Introduction

With luck, your cat is going to live a long time with CRF, so it pays to learn how to make medicating your cat as easy and stress-free as possible. To start with, if your cat only has mild CRF, you may not need to give too many treatments; but as the disease progresses, you may need various medications. Many cats dislike being pilled and handled, so this page explains ways in which to make the process go more smoothly for both of you. There are also links to veterinary drug reference information.

I recommend always telling your cat what you are doing and why, and how it will help them feel better. It may sound strange, but some people have found that their cats tolerate treatment better after they've explained it all to them. You can also choose a special word or phrase that tells them you are about to give them medication and/or fluids - the cat will soon learn what this means, and will then not be stressed when you approach him/her at other times.

For tips on the Sub-Q process, see How to Give Sub-Cutaneous Fluids: Syringe Method and How to Give Sub-Cutaneous Fluids: Giving Set Method. The Intravenous Fluids and Sub-Cutaneous Fluids page also has some information.

For the guidelines on using Epogen and additional tips, see the Anaemia page.

Cautions

Check with your vet before deciding to crush a pill or mix it with liquid. Some medications are extended release, meaning that giving the pill in crushed form releases all the medication in one go, which might be dangerous with some medications. Other medications may be enteric-coated, meaning they are intended to reach the small intestine intact. Crushing or cutting such pills will stop this happening.

If you forget to give a pill, check with your vet, but the general recommendation is to give it as soon as you remember, unless it is nearly time for the next dose, in which case you should simply give the next dose. So if you find your cat has spit up a daily morning pill six hours after you gave it, you can give it again; but if you find the pill the next day, just before you are due to give the next dose, do not double up but simply give one dose.

How to Pill a Cat

It is important to pill a cat correctly, because getting it wrong may cause aspiration pneumonia. Pet Place has more information on this.

Cornell University College of Veterinary Medicine has a video on how to give a cat pills or capsules.

Cornell University College of Veterinary Medicine has a video on how to give a cat liquid medications.

Washington State University College of Veterinary Medicine has a series of photos showing how to give oral medications to a cat.

The Humane Society of the United States has a series of diagrams showing how to give a cat a pill.

Pet Place describes how to give a pill.

Pagewise also has a description of how to pill a cat.

Ben, a CRF List member cat, happily receives his moistened gelcap (gelatin capsule) containing his medications.

Recent studies have shown that cats find it much easier to swallow pills if they are given some water immediately afterwards. You may want to keep a bottle of water (the sort used for feeding kittens can be useful) and give your cat a little water every time you pill him/her, or perhaps follow pills with some watered-down syringed food. It may also help to give a little water before giving a cat a pill.

Suspected clindamycin-associated oesophageal injury in cats: five cases (2006) Beatty JA, Swift N, Foster DJ, Barrs VR Journal of Feline Medicine and Surgery July 15 Epub reports on problems resulting from giving medication without food or water chasers. 

Oesophageal transit of capsules in clinically normal cats (2000) Graham JP, Lipman AH, Newell SM & Roberts GD American Journal of Veterinary Research 61.

Evaluation of oesophageal transit of tablets and capsules in 30 cats (2001) Westfall DS, Twedt DC, Steyn PF, Oberhauser EB & Van Cleave JW Journal of Veterinary Internal Medicine 15.

.Pet Education has an overview of these studies.

Pill Pockets and Similar

These products are designed to help you pill your cat more easily.

Pill Pockets are one option. These are chicken or salmon flavoured treats with a hidden pocket in which to hide your cat's medication. Some people find that, if they are only giving small amounts of medication, they only need to use half of a Pill Pocket, which makes them last twice as long. They are available as follows:

USA

Bullwrinkle and Entirely Pets sell 45 pill pockets for US$6.30, though they are sometimes on sale for only US$4.99.

Flavor Doh is similar but it comes in a tub and you use enough to wrap around the pill. It is available from Pet Food Direct.

BCP Veterinary Pharmacy sells Vet Chews, in which your cat's medications are compounded into flavoured chews.

UK

Best Pet Pharmacy in the UK sells something similar called Feline Tab Pocket, made by Waltham. They cost £6.03 for 20.

VetUK sells the same product more cheaply, for £4.65.

Canada

Cat-alog in Canada sells chicken or salmon flavoured Pill Pockets for CAN$9.99 a packet.

You might also want to try hiding the taste of your cat's pills, for example by covering them with butter.

Using a Pillshooter

If your cat is hard to pill, it can sometimes help to use a pillshooter. Here is a picture of one we purchased from our vet for £1.25. You can buy some pillshooters in syringe form, so that you can follow the pill immediately with some water as recommended above.

In the USA, the following pillers are available online:

Valley Vet sells a clever pillshooter which crushes the pill, then adds water to dissolve the pill. You can then either give the pill orally or add the mixture to food.

Omaha Vaccine sell one for US$1.29.

Pet People's Place have a pill gun which costs US$1.95.

Healthy Pets sell a pill gun that costs US$2.90.

Drs Foster and Smith sell a pillshooter which costs US$2.99.

If you have to give your cat several medications, it can be much easier to give them all at once by placing all the medications in an empty gelatin capsule (gelcaps in the USA) and just giving the one capsule; this also gets round the problem of foul-tasting medicines. You buy the gelatin capsules or gelcaps empty and fill them with the medications of your choice (though check with your vet about the combinations you have in mind, since not all medications can be taken with others). It may help to coat the capsule in butter before giving it to your cat: most cats like the taste of butter and it helps the gelcap go down smoothly. It is also helpful to follow any medications with water (see the importance of a water chaser).

Gelatin capsules come in various sizes, from 000-5, with 5 being the smallest. As a general rule, you need the smaller sizes for cats, and most people on the CRF Information List use size 1 -3, depending upon how many medications they will be putting in the capsule and how big their cat is. 

Torpac sizes shows actual sizes of capsules, but is a manufacturer, not a retailer.

Torpac dimensions gives the dimensions of the capsules.

Torpac Funnel is a little funnel to use when filling the gelcaps.

US Suppliers

Many health food shops sell empty gelcaps, usually the NOW brand which is available in a size 3.

Thomas Veterinary Drug charges US$9.95 per 1000 Size 4 gel caps with free shipping ground UPS in USA. Minimum order of US$30 required. They will ship to UK, but shipping costs will be high. Search for gel caps if necessary.

Papa Nature sells 1000 empty size 3 gelcaps for US$8.38. Shipping to the East Coast costs around US$1.50. They will ship internationally.

Always Affordable Vitamins sell 1000 size 3 gelcaps for US$8.99, and will ship to UK, charging around US$16 shipping for one or two lots and US$20 for three lots. They use airmail, which takes 4-7 days.

Thriving Pets sells a variety of gelcaps from size 0 - size 5, including 1000 size 3 for US$9.98, and will ship to other countries. Shipping costs are determined by weight. I have bought gelcaps from this company with no problems.

Capsuline sells size 3 beef or chicken flavoured Cat Caps. They are much more expensive than unflavoured gelcaps though (US$20.95 for 1000 plus shipping). They will ship abroad (US$19.95 to the UK). They also sell a capsule filling machine but it is expensive at US$69.99.

UK Suppliers

Baldwins only sell size 0 at present, at a cost of £3.69 for 100 or £17.45 for 500. P&P depends on weight but is unlikely to be more than £1. Search for capsules.

Thriving Pets sells a variety of gelcaps, including 1000 size 3 for US$9.98, and will ship to other countries. Shipping costs are determined by weight. I have bought gelcaps from this company with no problems.

Canadian Suppliers

T.U.B. Enterprises sells capsules in varying sizes. They cost CAN$10.50 for 1000 size 3s and CAN$10.20 for 1000 size 4s. Shipping and handling is around CAN$10.

In the USA and some other countries, it is possible to have medications compounded into a base of your choosing. These can be in either pill, liquid or capsule form. Unfortunately compounding medications is not legal in the UK so this is not an option there at present.

Common flavours popular with cats are fish, chicken etc. Not all cats like the taste of compounded medications, and they are relatively expensive, but they are worth considering for hard-to-pill cats. Compounding is essential for Calcitriol - it is the only way to obtain cat-sized doses, and it seems to work very well in compounded form. See below for information on finding a compounding pharmacy.

Do double check with your pharmacist regarding the medication you are considering having compounded, and consider switching to pills if the compounded form does not seem to be working as well as you expected. If you use a liquid compounded medicine, be sure to shake it very well before giving it to your cat.

Transdermal Medications

With some medications, it is even possible to have them compounded into a transdermal gel, which is rubbed on the inside of the cat's ear and absorbed through the cat's skin. However, not all transdermal medications give good and/or consistent results - some people have found that the transdermal amlodipine they have used, for example, has not successfully controlled their cat's blood pressure, whereas Norvasc pills have. Plus some cats may develop sore ears where the compounded medications are applied; alternating ears may help with this. If you do use transdermal medications, you should apply them using gloves so as to avoid absorbing any of the medication through your own skin.

Wedgewood Pharmacy has more information about transdermal medications.

Vetcentric also has some information.

Drug compounding for veterinary patients (2005) Papich MG  American Association of Pharmaceutical Scientists Journal 07(02) ppE281-E287, discusses the use of compounded medications, including transdermals, and states that evidence to date suggests that "absorption was incomplete, nonexistent, or highly inconsistent among cats".

The Winn Feline Foundation is funding a study into the effectiveness of transdermal medications for cats.

Do double check with your pharmacist and consider switching to pills if the transdermal form of the medication does not seem to be working as well as you expected.

International Academy of Compounding Pharmacies: you can type in your zipcode and how far you are prepared to travel and you will be given details of suitable pharmacies. This site also provides details of compounding pharmacies in Spain, Portugal, Canada, Chile, Brazil and Australia.

Mar Vista Vet provides a list of some compounding pharmacies in USA.

Vetcentric has information on compounding medicines and the use of transdermal medications.

BCP Veterinary Pharmacy sells Vet Chews, in which your cat's medications are compounded into flavoured chews.

Island Pharmacy is the main compounder of calcitriol (see Treatments) in the USA. It also sells other items.

The Medicine Shoppe Animal Pharmacy sells a pound of flavoured aluminium hydroxide for US27-39. It also sells other items.

Pet Health Pharmacy is a compounding pharmacy which can provide a number of different medications.

Pillcutters

Since cats often require low dosages of medication, you often have to cut tablets in order to give them the correct dose. This is particularly hard with Pepcid AC where you have to cut the tablets into quarters. Invest in a pillcutter (Betterware sell them for about £4, or you can often find them in chemists), and apply hard, fast taps when you cut the tablet - don't try to cut it slowly or the pill will crumble.

Drugstore sell the Apex brand for US$6.69. I have one of these and really like it - it cuts well, and has a useful little container to hold the pills after you've cut them. Drugstore will ship internationally.

Carol Wright Gifts sells a multi-shape pillcutter for US$4.99 that apparently can cut any shape of pill. However, I've had mixed reviews about this.

Auctionatic Store sells what looks like the same pillcutter for US$2.99.

Norvasc (amlodipine)

Norvasc is used to treat hypertension (high blood pressure). The usual dose is 0.625mg per day, but since the tablets dispensed are often 5mg, this means you need to break the tablet into eight, a tricky thing to do. One method of doing this is to use flat-edged tweezers:

• Snap the pill in half with your fingers.

• Take the half-pill and grip it firmly in the tweezers so that the edge of the tweezers are gripping the piece right in the middle. Then just grasp the other half of the piece with your other hand, and snap it off. 

• Repeat step 2 until you have eight pieces.

This method also works for the 2.5mg tablets.

Also see Pillcutters above - these may be of use in cutting Norvasc.

Some people have Norvasc made into a transdermal medication by a compounding pharmacy, but I would not recommend this for Norvasc, because it is hard to know how much of the Norvasc is being absorbed when it is given in this way. In fact, a couple of Feline CRF Information listmembers have found that the transdermal amlodipine they have used has not successfully controlled their cat's blood pressure, whereas Norvasc pills have. However, it is also possible to get Norvasc compounded into capsules, which may be an option if you use a reliable compounding pharmacy.

How Drugs Work and Possible Drug Interactions

Mar Vista Vet  - helpful information on various drugs, including how they work and possible interactions and side-effects.

Internet Vets - another website featuring veterinary drug information.

Drug Digest - on this site you can type in the names of drugs and check for interactions. The information is human-based but can be a helpful starting point.

Drugstore offers a similar service.

Drug Digest also allows you to type in the name of a medication and see photos of it in different strengths.

Pet Place has a drug library which offers information on 105 different drugs.

Pet Education also has a drug library with information on various medications.

Medical University of South Carolina allows you to choose drug shape, colour etc., to help you identify a medication.

Avoiding Adverse Drug Reactions (2001) is a paper presented by Lauren Trepanier  to the World Small Animal Veterinary Association World Congress 2001.

Merck Veterinary Manual - has a wealth of veterinary information.

Books

"The Pill Book Guide to Medication for your Dog and Cat", by Kate Roby and Lenny Southam, pub. Bantam, available from Amazon for £4.43/$6.99, can be very useful. This is an American book so not all the drugs mentioned are approved in other countries or available outside the USA, plus some of the names of the drugs may differ, but nevertheless it is a helpful book and good value for money.

Plumb's Veterinary Drug Handbook, by Don Plumb, pub. Iowa State University Press, available from Amazon for between £39.99 and £115 depending upon format (USA: $59.99 for the latest edition) is an excellent reference book.

Caring for a cat with kidney failure is a book by Dr Sarah Caney, a British veterinary specialist who only treats cats.

Medical Abbreviations

University of Illinois has information on veterinary abbreviations.

Washington State University College of Veterinary Medicine has a list of veterinary abbreviations.

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