Washout remedies for clomipramine?
Advance apologies for the length of this... usual for me.
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 Go! Natural Chicken. 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!)
Guardian of Taz (10) & one-eyed wonder Cube (10).
Forever in my heart: Patches Gizmo (1987 - 2008), Sierra (1999 - 2010), Rusty (1999 - 2012), Aubrie (1999-2014)
"If you can't afford the vet, you can't afford the pet."