Hypertension in Cats

A silent disease

Yes the ingredient in sileo is dexmedetomidine and yes dexmedetomidine is used for sedation however the dose used for sedation and the dose in sileo are markedly different. Dexmedetomidine causes a lower heart rate, however it actually does not routinely cause low blood pressure. Because Sileo is formulated to provide a low dose of dexmedetomidine, your dog remains calm, yet fully functional, and is able to interact normally with your family. SILEO is indicated for the treatment of noise aversion in dogs. Sileo® 0.1 mg/ml oromucosal gel for dogs. Sileo® 0.1 mg/ml oromucosal gel for dogs. Zoetis UK Limited. (in dots) to be administered for the corresponding bodyweight. If the dose for the dog is more than 6 dots (1.5 ml), half of the dose should be administered to the oral mucosa on one side of the dog’s mouth and the other.

While hypertension can be a common problem in older cats, the condition can be difficult to diagnose.^3,4

Hypertension can affect many parts of the body before detection and is strongly associated with target organ damage^3,4:

• Eyes
• Heart and vascular system
• Brain
• Kidneys

Without treatment, this silent disease can lead to serious illness and, sometimes, death.^3,4

Most often develops as secondary hypertension to diseases such as CKD and hyperthyroidism.³

Sileo In Cats

Efficacy

Proven to lower systolic blood pressure^1,10

A pilot dose determination laboratory study was conducted to evaluate the effectiveness of multiple oral doses and dose strategies of telmisartan on the reduction of systolic blood pressure (SBP) in clinically normal, healthy laboratory cats within a 14-day time period.¹¹

* Endpoint at day 14 was significant reduction from baseline compared to placebo (P < 0.0005).

† A clinically relevant reduction in group mean SBP was predefined to be ≥ 20 mmHg in the telmisartan group from baseline to Day 28. The number of cats available at Day 28 for comparison is less than at enrollment because of removal of cats for hypertension rescue or adverse reactions.

The only angiotensin receptor blocker (ARB) for first-line treatment of hypertension in cats

Because ARBs feature a unique, targeted mode of action that specifically blocks the harmful vasoconstrictive effects of the renin-angiotensin-aldosterone system (RAAS), SEMINTRA is shown to quickly lower blood pressure within 14 days‡

• Shown to be effective in cats with primary and secondary hypertension
• Proven to be safe and effective^10–13

Safety and Dosing

Flexible dosing to safely lower and maintain blood pressure in cats

• SEMINTRA offers a dose-dependent response—an initial 1.5 mg/kg (0.68 mg/lb) dose twice daily for 14 days lowers blood pressure to a healthy level quickly, followed by a 2 mg/kg (0.91 mg/lb) once daily dose to maintain control¹¹
• Dose may be reduced by 0.5 mg/kg (0.23 mg/lb) increments to a minimum of 0.5 mg/kg to optimize dosing and prevent hypotensive state

Easily given as oral liquid

Easy-to-use Syringe

— Flexible delivery of dose straight into the mouth or on top of food²

— Selection of accurate dose

Safe for long-term administration

— Safety shown to extend through 6 months in multiple studies^10–13

Convenient liquid formulation

As demonstrated in a study:

— 91.2% of cat owners perfer a liquid formulation²

Mode of Action

SEMINTRA is a highly targeted treatment

Sileo Dose In Cats For Sale

Telmisartan, the active substance in SEMINTRA, is an ARB, a class of medication that modulates the RAAS by selectively blocking receptors in the effector step of the RAAS. Unlike angiotensin-converting enzyme inhibitors (ACEis), ARBs do not block the conversion of angiotensin I to angiotensin II by angiotensin-converting enzyme in the RAAS cascade, thereby also blocking the activation of some of the receptor types with beneficial effects. And, unlike a calcium channel blocker, a class of pharmaceuticals that block the influx of calcium into cardiac and smooth muscle cells through calcium channels and potentially activate the RAAS, ARBs help to manage the RAAS.

Chronic activation of the RAAS can be harmful to tissues, including the kidney.

Watch this video for more information

• Activation of RAAS can be complex, but conditions like chronic kidney disease, cardiac disease, and hyperthyroidism typically increase RAAS activity
• Chronic, excessive RAAS activation can result in systemic hypertension because it promotes salt and water retention and increases blood pressure^14,15
• ACEis reduce the conversion of circulating angiotensin I to angiotensin II, which reduces all of the effects of angiotensin II at all receptors
• ARBs have a more targeted mode of action. They bind only to the AT₁ receptor, preventing activation of this receptor by angiotensin II
• Because ARBs do not bind to AT₂ receptors, the potentially beneficial effects of angiotensin II at these receptors are preserved

Watch this video for more information

Target-specific mode of action of ARBs

IMPORTANT SAFETY INFORMATION

• SEMINTRA is for oral use in cats only.
• The most common side effects reported in field studies include vomiting, diarrhea, lethargy, dehydration, poor appetite, and weight loss. If side effects should occur, pet owners should contact their veterinarian. Click here for full prescribing information.
• SEMINTRA has not been evaluated in cats with systolic blood pressure > 200 mmHg. The safe use of SEMINTRA has not been evaluated in cats with hepatic disease, cats less than 9 months of age, or cats that are pregnant, lactating, or intended for breeding.
• The safe use of SEMINTRA with other anti-hypertensive medications has not been evaluated.
• Mild anemia or non-regenerative anemia has been reported.
• Pregnant women should avoid contact with SEMINTRA because substances that act on the renin-angiotensin-aldosterone system (RAAS), such as angiotensin receptor blockers (ARBs), can cause fetal and neonatal morbidity and death during pregnancy in humans.
• Not for human use. Keep out of reach of children. If SEMINTRA is accidentally ingested, contact a physician.
• SEMINTRA is a clear, colorless to yellowish viscous solution containing 10 mg/mL telmisartan.

References:1. SEMINTRA^® (telmisartan oral solution) Prescribing Information. Boehringer Ingelheim Vetmedica, Inc. 2018. 2. Zimmering T. Ease of use of SEMINTRA and its effects on quality of life—update on cat owner feedback (“EASY Programme”) [abstract]. In: Proceedings from the 21st Federation of European Companion Animal Veterinary Associations (FECAVA); October 15–17, 2015; Barcelona, Spain. Poster. 3. Elliott J, Fletcher M, Syme HM. Idiopathic feline hypertension: epidemiologic study [abstract]. J Vet Intern Med. 2003;17:754. 4. Taylor SS, Sparkes AH, Briscoe K, et al. ISFM Consensus Guidelines on the diagnosis and management of hypertension in cats. J Feline Med Surg. 2017;19(3):288–303. 5. Maggio F, DeFrancesco TC, Atkins CE, et al. Ocular lesions associated with systemic hypertension in cats: 69 cases (1985–1998). J Am Vet Med Assoc. 2000;217:695–702. 6. Littman MP. Spontaneous systemic hypertension in 24 cats. J Vet Intern Med. 1994;8:79–86. 7. Stiles J, Polzin D, Bistner SI. The prevalence of retinopathy in cats with systemic hypertensionand chronic renal failure or hyperthyroidism. J Am Anim Hosp Assoc. 1994;30:564–572. 8. Syme HM, Barber PJ, Markwell PJ, et al. Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation. J Am Vet Med Assoc. 2002;220:1799–1804. 9. Kobayashi DL, Peterson ME, Graves TK, et al. Hypertension in cats with chronic renal failure orhyperthyroidism. J Vet Intern Med. 1990;4:58–62. 10. Coleman AE. Efficacy of oral telmisartan for the treatment of systemic hypertension in cats. In: Proceedings from the American College of Veterinary Internal Medicine; June 14–16, 2018; Seattle, WA. Abstract RRS08-E. 11. Coleman AE, Brown SA, Stark M. Evaluation of orally administered telmisartan for the reduction of indirect systolic arterial blood pressure in awake, clinically normal cats [published online ahead of print March 7, 2018]. 12. Glaus AM, Elliott J, Albrecht B, et al. Efficacy of telmisartan in hypertensive cats: results of a large European clinical trial [abstract]. J Vet Intern Med. 2018;32:577. 13. SEMINTRA^® (telmisartan oral solution) [Freedom of Information Summary]. St. Joseph, MO: Boehringer Ingelheim Vetmedica, Inc.; 2018. J Feline Med Surg. doi:10.1177/1098612X18761439. 14. Williams TL, Elliott J, Syme HM. Renin-angiotensin-aldosterone system activity in hyperthyroid cats with and without concurrent hypertension. J Vet Intern Med. 2013;27(3):522–529. 15. Syme H. Hypertension in small animal kidney disease. Vet Clin North Am Small Anim Pract. 2011;41(1):63–89.

What is prazosin

Prazosin is an oral medication used for managing high blood pressure [15].

Can cats use prazosin

Prazosin is commonly used for the treatment of high blood pressure, hypertension, congestive heart failure ^[1], FIC (feline idiopathic cystitis) ^[12], and conditions associated with FLUTD (feline lower urinary tract disease) ^[12] like urethral blockage ^{[2, 3]}, spasm, or infections. Since it helps in controlling intraurethral intraluminal pressure, it is beneficial for lessening the symptoms of urolithiasis, ureterolithiasis, and prostatic hyperplasia ^[4].

Although phenoxybenzamine, an alpha-blocker, has been the preferred choice of drug used for treating urethral obstruction in pets, it has now been replaced by prazosin because of its selective alpha-1 receptor blocking activity ^[4].

How does prazosin work in your cat

Prazosin inhibits the effect of nerve impulses on blood vessels by particularly binding to the alpha-1-adrenergic receptors of the smooth muscle ^{[13, 14]}. It lessens any resistance to the blood flow, thus reducing venous and arterial pressure, increasing cardiac output without causing any adverse effects on the sympathetic nervous system ^[5]. Therefore, it ensures free circulation of blood and oxygen around your cat’s body, which in turn, reduces strain on its heart ^[13]. It also helps in relaxing the smooth muscles of the internal urethral sphincter, thereby reducing spasm associated with feline urethral obstruction ^[5].

Prazosin dosage for cats: How much can be given

Talk to your cat’s vet to make sure that you get the dose right. The usually recommended dosage is 0.25 to 1.0 mg, given orally with food (or flavored food) at an interval of 8-12 hours a day ^{[1, 6]}. Always wash your hands after handling the medication ^[1].

It usually starts working within a few hours of giving the first dose; but in some cases, the effects may not become obvious before a few more doses.

What to do if you miss giving a dose

If a dose of prazosin is missed, try to get back on track as early as possible. However, if it is time for the next regular dose, it is best that you skip the missed dose and continue with the scheduled one. It is advisable to avoid giving a double dose^[7].

Prazosin overdose symptoms

• Decreased reflexes ^[5]
• Drowsiness ^[5]
• Tachycardia (your cat is coughing, and exhibiting physical weakness with abnormal breathing, or fainting) ^{[5, 8]}

If your cat shows any of these signs, immediately call your vet or the ASPCA’s Poison Control Center at 1-888-426-4435.

Prazosin side effects in cats

The side effects might occur when you first start to give the medicine ^[1]. Common side effects may include:

• Lethargy ^[5]
• Nausea ^[5]
• Diarrhea (your cat is having fever, decreased appetite, showing increased urgency to eliminate, losing weight) ^{[5, 11]}
• Vomiting ^[5]
• Constipation (the cat is straining to eliminate, discharging mucous or blood with small, hard, dry stools, showing less interest in food) ^{[5, 10]}

Some of the serious side effects, which may occur with its long-term use, include dizziness or loss of consciousness ^{[5, 9]}.

Contact your vet if your cat shows any of these symptoms while taking this medicine.

When should you not give prazosin to cats

Make sure that you inform the veterinarian about the medications you are already giving your cat for any pre-existing health conditions. Prazosin should not be administered to cats:

• With chronic kidney diseases or low blood pressure ^{[5, 9]}
• That are pregnant or breastfeeding ^[5]
• Already on beta blockers, nifedipine, verapamil, sildenafil, and clonidine ^[5]

References

1. Prazosin For Dogs And Cats – Wedgewoodpetrx.com
2. Initial treatment factors associated with feline urethral obstruction occurrence rate: 192 cases (2004-2010) – Ncbi.nlm.nih.gov
3. Prazosin Hydrochloride – Vetrxdirect.com
4. Prazosin – Vetbook.org
5. Prazosin For Veterinary Use – Wedgewoodpetrx.com
6. Feline Lower Urinary Tract Disease – Vin.com
7. Prazosin – Albertcottagevets.com
8. Rapid Heart Beat in Cats – Petmd.com
9. Prazosin Compounded – 1800petmeds.com
10. Constipation in Cats: Symptoms and Treatment – Pets.webmd.com
11. Diarrhea Causes and Treatments for Cats – Pets.webmd.com
12. Diagnosing and managing idiopathic cystitis in cats (Proceedings) – Vetrinarycalendar.dvm360.com
13. Prazosin – an alpha-blocker – Patient.info
14. Alpha-Adrenoceptor Antagonists (Alpha-Blockers) – Cvpharmacology.com
15. Prazosin, Oral Capsule – Healthline.com