Different gut stimulants and frequency of dose?

I am going back to the vet in a couple of days.... long story short, I've made a few threads on Barney and his slow gut. He's been on metaclopramide for 2 years now and the dose he has needed has just gone up and up.

We are now at 3ml 3 times a day.. he ranges from 3.3-3.7kg depending on his health, 3.7kg would be a good weight for him but these days I'm lucky if he stays above 3.4kg. I believe the top dose for his weight is about 3.3ml but vets are very reluctant to prescribe that dose. The vet also reckons he has developed a tolerance for the drug which is why he is getting worse.

I'm basically unable to keep up with it being 3 times a day - I am out of the house 11-12 hours a day due to work and I'm just not there to give it to him. In the past, I've made do by giving doses at 6.30am, 6pm and 12am, as the minimum time you can leave between doses is 6 hours, ideally it should be 8 hours. But having 5 hours sleep a night just isn't enough and I've gotten very run-down, I just can't maintain it and I have noone that can do it for me.

Now one option is to use the metaclop alongside zantac, both twice a day, I have tried this before and it worked short-term, but I don't really want Barney on yet another medication long-term (he also has metacam and bisolvon daily, is nebulised daily and has anti-biotics and vetergesic occasionally).

From what I understand, metaclop works in the front part of the gut and zantac the behind part, is that correct?

Does anyone know if zantac is always twice a day or is it sometimes more often?

Can anyone tell me how often cisapride should be given? We haven't tried this one yet.

Are there any other gut stimulants available?

Thanks in advance. I need to find some way I can just do 2 doses a day, as currently I'm just not meeting his needs.

I don't know how it compares with the others or if it can be given long-term, but my vets prescribe Domperidone and Zantac for a few days after stasis episodes. They are given in doses 12 hours apart. May be worth researching. I'm also guessing Domperidone could be given without Zantac but not sure about that.

Bunny Buddy said:

I don't know how it compares with the others or if it can be given long-term, but my vets prescribe Domperidone and Zantac for a few days after stasis episodes. They are given in doses 12 hours apart. May be worth researching.

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Thank you Bunny Buddy, I will add Domperidone to the list! I haven't really heard much about that one.

nessar said:

Thank you Bunny Buddy, I will add Domperidone to the list! I haven't really heard much about that one.

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Neither have I - I'm always puzzled as to why FHB uses it as first choice but I rarely see it mentioned and Metaclopramide is far, far more commonly used.

Bunny Buddy said:

Neither have I - I'm always puzzled as to why FHB uses it as first choice but I rarely see it mentioned and Metaclopramide is far, far more commonly used.

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According to a google books preview of Molly Varga's book Textbook of Rabbit Medicine, it isn't widely used and it can't be used in dogs so there hasn't been much research into it, but it is safe for rabbits and has fewer side effects than metaclopramide apparently.

The same section of the book says you shouldn't use ranitidine (zantac) alongside metaclopramide, because it may reduce their absorption or effect :? hmm maybe zantac and metaclop together is not a good idea long-term then, even though it does seem to be a combination that really works for Barney, at least short-term.

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Cisapride.htm

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Ranitidine.htm

http://wildpro.twycrosszoo.org/S/00Chem/ChComplex/Metoclopramide.htm

http://www.ncbi.nlm.nih.gov/pubmed/15470533

http://books.google.co.uk/books?id=...6AEwCQ#v=onepage&q=rabbit domperidone&f=false

Hi Nessar

I've just been reading some of your other posts about Barney. We have a bun who sounds like she has similar problems with a slow gut. In Mini's case she has problems with her bladder underlying it and we've just managed to get to the bottom of that and clear a horrible bladder infection.

Anyway we've been on metaclopramide/emeprid 3 x daily and zantac 3 x daily for several weeks now, so zantac can def be given more than twice a day. But the vet has never told me I have to leave 6 hours between doses - I tend to do 8am, 6pm and 10-11pm - and we've had no obvious ill effects from that.

The vet told me to stop the gut stimulants at the end of last week after her final penicillin injection as she was eating/pooping normally. Which resulted in her slowly eating less/pooping less over Saturday and Sunday, so that I had to start giving the Zantac & Emeprid again

Unfortunately they're closed today for a local holiday but I want to find out what we do next. I'm going to try to change her diet as we've been trying to encourage weight gain so she's been having quite a lot of pellets which I know won't be great. I wondered as well about maybe gradually reducing the gut stimulants to try to get her off them (can they develop a dependency?), but I'm concerned she's going to need them long-term.

I don't have any ideas of other meds but I just wanted to reply to say I feel your pain. It's really hard giving her meds 3 x a day and working in between. Even worse when her gut is sluggish and I feel like I should be there to keep an eye on her.

I think Barney is quite similar to Doughnut as her gut is slow and she gets constipated and reflux. She has been really well now on just 0.5 x 2 of metaclop and 0.7ml infracol. The infracol is really helping her gas situation. She is now constantly out instead of in her hutch and run over night so is getting more exercise and I pick grass for her morning and evening which helps and give her readigrass.

Rantidine didn't help her but she is now having medicine twice a day instead of three times and has metacam and cisapride on standby if she suddenly doesn't go to the toilet, but I haven't had to use it yet, her problem is mainly the upper gut but the cisapride will push the food along the lower gut if it gets stuck there.

Thank you for your replies, everyone. I really welcome your input.

I've managed to get an appointment for Friday, but not with my normal vet. I've only seen this one once before, she did Annabella's dental, but she wasn't able to flush the tear ducts under GA, they were too blocked. But then my normal vet did them a week later, completely conscious using local anesthetic, no sedation even, and he managed fine. They may just have been easier to do later, but it makes me a bit suspicious of how bunny-savvy she is.

So I think I'll just get a prescription for some more metaclopramide and metacam and ask for some zantac too, as even though the combination is not recommended it seems, it does really help him. Might discuss antibiotics as well for his snuffles. Then I'll have an appointment in a couple of weeks with my normal vet and I can ask him to review the meds properly then.

With Barney, I rarely get an instant obvious improvement from a drug (except metacam) or an instant reaction to a food etc. He isn't constipated and his poos don't actually look bad. They get a bit irregular in shape and there are slightly less of them when his gut slows, but other than that they usually look better than a lot of people's healthy bunnies and he poos a LOT - this is his today, and he's not great at the moment. There's no scale but the smaller ones are 5p size and they crumble easily.
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Considering his health, they look pretty good huh? Non-rabbit savvy vets always say that if I hadn't told them he was ill that they would think he was healthy, just thin, as outwardly that is the only obvious sign. I have to rely on subtle changes in how he seems in himself to judge his gut health, as well as feeling his gut and looking at his poos, but like I said they're not that good of a pointer. Normally the only sign of if things are helping or not is gradual weight loss or gain over a couple of months. I also have noticed a direct correlation between his snuffles (mild but chronic) and his gut health, although I can't tell which one is causing which. Occasionally he'll exhibit pain symptoms, but that's usually after at least a week of him not doing so well. It makes it very frustrating as I find it very hard to tell what is working and what isn't.

Jane - now I'm not a complete ninny but for the life of me I can't make out what that paragraph on the study of interactions between zantac and metaclop is saying.... is it saying that there is an interaction when you take them at the same time, or when you take it after, or when you take metaclop after long-term zantac or all of them?

Gem - Yes they do get dependent on it, quite quickly too. The gut adapts and doesn't produce as much of it's own substances that keep the gut moving. So I would try weaning him off it slowly and you should have more luck. If his diet is high in pellets, this will contribute to the slow gut, so I'd try to up the hay in his diet whilst you are weaning him off it.
I got the 6 hours thing both from the vet and the leaflet in the box, so I would double-check with your vet. According to the link Jane posted, it can be given every 2-4 hours when given in low doses, so may be worth checking the dose he is on. If you're using Emeprid syrup, 1ml = 1mg.
Yes, it is exhausting doing it three times a day...I've had to plan my whole life around it, and even then sometimes it's just not possible due to work.

CPayne - Yes I think their symptoms are similar, although I think the underlying problem isn't so much as he doesn't seem to get constipated or reflux. Thanks for the advice on infacol - I've tried this but not had any noticeable improvement. Gas was an original issue but the last time he had an xray of the gut was 2 years ago, so I'm not sure if it was a byproduct or a cause of the unhealthy gut. I have also found that exercise helps Barney, like Doughnut, he has 24 hour access to his run usually and I did notice a decline in his hay eating when he was confined to his hutch at night for a couple of weeks. I'm not sure where the problem is with Barney, the scans showed the entire gut was inflamed and unhealthy, but the stomach was also much bigger than it should be, which I guess would suggest that food was building up there, so it may well be more of a forward part of the gut issue, which of course metaclop is best for.
When you give cisapride, is it in combination with or instead of the metaclop?

The cisapride is in combination.

What happened was she was her gut slowed down and i had given metaclop and metacam as she was in pain and throat rubbing. Nothing happened so gave her some more later but still nothing so took her to the specialist. Thought the metaclop hadnt worked. It had but food was stuck in the lower gut which it doesn't act on so the cisapride was given and that relieved her.

I haven't need to use it but i now know that more metaclop isnt the answer its to get the lower gut moving. So got cisapride if she gets in trouble if that doesn't work them off to the specialist.

She has been so well on just metaclop and infracol though for three months so fingers crossed this is the best medicine for her.

You may remember I had very similar issues when I had my Barney ((who is now at rainbow rabbits). His new vet apparently diagnosed him with a nasty bladder infection, which could be the reason for all of his gut problems (as someone else on this thread has said happened with their bunny too!). Just wondering if you've had his urine tested at all and if it's maybe worth looking at?
I know exactly how you feel re: the frequency of meds and working, that's one of the reasons Barney went to RR; it's very difficult and stressful and I feel for you xx

Just a quick update - took Barney to the vets on Friday and also had a follow-up phone appointment with my normal vet today. The vet I saw wasn't the one I was expecting and she was okay.

He is back on the zantac - he is to have 1ml zantac and 3ml metaclop, both twice a day. His metacam dose has also been increased to a 15kg dog dose once a day. She said we've got the option of upping the metacam to 20kg dog dose and the metaclop to 3.5ml if needed, but they don't want to use these doses unless they have to.

She said basically there isn't a longer-acting gut stimulant, they all have more or less the same time of effect, so combining them and having a stronger effect is what we're going to do. She said that whilst there is an interaction between zantac and metaclop, it is fine to give them together if I don't have time, but if I have the time leaving an hour between them should be enough. She said it's not worth worrying about as long as the zantac is helping.

His breathing is bad too, which isn't helping matters - the vet I saw said to take him off the bisolvon, but my normal vet today said to continue it. The vet I saw also said to try and minimize dust from hay... not sure how I'm going to do this as the ones he likes are the fresh baled hays and hence non-processed... They also don't want to try antibiotics again as there was no improvement with baytril and septrin helped only very slightly. There is also the issue of antibiotics causing a gut flora imbalance, so like with the hay looking after his tummy and respiratory issues are a balancing act... Instead of antibiotics I am going to start nebulising with F10 disinfectant and see how we go with that. He basically said that apart from nebulising there isn't much more they can do for his breathing - his chest is clear it's the upper respiratory tract and there is very little discharge and no pus/coloured discharge so it is suspected to mainly be scarring and the heat wave causing the issue.

The two issues seem to be connected so we are hoping that a positive change in one will help the other too.

No he hasn't had a urine test done recently, he had one a few years ago and it came back negative. He has had incontinence twice before (3 years ago and 1 year ago) but they seemed to be caused by his very poor condition and malnutrition (due to snuffles and gut problems) at the time. The incontinence improved when his general health improved - the last time I don't think we even tried antibiotics, we focussed on his gut problem and it went by itself. He has always drunk loads, even before he was ill. No calcium issues.

I will ask them about the possibility of a urine infection but I think we'd see more consistent signs, wouldn't we? as well as noticeable improvement when on antibiotics - I take it baytril and septrin would work on a bladder infection too?

I don't know the history of your bunny or his gut issue and of course I'm not a vet but... I've been reading a lot about issues of rabbit gut motility and slow guts lately, causes and treatments, and I've come across several experts (one was Dana Krempels the Phd in vet medicine, who works with the house rabbit society) and they seem to believe gut motility drugs are bad for the gut long term... and don't really work— at least that was my understanding of what they were saying. But like I said, I don't know your bunnies history, or what else you've tried to get his gut working, but I thought I would post that bit of information incase you want to research more about efficacy of gut motility drugs in rabbits yourself. The articles I read came up when I googled terms like: rabbit, gut, gut motility, slow gut, etc... Most of what I read said its better to treat slow guts with other methods, hydration, and diet changes, instead of motility drugs.

Max1 said:

I don't know the history of your bunny or his gut issue and of course I'm not a vet but... I've been reading a lot about issues of rabbit gut motility and slow guts lately, causes and treatments, and I've come across several experts (one was Dana Krempels the Phd in vet medicine, who works with the house rabbit society) and they seem to believe gut motility drugs are bad for the gut long term... and don't really work— at least that was my understanding of what they were saying. But like I said, I don't know your bunnies history, or what else you've tried to get his gut working, but I thought I would post that bit of information incase you want to research more about efficacy of gut motility drugs in rabbits yourself. The articles I read came up when I googled terms like: rabbit, gut, gut motility, slow gut, etc... Most of what I read said its better to treat slow guts with other methods, hydration, and diet changes, instead of motility drugs.

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Hiya, yes the gut does become dependent on them long-term, which is why other methods can be better for some cases. Unfortunately Barney has a very high fibre diet and drinks way more than a normal rabbit should, but still has a slow gut, so they are necessary in his case. But thank you for mentioning it, it is always good to think outside the box :thumb:

Saw the vet again, but he was running late so didn't get to discuss things in detail.

Barney has lost weight, again. He's not doing well. Vet says basically he's on all the meds he can give him and there's not much else we can do now, it's just a case of carry on. I'm feeling very down about it all, it all just seems so hopeless.

I could give 3 doses a day of the empeprid some days, but not others, and I worry that doing that so inconstantly may be worse than not doing it at all.

I think I'm going to change his diet again to:

10ml tomato/carrot juice (for syringing meds)
1 (8-10g) tablespoon excel mature
1 tablespoon profibre pellets
30g fibafirst
10g vetcare digestive
half a handful of non gassy, non sugary, non carby, non lettucey greens
half a handful/a cube alfalfa
hay

and see how we go with that. Food change is very gradual process with Barney so I'll start with the alfalfa and greens for a month first.

He's also not grooming himself. He sat in his wee at the weekend and still hasn't groomed it off. It's a bit damp still, so I've dowsed it in flour and we'll see how it is tomorrow. I don't want to bathe him unless necessary due to the stress.

Sorry to hear that Barney's not doing so well, nessar.

In terms of the cleaning, we have the same problem with Mini. She has some mobility issues on top of everything else and doesn't really groom herself properly around her bum and back legs anymore. I find the best thing is to keep on top of it every day, just brushing her while she sits on my lap. She freaks out if we try to give her a wet bath, and she isn't much a fan these days of being turned over so she's tummy up, so to avoid stress for both of us I brush the fur above her tail (or comb it) and lift her bum slightly to get to the fur just underneath. It's not a perfect system, I don't get to all the mess, but she seems to not mind it too much and it deals with the worst. If she's wet I give her a wipe with a rinsed babywipe to get the worst off, then dry her with a towel and brush the fur out. I have been known to use a hair dryer on low occasionally but only really when I've tried to wash her so she's REALLY wet. Cornflour can help get the worst of the wetness out but I find the towel-drying and brushing method works best for us.

We also struggle to keep Mini's weight up. She's such a tiny thing so it's quite scary when she loses, and we're now at 1.7kg compared to over 2kg before the health issues started. I can't offer much more than moral support though; we actually find that feeding her separately from her buddy and giving her a good portion of pellets works best for her, which clearly wouldn't work for Barney.