Medications for Cats with Heart Disease

For more information regarding the following medications, and Wikipedia and PetMD are just some excellent online resources.  Each medicine and supplement discussed below is linked to a page of information.  Feel free to search the above sites for additional information.

Medications can be purchased either at a regular pharmacy-Target and Kroger offer $4.00 generics for many of those listed below-or from the vet (but usually more expensive than a regular pharmacy), and at online pet pharmacies such as Road Runner.  Call your local pharmacy and shop online to compare prices and to find what is affordable and convenient for you.

*Please remember that cats with heart disease cannot have any form of steroid medication.
**For a complete and updated list of what Myrna takes, please refer to the Med tab at the blog "Cat Living with Hypertrophiccardiomyopathy".

Medications Our Cats Take

These following meds (other than Valium) are what you should consider for your heart diseased/HCM cat.  Our cat with HCM-hypertrophic cardiomyopathy-is Myrna Loy.  Cooper has Moderator Band Cardiomyopathy.  Depending on the extent of the heart disease, a cat may not need every medication which they receive.  They may receive something such as lasix and atenolol at first, then have others added as the disease progresses or as symptoms appear.    

1)  Myrna takes Valium four times a day for a total of almost 2 mg.
     Cooper takes Valium three times a day for a total of 1.25mg.

Valium is used by Myrna and Cooper for litter box use and can be safely used by heart diseased cats to help solve any anxiety issues and is safe for heart diseased cats as long as the cat can tolerate it.   It is the only medication that as far as studies have shown, is not contraindicated with Plavix.  A cat on Plavix should not take psychotropics such as Prozac or stomach medications such as Prilosec.  The FDA issued a warning a few years ago that psychotropics and anti-acid stomach medications interfere with the blood clotting properties of Plavix.  A cat with heart disease needs to take Plavix to prevent clots from forming. 

2)  Myrna takes baby buffered aspirin 81 mg once a day on Wednesdays and Saturdays         because, in general, cats cannot take and tolerate aspirin well.  

Blood tests continue to show she tolerates aspirin well.  Your cat may or may not be able to tolerate aspirin and blood work is needed constantly at first to monitor liver and kidney function.   If the cat begins to vomit each time you give aspirin, then the aspirin needs to be stopped.  And of course, any time a new med is introduced and your cat begins to have stomach upsets, it might be the new med and the cat needs to either be given time to adjust, or the med needs to be decreased until the regular dose can be tolerated (but only the vet can decide if this course of action), or the med suspended altogether.  Always discuss medication needs and changes with the vet.

3)  Myrna Loy and Cooper take 1/4 tab once a day of Plavix, the blood thinner, to prevent         clots.   

Thinner blood is also easier for the heart to circulate.  
An article that discusses how Plavix is contraindicated with stomach anti-acid meds and psychotropics. (The article is a few years old and is outdated regarding generic Plavix which does exist now in the U.S.)

4) Myrna receives 1/4 twice a day atenolol-beta blocker-which slows the heart rate, lowers the blood pressure which helps the heart not work so hard.  

5)  Myrna takes 1/2 tab twice a day of enalapril-an ACE inhibitor.  

It keeps veins opened and from being restricted, aids in reducing sodium retention and therefore fluid in the body, and thereby lowers blood pressure.  

6)  (Now on Torsemide as of 1/2015) Myrna takes lasix 15mg in the a.m., 13mg at 2 p.m., 15mg at 6:30 p.m., and 13mg at 11 p.m. 

      *As of May 2014, Cooper now takes Torsemide, a different type of loop diuretic.  He takes 2.5mg in the morning; 2.5 mg at 2 p.m.; 2.5 mg at 6:30 p.m.; and 2.5 at 11 p.m. depending on breathing rate.  We will inject lasix as needed.  We have had to inject .3-.4ml of lasix when lasix or torsemide was not enough to fight congestion.  But as of 5/30/14 Torsemide alone is working well for him.

Lasix-diuretic-a fluid reducer, therefore also aids in lowering blood pressure, helps the heart by having less fluid volume to circulate, prevents congestive heart failure and aids in getting rid of fluid if the cat develops CHF (it is more typical for cats to receive 5 mg twice a day but more will be needed as the disease progresses or as congestion becomes a constant problem.).   

We also tried injecting lasix into Myrna but had some difficulties with it which most cats do not.   It caused cutaneous skin lesions and the subsequent antibiotic used to clear them up caused severe diarrhea (although it solved the congestion issue we were fighting.)  We stopped injecting and increased the pill dose instead.  We have the supplies on hand for those times when we still need to inject lasix. When we inject, we first clean the skin with Chlorhexidine antiseptic pads for pets.  That has so far prevented lesions.  We have chosen to inject only when she is congested and an increase in the pill is not decreasing the congestion.   

6)  Cooper  and Myrna take  1/4 x2 day of  spironolactone-a diuretic and potassium saver-potassium is necessary for body function, especially for the kidneys.  

7)  Myrna takes 1/4 isosorbide once a day in the evening.

It helps increase oxygen and blood to the heart but also redistributes the load from the heart (this one is difficult to explain and she was put on it in June to reduce the cardiovascular load to help ease her congestion which was a problem in June. Your cat may not yet need this.) This she receives at bedtime.

8)  Cooper takes Vetmedin a.k.a. Pimobendan.

Pimobendan or Vetmedin was created for use in dogs with heart disease.  It was not approved by the FDA for use in cats but some vets do prescribe it.  We chose not to give it to Myrna because it is not meant for pets with HCM.  It improves the contractility of the heart but has potential side effects.  Cooper's heart has low contractility so we are hoping the Pimobendan improves that condition.

Use of Pimobendan in 170 Cats 2006-2010

From a study about the use of pimobendan with cats:
"To date, there is scant information regarding use of pimobendan in cats...Indications for pimobendan administration included CHF and advanced heart disease with poor response to standard CHF treatment...One hundred and five out of 170 cats (62%) had documented recheck visits. All rechecks were in CHF cats (105/164). Congestive heart failure was judged to be resolved in 69 cats...Survival analyses were limited to the 164 cats with CHF. Forty-three cats were still alive at last contact...Median survival time
after initial examination was 151 days (range,1e870) progressive hypertrophy was noted in those cats that had a follow-up echocardiogram.

More on Pimobendan:

"It is a benzimidazole pyridazinone derivative. It is classified as an inodilator and has a dual mode of action. It causes vasodilation through phosphdiesterase III inhibition and it causes an increase in cardiac contractility through increased Ca++ sensitization of the cardiac myofilaments...The increase in contractility is achieved by increasing the efficiency within the cardiac myofibrils without an increase in myocardial energy requirements...The vasodilator effect of pimobendan reduces both afterload and preload of the peripheral and coronary vasculature...Pimobendan is highly protein-bound and consideration should be give to the animal’s serum albumin concentration when dosing the drug. Adverse side effects that have been reported after clinical use include tachycardia, vomiting, diarrhea, inappetence, incoordination, convulsions, polyuria, and polydypsia. Dose-dependent cardiotoxic effects include damage to the chordae tendineae that can lead to rupture, thickening of the mitral valve, and jet lesions on the endocardial surfaces. The lesions seem to be associated with the positive inotropic properties of the drug...worsening of the mitral regurgitation in dogs chronically treated with pimobendan for valvular disease. The changes were reversed when the drug was discontinued. There is also a concern that the drug could predispose the heart to tachyarrhythmias and lead to an increased incidence of sudden death...suggested by some that this mechanism could lead to an increase in diabetes in patients chronically treated with pimobendan."

There are other meds some vets choose to prescribe which Myrna's vet does not: 

One is carvedilol, a beta blocker like atenolol. The vet prefers atenolol.  

Nattokinase, a soy based enzyme, which is used as a blood thinner but with limited results.  Plavix or aspirin is best.

Aminophylline, a bronchodialator that opens up airways in the lungs when there is congestion.  This is an old method and should no longer be given to fight congestion in the lungs. It also raises the heart rate which is not what a cat with heart disease needs. Lasix should be used instead.  Aminophylline is best used for cats with asthma.


Supplements are necessary to replenish electrolytes and other vitamins and minerals that are removed due to the diuretics and other heart meds the cats take.  These are necessary for survival, for strength, for endurance against heart disease. Without replenishment, the body grows weak and is unable to handle the heart disease.  Symptoms such as lethargy, fainting will occur without potassium for example.  The kidneys need potassium, bicarb, and others to properly function. The heart rate needs potassium as do the nerve and muscles, along with many of the other vitamins and minerals. 
  • Myrna and Cooper receive 100mg three times a day of Nature Made COQ10 which we mix into food.
  • They receive one 595mg tabs of Sundown Potassium Gluconate that are cut into pieces and given with regular medicines.
  • Cooper also receives Tumil-K a potassium supplement made for cats.  One table is cut into two and given with other meds.
  • For a food source for potassium, we add Gerber Baby First Foods Sweet Potatoes to his food.  Sweet potatoes are very high in potassium. We use the First Foods because it is a liquid, easier to blend into wet food, and the smell is not as strong.
  • Both receive an inch of Petco cat vitamin gel.  
  • They receive one ml a day of lysine, an amino acid, to help fight the herpes virus she was exposed to as a kitten.  It is also good for the heart.   
  • Cooper receives 250 mg Nature Made magnesium, cut into quarters, and given four times a day.  This is an essential electrolyte and since he's on high levels of Torsemide, we are trying to find ways to replenish his electrolytes. 
  • Cooper receives half of a 1000 mg  B12 Nature Made vitamin once a day. 
  • Cooper receives a drop of corn syrup in his food only in the a.m. to get some glucose in him.  Glucose is an essential electrolyte, helps to boost energy levels.  

Many of these can be purchased at the grocery store, the pharmacy, pet stores, vets' offices, online pet stores, and Amazon.  That many of these links are linked to Amazon is in no way a support or an ad for Amazon.  Whether it is medicines or supplements or cat supplies, shop around at online stores, Amazon, and local stores and compare prices to find the most convenient to buy and affordable for you. 

What About Pain Meds?

If your cat needs a pain medication, Buprenex or Valium are safe choices depending on the cat's heart health.  All other medications may not be safe because they may lower the breathing rate too far.   Cats with poor hearts cannot tolerate typical surgical anesthesia.  If your cat needs surgery, discuss with the cardiologist what the cat may be able to tolerate before proceeding with any surgery. 

Remember-HCM and heart disease cats CANNOT have any form of steroids.

No comments:

Post a Comment