Reglan Toxicity in Dogs

[Jaybay]

I discovered just before Thanksgiving that Chica was having a bad reaction to the reglan used to control her nausea.  The initial dose was one 10 mg pill every 12 hours.  As her kidneys failure worsened, it took me a few days to make the connection that it was the reglan causing the odd behavior.  She got very restless, paced the floors, and her pulse got very rapid and thready.  

I did some research online as my vet had no idea what was going on (other than it was unrelated to her kidney failure) and discovered that reglan is metabolized in the kidneys.  Bingo!  Obviously she couldn't process that dosage any longer so I cut it back by half.  That worked for a couple weeks until the vomiting worsened.  I found one article regarding reglan toxicity that exactly described her symptoms.  Apparently this extrapyramidal reaction occurs in people as well, and in two cases reglan was directly tied to mental changes that led to suicide.  Have you ever come across anything like this in your practice?

With other nausea meds being completely out of our budget, we've begun using reglan injections.  No side effects to speak of except for about 15 minutes of a little restless behavior, and then she's fine.  It very effective on the vomiting as well and usually lasts a full 24 hours.  Since reglan still has to be processed through the kidneys regardless, can you help me understand why the side effects are so much more severe with the oral meds as opposed to the injections?

Another little discovery I made while dealing with Chica's renal failure is Cran Assure. Chica had been obsessively licking her vaginal area before and shortly after the renal failure diagnosis. There is no UTI requiring antibiotics, but she was obviously very uncomfortable.  I figured if cranberry juice helps humans with a UTI, why not dogs? It worked wonders with the first dose, and I've had her on one pill a day with no further licking. Thanks!

[Aleda M Cheng, D.V.M., C.V.A]

Jaybay,   I have a list of at least 12 anti-emetics (anti-nausea) medications that I will list tomorrow from the office since I have my reference materials there.

But to discuss your use of Cran Assure:  I often have my patients with urinary tract infections take a cranberry supplement or juice.  I also have them take vitamin C since it acidifies the urine.  Dogs produce enough vitamin C when healthy, but need supplementation when illness strikes.

[Jaybay]

Thanks very much!  :-)

[Aleda M Cheng, D.V.M., C.V.A]

Dear Jaybay,  Sorry about the delay in getting back to you about anti-emetics.  There was a fire in a near by pet boarding facility this week and we (me and all the employees at my practice) had our hands full  trying to help the survirors.  Lots and lots of emergency treatment and lots of tragedies.

The following is a list of anti-emetic medications that may be able to replace Chica's Reglan:
And some of them are over the counter:    

Acepromazine 0.025-0.2 mg/kg, IV, IM, SC, maximum 3 mg; 1-3 mg/kg, PO
Chlorpromazine 0.5 mg/kg, IV, IM, SC, tid-qid  
Prochlorperazine 0.1 mg/kg, IM, tid-qid; 1 mg/kg, PO, bid  
Isopropamide 0.2-1.0 mg/kg, PO, bid  
Propantheline 0.25 mg/kg, PO, tid  
Dimenhydrinate 4-8 mg/kg, PO, tid  
Diphenhydramine 2-4 mg/kg, PO, tid  
Cyclizine 4 mg/kg, PO, tid  
Meclizine 4 mg/kg, PO, sid  
Butorphanol 0.2-0.4 mg/kg, IM, sid-bid  
*Reglan (Metoclopramide) 0.1-0.5 mg/kg, IM, SC, or PO, tid; 0.01-0.02 mg/kg/hr, IV infusion
Ondansetron 0.1-0.2 mg/kg, PO, sid-bid ; 0.22 mg/kg, IV, bid-tid  
Dolasetron 0.6 mg/kg, IV, sid