Brand Name: Entyce for Dogs, Elura for Cats

Available as an oral solution

Background

The simple act of eating food and assimilating nutrients is the very basis of survival. Our bodies need nutrition for growth and healing as well as for normal activity. Unfortunately, many disease states interfere with appetite, leading to reduced nutrition and debilitation. Aside from appetite-altering diseases, sometimes diet change is needed to preserve health, but the diet change may not be appealing. In either situation, a sick patient is not eating, and something must be done about it. Traditionally, patients in need of nutritional support have relied on hand-feeding, tube feeding, medications that have an increased appetite side effect, and other techniques with assorted success, laboriousness, and expense.                

Capromorelin was developed to essentially turn on the brain's hunger center and generate an appetite so as to support the patient during the medical evaluation and treatment process.

This is accomplished by using the body's natural system of generating hunger. A hormone called ghrelin is produced by the GI tract when the stomach is empty. In the hypothalamus of the brain, circulating ghrelin is detected, and the sensation of hunger begins. When the stomach is full, ghrelin secretion stops, and hunger stops with it. Capromorelin mimics ghrelin, so it acts on the brain to create hunger in the same way that natural ghrelin does. The idea is to create an appetite so that the patient can simply begin eating and thereby begin recovering.

How This Medication is Used

Capromorelin is available as a vanilla-flavored oral liquid for use once daily in dogs of any age or size or in cats over the age of five months. Capromorelin is meant for use throughout the course of illness (not intermittently). In other words, do not only use it on days the pet is not eating well; use it daily throughout the illness period.  When the patient's appetite is at a desirable level, and appetite support is no longer needed, capromorelin can be withdrawn.

Some chronic disease patients may need capromorelin indefinitely, while others only need it during their recovery period. The increased appetite effect of capromorelin is typically seen within an hour of use and lasts for a few hours after. It should be clear if the medication is working within a few days.

Capromorelin should be considered a supportive measure and not a complete treatment. Whatever condition may have led to poor appetite should be pursued and treated appropriately; capromorelin allows for the patient to have an improved appetite during this process. Capromorelin was tested in cats with kidney insufficiency and is specifically approved for this population.

In initial studies of capromorelin, test dogs showed a 60 percent increase in appetite/food consumption after the four-day test period. While this is encouraging, consider that approximately one owner in three did not see a response. For some dogs, alternative means of nutritional support may still be needed.

Side Effects

Side effects felt to be minor/not serious include a mild upset stomach (vomiting, diarrhea, drooling), increased thirst, and gurgling sounds from the stomach. If these signs persist or seem to be more than a minor issue, contact your veterinarian.

In safety studies done for long-term use at high doses (well above the normal dose), some dogs developed swollen feet as well but no side effect was deemed serious or severe enough to discourage long-term use of capromorelin at usual doses.

Increased blood sugar levels can be a side effect, so this product is not recommended for diabetic patients. Capromorelin may lower blood pressure. 

Use in animals with Cushing’s disease (hyperadrenocorticism) may not be appropriate.

Interactions With Other Drugs

Some medications slow down the removal of capromorelin from the body (making capromorelin last longer), while other medications speed up the removal of capromorelin from the body, so it doesn't last as long.

Medications that can prolong the activity of capromorelin include cimetidine (antacid), diltiazem (heart medication), erythromycin (antibiotic), and the antifungal medications ketoconazole, itraconazole, and fluconazole.

A medication that might increase capromorelin removal from the body would be phenobarbital, a seizure treatment.

Concerns and Cautions

The product information label that comes with the medication includes caution for patients with liver or kidney disease for the reasons listed above. That said, capromorelin is specifically approved for weight management of cats with kidney disease with good effects seen. There is a label caution for cats with heart disease, and since blood sugar elevations can be seen with this medication, capromorelin may not be a good choice for diabetic patients.

Capromorelin has not been tested during pregnancy or nursing, so is best not to use it in these situations.