To start with, if your cat only has mild CKD, you may not need to give too many treatments; but as the disease progresses, you may need various medications. 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.

If you only have to give one or two medications a day that do not have a nasty taste, I would recommend Pill Pockets. I've been giving my two girls their amlodipine (for hypertension) in Pill Pockets for over a year. They both love them, think they are a treat and eat them willingly (and even ask for more), which means so much less stress for them and me. I use the salmon flavour.

If you have to give several medications a day, or if you have to give one that tastes unpleasant, I would consider gelcaps. You can put several medications in the gelcap at once (exactly how many depends on the size of the pills and the size of the gelcap) so you only need to pill your cat once, and your cat won't have to taste the nasty pill.

For tips on the Sub-Q process, see How to Give Subcutaneous Fluids: Syringe Method and How to Give Subcutaneous Fluids: Giving Set Method.

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

Cautions                                                                                                                     Back to Page Index

Make sure you have been given the correct medication! Mistakes can happen. You can check some medications online (see below). If you get your next round of supplies in before you have run out, you can check to see if the pills look the same.

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                                                                                                       Back to Page Index

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.

Veterinary Anesthesia and Analgesia Support Group has a number of tips on how to make pilling less stressful for you and your cat.

Pet Place describes how to give a pill.

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

Ben happily receives his moistened gelcap (gelatin capsule) containing his medications.

The Importance of a Water Chaser

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. Below are links to pillshooters which enable you to give water immediately after the pill. Alternatively you could give a little moist food, such as a spoonful of baby food.

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 Products                                                                       Back to Page Index

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

Some people find that, if they are only giving small amounts of medication, they only need to use half of a Pill Pocket, which means they last twice as long. I do this with my girls, since it can be hard (though not impossible) to get Pill Pockets in the UK.

I am occasionally asked if Pill Pockets are high in phosphorus. Actually, they aren't, they have only around 0.64% phosphorus on a dry matter analysis basis, but since you only give one or two a day, I would not be too concerned if they had higher phosphorus levels.

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 Vet Depot

 Pet Food Direct.

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

UK

Unfortunately Pill Pockets are not available in Europe, and the manufacturers have no plans to introduce them into this market.

Amazon UK sells Pill Pockets for £11.99 with free shipping. I have bought these myself, ordering on a Saturday, and they arrived the following Wednesday. Unfortunately they are not always in stock, however, if you wait a few days they often reappear. If you are desperate, they are also usually available from other sellers based in the USA, but with very high shipping costs and they may take longer to arrive. If they are not in stock at the free shipping price and you need them urgently, it can be worth checking Amazon.com too, because the sellers there may charge you less overall.

Vitacost in the USA sells Pill Pockets for US$4.67 per pack plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast.

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, or mixing them in baby food.

Using a Pillshooter                                                                                                   Back to Page Index

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.

Jeffers Pet sell the Buster pet piller which allows you to give water after the pill. Search for pet piller.

Amazon also sells the Buster pet piller.

Omaha Vaccine sell a standard pet piller 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.

Gelcaps/Gelatin Capsules                                                                                      Back to Page Index

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 Tanya's CRF Support Group use size 3-4, or occasionally size 2, depending upon how many medications they will be putting in the capsule and how big their cat is. If you can only buy size 0 or size 1, one member found that if she took the capsule apart and cut part off the top of one end, when it was reassembled it was smaller and easier to give.

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. If they don't have them in stock, they can usually order them for you quite quickly.

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 and only seems to work for larger size capsules.

UK Suppliers

Amazon UK has a seller who sells 100 size 4 capsules for £2.97 plus £4.48 shipping.

Value Healthcare sells gelatin capsules in a variety of sizes, together with capsule fillers and a compressor.

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.

Compounded Medications                                                                                    Back to Page Index

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.

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.

Compounded medications have a short shelf life, a maximum of thirty days for most medications, so be sure not to use a product beyond its expiry date.

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.

Confounding compounding is a 2009 report into the pros and cons of compounded medications.

FDA calls veterinary compounding at Francks illegal is a report from April 2010 on how and why the FDA appears to be clamping down on the compounding of medications for veterinary use.

Compounding Pharmacies USA

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.

Wedgewood Pharmacy sells Gourmeds, another type of flavoured chew.

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.

Compounding Pharmacies UK

In the UK, compounding (known as "unlicensed specials") is not very common and often very expensive. However, In 2011 The Veterinary Medicines Directorate issued a register of three manufacturers who only produce specials veterinary medicines (although one of those specialises in equine medications).

One of the three, Summit Veterinary Pharmaceuticals Limited, sells amlodipine (for high blood pressure) in cat-sized 0.625mg doses, and perhaps they will bring out more medications in due course. You might be able to obtain some human medications (such as famotidine) from a human compounding pharmacy in cat-sized doses.

The Specials Laboratory does now offer veterinary compounding in the UK. It can compound famotidine (Pepcid AC) into cat-sized doses and will quote for other medications.

Transdermal Medications                                                                                       Back to Page Index

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. Veterinary Information Network has some information on this.

Wedgewood Pharmacy has more information about transdermal medications.

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".

Efficacy and safety of transdermal methimazole in the treatment of cats with hyperthyroidism (2004) Sartor LL, Trepanier LA, Kroll MM, Rodan I, Challoner L J Journal of Veterinary Internal Medicine 18(5) pp651-5 found that transdermal methimazole (for hyperthyroidism) took longer to work than oral medications but appeared to have fewer side effects.

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.

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.

For information on cutting amlodipine (Norvasc or Istin, used for hypertension) into cat-sized doses, see All About Hypertension.

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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.

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 is an excellent reference book. It is also available from Amazon UK.

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

Medical Abbreviations                                                                                             Back to Page Index

University of Illinois has information on veterinary abbreviations.

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