Slowing Down Feline Hyperthyroidism: Is Methimazole Worth It?

Your cat has been your best pal for years. You make sure your cat is pampered and feels loved. It hurts you that your furry friend no longer wants to play and constantly feels fatigued with hyperthyroidism. Your veterinarian may prescribe the only antithyroid medication known as methimazole. What is methimazole and will it work? What do I do if my cat will not take the tablets? Compounded medications can save the day and help your cat get back to long days of playtime and meowing. Purr-fect! 

What is hyperthyroidism?1-3

When the thyroid gland, a butterfly-shaped gland in the neck, is enlarged and over produces thyroid hormone, this is known as hyperthyroidism. Thyroid hormone is responsible for the body’s metabolism, growth, and development, so it has a huge effect all over the body. It is one of the most common diseases in cats that typically occurs during their middle ages. No breeds are at a greater risk, but Siamese, Persian, and Himalayan cats have less of a risk. 

Symptoms include weight loss, increased appetite, frequent urination, increased thirst, weakness, greasy hair, restlessness, aggressive behavior, depression, difficulty breathing, and stomach problems. The symptoms may be mild at first, then they become more severe over time. If you notice these signs in your cat, you may want to check with your veterinarian about performing a thyroid test.

If your cat is diagnosed with hyperthyroidism, your veterinarian may prescribe methimazole. The prognosis for cats being treated with hyperthyroidism is promising. Your cat will have a better quality of life and can continue to be your snuggle buddy, so it is worth getting treatment! 

What is methimazole?2,4

Methimazole is an antithyroid medication, so it works by suppressing your cat’s thyroid to release a normal amount of thyroid hormone. Since the thyroid works all over the body, this medication helps decrease the risk of your cat getting high blood pressure and heart disease. Thyroid hormones increase your cat’s heart rate, so more blood is pumped faster around the body which can damage the eyes, liver, and other organs. This would require more medications and even surgery. Methimazole helps your cat continue to live a healthy and long life by managing the thyroid, but it is not a cure. This medication is given for the rest of your cat’s life. 

Josefs Pharmacy offers the generic version, methimazole, that is less expensive than the brand name, Felimazole, and will work with your pet’s insurance to give you an affordable price.

Does methimazole work?5

In a 3-year study with 60 cats with hyperthyroidism, methimazole compounded transdermal gel was shown to have less side effects and lower thyroid levels within a normal range with regular monitoring. The pet owners found the gel to be easier to give than the manufactured oral tablets. The tablets were also associated with more side effects like stomach issues. However, this medication is given lifelong and dose adjustments may be needed after getting an established dose. 

How do I give methimazole to my cat?4,6

Administer methimazole just like your veterinarian told you. Always wash your hands before and after giving this to your pet. The oral tablet and oral compounded liquid can be given to your pet on an empty stomach or with food. Giving it with food helps your pet feel less sick. Never crush or break the oral tablets. 

This medication also comes in a compounded transdermal gel that can be applied on hairless skin like the inside of the ears. Rubber gloves should be worn when applying the gel. It is important you measure the liquid and gel doses properly to give your cat the correct dose. Giving your cat too much or too little can cause the medication to fail or be toxic. 

It takes a couple of weeks for this medication to work, so you will not notice improvement in signs immediately. If you miss a dose, give it to your cat as soon as you remember unless it is close to the next dose. Then, skip the missed dose and return to the normal dosing schedule. Never double up on doses. 

What are the side effects?4,5

Your cat may experience tiredness, vomiting, and weight loss within the first 3 months of treatment. Your veterinarian may shortly stop the medication and prescribe a lower dose. Less common side effects include upset stomach, itchiness, and low blood cell counts. In cats with liver or kidney disease, this medication may cause more side effects. Let your veterinarian know if your pet experiences any of these effects. 

Is there any special monitoring with this medication?5,6

Your veterinarian will check your cat’s thyroid levels before starting treatment, then every 2 weeks for the first 3 months of therapy. This is to make sure the medication is working right without limiting side effects. Once the appropriate dose is determined, thyroid levels are checked every 3 to 6 months. Even after the dose is established, it may need to be adjusted as your cat continues long-term treatment. It is crucial your cat is regularly monitored to make sure the medication is working and your cat is not at risk of toxic effects. 

What is the difference between the manufactured and compounded methimazole?5,6

The compounded forms, liquid solution and transdermal gel, work just like the compounded oral tablet. The tablet has a bitter taste, so it may be difficult giving this to your cat. Your cat may not like the taste, have trouble chewing, or have trouble swallowing, so a liquid or gel may be better. The gel is applied inside the ears, so it may be easier for both you and your pet. That is the beauty of compounded medications, they make it easier for your fur baby!  

 A pharmacist at Josefs Pharmacy can help you make this switch to a formulation that is both easier for you to give and your cat to take. Compounded medications can be more expensive, but Josef’s Pharmacy will help you get the best treatment in a form your pet will enjoy with the best price.

Can I share my thyroid medications with my cat?6

If you have a medication that is for treating your thyroid or for your child, do not share them with your cat. We may think of our pets as our children, but they do not get the same medications as us or respond to them like us. Human medications are different from vet medications and they can be toxic to your cat. It is only legal to use medications in the people that are prescribed them. You may take your daily thyroid medication and think you can split the tablet with your cat, but it actually could be too much for your cat since thyroid medications are highly personalized.

Methimazole Safety Tips4,5

  • Keep this drug out of reach of children and pets.
  • Let your veterinarian know if your cat takes any vitamins, supplements, or medications that may affect methimazole.
  • Methimazole tablets should be stored away from light in a dry place at room temperature. Compounded products should be stored according to the compounding label.
  • Do not use this medication if your cat is pregnant or nursing.

If you have questions about treating your cat’s hyperthyroidism with compounded or manufactured medications, talk with your veterinarian or pharmacist today.

References:

  1. Cat hyperthyroidism (overactive thyroid). WebMD website. https://pets.webmd.com/cats/guide/cat-hyperthyroidism#1. Accessed November 14, 2021.
  2. Hyperthyroidism in cats. Cornell University website. https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/hyperthyroidism-cats. Accessed November 14, 2021.
  3. Caring for an ill senior cat and the lessons I learned along the way. Ethos website. https://www.ethosvet.com/blog-post/caring-for-an-ill-senior-cat-and-the-lessons-i-learned-along-the-way/. Accessed November 14, 2021.
  4. Methimazole. VCA hospitals website. https://vcahospitals.com/know-your-pet/methimazole. Accessed November 14, 2021.
  5. Methimazole: Management of feline hyperthyroidism. Today’s veterinary practice website. https://todaysveterinarypractice.com/focus-on-pharmacology-methimazole-management-of-feline-hyperthyroidism/. Accessed November 14, 2021.
  6. Methimazole transdermal gel and cream for cats. Avriorx website. https://avriorx.com/methimazole-transdermal-gel-and-cream-for-cats/. Accessed November 14, 2021.

Getting to the Heart of Pimobendan in Heart Failure: Will It Work For My Dog?

You just found out your dog has congestive heart failure (CHF). It is scary, stressful, and heartbreaking. You cannot imagine life without your pet. You wonder what the treatment is? Is it safe and can I afford it? Will it work? Fortunately, pimobendan is commonly prescribed by your veterinarian to treat your pet’s condition. Am I out of options if my dog has trouble taking tablets? This is where compounded pimobendan provides benefit! Pimobendan can treat your furry friend’s heart disease to live a long, happy, and playful life. 

What is CHF?1,2

CHF or heart failure happens when your dog’s heart is not able to pump blood effectively all over the body. This could be due to a weak heart muscle or leaky heart valve. Doberman Pinschers have one of the highest risks for CHF. Common signs that your dog may have heart failure include coughing with difficulty breathing, tiring more easily, and not playing or walking like they used to. Your dog might have a swollen belly, loss of appetite, excessive panting, coughing at rest, or pale gums. If your dog experiences these, contact your veterinarian immediately.

If your dog is diagnosed with CHF or even at risk, your veterinarian may prescribe pimobendan. Pimobendan has been clinically proven to prevent abnormal heart beats that can be deadly. Your dog still has a lot of life left, so it is worth it! 

What is pimobendan?3-5

If your dog has congestive heart failure, pimobendan may be a great benefit. Pimobendan is a vasodilator, so it works by decreasing your dog’s heart rate to pump stronger and more effectively. Your dog’s blood vessels expand, so blood is better able to be pumped all over the body and provide more nutrients to the heart. This decreases the symptoms your dog has been having, so he or she can do activities like before being diagnosed. It helps improve your pet’s quality of life, but it does not cure the disease. This is likely a life-long medication that is used with other heart medications.

This medication can be pricey, especially if you have a large dog. Josef’s Pharmacy offers the generic version, pimobendan, that is less expensive than the brand name, Vetmedin, and will work with your pet’s insurance to give you a comfortable price.

Does pimobendan work?6

Pimobendan has proven benefit to reduce death in dogs with CHF, even before CHF onset. In a five-year study with 360 dogs at risk for CHF, it was shown to extend the time before symptom onset by 15 months and reduce their symptoms of coughing at rest, swollen bellies, difficulty breathing, and increased tiredness. This included dogs with increased heart size because of their heart’s decreased ability to pump correctly. 

How do I give pimobendan to my dog?3,5

Give pimobendan just like how your veterinarian told you. Administer pimobendan to your dog on an empty stomach an hour before feeding time. Be sure to wash your hands first. Pimobendan only comes in chewable tablets, so if it needs to be split, be sure to properly cut it in half. If your dog misses a dose, give the next dose as soon as you remember and return to the normal dosing schedule. If the next dose is due shortly, just wait and give that dose. Never double up on doses.

What are the side effects?3-5

Your dog may experience loss of appetite, low energy, diarrhea, and difficulty breathing. These side effects may be uneasy, but this medication is generally tolerated well by pets. It is important to continue giving your dog this medication to prevent heart failure exacerbations or other dangerous events. Your veterinarian or pharmacist may be able to offer tips on reducing these side effects.

A few less common, but serious side effects include changes in heart rhythm and kidney function, poor balance, and weakness. If your dog experiences any of these side effects, be sure to contact your veterinarian. 

Can this be compounded and how is this different from the manufactured medication?7,8

Currently, pimobendan is only available as a chewable tablet and you may find it hard to split in half if that was recommended by your veterinarian. Your veterinarian may prescribe a dose that is weight-based and the dose is not commercially available. Maybe your dog has trouble chewing or does not like the flavor. It might be easier for your dog to take it as a liquid solution. This is where a compounded medication comes into play. Compounded medications are customizable to find the needs of your four-legged friend. Here are a few compounding options:

  • Flavored or unflavored chewables
  • Flavored or unflavored liquid solutions and suspensions
  • Flavored or unflavored capsules and tablets
  • Eye drops
  • Topical creams

 A pharmacist at Josef’s Pharmacy can help you make this switch to a formulation that is both easier for you to give and your pet to take. Compounded medications can be more expensive, but Josef’s Pharmacy will help you get the best treatment in a form your pet will love and for the best price.

Can I share my heart disease medications with my dog?9

If you have a medication that is for treating your heart disease, high blood pressure, or CHF, do not share them with your dog. Dogs are not tiny humans. You may think it will save you money, but it actually does more harm than good. Not only is it illegal to share medications, but the medication will affect them differently due to differences in body weight and composition. A drug that may be given daily for you would likely need to be given less frequently for your dog to avoid toxicity.

Safety Tips

  • Keep this drug out of reach of children and pets.
  • Do not give this medication if your dog is pregnant or nursing.
  • If your dog has a poor liver or kidney, this should be used with caution.
  • Let your veterinarian know if your dog has any other cardiac conditions before taking this medication like an untreated arrhythmia.
  • Store the medication at room temperature away from sunlight and heat. Do not store it in the refrigerator or freezer.

If you have questions about treating your dog’s heart disease with compounded or manufactured medications, talk with your veterinarian or pharmacist today.

References:

  1. Congestive heart failure in dogs. VCA Hospitals website. https://vcahospitals.com/know-your-pet/congestive-heart-failure-in-dogs. Accessed November 1, 2021.
  2. Get to the heart of congestive failure. DVM 360 website. https://www.dvm360.com/view/get-heart-congestive-heart-failure. Accessed November 1, 2021.
  3. Pimobendan for dogs. Wedgewood pharmacy website. https://www.wedgewoodpharmacy.com/learning-center/medication-information-for-pet-and-horse-owners/pimobendan-for-dogs.html. Accessed November 1, 2021.
  4. Pimobendan for Congestive heart failure in pets. Avriorx pharmacy website. https://avriorx.com/pimobendan-for-congestive-heart-failure-in-pets/. Accessed November 1, 2021.
  5. Pimobendan: Good for your dog! CSF pharmacy website. https://www.cfspharmacy.pharmacy/blog/post/pimobendan-good-for-your-dog. Accessed November 1, 2021.
  6. Improving quality of life for pets with heart disease: This is epic. https://heartvet.com/blog/heart-disease-epic-study/. Accessed November 1, 2021.
  7. Yes, pets get heart disease too. Compounding center website. https://www.compoundingcenter.com/blog/pets-heart-disease?Tag=pets%20health. Accessed November 1, 2021.
  8. Compounding FAQ for pet owners. AVMA website. https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/compounding/compounding-faq-pet-owners. Accessed November 1, 2021.
  9. Is it safe to share my medication with my pet? Single care website. https://www.singlecare.com/blog/pet-meds/. Accessed November 1, 2021.

Histamine Intolerance or Allergy?: Solving Your Mystery Symptom

Have you ever had mysterious headaches or skin rashes? Does your nose suddenly begin to run when you eat avocados or bananas? You may have thought it was an allergy, but you also felt the same when you ate other types of food like cheese. You may have histamine intolerance based on those foods having higher amounts of histamine than you are able to break down. Luckily, there are treatment options for you. Read on to learn if diamine oxidase (DAO) supplements could be helpful for you!

What is DAO?1,2

DAO is an enzyme that is used to help break down your foods that contain histamine. Histamine is a chemical released by your immune cells to promote inflammation and respond to allergens. When your body detects something that it thinks is going to harm you like if you eat peanuts and have a peanut allergy, it begins a protective response by releasing histamine. If you do not have enough DAO or your body makes too much histamine, you may feel sick after eating foods that are high in histamine. This is called histamine intolerance

What is histamine?2,3

Histamine is a neurotransmitter released by your immune cells to communicate to your intestines, brain, heart, skin, and lungs. It is a promoter of an immediate inflammatory reaction. Histamine is released when it is triggered by an allergen like dust, pollen, or something that it thinks will harm your body. Histamine levels increase and bind to their receptors for activity which can lead to symptoms of runny nose, sneezing, and difficulty breathing. You may have heard of antihistamines being used for seasonal allergy symptoms. Their role is to prevent the histamine reaction from occuring, not lowering histamine levels. Histamines are also involved in food allergies which trigger allergic reactions.

What is histamine intolerance?1,4

Histamine intolerance is a condition where you have high levels of histamine in your body. It can be caused by over-making histamine, not making enough DAO, eating too many foods high in histamine, drinking alcohol, medication, and genetic mutations. If you do not have enough DAO, your body is not able to eliminate histamine normally, so histamine builds up in your body and may cause uncomfortable symptoms. A high amount of histamine in your body can cause the following symptoms: migraines, bloating, gas, stomach pain, constipation, diarrhea, vomiting, muscle aches, pain, runny nose, difficulty breathing, hives or skin rash, itchy skin, and dizziness.

What foods are high in histamine?1,2,5

The following foods are high in histamine and may be causing your symptoms: avocados, nuts, mushrooms, eggs, shellfish, soybeans, chocolate, strawberries, pineapple, dairy products, food preservatives, and alcohol like beer and wine. Have you noticed any histamine intolerance symptoms when eating these foods? It is helpful to know your food triggers, so removing these foods for a month before reintroducing them may help determine your triggers. Your symptoms may be caused by eating some of these foods and some symptoms may be more severe than others. 

Is histamine intolerance an allergy?6

No, histamine intolerance is not an allergy because it is not caused by one type of food. Histamine intolerance is caused by foods that are high in histamine, so it can be several foods that irritate you. This also makes it harder to figure out what foods are giving you symptoms since there can be several different types of food from bananas to a glass of wine. Histamine intolerance may only occur in 1% of the population, but there are treatment options for you!

What are the benefits of DAO supplements?2,4

DAO supplements provide your body with DAO, so it can break down histamine in your food and help relieve your symptoms of histamine intolerance. Based on research, DAO supplements best help with the following symptoms and issues:

  • Headaches – DAO supplements may help reduce your headache severity based on a study with people who had low DAO amounts after taking them for a month. The length of headaches was reduced by 90 minutes.
  • Digestive issues – The amount of histamine in your body may not only be lowered, but it may promote healing and less inflammation of your gastrointestinal tract. In a four-week study with people that had poor levels of DAO, DAO supplements helped lower the intensity and amount of stomach problems like constipation, bloating, and diarrhea.
  • Skin irritations – If you develop rashes, hives, or itchy skin after eating foods high in histamine, DAO supplements may help reduce these symptoms. In a 30-day study with 20 people, they received relief from itchy skin rashes and ended up needing less DAO supplements later on.

DAO supplements do not cure histamine intolerance and do not lower the amount of histamine your body makes, they only break down histamine you obtain from your diet. These supplements may not provide the same level of benefits or work the same for everyone. Studies have shown the benefits of DAO supplements, but more research is needed to fully understand their effects and usage.

What are the risks of DAO supplements?4,7

One of the risks with taking DAO supplements is that there is not a formal test to diagnose it. The symptoms of histamine intolerance can overlap with symptoms of other conditions too. If you think you may have histamine intolerance and take DAO supplements, but do not actually have it, this may be harmful. That is why it is important that you talk with your doctor or pharmacist if you are having symptoms from eating foods high with histamine, so they can help you create an appropriate treatment plan.

Another risk is that not all supplements are made with the same safety and efficacy standards since they are not highly regulated by the Food and Drug Administration (FDA) like drugs are. It is best to speak with a pharmacist before you select a supplement. One thing to look for when selecting a supplement is to find one that has United States Pharmacopoeia (USP) approval. USP approval means that the supplement contains all the ingredients on its label; has been tested for purity, stability, and potency; and has been made following Good Manufacturing Practices (GMP). Once you find a supplement, you should stick with that brand because not all DAO supplements have the same ingredients or the same dose. 

Are there alternatives to DAO?2,4,8

Yes! Instead of taking DAO supplements, you could manage your symptoms by increasing the amount of copper, vitamin B6, vitamin B12, vitamin C, phosphorus, zinc, magnesium, and iron in your diet. These vitamins and minerals are involved in breaking down the amount of histamine in your body, so if you increase their levels, your body will better be able to eliminate histamine. If you are having trouble eating foods with these vitamins and minerals, you could consider taking a daily multivitamin. Here are some great food sources:

  • Copper – grains, beans, potatoes, and dark leafy greens
  • Vitamin B6 – poultry, oats, tuna, and dark leafy greens
  • Vitamin C – peppers, broccoli, and brussel sprouts
  • Phosphorus – whole grains, chicken, turkey, and lentils
  • Zinc – poultry, beans, and whole grains
  • Magnesium – whole grains, dark leafy greens, and potatoes
  • Iron – sweet potatoes, oatmeal, peas, and chicken

Another way is by following a low-histamine diet. Foods that are low in histamine include vegetables except spinach and eggplant; fruits except berries, citrus, and tomato; olive oil; and grains like rice and quinoa. By limiting your histamine intake, this could improve your symptoms by as much as a 50% reduction. You could also try to eliminate those foods that cause you the most symptoms. A low-histamine diet may help you figure out which foods cause you the most symptoms.

If you are having symptoms of histamine intolerance and are considering taking supplements, talk to your doctor or pharmacist today.

References:

  1. What to know about diamine oxidase (DAO) for histamine intolerance. WebMD website. https://www.webmd.com/allergies/what-to-know-about-diamine-oxidase-histamine-intolerance. Accessed October 25, 2021.
  2. Histamine intolerance: All you need to know. Amy Myers MD website. https://www.amymyersmd.com/article/histamine-intolerance/. Accessed October 25, 2021.
  3. What are histamines? WebMD website. https://www.webmd.com/allergies/what-are-histamines. Accessed October 25, 2021.
  4. What is DAO? Diamine oxidase supplements explained. Healthline website. https://www.healthline.com/nutrition/dao-supplement. Accessed October 25, 2021.
  5. Chronic allergies or a histamine intolerance? How to tell for sure. The Demspter Clinic website. https://thedempsterclinic.com/allergies-histamine-intolerance/. Accessed October 25, 2021.
  6. Your mystery food sensitivity might actually be a histamine intolerance. ENT and allergy website. https://www.entandallergy.com/blog-posts/details/your-mystery-food-sensitivity-might-actually-be-a-histamine-intolerance. Accessed October 25, 2021.
  7. What you need to know about dietary supplements. FDA website. https://www.fda.gov/food/buy-store-serve-safe-food/what-you-need-know-about-dietary-supplements. Accessed October 25, 2021.
  8. The best foods for vitamins and minerals. Harvard website. https://www.health.harvard.edu/staying-healthy/the-best-foods-for-vitamins-and-minerals. Accessed October 25, 2021.

Settling Down Your Pet’s IBD With Budesonide

Our pets are like our children, we want the best for them and we do not like to see them in pain. One of the biggest issues our pets can face is having irritable bowel disease (IBD) which affects your pet’s gastrointestinal system in the form of recurrent upset stomach. You may have heard of budesonide being used to treat IBD in humans, but did you know it can be used in our cats and dogs too? How and is it safe? This easy read will break down IBD and its signs, and answer your questions to best help treat your fur-baby.

What is IBD?1-4

Not only is IBD common in humans, but it also is a problem for cats and dogs. IBD is a chronic condition where the gastrointestinal tract becomes inflamed and disorganized due to the body’s immune response. When toxins, bacteria, parasites, or certain proteins your pet digests reach the intestines, it may cause the body to create an inflammatory reaction and irritate your intestines. The genetic make-up of your pet can make them more likely to get IBD. Your pet may be more susceptible to certain triggers or not be able to control the immune response. Breeds like Basenjis, Wheaten Terriers, Yorkshire Terriers, Boxers, German Shepards, and Norwegian Lundehunds are at an increased risk of IBD. The gastrointestinal membranes and cells are highly organized to digest your food, so when this is destroyed, this creates an issue with your pet’s ability to move and absorb nutrients. This is not irritable bowel syndrome (IBS) which is a collection of gastrointestinal symptoms that is linked to stress. Unfortunately, pets are rarely cured of IBD because it is hard to determine the exact cause.

What are the signs of IBD?3,5

IBD affects the gastrointestinal tract, so the signs include diarrhea, vomiting, weight loss, and poor appetite. If the stomach is the issue, your pet will typically experience recurrent vomiting while if the intestine is the issue, your pet will experience recurrent diarrhea. Vomiting and diarrhea will present at least weekly, so this is a chronic condition instead of presenting every now and then. IBD is diagnosed once all other possible causes have been ruled out – it is a tricky diagnosis! Your veterinarian will diagnose it after examining your pet’s blood, feces, and intestine imaging reports.

How is IBD treated?3,5

The treatment goal is to provide relief that can be done through a combination of diet changes and medications. Typically a new diet is started like a high fiber, hypoallergenic, or low residue diet. Many pets start a hydrolyzed protein diet that includes proteins that are already digested and are too small to be recognized by the immune system as a threat. A hydrolyzed diet prevents your pet’s immune system from causing an inflammatory reaction and upset stomach. When starting a new diet, it takes about 6 to 12 weeks to determine your pet’s response and diet changes. After the 12 weeks, your pet may be able to return to the previous diet. When starting a new diet, you should not give your pet other foods or treats. Sometimes a diet alone is not enough and corticosteroid drugs like budesonide are used to help treat your pet’s symptoms. Probiotics may be recommended to restore your pet’s healthy gut bacteria and digestive functioning since IBD disrupts the normal bacteria. Depending on your pet’s vitamin B12 levels, your pet may need vitamin B12 injections to help absorb nutrients from food.

What is budesonide?1

This name may sound familiar to you because budesonide is also used orally to treat IBD, and inhaled to treat asthma and Chronic Obstructive Pulmonary Disease (COPD) in humans. Budesonide is a steroid or glucocorticoid that is used for treating inflammatory diseases like IBD. It is commonly used for pets that do not tolerate other steroids like prednisone. Budesonide works locally in the intestines after giving it instead of traveling all over the body to have effects because of its poor absorption. Budesonide does not cure IBD, but it helps relieve your pet’s symptoms.

How do I give budesonide to my pet?1,6

Give budesonide just like your veterinarian told you. It comes in the form of a tablet, capsule, oral suspension, and gel. If it is a capsule, do not crush or let your pet chew it. If your pet misses a dose, give the dose as soon as you remember it and return to the normal dosing schedule. If it is close to the next dose, skip the missed dose and return to the normal dosing schedule. Never give double doses. After giving the medication, be sure to wash your hands.

What are the side effects of budesonide?1

Side effects include increased appetite, thirst, urination, and hair color change. If your pet shows signs of weakness, black and tarry stools, bloody stools, or an inflated belly while taking budesonide, contact your veterinarian as soon as possible. However, do not stop giving this medication abruptly because it could cause weakness, collapsing, vomiting, and death. This medication should not be used if your pet is allergic to it. 

What happens if my pet overdoses?1,6

If you think your pet has overdosed on budesonide, immediately contact your veterinarian and bring the medication with you or the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center

What could budesonide interact with?1

Budesonide should not be used with the following medications: erythromycin, cimetidine, ketoconazole, itraconazole, fluconazole, and diltiazem. If used with these medications, budesonide could cause toxicity because it will be inhibited from being metabolized and eliminated from your pet’s body.

When will my pet feel better?5

After taking the medication for a couple of days, the medication should start working. It is more difficult to see how your pet is feeling, but your veterinarian will continue to monitor and do tests to see how your pet is improving. Most pets remain on medication and a fixed diet for life.

What other safety information should I know?1,6

  • Be sure you keep this medication out of the reach of children or your pet. Even though budesonide is used in people too, only give this medication to the pet it was prescribed for. 
  • If your pet has an infection, ulcer, diabetes, cataracts, or poor liver function, be sure to tell your veterinarian and use it with caution.
  • If your pet is about to have a surgery, make sure your veterinarian knows your pet is taking this medication.

If you have any questions about treating your pet’s IBD or budesonide use in animals, contact your veterinarian or pharmacist today.

References:

  1. Budesonide for veterinary use – IBD in cats and dogs. Wedgewood pharmacy website. https://www.wedgewoodpharmacy.com/learning-center/professional-monographs/budesonide-for-veterinary-use.html. Accessed October 13, 2021.
  2. Inflammatory bowel disease in dogs and cats. Veterinary partner website. https://veterinarypartner.vin.com/default.aspx?pid=19239&id=4951476. Accessed October 13, 2021.
  3. Inflammatory bowel disease (IBD) in dogs and cats. Today’s veterinary practice website. https://todaysveterinarypractice.com/inflammatory-bowel-disease-dogs-cats/. Accessed October 13, 2021.
  4. Irritable bowel disease. Brookfield animal hospital website. https://www.brookfieldanimalhospital.com/project/inflammatory-bowel-disease-in-cats/. Accessed October 13, 2021.
  5. Inflammatory bowel disease in dogs. VCA hospitals website. https://vcahospitals.com/know-your-pet/inflammatory-bowel-disease-in-dogs. Accessed October 13, 2021.
  6. Budesonide for dogs and cats. Wedgewood pharmacy website. https://www.wedgewoodpharmacy.com/learning-center/medication-information-for-pet-and-horse-owners/budesonide-for-dogs-and-cats.html. Accessed October 13, 2021.

COVID-19 Booster Dose: Frequently Asked Questions

Since before COVID-19 vaccines were made available, there has been speculation on if initial vaccination would be sufficient or if there would be recommendations for yearly vaccination, like the flu shot. As the vaccines continue to be studied and more information about COVID-19 becomes available, every effort is being made to ensure that you have the information and tools necessary to protect yourself from COVID-19 infection. Based on the data available, the FDA has recently authorized an additional dose or booster dose of certain COVID-19 vaccines for patients meeting specific criteria. At this time, only one COVID-19 booster dose is recommended. 

WHAT DOES “BOOSTER” MEAN?

The term “booster” is used to describe an additional dose of a vaccine that is given to boost your immune system. The booster shot helps you to maintain immunity and keep you protected against COVID-19 after the immunity from the first two doses begins to naturally decrease over time.1

WHY IS A BOOSTER DOSE NEEDED?

Studies have shown that COVID-19 vaccines are effective at preventing severe disease and reducing the risk of hospitalization, but protection against the virus may decrease over time. This is due to natural waning of immunity, which is why a booster dose is needed.2 Other routine vaccinations, such as the tetanus shot, require booster doses for the same reason. A booster dose triggers a memory response within your immune system so that your immune system is able to respond quickly if you are ever exposed to the virus.1 With the emergence of COVID-19 variants that are highly infectious, such as the Delta variant, it is extremely important to maintain immunity, which can be done through a booster dose. One study on the Pfizer-BioNTech vaccine showed that a booster dose increased patients’ immune response, which provides increased protection against COVID-19, including variants.2

WHEN CAN THE BOOSTER DOSE BE GIVEN?

The FDA has authorized the Pfizer booster dose for those meeting certain eligibility criteria as listed in the next section. For patients meeting this criteria, the booster dose can be given at least 6 months after the second dose. 2  

For patients with moderate to severe immunocompromising conditions, such as those listed in the next section, the FDA has authorized a third dose of Pfizer and Moderna. For these patients, the third dose can be given at least 28 days after the second dose. This additional dose is given sooner because patients with weakened immune systems are more likely to have severe illness if infected with COVID-19 and are less likely to develop sufficient immunity after only two doses of the vaccine.3

Currently, an additional dose of Moderna is only authorized for immunocompromised patients and not yet available for others. The Johnson & Johnson COVID-19 vaccine has not not been authorized for booster doses.

The FDA is consistently reviewing data on COVID-19 vaccines, and booster doses that are not currently available for patients who do not meet the following criteria may become available at a later date. 

WHO IS ELIGIBLE?

According to the CDC, you should get the Pfizer booster dose if you have completed the 2-dose Pfizer series at least 6 months ago and fall into one of the categories below:

  • 65 years of age or older
  • 50-64 years old with underlying medical conditions (obesity, asthma, heart disease, high blood pressure, diabetes)
  •  A resident of a long-term care facility and at least 18 years old

If you do not meet the above criteria but would like to get a booster dose, you may get the Pfizer booster dose at least 6 months after completing the 2-dose Pfizer series if you fall into one of the categories below:

  • 18-49 years old with underlying medical conditions (obesity, asthma, heart disease, high blood pressure, diabetes)
  • 18-64 years old and working in a high-risk setting where you may be exposed to COVID-19 (healthcare workers, first responders, teachers, retail and restaurant workers, public transportation workers, etc.)
  • 18-64 years old and living in a high-risk setting where you may be exposed to COVID-19 (correctional facilities, homeless shelters, college dorms, any group living setting).2,4

If you have one of the following immunocompromising conditions, you should get a third dose of Pfizer or Modera at least 28 days after completing the 2-dose series:

  • Active cancer
  • Organ transplant and taking medication to suppress the immune system
  • Stem cell transplant within past 2 years or currently taking medication to suppress the immune system
  • Advanced or untreated HIV
  • Active treatment with medications that suppress the immune system.3,4

DOES IT MATTER IF I GET A DIFFERENT MANUFACTURER FOR MY BOOSTER?

The CDC currently recommends that any additional dose match the vaccine that you initially received. This means that if you completed the 2-dose Pfizer series, your next dose should be the Pfizer vaccine, but if you completed the 2-dose Moderna series, your next dose should be the Moderna vaccine. Some exceptions do exist where your next dose could be different than what you previously received. If you are unsure of which vaccine you should be getting for your booster dose, please contact your doctor or pharmacist.3  

WHAT IF I AM NOT ELIGIBLE FOR A BOOSTER DOSE? WHAT DO I DO? 

At this time not everyone has been made eligible for a booster dose of the COVID-19 vaccine. However, it is important to stay alert to changes in eligibility as new information is made available often. If you have any questions about eligibility or updates in the media, reach out to your doctor or pharmacist to get the most accurate information. In the meantime, it is important to continue safe practices as recommended by the CDC which include wearing a mask, frequent hand washing, avoiding crowds, and practicing social distancing.5    

REFERENCES

  1. Will you need a COVID-19 booster? What we know so far. yalemedicine.org. https://www.yalemedicine.org/news/covid-19-booster. Published July 27, 2021. Updated September 24, 2021. Accessed October 4, 2021. 
  2. Who is eligible for a COVID-19 vaccine booster shot? cdc.gov. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html#HighRisk. Updated September 30, 2021. Accessed October 4, 2021. 
  3. COVID-19 vaccines for moderately to severely immunocompromised people. cdc.gov. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html. Updated September 2, 2021. Accessed October 4, 2021. 
  4. COVID-19 vaccine boosters and additional doses. ncdhhs.gov. https://covid19.ncdhhs.gov/vaccines/boosters. Accessed October 4, 2021.
  5. COVID-19 and your health. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Updated 2021. Accessed September 30, 2021.

COVID-19, flu, and common cold: What’s the difference?

It’s that time of the year again – the influenza (flu) and common cold season! The COVID-19 pandemic makes it even tricker to understand their symptoms and know which is which. You may be thinking you have a fever and are wondering if it is flu or COVID-19? Is my cough because of the common cold or COVID-19? How do I treat them and can they be prevented? Here is a simple explanation of their symptoms, what to do if you think you are infected, when to visit your provider, and how to prevent them.

How are COVID-19, flu, and common cold different?1,2

COVID-19, common cold and flu are all caused by different contagious upper respiratory viruses. COVID-19 is caused by the SARS-COV-2 virus. COVID-19 symptoms present between 2 and 14 days of getting the virus. The common cold can be caused by rhinoviruses, parainfluenza, and seasonal coronaviruses, but this is not the COVID-19 virus. Symptoms present between one and three days after being exposed.  The flu is only caused by influenza viruses and symptoms present between one and four days of being infected. COVID-19 is a more serious illness, takes longer to show symptoms, and the contagious period to infect others can last longer than the others. The flu typically has more intense symptoms and can result in pneumonia and bacterial infections, unlike the common cold. Both COVID-19 and the flu can result in hospitalizations. People with colds typically have a runny or stuffy nose than those with the flu. The common cold normally does not have severe complications like COVID-19 and the flu. The flu can be treated with medications prescribed by your physician, but there is no cure currently for COVID-19 and the common cold. Unlike the common cold, COVID-19 and flu have vaccines available to prevent them or protect you against the severity of the illnesses.

How are they alike?1,3,4

Since they are all respiratory illnesses, they can all affect your breathing and blood vessels. They spread by being within six feet of others and by the release of respiratory droplets when you cough, sneeze, or speak. They also spread by touching a surface someone has touched with one of these illnesses, then you touch your nose, mouth, or eyes. You can affect someone a day before you experience any symptoms.

Both the flu and COVID-19 share the following symptoms: cough, fever, chills, shortness of breath, fatigue, sore throat, runny or stuffy nose, muscle pain, headache, loss of taste or smell, and vomiting and diarrhea. The common cold can also causes headache, fever, cough, runny or stuffy nose, fatigue, and sore throat. The loss of taste or smell is more common with COVID-19, but it can occur from the flu or common cold. You could have none, few, or many symptoms that are mild or serious because these illnesses differ in everyone. COVID-19 and flu can cause severe complications like pneumonia, organ failure, heart attack, stroke, respiratory distress, and death. Those at the highest risk for the flu and COVID-19 include pregnant women, people over 65 years old, and those with other medical conditions like diabetes, kidney disease, heart disease, hypertension, cancer, lung disease, asthma, liver disease, immunocompromised, and obesity.

What are the symptoms of each?1,5

The common cold is more mild and can be cleared within a week without treatment. The symptoms include runny nose, fatigue, chills, cough, sneezing, sore throat, and headaches. Fevers are more common in children than adults. You should not feel limited to complete basic tasks, but you may not be able to carry out your daily activities as actively. The flu symptoms are like the common cold symptoms, but include a fever and muscle pain. You may also feel more tired and the symptoms typically last about a week. COVID-19 symptoms may first appear like the common cold or flu with cough, fever, and fatigue. Many people report a loss of taste or smell early on. Later, you may feel shortness of breath or muscle pain which means you should contact your physician. The symptoms can be present for a short or long time depending on the person, but they typically last two weeks.

Testing is needed to confirm a diagnosis since it is not just based on symptoms. Only a doctor can diagnose you of a disease. If you experience symptoms, contact your physician.

What do I do if I have COVID-19, flu, or cold symptoms?3,6

If you end up getting one of these viruses, it is best not to spread the infection to others, stay home from work, and take care of yourself with plenty of rest and stay hydrated. If you have a fever, you should stay home from work and treat it with over-the-counter fever reducing medications. You should not return to work until you have stayed home with your fever and at least 24 hours after the fever without using medication. You could also contact your physician for an appointment and treatment plan or visit the emergency room if you have serious symptoms.

Which symptoms should I immediately tell my provider?5

Regardless of the diagnosis, you should tell your provider of the following symptoms: shortness of breath, chest pain, persistent pain, sudden confusion, pale skin, and trouble falling asleep or staying awake. These may indicate something more serious. If you are over 65 years old or have other conditions like diabetes, cancer, lung disease like asthma, kidney disease, pregnancy, current smoker, or are immunosuppressed, you are at a higher risk of illness complications. If you are fairly healthy without other diseases, the following symptoms can be best taken care of by staying home, wearing masks in public areas, and getting rest: cough, sore throat, fatigue, headaches, loss of taste or smell, and muscle aches. 

Can I have the flu, common cold, and COVID-19 at the same time?3

Yes, these are different viruses, so it is possible to have more than one at the same time.

Can the flu become COVID-19?3

No, the flu and COVID-19 are different viruses, so one cannot turn into the other. 

How can I avoid the flu and COVID-19?3,5

Last year, social distancing and wearing masks helped the flu season be more mild than it normally has been, but as restrictions lift, the flu season this year may be more intense. There will likely be an increase in flu cases, so it is important to get your flu vaccine this year. Research has shown that getting the flu vaccine may reduce your risk of getting COVID-19, but the flu vaccine does not prevent COVID-19. According to the Centers of Disease Control and Prevention, “Getting a flu vaccine is more important than ever during 2020-2021 to protect yourself and the people around you from flu, and to help reduce the strain on healthcare systems responding to the COVID-19 pandemic.”

If you have not already gotten your COVID-19 vaccine, this would also help reduce your risk of getting COVID-19 and the severity of its complications. Other precautions include avoiding large gatherings; staying within six feet of others outside of your household; wash your hands with soap and water for 20 seconds or use a hand sanitizer with at least 60% alcohol; wear a face mask in public spaces; avoid touching your eyes, nose, and mouth; cover your mouth and nose when you sneeze or cough with your elbow; and clean high-touch surfaces like doorknobs and counters daily. For all of them, social distancing, wearing masks, and limiting time in public areas helps reduce the spread of them.

Josefs pharmacies offer COVID-19 and flu vaccines. COVID-19 vaccines are by appointment only and are free, so click here to schedule an appointment. Click here to find a location near you to reserve your appointment online or walk-in for flu vaccines. You can get the flu vaccine free of charge with participating insurances. 

References:

  1. Similarities and differences between flu and COVID-19. CDC website. https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm. Accessed October 1, 2021.
  2. Cold versus flu. CDC website. https://www.cdc.gov/flu/symptoms/coldflu.htm. Accessed October 1, 2021.
  3. COVID-19 vs. flu symptoms: How can you tell the difference? Health partners website. https://www.healthpartners.com/blog/covid-19-vs-flu-symptoms/. Accessed October 1, 2021.
  4. COVID-19 vs. flu: Similarities and differences. Mayo clinic website. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vs-flu/art-20490339. Accessed October 1, 2021.
  5. Coronavirus, the flu or the common cold? Here’s what to know. Global news website. https://globalnews.ca/news/7370979/coronavirus-flu-common-cold-what-to-know/. Accessed October 1, 2021.
  6. How to tell the difference between COVID-19 and flu symptoms (because they can look very similar). Real simple website. https://www.realsimple.com/health/preventative-health/cold-flu-allergies/how-to-make-flu-shot-more-effective. Accessed October 1, 2021.
  7. COVID-19, cold, allergies, and the flu: What are the differences? Mayo clinic website. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-cold-flu-and-allergies-differences/art-20503981. Accessed October 1, 2021.