Page 673 - Small Animal Internal Medicine, 6th Edition

CHAPTER 37 The Exocrine Pancreas 645

VetBooks.ir Drugs Used for Hepatobiliary and Pancreatic Disorders—cont’d INDICATIONS AND COMMENTS

DOSAGE
DRUG NAME (TRADE NAME)
Maropitant (Cerenia) Dogs > 8 wk—1 mg/kg SC Centrally acting antiemetic (NK1 receptor antagonist)
q24h for up to 5 days, or Antiemetic of choice in canine pancreatitis, no obvious
2 mg/kg orally q24h for up prokinetic effect
to 5 days Use with care in liver disease because metabolized in
Cats > 16 wk—1 mg/kg SC the liver, so do not use if significant liver dysfunction
q24h for up to 5 days; not Not licensed for oral use cats
currently licensed for oral
use in cats
Ondansetron (Zofran) Cats and dogs—0.5 mg/kg IV Refractory vomiting; may be contraindicated in
loading dose followed by pancreatitis because it has been reported to trigger
0.5 mg/kg/h infusion q6h vomiting in humans
or 0.5-1 mg/kg PO q12-24h

Antiencephalopathic
Lactulose 5-15 mL PO q8h (dogs) Hepatic encephalopathy with acquired or congenital
0.25-1 mL PO q8h (cats) portosystemic shunts
Can also be given as retention Overdose produces diarrhea
enema in acute Titrate to effect (two or three soft bowel movements/
encephalopathy day)
Antibiotics (e.g., ampicillin, See antibacterial section
metronidazole, neomycin)
Propofol Constant rate infusion; rate Drug of choice for seizures because of liver disease,
calculated by giving initial hepatic encephalopathy
bolus to effect (usually Should not be used in pancreatitis because it is a lipid
≈1 mg/kg) and timing vehicle
duration of action; usually
≈0.1-0.2 mg/kg/min
Phenobarbital 5-10 mg/kg PO q24h Can be used prophylactically before and immediately
preoperatively followed by after surgery to reduce risk of postoperative seizures
3-5 mg/kg q12h after ligation of PSS, but anecdotal evidence of
postoperatively for 3 wk effectiveness
Levetiracetam (Keppra) Dogs—20 mg/kg PO q8 for Efficacy for preventing hepatic encephalopathy only
minimum of 24 hours before reported with pretreatment before surgery for
surgery for portosystemic portosystemic shunts
shunt. Doses of 30 or Drug appears most effective short term
60 mg/kg IV have been Efficacy of longer term oral treatment not demonstrated
reported in status epilepticus
in dogs

Antiinflammatory-Antifibrotic
(Note spironolactone also has putative antifibrotic effect—see diuretic section)
Prednisolone (prednisone) Antiinflammatory Antiinflammatory or immunosuppressive doses in
dose—0.5 mg/kg PO q24h lymphocytic cholangitis in cats; immunosuppressive
Immunosuppressive doses in suspected autoimmune chronic hepatitis in
dose—1-2 mg/kg PO q24h dogs (see text), and in suspected immune-mediated
Taper at 0.5 mg/kg PO q24h pancreatitis in English Cocker Spaniels (see text)
or q48h
Avoid in suppurative cholangitis
Avoid in portal hypertension or animals with ascites
(potential GI ulceration)
Avoid use of dexamethasone—very ulcerogenic
Continued