How to manage feline chronic diarrhea, Part II: Treatment - Veterinary Medicine
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How to manage feline chronic diarrhea, Part II: Treatment
Targeted drug therapy, dietary changes, prebiotics, and probiotics are some of the tools that can help you get cats with persistent diarrhea back to normal GI function.



Cyclosporine is a T-cell lymphocyte suppressor with demonstrated efficacy in steroid-refractory IBD in dogs.20 It is occasionally used to treat dermatologic conditions in cats, but its use in cats with IBD has not been reported. The recommended dose for cats is 1-4 mg/kg orally every 12 to 24 hours (Table 3).21 Cyclosporine can cause vomiting or anorexia in some patients.


Azathioprine is a purine antagonist antimetabolite with potent immunosuppressive properties. It is routinely used for refractory IBD in dogs. However, it is not recommended for use in cats because of the potential for fatal bone marrow toxicosis and difficulties with accurate dosing.


Adjunctive therapies in cats with chronic diarrhea include cobalamin, pancreatic enzymes, prebiotics, probiotics, GI protectants, and motility modifiers and may be needed in patients with the specific conditions described below or in patients with nonspecific diarrhea in which conservative therapy is preferred.


Table 4
Hypocobalaminemia is commonly documented in cats with malabsorptive or infiltrative distal small intestinal mucosal disease and is a predictable finding in cats with exocrine pancreatic insufficiency (EPI).22,23 Treating hypocobalaminemia reduces the frequency of diarrhea and improves fecal consistency in cats with chronic enteropathies.24 All cats with serum cobalamin concentrations < 300 ng/L should receive parenteral cobalamin supplementation. Cyanocobalamin is the generic preparation used for subcutaneous or intramuscular injection. It usually contains 1,000 g/ml of cobalamin in solution, making it more convenient and less irritating than B-complex preparations. The standard dosing regimen is described in Table 4. Cobalamin supplementation is often administered long-term or until resolution of the underlying disease.


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