Washout remedies for clomipramine?
Advance apologies for the length of this... usual for me. :sorry:
Aubrie, currently 14 years old, has been a random time, random place urinater for many years (since I got her in 2001). It was never often or predictable and I tried many remedies including using different litter (scented, unscented, pine, clumping and the Cat Attract litter or just additive), litter box retraining (very difficult in a multi-cat household), herbal/pheromone calmers, and finally had reasonable success with installing a litter box in her modified dog kennel (magnetic cat door so only she can access it; food and now litter box in there). She was checked, at least 3 times, for any physical problems - none. Though the "exclusive" litter box helped, we would still find a pee puddle in our closet, on the bath mat in the bathroom (we no longer have bathmats for this reason!), in the middle of the basement floor, and other random places occasionally.
Taz has been on clomipramine (for a multitude of symptoms - all resolved because of this) for a number of years. Since I knew that the primary reason for this medication for Taz was inappropriate urination, I cleared it with the vet and started Aubrie on it about 18 months ago. She started out getting 5mg daily. We had immediate improvement in her litter box habits, with the worst problem being the rare "miss" (where she appears to have been in the box but peed over the edge). However, this came with a different cost: extremely smelly soft stools, diarrhea and sometimes even bloody and/or mucousy diarrhea. :( All were in the litter box, but the stench was horrendous - especially since she pretty much never buries her poop.
At first, I didn't attribute it to the medication, and tried a couple of different foods, some (human) probiotics, added yogurt to her food... no difference. A few months after starting, she was due for her annual vet check and I asked the vet if the medication could be the cause of her fecal problems. She insisted that it couldn't be and suggested it was colitis and Aubrie might benefit from a prescription vet food. Not going to happen. Aubrie was already eating a grain-free food, but I tried 2 other varieties of grain-free after that, finally giving up and settling on [URL="http://www.petcurean.com/for-cats/go/refresh-and-renew-chicken"]Go! Natural Chicken[/URL]. The poops weren't good but seemed the best on this and food transitions were taxing my patience (and memory).
A year goes by, over which I slowly decrease Aubrie's dosage to 2.5mg every other day. This dosage seems to resolve the urination issue, but the poop issue remains, and now worse: if I forget a dose she poops (not by accident) in the closet, in the kitchen, in the middle of the living room, etc. I cannot even begin to describe the horror of being awoken at 2am to the sound of a cat squirting crap beside your bed (or the smell or trying to clean it up without waking the rest of the family). I set a reminder in my phone so I didn't miss doses again. And then my reminder program wasn't always working, and on Christmas Eve, Aubrie was due for a dose but I forgot. Christmas Day, Aubrie pooped not once, but twice, underneath the Christmas tree (thankfully after the gifts were opened, but the first time was on my white tree skirt). Out of sheer frustration, I googled "clomipramine cat diarrhea" and come up with multiple sites written by vets stating that diarrhea is the most common side effect they encounter with this medication in cats. Not Impressed With My Vet.
January is another annual check, different vet. She also hesitant to attribute the diarrhea to the medication but at least willing to help me figure it out. We did not run fecal analysis or blood work at this time. First "prescription" was to add a small dose of fibre (metamucil) to Aubrie's diet. 3 weeks, no improvement. Next was to continue fibre and add a dose of Feline FortiFlora (probiotics). 30 day run of that, no improvement. Still dosing clomipramine every other day. Vet basically admits defeat at this point, suggesting blood work, fecal analysis and possibly a course of antibiotics. Estimated cost: $450. Did I mention that Aubrie is 14 and at her last blood check (12 yrs) she had the blood profile of a much younger cat? When I made a noise about the cost, and asked about changing medications, she said we'd need to do a washout before trying anything new.
I made the decision to not do the blood & fecal and suck it up with the washout, thinking it wouldn't be more than a few days. Ok, she might poop randomly but I can handle it for a few days. And then I read that it can be 2-3 weeks. Oh crap, literally. We're now on day 8 since her last dose and there has been at least one poop outside the litter box everyday. Two separate ones between 2 & 3am on the same night. *sob* I've resorted to locking her in her kennel (food, water, litter box, blanket) at night, but she has still pooped on the floor during the day. It's not fair to her to make her stay in her kennel constantly until this washout is done but I can't handle the diarrhea all over my house. We have a 3 year old child, Cube & Taz, and the stink - egads!!
Finally getting to the point: my questions
1. Is there anything I can give her (fibre, fortiflora, different food) to help to correct the diarrhea now that she's off the medication? I was thinking about trying the Eagle Pack Transition Powder but not sure if it would help or just be a waste of money.
2. Will the diarrhea resolve once all traces of the medication are gone, or is there a possibility that permanent damage was done?
3. Do I really need to wait out the full washout period before starting on something new?
4. Are there any medications for cats to deal with inappropriate urination that have the side effect of constipation? Or at least NOT the possibility of diarrhea?
5. Are there any other suggestions for dealing with this situation?
Again, so sorry for the length of this! Any further questions don't hesitate to ask.
Thanks in advance for any help you can offer.
Melissa (and Aubrie - I'm sure she's not happy either!)
Forgot to mention: Aubrie has been dewormed and is an indoor-only cat.
My first though is that perhaps it is not the medicine and you are over focused on it being the cause.
Perhaps she has Giardia or some other single cell parasite. This is tested from a fecal sample and can sometimes require several samples to diagnose.
How does an indoor-only cat get Giardia, when no other pets have it? And the diarrhea started immediately after starting the medication. Bit too coincidental to be anything else.
Ah come on, someone has to have something. I just spent 20 minutes cleaning up 3 separate diarrhea puddles - from berber carpet - and cleaning the pee out of a round scratcher-ball toy.
Aubrie is staying in her kennel permanently until further notice. I cannot deal with this.
At this point, it sounds like it's getting dangerous--if she dehydrates further, things will get scary. Have you started her on a probiotic or slippery elm? If they've had no effect, a fecal should probably be run to rule out other causes than the meds. There are causes of diarrhea that don't involve catching something outside--response to toxins, exposure to indoor varmints (mice are a big problem this time of year), even just intestinal imbalance, all of which can usually be detected through fecal examination and blood work. But prolonged diarrhea can cause dangerous dehydration after a few days....
Aubrie is not dehydrated. She is drinking plenty of water. Her vet was not concerned about dehydration. She has had a probiotic - the FortiFlora - which had no effect. We do not have mice in or near our house.
I have had Aubrie for 12 years. We have lived in this house for 7 years. I do *not* believe that it is environmental, toxin, parasite or anything other than the drugs. Clearly, my vet doesn't either as her first course of action was NOT to run a fecal or blood analysis.
I'm really surprised that no one has anything. This is a very common drug and surely someone else has gone through a wash out with their cat.
Aubrie has been locked in her kennel for over 24 hours now. She doesn't appear upset about it anymore: is not trying to get out though she does offer a sad little meow every few hours. She is eating right now and when she's done I'm going to cuddle with her. Unfortunately, until I can get her on a different drug for the inappropriate bathroom habits, she will have to stay in there. I miss my girl & I feel bad about her being stuck in there.
I second HRP's recommendation to try slippery elm bark powder. It was the only thing that helped my IBD kitty many years ago.
(Also just want to mention that a cat can still be dehydrated even though they're drinking lots. Not saying that's the situation with Aubrie, but in case anyone else with similar circumstances reads this and thinks they're safe cause their sick cat is drinking - it's not that simple).
That's basically the animal version of acidophilus. You can find it here.
Your problem with Aubrie goes way beyond that, though. We had a cat, Meisje, who eliminated in inappropriate places. She lived to be 21, and stopped the behavior as soon as her nemesis and resident bully Natasha passed away. So for the final 6 years of Meisje's life, she only occasionally pooped next to the litter box, and only if her son came along while she was trying to go.
I can't tell you what would fix her issues. Do you have a bully in the house that stalks Aubrie when she tries to use the litter box? Is there a way to distract the bully? There is one more thing you can try, which I'm actually using right now to eliminate stalker and drive-by attack behavior from one of my new bullies:
It's essential oil essences that you put into water or dribble onto the cat's fur. I didn't think it would work, but it really does! Our bully has mellowed out, and our resident victim has learned to stand up for himself. It's a set of three essences, although you can get individual bottles, as well. I'm honestly not sure how it works, but I was ready to try anything, because our Nicky was constantly harrassing our middle aged gentleman Samson to the point where poor Samson constantly had to look over his shoulder for a "hit and run", as I call them. He started peeing on the hardwood floor right in front on me, as if to tell me: "Ma, this has to stop, or I'll ruin your house".
The remedy takes a couple of weeks to work, so give it time. And I'd also recommend feliway plug-ins to go along with it. Especially in the litter box area. Good luck!
It's essential oil essences that you put into water or dribble onto the cat's fur.
Just wanted to clarify that the Spirit Essences you reference are not actually *essential oils*, which are toxic to cats. They're [I]flower essences[/I], which are highly diluted flower material that work on an energy principle. Rescue Remedy is an example of well known flower essence combination.
[QUOTE=sugarcatmom;1055322]Just wanted to clarify that the Spirit Essences you reference are not actually *essential oils*, which are toxic to cats. They're [I]flower essences[/I], which are highly diluted flower material that work on an energy principle. Rescue Remedy is an example of well known flower essence combination.[/QUOTE]
You're right, of course. And I'm seriously amazed at how well they actually work.
Probably of no help but:
One of my cats is prone to very loose stool. I have found two causes.
The primary is giving her snacks. Anything other than her normal food in any amount will result in loose stool. One thing that surprised me is that the quantity didn't seem to matter. A single bite of ham or meatloaf or almost anything will do it.
She prides herself on her thievery skill and will swipe food off any unguarded plate (even an occasional string bean or carrot slice). Second only to thievery skill is her begging skill. She is a master beggar, it takes some time to train household members, friends and guests to not feed her. Even then they have to be watched or they may feed her, such is her skill.
Second cause is toothpaste. Sinks must be kept clear or she will lick up any drops. For unknown reasons she loves the smell/taste of toothpaste.
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