Metoclopimide dose

Hi

I wonder if anyone can give me some advice about the following please.


My rabbit Patch’s digestion is not good. After a bout of stasis eighteen months ago he has never really fully recovered and seems to be in and out of stasis but never completely normal. He has been on a maintenance dose of Zantac and metoclopimide for six months - right now on a dose of 0.25 mils three times each day. He went to the vet yesterday for a check up and a medicine review. The vet now wants to increase his dose beginning with 1/2 a mil two to four times a day gradually rising if there is no improvement to 1 1/2 mils two to four times per day! Sounds rather a lot to me. I have not increased his dose as I am concerned . I have never heard of a rabbit on such a high dose. I rang and queried it with the vet who says this dosage won’t hurt him.

Anyone else been prescribed such a high dose for their rabbit. He is a Dutch rabbit weighing 2.8 kilos, which is a bit overweight I know but that is perhaps another issue.


Any advice will be much appreciated.

Thanks

Christine

is your vet exotics/rabbit savvy?

the dose sounds fine to me personally. possibly on the low side, although this could be because it's long term. just for example, i have a piggy on metaclopramide at the moment and he has 0.5ml 3x a day. and when my rabbit bisc had/has stasis, tummy episodes etc, he has a course where he's on 1ml 3x a day.

it varies depending on the animal and what the issue is. if you're vet is rabbit savvy then i would go with what they suggest. if they're not, perhaps change vets, or ask your vet to consult with them for advice.

not sure about the zantac dose as i can't remember exactly what mine have been on dose wise.

eta: they may want to increase short term to establish where he begins to improve, reduce and then when symptoms start, they can increase slightly and keep him stable at just above the lowest dose he needs particularly.

Has he had any diagnostics to try to identify the primary cause of his GI tract hypomotility ?

biscandmatt1 said:

is your vet exotics/rabbit savvy?

the dose sounds fine to me personally. possibly on the low side, although this could be because it's long term. just for example, i have a piggy on metaclopramide at the moment and he has 0.5ml 3x a day. and when my rabbit bisc had/has stasis, tummy episodes etc, he has a course where he's on 1ml 3x a day.

it varies depending on the animal and what the issue is. if you're vet is rabbit savvy then i would go with what they suggest. if they're not, perhaps change vets, or ask your vet to consult with them for advice.

not sure about the zantac dose as i can't remember exactly what mine have been on dose wise.

eta: they may want to increase short term to establish where he begins to improve, reduce and then when symptoms start, they can increase slightly and keep him stable at just above the lowest dose he needs particularly.

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Thank you for your response which was very helpful. I guess I felt uncertain as never before in the entire 18 months that he has had this problem has he ever been prescribed more than 0.25 three times each day and one vet at the practice even said the dose could not be increased. So looks like it will be okay to start him on 0.5 for a twice a day and increase if no improvement. It is just the huge jump from 0.25 to 1.05 that has me worried even though it is supposed to be done in increments.

I have to assume that my vet is rabbit savvy as they should all be in the practice, often the confusion arises when we have to see different vets who all seem to have different ideas.

Interesting what you say about increasing dose “short term to establish where he begins to improve, reduce and then when symptoms start, they can increase slightly and keep him stable at just above the lowest dose he needs particularly” recently he went into full blown stasis while he was on the present dose of medication, so perhaps he does need more.

Once again many thanks.

Jack's-Jane said:

Has he had any diagnostics to try to identify the primary cause of his GI tract hypomotility ?

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Thank you for your reply.

He has been examined numerous times and has had an x ray, there is a benign small lump in his gut and he has too much fat deposits on his abdomen but neither is supposed to be causing the gastro stasis. He has been put on a diet with certain food restricted but this is more of a weight issue than anything else. The vet said yesterday that once digestive problems begin there is a tendency for the rabbit to have problems, particularly an older rabbit like Patch. He is eating well enough, but his droppings are smaller and less frequent, has has been much worse but never back to normal.

Once again thank you

Why does your Vet feel that the excess fat and the 'benign lump' are not the primary cause of his GI tract problems ?

Has he had any blood tests, especially to ascertain his Liver function.

Solarwind said:

Thank you for your response which was very helpful. I guess I felt uncertain as never before in the entire 18 months that he has had this problem has he ever been prescribed more than 0.25 three times each day and one vet at the practice even said the dose could not be increased. So looks like it will be okay to start him on 0.5 for a twice a day and increase if no improvement. It is just the huge jump from 0.25 to 1.05 that has me worried even though it is supposed to be done in increments.

I have to assume that my vet is rabbit savvy as they should all be in the practice, often the confusion arises when we have to see different vets who all seem to have different ideas.

Interesting what you say about increasing dose “short term to establish where he begins to improve, reduce and then when symptoms start, they can increase slightly and keep him stable at just above the lowest dose he needs particularly” recently he went into full blown stasis while he was on the present dose of medication, so perhaps he does need more.

Once again many thanks.

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no problem. i hope you can find a dose to keep him comfortable. as jane says aswell, there may be more tests that can be done so definitely look into that.

just incase you need it, here's a site with listed vets. you can select accredited practices and then scroll through the ones in your area who treat exotics. best of luck

eta: the actual link might have helped there :roll: :lol: ... http://findavet.rcvs.org.uk/find-a-vet/

Doughnut is on metaclop permanently now. She weighs 1.3kg and is on 0.5ml twice a day. She was on 0.5 three times a day at one point. I've found if i reduced it to 0.4 she starts getting unwell so keeping it at 0.5 now.

She is under a great exotic vet specialist so those were his recommendations. Obviously its nice to cut down any medication if possible and for to still be well.

Good luck

Jack's-Jane said:

Why does your Vet feel that the excess fat and the 'benign lump' are not the primary cause of his GI tract problems ?

Has he had any blood tests, especially to ascertain his Liver function.

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I am not sure will ask next visit. The consensus of opinion amongst the vets - he has seen all the practice’s vets at some point - seems to be that diet is the main problem, though it appears to me that no matter what he eats or what medication he takes he goes in and out of stasis. He does not eat much hay and has been on grass all summer but now good quality grass is scarce.

Will enquire about blood tests though this has never been suggested.

Thank you for your reply and suggestions

biscandmatt1 said:

no problem. i hope you can find a dose to keep him comfortable. as jane says aswell, there may be more tests that can be done so definitely look into that.

just incase you need it, here's a site with listed vets. you can select accredited practices and then scroll through the ones in your area who treat exotics. best of luck

eta: the actual link might have helped there :roll: :lol: ... http://findavet.rcvs.org.uk/find-a-vet/

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Yes hopefully a higher dose may help. Thank you for the link which was very helpful and indicated our vets does not treat exotic/wild animals which I assume means they are not particularly experienced in the treatment of rabbits. So will need to look into that if things don’t improve. Right now he is eating okay but still not keen on hay but his droppings are smaller than they should be and vary in frequency and he has never returned to normal now for eighteen months.

Thank you for the information

cpayne said:

Doughnut is on metaclop permanently now. She weighs 1.3kg and is on 0.5ml twice a day. She was on 0.5 three times a day at one point. I've found if i reduced it to 0.4 she starts getting unwell so keeping it at 0.5 now.

She is under a great exotic vet specialist so those were his recommendations. Obviously its nice to cut down any medication if possible and for to still be well.

Good luck

Click to expand...

Thanks for the information. From what you say an higher dose should not harm him which was my main concern as up until last Friday all the practice vets said they could not increase the dose of 0.25 mils three times a day, so I was concerned when the vet said to up the dose to 1.25 mils three times a day in increments starting with 0.5 two to four times a day. I have increased his dose to 0.5 twice a day and will increase to three times and see if there is any improvement.

Thank you for your help.

How's it all going? Doughnut also has 0.7ml of infracol twice a day which helps her with her gas so is comfortable.

I am still picking the grass. I saw my specialist the other week and he said the grass is really good now. I think it's low grade and not rich which is what you want for sensitive tummies. She sometimes gets loose on grass but since it's so good for her digestion he thinks I should continue picking a handful once or twice a day for her so that's what I'm doing.

It would be interesting to know your bunnies exact diet. The recommended diet is about 85-90% hay/grass, 5% veg and 5% pellets or so. The pellet/muesli manufacturers often give instructions to give much higher than is sensible/needed/healthy. It could be that too many pellets are causing him to not want to eat hay/grass as much, which can lead to stasis. It would be interesting to know what veg you feed too, and how much. Readigrass and other dried grass alternatives may be good to replace fresh grass, but obviously with a bunny who suffers stasis it would not be a good idea to introduce anything without consulting a vet.

Yes diet is very important. My specialist swapped Doughnut over to muesli as it suits her tummy better, the pellets made her unwell too. She is now on 20g of muesli a day and different hay. He said just do it back to basics. Quite a few rabbits on here don't tolerate pellets very well although they are considered the healthier option. She can't have veg any more which is a shame as she loved it.

I did introduce readigrass but I think it's too rich for her so sticking with normal grass for as long as I can.

cpayne said:

Yes diet is very important. My specialist swapped Doughnut over to muesli as it suits her tummy better, the pellets made her unwell too. She is now on 20g of muesli a day and different hay. He said just do it back to basics. Quite a few rabbits on here don't tolerate pellets very well although they are considered the healthier option. She can't have veg any more which is a shame as she loved it.

I did introduce readigrass but I think it's too rich for her so sticking with normal grass for as long as I can.

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Sorry it’s taken so long to reply to your post. You may well be right about the redi grass and too much veg, I maybe try the muesli see if that helps. Right now he is on 0.5 metoclop three times a day but still goes in and out of stasis. Anyway thank you so much for taking the time to reply and again so sorry about the delayed reply

yaretzi said:

It would be interesting to know your bunnies exact diet. The recommended diet is about 85-90% hay/grass, 5% veg and 5% pellets or so. The pellet/muesli manufacturers often give instructions to give much higher than is sensible/needed/healthy. It could be that too many pellets are causing him to not want to eat hay/grass as much, which can lead to stasis. It would be interesting to know what veg you feed too, and how much. Readigrass and other dried grass alternatives may be good to replace fresh grass, but obviously with a bunny who suffers stasis it would not be a good idea to introduce anything without consulting a vet.

Click to expand...

Thank you for your advice, I am sorry it has taken so long to respond to your post.

Unfortunately he eats very little hay nothing like 85 percent. He eats spring greens, parsley, carrots, apples, basil, and thyme, regular pellets and pro fibre pellets and dried dandelions. I think you may be right about too many pellets but I worry that if he does not eat pellets he won’t be eating much else. Sometimes it seems that no matter what he eats he goes into stasis almost routinely.

Again sorry for the long delay in responding. I do appreciate your advice and that of everyone who has taken the time to respond.

I wouldn't start your rabbit on muesli as it is low in fibre and can cause slow gut motility if he doesn't eat a lot of hay alongside it. To improve gut motility, you should increase the amount of fibre in his diet. The best way to help him long-term is to get him to eat more hay. It's hard when you have a fussy bunny but even a small improvement in his hay eating will help him, so I'd try lots of different types. You can buy a lot of different hays at www.thehayexperts.co.uk and if he likes grass I'd recommend to keep giving it to him all winter, you can also buy dried grass called readigrass.

I'd also have a look at the fibre content of the pellets that he is on, as it can vary. There are a type of pellets made by Supreme that are sticks rather than normal pellets. They have as much fibre in them as hay, so they're ideal for bunnies that don't eat much hay. There's two I'd recommend, Fibafirst and VetCare Digestive. You can buy them both at the hay experts website and fibafirst is also available in Pets at Home.
http://www.supremepetfoods.com/fiba-first-2/
(scroll down) http://www.supremepetfoods.com/supreme-products/supreme-veterinary-exclusive-range/
Bunnies with sensitive tummies do need any changes to their diet to be done very slowly or it can cause a slow-down, so if you choose to change his food over do so gradually.

As for the gut stimulants, my rabbit is bigger than yours so needs a higher dose anyway, but he is on 3ml of metaclopramide 2-3 times a day and 1ml of zantac twice a day, so the amount of metaclopramide prescribed for your rabbit doesn't seem too high. However, if you do have concerns about your vet's knowledge of rabbit medicine, I'd recommend you ask your vet to refer you to a specialist, they should be happy to do so. If your bunny isn't already on pain relief you also may want to discuss this with your vet, as a slow gut and stasis can be extremely painful and pain then causes gut slow-downs, it's a nasty cycle.

I hope your bunny improves soon.