Hi Dr. Barchas:

My female Tabby has recurring hemorrhagic cystitis. Lately, it has been recurring OFTEN, like every other week and then every other day! My vet has prescribed Amitriptyline, Royal Canin food, and Valium. I cannot get the Amitriptyline into the cat (I even tried an oral liquid version-which was a disaster!), but I can sneak the Valium into her food. She seems to respond best to the Valium (she is a very twitchy kitty!) but I am concerned about its toxicity to her liver and whether or not she will become addicted to it.

I heard that Cerenia is a good alternative – what do you think? Also, I read that it is not wise to keep the cat on the special food for too long, as the change to the acidity of the urine has other negative effects on the body. Any thoughts on this? Please help, I am desperate and our household is a wreck due to the recurrent episodes of bloody urine all over the place!

Ramona
Pasadena, California

Feline cystitis (also known as FIC, FLUTD, and FUS) is a condition in which the bladder becomes inflamed. The syndrome can lead to pain, house soiling, bloody urine, and urinary obstruction in males.

The cause of FIC is not known. However, diet, obesity, and stress appear to play a role. There also appears to be a hereditary component to the syndrome.

Treating FIC is frustrating. Antidepressants such as amitriptyline and anti-anxiety medications such as valium appear to help with the syndrome by attenuating the stress component. Long term valium rarely has been linked to sudden liver damage in cats; however, liver injury is not an issue for a majority of cats (nor is addiction).

It has been my experience that the best long term treatment option is permanently changing the diet to one that is designed to fight the syndrome. I prefer to manage the syndrome with diet, rather than medication, if possible. I have not generally seen adverse issues develop in cats that have consumed special urinary diets over long terms.

Cerenia is a relatively new drug that is labelled for nausea and motion sickness in dogs. Its use in cats is off-label and somewhat experimental. However, it appears to have great potential for the treatment of FIC. Some vets dose the medication at 1 mg/kg per day; others prefer 2 mg/kg twice weekly. If you try the medication, I’d recommend experimenting and working towards the lowest effective dose.