats wouldn't.
I would go with Kay's suggestion and build her up slowly.
The difference in the tablets as I understand it is that Vidalta is slow release meaning just the one daily tablet is required but thyroid hormones fluctuate during the day (they are highest at night).
Just like Levo, Armour or anything else you might be taking, sometime a split dose works better (which reminds me!!).
Hope that helps. I'm not the cat hyper expert on here but I do know a bit about human hypo.

[Kay and Penny]

I'm afraid I don't think they have much idea at all about the proper treatment for Dot - being hyper gives some support to failing kidneys, and reversing it so quickly risks causing total kidney failure - to overdose her like that shows a very high degree of ignorance of the condition, in my opinion

if you posted her levels on the Yahoo group they would be begging you not to medicate at all until the level had come up, and certainly not at 5mg a day - I don't feel I have their expertise to say that myself, as I understand it is so difficult to go against your vet

lethargy is the first sign of overdose, but at Dot's age she isn't going to be particularly lively, so it's a difficult one - go by your gut instinct, I'd say, whatever anyone, including the vet, says - keeping her as well as possible is the main aim,  and you are the best placed to achieve it

I haven't researched the difference in the medications - I think they are based on the same drug, but Vidalta was formulated for animals, and Felimazole, which is the same as the Methimazole used to treat overactive thyroid in humans, was licensed later for veterinary use, which is why some older vets stick with the Vidalta they first started to prescribe

[ellarose]

Thanks for the quick reply Kay.

Can you explain the difference between the two medications?

Seems strange that Dot's levels are so low and still they are pumping  medication in to her that lowers it even further.  I suppose they know what they are doing?  I have to admit don't have faith in either doctor or vet regarding thyroid.

Think I have to stick it out for the two weeks and do as I am told...watch her like a hawk and decrease the medication only if she seems under any type of stress.  After that I will feel I am entitled to have an opinion and let it loose!

The next set of blood tests will tell all.
They haven't taken her weight into consideration or her great age (19) and I'm sure it's relevant.

ellarose

[Kay and Penny]

no wonder she reacted so badly - that is a huge drop in thyroid level in a short space of time

personally I wouldn't hesitate to halve that Felimazole dose, as she needs her level to go up at the moment, and she seems to be sensitive to drugs

my Trigger, weighing twice as much, came down from 60 to 45 after 4 weeks on 1.25mg Felimazle twice a day, and my vet, and the clinic offering the radioactive iodine treatment,  were satisfied with that drop

and he never had the slightest sign of any side effects 

[ellarose]

Have had results of both Dot's blood tests.
the story so far. She presented feeling terrible and the first blood test results were:
 24th Sept 2013 Total T4 = 62.50  nmol/L  Normal Range   13.00 - 50.00   H        so she was hyper but not desperately so.

She was given Vidalta 10 mg and was not well on it at all.  In spite of instructions I crushed tablets and gave some to her twice a day which improved things. At least she didn't seem ill.

After three weeks  the second blood test results:

16th October 2013  Total T4 = 9.27 (see above for range etc) So now she's hypo! They have changed her medication to Felimazole 2.5 mg twice daily (thanks to your advice on here...I asked if they would change it)  I have been warned about crushing tablets...rubber gloves etc.

Dot weighs less than 2.5 kilos although I have managed to put a few ounces on her. I wonder if she is still being given too much but suppose must do as I am told (I'm being very good so far)
 
Would appreciate comments from those with more experience please.
Have been given 2 weeks pills and then she will have another blood test. This is a fair test of how she will react to it I suppose.

  ellarose

[Sue P (Paddysmum)]

Paddy was hyper-T in his latter years, and he was a semi-longhair.  He used to get mats round his rear legs and tummy, some of which we had to cut out, as they were too bad to comb out, which he found painful as he got older.   He was still self grooming, so we suspected it was a side effect ofthe Hyper T, if that helps?

[Kay and Penny]

lethargy can indeed suggest a too high a dose, causing a hypo, but this would go back to the giving of the Vidalta, as it wouldn't come on that quickly

as she too is very light I'd suggest cutting the pills in half - too low a dose does a lot less harm than too high a one, and I suspect 2.5mg altogether, in two 1.25mg doses, is the way to go initially

HT does affect the coat, making it look unkempt and spiky - not sure it would cause mats, but if your vet will say it is a side effect surely the insurance would accept that

[jensuz]

Hi All, Just following on from recent posts.  Could anyone advise if lethargy is a sign to be concerned about when first taking Felimazole.  Flossie has only started 2.5 mg today and had one tablet.  Although vet has prescribed 2 x 2.5 mg per day, I am concerned to not over medicate as she is so tiny (only 2.25 kg).  Will be able to write with more info when have blood tests and, Rosella moggy, thanks a lot for advice posted to also have kidneys results.  Also, another query has come up since writing to previous vets for details for insurance claim.  The matted fur which Flossie has they have stated will not be included on the HT claim as it isn't related and therefore wouldn't get any help with this cost (£65) as it is below excess level if claimed as separate treatment.  However, I have read that this is a symptom of HT.  I am intending to query and would much appreciate if anyone has any detailed research knowledge in this respect.      Flossie and Jenny

[Rosella moggy]

it's really important you know the thyroid level, as if it is not much above the top of the norm, it would be better to start her on half that dose of Felimazole, to see how she goes, given that she is such a small cat

I have to say that, whilst I am very much prone to acquiescing like a lamb to vets usually (coz ya know they "did the time" so to speak), I would stand my ground on this and have to agree with Kay. Surely it makes sense that size of cat and level of blood results are what must direct the dosage 

Thanks heavens our vet puts up with my constant queries.  Apparently, when OH went to collect our darling Ruby after her dental last week (in my absence in Ireland), he and our lovely vet discussed how I have a tendency to question them both.  As if!   

Given past experience, I would always insist on seeing blood results for HyperT and kidneys.  I'm a numbers kinda gal.  They make more sense to me than someone else's description of how mild/severe it might be; given that most results give "normal" parameters to compare.

[Sue P (Paddysmum)]

Provided you've paid for the blood tests you're entitled to disclosure of the results.

[Kay and Penny]

I have asked for blood test results at two different surgeries and had no problems at all

it's really important you know the thyroid level, as if it is not much above the top of the norm, it would be better to start her on half that dose of Felimazole, to see how she goes, given that she is such a small cat

[jensuz]

Hi Ellarose, We do very much seem to be on the same path with the treatment for Dot Dot and Flossie.  I have asked for blood test results from the previous vet to be requested by the new vet and I will also request them direct so hopefully should get hold of them one way or the other.  I'm uncertain of the situation regarding the right to have them but would definitely think we do have.  If you do have any problems do post and I'll try to research further.  Hopefully, someone else on the forum may have an opinion on this too.   Wishing you well for tomorrow and keep me posted re. Dot Dot.  Flossie and Jenny 

[ellarose]

Hi Jenny
I seem to be in a similar predicament to you. The result of Dot's blood test was that she is being over medicated and I have to collect Felimazole 2.5 x2 per day tomorrow. This means Vidalta was not for her.  Spreading it out over the day had been better for her but it was still too much. I have asked to collect blood test results when I collect pills tomorrow. There was some umming and ahhing on the telephone but I will make sure I don't leave without them.  The amount this is all costing means I feel entitled to have the results to hand.
Do you know if they can refuse me?  I have to take her back in 2 weeks for another blood test and then hope we can have a bit of a rest from vets for a while if she gets to a decent level.

Tomorrow I'm off to the doctor to have my thyroid blood test....all part of the fun lol!
ellarose

[jensuz]

Thanks, Kay for your message.  That's the problem also with Flossie at the moment. as she is a tiny cat the thyroid can't be felt.  Shall keep posting with any updates.  1st Felimazole tablet happily taken mixed with Sheba, so that's a relief.  Take care Flossie and Jenny

[Kay and Penny]

the problem with thyroid surgery is that there can be ectopic tissue elsewhere, which simply kicks in if the main gland(s) - there are two of them -  is removed - if the enlarged gland(s) can be easily felt then surgery might be successful  - it was never an option for my Trigger, as although he is naturally skinny several vets couldn't feel his thyroid at all

[jensuz]

Thanks, Liz for info.  Flossie and Jenny

[Liz]

Our Max had his thyroid removed but a small part was in operable so 18 months after the op his symptoms were back so he is on Vitalda 20mg a day and Clio feral due to her nature at times is keeping hers and on 15mg a day

[jensuz]

Hi Everyone, Flossie has had a much better experience at the new vets this morning She has been prescribed 2.5 mg Felimazole to be taken twice a day for three weeks and see how her symptoms are during this time.  Did ask re. blood test details from previous vet and apparently it only says 'high' for HT on consultation details so going to request actual blood test results now.  Vet did put to me the option of having thyroid removed if she stabilises.   Any experience of this anyone may have would be much appreciated. Anyway shall keep updating and take care all. Flossie and Jenny

[jensuz]

Hello everyone, Going to another vets for second opinion this morning.  Will post how it goes later.  Very best wishes all Flossie and Jenny xx

[ellarose]

Thank you Kay I have joined. Just waiting to be accepted. I gave" Purrs in our hearts"  as a reference!

  ellarose

[Kay and Penny]

did you see my earlier link to the Yahoo group? http://pets.groups.yahoo.com/group/feline-hyperT/

joining that group is particularly worthwhile for owners whose cats are not coping well with HT medication, or have more than one medical problem

[ellarose]

Ha ha! thanks for you reply Rosella...how strange with the name. It's actually my first grandaughter's first and second names put together. Always use on Internet or I forget who I am!
Yes am starting to feel very familiar with this thyroid problem having had the same troubles myself, and a decent doctor/vet is as important as the medication itself. I am obviously in the hands of a novice vet at the moment and get passed from one to the other and they never seem to READ UP THE NOTES before a consultation so unless I know what is going on they have no idea (I even had to ask her to weigh Dot, so important for such a frail little animal)  I think I have scared the pants off the latst one with my questions so no doubt will have a note on Dot's record "BEWARE OF KNOW-ALL OWNER!" They will be drawing straws for who takes me on soon lol!

I will do my research as I have done for myself and have so much help on here from kind cat lovers which makes it so much easier.
I am 100 % sure that Dot was very over medicated with the Vidalta but the blood test will tell me exactly what is going on and, after I asked...and the baby vet had read the instructions on the medication (can you believe that?) then I have been told I may have the Felimazole, which I will certainly try. Must be patient now and just wait.
For the past two days I have crushed one 15 mg tablet up and given it to her three times during the day. She is fine on that so I am very hopeful. Am being careful and use rubber gloves...it's quite an operation but Dot is worth it.
  ellarose

[Rosella moggy]

I think your name is back to front Ellarose or perhaps it's me   

There is another thread atm on Felimazole.  Here it is.

http://www.purrsinourhearts.co.uk/index.php/topic,43793.0.html

I posted the link to the NOAH fact sheet for Felimazole there but do so again here for ease and also for Vidalta.  Use the "previous" and "next" arrow keys to move through the factsheets.

http://www.noahcompendium.co.uk/Dechra_Veterinary_Products_Ltd/Felimazole_ACY-reg_ADs-_Coated_Tablets_for_Cats/-40419.html

http://www.noahcompendium.co.uk/MSD_Animal_Health/Vidalta_10_mg__ACY-amp_ADs-_15_mg_prolonged-release_tablets_for_cats/-58685.html

I think the general consensus seems to be start off with low doses if blood tests indicate it is safe to do so. The idea is to let the body adjust to the meds and slowly increase as dictated by blood tests until they settle within normal range.   It can take a while with some cats.  Naturally if a cat has very high results, the vet is likely to suggest a higher starting dose.   

Felimazole now do tabs as low as 1.25mg so much easier to adjust dosage with Felimazole which is usually twice a day meds.  Not so easy with Vidalta which is a once a day slower release med.

Sending every good wish to Dot Dot 

[jensuz]

Hi Ellarose, Glad consultation went well, makes all the difference to anxiety levels!  Shall be here for blood test results. In the meantime, very best wishes to you and Dot Dot.