Pain meds for rabbits and famotidine dose

Question
Dana,

Thanks so much for the famotidine dosage.  I got him started on it.  He crashed early this morning (severe pain grinding, urinating all over himself, unable to get up) so I got him in to see the only emergency vet available.  She dosed him with the highest possible buprenex dose but he was still pain grinding.  The blood panel they were able to run suggests mild kidney damage, so pain seems hip related.

The vet wasn't an exotics vet, but she was willing to get on the vet listserv to look for Tramadol info in rabbits.  She did explain that Tramadol is unique because it has the activity of an opiod (I think on the "mu" receptor) but also partially mimics an NSAID, and can be used in combination with other NSAIDS in some species.  She's used Tramadol in dogs so had some experience with it.  On the listserv she found several exotic vets using Tramadol in combination with metacam for rabbits with chronic pain.

She agreed to send him home on Tramadol, and Presley stopped pain grinding a few hours ago. We'll see how tonight goes.  We're going in to see the exotics vet first thing in the morning.

I'll let you know how the Tramadol works out for us.

Thanks for your help,
Lyssa  
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Followup To

Question -
Hi Dana,
I was wondering if I could pick your brain? My 14 yr old neutered Rex (Presley) has a long history of medical problems (bladderstone removal/intestinal adhesions/severe hip arthritis/now mostly blind from cataracts).  Our current problem seems to be that the "normal" pain med cocktails are not giving him much coverage, and my vet for the past 6 yrs has left the state.

Presley is presenting with classic ileus (I know your article by heart), and has a strong reluctance to move.  His abdomen isn't painful, but he will not leave his memory foam pillow.  He's pain grinding even though he's on Rimadyl (he can't tolerate Metecam). Presley went to a reasonably experienced rabbit vet and got his teeth checked and it was confirmed no impactions.  Blood draw wasn't sucessful, so I'm taking him back in on Monday for that.

Have you ever used Tramadol in rabbits?  A good friend who's rabbit had severe spondylosis saw improvement, but they were also using this as a last resort kind of drug.  Her rabbit was on it for a month, in combination with metacam.  Even if I can talk my new vet into trying Tramadol (as long as Pres' kidneys are fine), it's not recommended humans take it for more than 5 days because of ulceration risks.

We've tried many combinations of NSAID/opiod previously and Rimadyl  combined with short courses of Buprenex seemed to work.  But barring any organ issues, I think his arthritis pain is triggering the new case of ileus.

My new vet hasn't used famotidine in bunnies, and Presley has had previous episodes of ulceration when he's in stasis.  I can't find a dosage.

Do you have any suggestions in terms of pain options?  I don't think he's at the point of needing to be euthanized.  He was doing reasonably well (leaving his cage for play time, jumping on my bed) before this episode.

Anyways, sorry so long.  And I think it's *very* cool that you are taking the time to answer bunny questions for people who haven't heard of the HRS or etherbun.

Thanks so much,
Lyssa

Answer -
Hi, Lyssa

Wow, you sound as if you've tried everything but the kitchen sink for Presley!  Congratulations on getting him to such a good age!  :)

I was going to suggest a low dose of buprenex, since that won't cause ulcerations.  I've never tried Tramadol, and don't really know anything about its use in rabbits.  But if it's an NSAID, then you're wise to consider the possibility of ulcers.

We've used both famotidine (I give 5mg for a medium-sized bunny; the dose is flooby), and I've also used Prevacid with pretty good results (though I guess you can't know for sure that ulcers are prevented without a post-mortem, which is something we'd all like to avoid!!)  Prevacid actually binds irreversibly to the acid-producing cells in the mucosa, so the cells are inactivated until they're replaced, which is about every three days or so.  The key is to not give so much that you inactivate *all* the cells...and I don't know anyone but myself who has experimented with Prevacid in lagomorphs (we used it for a hare, and she did fine).

Another thing to have on the shelf, if you think there are actually ulcers present, is sucralfate.  It's useless for *preventing* ulcers, but it binds to the surface of existing ulcers and helps them heal, a bit like a chemical "band aid."

I wouldn't even *begin* to think of the E word for Presley if he's doing this well.  It's just a bump on the road.

I hope this helps!

Dana  

Answer
Hi, Lyssa

Wow, I'm glad the tramadol worked for you!  Hey, at a point like that, it's time to try new things.  And now you can add your experience to that of others, when some people ask about tramadol and bunnies.  :)

I think people are just now talking about it on EtherBun, too.  Are you in on that discussion?

Dana