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Fortekor tablet dosage, confusion please help!

I have a rabbit called Arthur. He has renal failure following a horrendous bout of EC. It's been a traumatic 8 weeks. Arthur is doing very well all things considered but has been left with kidney failure. I've seen two different vets and been told two different things regarding Fortekor dosage. I wondered if anyone here has any advise and would share their experience with the drug in tablet form.

Arthur is 1kg (usually a little more) and he has been prescribed 1/4 of a 2.5mg tablet twice daily. So he's having 1/2 of a 2.5mg tablet per day.

I saw another vets who told me to half that dose so give him just a 1/4 of a 2.5mg tablet once a day (instead of twice a day).

Thank you for your time, I'd love to hear from you knowledgeable folk

David & Sandra.
 
I have a rabbit called Arthur. He has renal failure following a horrendous bout of EC. It's been a traumatic 8 weeks. Arthur is doing very well all things considered but has been left with kidney failure. I've seen two different vets and been told two different things regarding Fortekor dosage. I wondered if anyone here has any advise and would share their experience with the drug in tablet form.

Arthur is 1kg (usually a little more) and he has been prescribed 1/4 of a 2.5mg tablet twice daily. So he's having 1/2 of a 2.5mg tablet per day.

I saw another vets who told me to half that dose so give him just a 1/4 of a 2.5mg tablet once a day (instead of twice a day).

Thank you for your time, I'd love to hear from you knowledgeable folk

David & Sandra.



Hi David and Sandra and welcome to the Forum :wave:

I'm really sorry to hear about Arthur, but it sounds like you may be able to stabilise him and give him a great quality of life for a while yet :). I am reluctant to actually recommend a dosage, even though I have had rabbits of my own on Fortekor, but perhaps the info here can help you a little?

http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/ChronicRenalLagomorph.htm#MedicalTreat

I was also wondering whether your vet would consider injections of an anabolic steroid (NOT to be confused with a corticosteroid) which may help to reduce the rate of muscle wastage. Anabolic steroids can also help with appetite, which sometimes comes and goes with kidney failure. It will also help address the possible issue of anaemia.

A diet increasing fresh veggies will also ensure the maximum retention of fluid and Epogen (erythropoietin) injections are extremely helpful if your rabbit's RBC (red blood cell) count is low. I give daily sub-cut fluids, and the vet can give vitamin injections (specifically vitamin B12).

I realise you only asked for the Fotekor dosage, so I hope you don't mind me adding in my thoughts :)

Has Arthur had a course of Panacur? I am assuming yes? x
 
I have just managed to find these threads, which may help:

http://forums.rabbitrehome.org.uk/showthread.php?255822-Administering-Fortekor

http://forums.rabbitrehome.org.uk/showthread.php?435175-Benazepril-(Fortekor)-Dose

Here on Wiki, two references taken from Varga and Meredith:


Starting dose 0.05 mg/kg PO q24h. Dose may be increased to a maximum of 0.1 mg/kg. (Meredith, 2015)
0.05 mg/kg PO sid (Varga, 2013)


And the dosage taken from the BSAVA small animal formulary ...

Rabbits: 0.25-0.5 mg/kg p.o. q24h.

Hope that helps a bit :D
 
I have a rabbit called Arthur. He has renal failure following a horrendous bout of EC. It's been a traumatic 8 weeks. Arthur is doing very well all things considered but has been left with kidney failure. I've seen two different vets and been told two different things regarding Fortekor dosage. I wondered if anyone here has any advise and would share their experience with the drug in tablet form.

Arthur is 1kg (usually a little more) and he has been prescribed 1/4 of a 2.5mg tablet twice daily. So he's having 1/2 of a 2.5mg tablet per day.

I saw another vets who told me to half that dose so give him just a 1/4 of a 2.5mg tablet once a day (instead of twice a day).

Thank you for your time, I'd love to hear from you knowledgeable folk

David & Sandra.

Hello

I am sorry to hear about poor Arthur. None of us are qualified to give you specific advice re the appropriate dose rate of Fortekor (Generic name Benazepril) but there are some references on here, not sure if you have already seen them :

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

The prescribing Vet will be mindful of the specific clinical details pertaining to Arthur (from blood test results) and also of the fact that one of the effects of Fortekor is a lowering of the Rabbit's blood pressure. Obviously this too needs to be monitored. The second Vet may have had very good reason for reducing the dose for Arthur :)

There are other supportive measures that can be taken to help a Rabbit in CRF, I posted this on another thread a couple of months ago

. When used to treat CRF Benazepril reduces the protein loss in urine and lowers the systemic and intraglomerular (within the kidneys) blood pressure. Reduction in glomerular hypertension (high blood pressure within the kidneys) slows the progression of kidney disease by reducing the rate of further damage to the kidneys. Fortekor has been found to increase the appetite too.

Anabolic steroids can be useful, they act as an appetite stimulant, reduce uraemia (raised levels of urea in the blood), reduce muscle wastage (which often accounts for the weightloss seen with CRF) and may help with the retention of electrolytes.

If blood tests show low potassium (hypokalaemia) then a Potassium supplement could be given

If anaemia is a feature of the CRF then giving Erythropoetin may be an option. It is a hormone normally produced in the kidneys.

Rabbits in CRF do need some dietary modifications which include moderating calcium intake -eg minimal alfalfa hays/pellets and restricting phosphate intake, so no carrots, tomatoes or banana

Sometimes fluid therapy becomes necessary- fluid given IV or possibly subcutaneously.

I hope that Arthur can remain as comfortable as possible x
 
Hi, thank you all for your replies, well wishes and information regarding this matter. I had come across those links and dosages online but it only confused me further and worried me that Arthur was on a dose way too high. I wonder if you can help me understand something.

For example:

Frequently I've seen "0.1 - 0.5 mg/kg orally once daily in the treatment of progressive renal disease"

Am I correct in assuming that since Arthur has a 2.5mg tablet which is broken in to 4 pieces and I give him 2 of those pieces a day (half a tablet) that I'm giving him 1.25mg/kg per day (2.5mg divided by 2 = 1.25mg). This is over DOUBLE of the very highest amount I've seen on information I've read, including that above. I've seen some say up to 0.05mg/kg which would be as if I broke the tablet into about 50 pieces. Am I calculating something wrong? That seems ridiculous.

From everything I read it seems Arthur was on considerably more than twice the maximum dosage for his size which just seems a little strange given his renal failure was "mild" at the last blood test.

I want to reiterate I would never change a dose based on suggestions or what I've read online. I am simply trying to further my understanding and ensure I've accumulated various information to feel comfortable in what I'm doing.

Arthur was on Panacur for 28 days, off it for 5 days and then the EC returned. Arthur has been on it since for about 3 weeks.
 
Hi, thank you all for your replies, well wishes and information regarding this matter. I had come across those links and dosages online but it only confused me further and worried me that Arthur was on a dose way too high. I wonder if you can help me understand something.

For example:

Frequently I've seen "0.1 - 0.5 mg/kg orally once daily in the treatment of progressive renal disease"

Am I correct in assuming that since Arthur has a 2.5mg tablet which is broken in to 4 pieces and I give him 2 of those pieces a day (half a tablet) that I'm giving him 1.25mg/kg per day (2.5mg divided by 2 = 1.25mg). This is over DOUBLE of the very highest amount I've seen on information I've read, including that above. I've seen some say up to 0.05mg/kg which would be as if I broke the tablet into about 50 pieces. Am I calculating something wrong? That seems ridiculous.

From everything I read it seems Arthur was on considerably more than twice the maximum dosage for his size which just seems a little strange given his renal failure was "mild" at the last blood test.

I want to reiterate I would never change a dose based on suggestions or what I've read online. I am simply trying to further my understanding and ensure I've accumulated various information to feel comfortable in what I'm doing.

Arthur was on Panacur for 28 days, off it for 5 days and then the EC returned. Arthur has been on it since for about 3 weeks.

I can understand that, information overload can make my brain freeze ! I agree with your calculations and that Arthur is on 1.25mg a day, which going by the data available online does seem to be a high dose. However, as we have said, it's best to contact the Vet to clarify the situation.

I assume that Arthur is a Nethie as he sounds to be a tiny fella ?
 
Hi, thank you all for your replies, well wishes and information regarding this matter. I had come across those links and dosages online but it only confused me further and worried me that Arthur was on a dose way too high. I wonder if you can help me understand something.

For example:

Frequently I've seen "0.1 - 0.5 mg/kg orally once daily in the treatment of progressive renal disease"

Am I correct in assuming that since Arthur has a 2.5mg tablet which is broken in to 4 pieces and I give him 2 of those pieces a day (half a tablet) that I'm giving him 1.25mg/kg per day (2.5mg divided by 2 = 1.25mg). This is over DOUBLE of the very highest amount I've seen on information I've read, including that above. I've seen some say up to 0.05mg/kg which would be as if I broke the tablet into about 50 pieces. Am I calculating something wrong? That seems ridiculous.

From everything I read it seems Arthur was on considerably more than twice the maximum dosage for his size which just seems a little strange given his renal failure was "mild" at the last blood test.

I want to reiterate I would never change a dose based on suggestions or what I've read online. I am simply trying to further my understanding and ensure I've accumulated various information to feel comfortable in what I'm doing.

Arthur was on Panacur for 28 days, off it for 5 days and then the EC returned. Arthur has been on it since for about 3 weeks.


You're very welcome :)

Renal failure can be a scary diagnosis, but there is so much that can be done to make a rabbit's quality of life better these days.

I do agree that Arthur would appear to be on quite a high dose of Fortekor, but I was happier to give you guidelines so that you could further discuss this with your vet.

When you say he was on Panacur, then came off it, the EC returned - on what basis did the vet make those diagnoses? Has going back on it made any significant difference?
 
haha yes he is a Netherland Dwarf. We call him our little brown mouse he is so small lol. Thank you for confirming that and walking through that with me I really appreciate your time. I will mention it to the vets. I thought it seemed high too.

Arthur was walking like he'd had a stroke, rolling over, eyes scanning, head dropping etc. Then he immediately improved upon panacur treatment for 28 days, by the end of which he was virtually back to normal. Then after coming off for 5 days he began rolling again, losing control of walking again etc. Since going back on it he improved once again and is stable again.

It's been an incredibly rough time and it's felt like we've pulled him out of the darkest times on numerous occasions. Luckily he is charging around excited and happy etc at the moment.You wouldn't know he was ill except for this bizare front leg spasm which is how this all began.

In November out of the blue he started holding his front leg tentatively, like a twitch almost and he kept tapping it on the floor. It seemed almost neurological. Vet thought arthritis which we weren't convinced on. Took him for x ray, x ray showed arthritis so we thought we were wrong but yet didn't fully believe that was the cause of the weird problem. Metacam didn't help it. Then January started and the EC explosion happened and that really got us where we are now. He still has the twitching leg spasm type thing and he actually has it in the other front leg too. It's incredibly odd.

He's had bloods done, two different x rays, urine tested the poor guy has been through the mill recently. He's doing very well on the whole now. Just so sad about the kidneys which seem like an inevitable problem eventually.

Thank you so much for all of your comments and help I will go back to my vet today and discuss it with them. I just wanted to be armed with some info so that I could query it with them without them thinking I am crazy! It is all so confusing isn't it!
 
haha yes he is a Netherland Dwarf. We call him our little brown mouse he is so small lol. Thank you for confirming that and walking through that with me I really appreciate your time. I will mention it to the vets. I thought it seemed high too.

Arthur was walking like he'd had a stroke, rolling over, eyes scanning, head dropping etc. Then he immediately improved upon panacur treatment for 28 days, by the end of which he was virtually back to normal. Then after coming off for 5 days he began rolling again, losing control of walking again etc. Since going back on it he improved once again and is stable again.

It's been an incredibly rough time and it's felt like we've pulled him out of the darkest times on numerous occasions. Luckily he is charging around excited and happy etc at the moment.You wouldn't know he was ill except for this bizare front leg spasm which is how this all began.

In November out of the blue he started holding his front leg tentatively, like a twitch almost and he kept tapping it on the floor. It seemed almost neurological. Vet thought arthritis which we weren't convinced on. Took him for x ray, x ray showed arthritis so we thought we were wrong but yet didn't fully believe that was the cause of the weird problem. Metacam didn't help it. Then January started and the EC explosion happened and that really got us where we are now. He still has the twitching leg spasm type thing and he actually has it in the other front leg too. It's incredibly odd.

He's had bloods done, two different x rays, urine tested the poor guy has been through the mill recently. He's doing very well on the whole now. Just so sad about the kidneys which seem like an inevitable problem eventually.

Thank you so much for all of your comments and help I will go back to my vet today and discuss it with them. I just wanted to be armed with some info so that I could query it with them without them thinking I am crazy! It is all so confusing isn't it!

Arthur may be a tiny Bunny but he is obviously a very brave one. He has been through a lot, but he sounds to be coping remarkably well. The good thing is he is oblivious to how serious his problems are. As long as he feels OK within himself then for him all is well. Unfortunately it is you who has to do the 'knowing' and consequently the worrying x
 
haha yes he is a Netherland Dwarf. We call him our little brown mouse he is so small lol. Thank you for confirming that and walking through that with me I really appreciate your time. I will mention it to the vets. I thought it seemed high too.

Arthur was walking like he'd had a stroke, rolling over, eyes scanning, head dropping etc. Then he immediately improved upon panacur treatment for 28 days, by the end of which he was virtually back to normal. Then after coming off for 5 days he began rolling again, losing control of walking again etc. Since going back on it he improved once again and is stable again.

It's been an incredibly rough time and it's felt like we've pulled him out of the darkest times on numerous occasions. Luckily he is charging around excited and happy etc at the moment.You wouldn't know he was ill except for this bizare front leg spasm which is how this all began.

In November out of the blue he started holding his front leg tentatively, like a twitch almost and he kept tapping it on the floor. It seemed almost neurological. Vet thought arthritis which we weren't convinced on. Took him for x ray, x ray showed arthritis so we thought we were wrong but yet didn't fully believe that was the cause of the weird problem. Metacam didn't help it. Then January started and the EC explosion happened and that really got us where we are now. He still has the twitching leg spasm type thing and he actually has it in the other front leg too. It's incredibly odd.

He's had bloods done, two different x rays, urine tested the poor guy has been through the mill recently. He's doing very well on the whole now. Just so sad about the kidneys which seem like an inevitable problem eventually.

Thank you so much for all of your comments and help I will go back to my vet today and discuss it with them. I just wanted to be armed with some info so that I could query it with them without them thinking I am crazy! It is all so confusing isn't it!


Ah he sounds like a little sweetie pie :love:

I am glad you and your vet think that the Panacur has stabilised him. I can totally sympathise with you saying that you've pulled him out of the darkest of times, as that's how it's felt with my rabbits on occasions. It's very stressful for the human, too ...

I so glad to hear he is running around - what a beautiful soul he is :)

I hope you get on well at the vet. You aren't crazy at all - so many people now do their research and go armed with lots of questions to the vet. Vets must up their game to keep up with us sometimes.

Good luck xx
 
Thank you to both of you for your messages and all your time. You are absolutely right, its us that's suffering the most as he seems to have no idea lol. Arthur is doing good for now. Time will tell what happens. It's been such a shock to the system, in my naivety I really thought he would live forever I never saw the day he would age.

I'm sure I'll be posting again and updating with Arthur's progress. Sandra said she would give him one of her Kidney's if she could, I suggested we take it out of her and strap it to Arthurs back, I'm no medical expert but surely it's worth a shot ;), can't believe no one else has done this before to be honest :).

You are right he is a beautiful brave soul, our two rabbits are everything to us. Words cannot explain.

I feel better for posting and more positive.

Thank you again

David & Sandra
 
Thank you to both of you for your messages and all your time. You are absolutely right, its us that's suffering the most as he seems to have no idea lol. Arthur is doing good for now. Time will tell what happens. It's been such a shock to the system, in my naivety I really thought he would live forever I never saw the day he would age.

I'm sure I'll be posting again and updating with Arthur's progress. Sandra said she would give him one of her Kidney's if she could, I suggested we take it out of her and strap it to Arthurs back, I'm no medical expert but surely it's worth a shot ;), can't believe no one else has done this before to be honest :).

You are right he is a beautiful brave soul, our two rabbits are everything to us. Words cannot explain.

I feel better for posting and more positive.

Thank you again

David & Sandra

Arthur is obviously a very much loved member of your family. He will be living in the moment and not at all concerned about what the future will bring. I do hope that you will keep us updated about how Arthur is doing. I feel as though I 'know' him now :love:
 
Thank you to both of you for your messages and all your time. You are absolutely right, its us that's suffering the most as he seems to have no idea lol. Arthur is doing good for now. Time will tell what happens. It's been such a shock to the system, in my naivety I really thought he would live forever I never saw the day he would age.

I'm sure I'll be posting again and updating with Arthur's progress. Sandra said she would give him one of her Kidney's if she could, I suggested we take it out of her and strap it to Arthurs back, I'm no medical expert but surely it's worth a shot ;), can't believe no one else has done this before to be honest :).

You are right he is a beautiful brave soul, our two rabbits are everything to us. Words cannot explain.

I feel better for posting and more positive.

Thank you again

David & Sandra



Hi David and Sandra

Rabbits do get under the skin in a most remarkable way. I also want my rabbits to live forever and it's heartbreaking when they get poorly or pass away.

I really hope Arthur has lots of life left in front of him. He's obviously captured your hearts :love: And of course he has a friend which will give him a reason to get out of bed in the morning - I always find it helps :)

I am glad you are feeling a bit better and I look forward to hearing more about your rabbits in due course.

Lots of luck xx
 
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