Hi Tony,
As you know, my new vet gave me a week's supply of Mirtazapine for Graham and the result has been nothing short of miraculous! Previously, I had trouble getting Graham to eat one meal a day and he very often didn't finish it. Since the first day on Mirtazapine his appetite has been remarkable. He will eat four small meals a day now and never leaves anything in his bowl.
My question is - is this drug something he can stay on for ever, or is it only used short-term?
Graham had blood tests yesterday and the vet is going to phone me with the results, maybe tomorrow. I will ask him about the Mirtazapine but I wanted your opinion first.
Thanks Tony,
Hi Betty.
That's such great news. I'm delighted in Graham's response to the Mirtazapine. Getting him to eat better is half the battle won ... getting the numbers to come down may take a while longer, but this is a terrific step forward.
Dogs can usually stay on Mirtazapine long-term for conditions like kidney failure and inappetence associated with it. However, like all drugs, it does have side effects and it can affect both the kidneys and neurological systems over time. It is worth re-assessing whether the drug is needed at intervals - obviously, withdrawal needs to be done under vet supervision, as there are withdrawal effects that need to be avoided. Tapering (slow withdrawal) is always advised. After two or three weeks of being off the drug, the original symptoms may return - and in this case re-starting the drug is important as soon as possible.
It may not surprise you to know that most dogs with kidney disease simply don't survive long enough for there to be many problems with Mirtazapine long term. Some dogs can have allergic side effects, and these are worth learning about, just in case.
Tony
Graham had the Mirtazapine daily for seven days, then the vet advised to give every other day and gradually space it out, He had his last one on Saturday and still ate all his meals yesterday and one this morning.
There is a problem though, which I would like to ask you about.
I've noticed that Graham is 'wobbly', I can't think of a different way to describe it. It's mainly while he is standing still. Could this be a side-effect of the drug?
I haven't given him any Mirtazapine today.
Hi Betty. It could be the Mirtazapine - or the withdrawal of it - in which case the effects will wear off very quickly. But it could also be the start of muscle wastage or neurological problems associated with kidney disease. These are two big symptoms worthy of talking to your vet about - along with new blood testing to see if there are any significant changes that may account for it. I'd give the withdrawal effects time to subside and in 3 or 4 days time check again to see if he is still exhibiting this symptom.
Tony
Thanks Tony,
I haven't given him a tablet today and he is still eating.
Should I wait until he loses his appetite before giving him another one?
I did put a copy of his latest blood test (last Monday) on the Facebook page but maybe you didn't see it.
Betty
The usual withdrawal regime is to halve the dose each week, if possible. Eventually this can be done on alternate days and then every 3 days and then every 4 until it can be stopped completely. Take your vet's advice on how best to achieve this as it may mean a change in the dosage of tablets being given. This will help prevent all withdrawal effects. If poor eating starts again, then the Mirtazapine can recommence.