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Gut Motility Drugs for Rabbits

22 10:03:09

Question
Hi Dana!
In regards to Cisapride and Reglan...they each affect a different area of the gut don't they? Which affects which part of the gut?

We had an instance of Mucoid Enteropathy with our two 8 weeks old bunns a little while ago...we managed to pull one through but lost the other. One presented with diarrhea and the other with stasis. We lost the buck with the diarrhea, it was less than 12 hours from the first recognizable symptoms until he died. The second boy showed early signs and then went into stasis.
He was horribly swollen..and made the hallmark waterbottle noises, accompanied by gouts of mucus, the vet thought he was a goner too.
We were treating with SulphaTrimeth, Ovol, pedialyte and finally when it looked like we were losing the battle I broke down and started soaking cisapride in pineapple juice.(this was after nearly 3 days with no poops)I knew there was the possiblity that this could be fatal...we knew there was a major blockage it could be identified through palpation of the tummy...but we were treating him every hour on the hour and making no headway whatsoever. He was getting weaker and we were getting desperate. Anyway it did work and he is a healthy obnoxious pre-teen bunny now...
My question is this...should I have used one type of gut motility drug over the other?  I would like to know for future reference...we don't have an afterhours emergency vet here that deals with rabbits...so it often falls to us to do what we can until we can get to our vet! And rabbits ALWAYS get sick on long weekends and holidays! (Our vet almost always prescribes Cisapride for any type of gut motility issue...I just want to know what is best for our buns!
Thanks
Danielle

Answer
Dear Danielle,

The truth of this matter is:  NO ONE knows exactly how either cisapride or Reglan (metoclopramide) act on the rabbit intestine.  Conventional wisdom holds that Reglan affects the motility of the more anterior portions of the intestine, and particularly the distal end of the stomach sphincters, down to the middle portion of the small intestine.  Rabbits have been used as animal models for metoclopramide studies, and some of these indicate a mode of action similar to that seen in humans:

http://www.ncbi.nlm.nih.gov/pubmed/7110532

But as far as I know, the drug hasn't been formally evaluated for veterinary efficacy in rabbits suffering from ileus.

Cisapride, in humans at least, increases motility of the esophagus and stomach.

Because the two drugs target different areas of the intestine, many vets prescribe both together.

In a case like the one you describe, either drug would probably have been helpful, though--as you suggest--they might make things worse if there is a true blockage.  Our own vets say that they have never seen gut motility drugs cause a blockage to be worse.  And in truth, if there is really a true blockage, *anything* is worth a try to get things moving.  It's complicated, with hydration of intestinal contents being of paramount importance.

But I'm really glad that you got the little guy up and running again!  Congratulations!  

Dana