Benazapril - what should I watch for?

[samesque]

My dog was recently put on Benazapril for her kidney issues. Some of the side effects say it can cause kidney issues. Anyone have any idea what I should be watching for to differentiate the Benazapril side effects from her kidney failure symptoms? Anyone have experience with it? One of the side effects is also anorexia, and she is not interested in food today. I can't tell if this is because of the new meds or her illness.

[tonyb286]

Hi. Great blood numbers. Yes, the creatinine is high - but you may not be able to control it, because if the kidneys are deteriorating progressively (not unusual in CKD) then all you can hope to do is slow it down. If it stays at that level for the next blood test (or even better falls) then you're on the right track for sure. If it rises, then maybe a period of SubQ fluids will help bring it down and stabilize it. Worth talking to your vet about that.

My only slight worry is the Na (sodium), which is high. Allowing this to climb may cause some neurological and consequentially muscle issues, including tremors and loss of balance. Are you giving filtered water? Faucet water has sodium in it, so you don't really want to add to the problem. Also, make sure any treats you give are not high in sodium.

Other than that, I think you are doing really well. I would prefer not to see any dry food being given, but if she's happily eating it, that's fine. Always pre-soak it for at least half an hour.

Tony

[samesque]

I soak it for at least that long - she has very few teeth left, and seems to prefer it being wet, though sometimes she really just wants her kibble dry. Then I just try to make sure she's drinking enough.

I have a Blue Pearl appointment today, so I might have updates on blood stats later. I'm hoping some of her stats come back down.

[samesque]

I brought her in today because she has been weird about eating this week. I don't have her full blood work counts on hand yet, they'll be coming via email later today, but her creatinine crept up to 3.1, one of her liver values was up, and a pancreas level was elevated. Doc says the elevated creatinine is probably because of the benazapril. Everything else was 'normal'.

Ultrasound confirms that she has pancreatitis. Doc recommended a different antacid, upping her tramadol to 3 times per day and taking her off the benazapril. Checking back with the vet if she isn't eating better or showing improvement over the next 5-7 days for a possible diet change.

I'm actually relieved. With the weird eating, I thought her kidneys were deteriorating, but knowing that its pancreatitis is helpful.

[tonyb286]

Pancreatitis is made much worse with fat in the diet, so that's something worth assessing. If any food has moderate to high fat, change it for something more appropriate (low fat).

Tony

[samesque]

I am a little confused why she put her on this. It was supposed to be to help with kidney function, but she seems to be doing fine with just the food. All of her stats are in the normal range except for her creatinine, which was 2.8 at last reading and it had come down from 3.1. She has had her blood pressure checked twice, and they were both in the high-normal range at the vet's office, so they said she probably has normal blood pressure when she is at home and not in a high-stress situation, like at the vet.

[tonyb286]

Then I assume the benazepril is entirely being given to help the kidneys. It will increase blood flow/blood volume, which in turn will help flush the kidneys. As stated above, caution is advised - regular blood pressure monitoring is very important. High blood pressure is a very common symptom of canine kidney disease - and very damaging, so if readings were in the normal high region, it's a worthwhile treatment.

If your dog seems to have periods of severe lethargy or suffers a "drunk like" state then get her to the vet for a blood pressure check straight away.

It's excellent that creatinine has come down. At 2.8 this puts your dog in Stage 3 of the disease. This calls for restricted protein (no more than 12% of any meal) - and the protein must be high quality (human grade). What food are you feeding?

What was the phosphorous blood test result? When were bloods last tested?

Tony

[samesque]

She is on Science Diet KD dry and wet.

Bun  24
Creat 2.8
Phos 4.7
Na 157
K 4.9
Na/K 32
CI 121

Prescritions:
Famotide 15-20 mg 2X daily
Benazapril 10 mg daily 1X daily (only since saturday)
Tramadal 50 mg 2X daily (for severe arthritis in her hips)

Should the Benazapril help for a while at least?

She is a 14 year old black lab husky mix, 15 in April. I'm so lucky to have had her for as long as I have, but I know she is old and is going to leave me sooner than later.... And I know if it wasn't kidney failure it would just be something else that took her.... That's the price to be paid for caring well for an animal - they live long, but they will ultimately succumb to an age-related disease. I just want to hold on to her for as long as possible.... as long as she is comfortable...

[tonyb286]

Hi. It really depends on why your vet put her on Benazepril? Is it for diagnosed high blood pressure - or is it to help the kidneys function better through increased blood flow?

Benazepril is a good drug for either, but if it is merely to help the kidneys (in other words, if your dog does not already have high blood pressure), then extreme caution is needed. The Benazepril will lower blood pressure, so if your dog does not have high blood pressure - the medication could cause blood pressure to fall dangerously low. With cautious low-dosing and very regular blood pressure monitoring, it can be advantageous. However, if there isn't at least weekly checks on blood pressure, then it's a dangerous form of treatment for a dog that has normal blood pressure.

All drugs, not just Benazepril, cause issues for the kidneys. Why? Because most drugs are metabolized in the digestive system and waste by-products need to be cleared out of the system by the kidneys. Most of the by-products are toxic, so they have to be removed from the body - and the already damaged kidneys can find this work hard to perform, so some toxins end up circulating back in the bloodstream.

Benazepril, thankfully, is metabolized chiefly by the liver. So this is actually a better drug than many for this type of treatment, as it spares the kidneys. It is worth adding Milk Thistle to the daily supplement list (if you have one), as Milk Thistle helps protect the liver from damage.

I wouldn't worry too much about the other side effects occasionally known to affect dogs with this drug. The kidney disease is far more likely to cause them than the Benazepril.  

Tony