CAPROMORELIN

(for veterinary information only)

BRAND NAME: ENTYCE

AVAILABLE AS 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 with appetite stimulation as an exploitable 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 diagnostic 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 is a ghrelin-mimetic, meaning that it acts on the brain to create hunger in the same way that natural ghrelin does. The idea is to create appetite so that the patient can simply begin eating and thereby begin recovering.

This medication is new as of the autumn of 2017 and products are available for both dogs and cats.

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 age 5 months. Capromorelin is meant for use throughout the course of illness (not intermittently). When the patient's appetite is at a desirable level, capromorelin can be withdrawn. Some chronic disease patients may need capromorelin indefinitely while others only need it during their recovery period.

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. In cats, 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% increase in appetite/food consumption after the 4 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

In the 171 dogs participating in initial testing, 7% had diarrhea, 6% had vomiting, 4% had increased thirst, and 2.3% had an increase in salivation.

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 feline side effect so this product is not recommended for diabetic cats.

INTERACTIONS WITH OTHER DRUGS

How capromorelin interacts with other drugs mostly relates to how capromorelin is removed from the body. If the removal system must handle more than one substance at once, often one substance is removed more slowly. This can translate into prolonged activity of that substance while it takes longer than normal to process removal. Alternatively, sometimes an additional medication can enhance removal of another by inducing greater activity in the removal system.

Capromorelin is removed by two systems: the liver (via the cytochrome p450 system) and by the kidney (i.e. excretion into urine). Approximately, 2/3 of a capromorelin dose is handled by the liver and the other 1/3 by the kidney. Other medications that employ the cytochrome p450 system, will occupy the removal system in such a way that their removal as well as the removal of capromorelin is slower. This could translate into prolonged activity for both the capromorelin as well as the other medication. Commonly used medications that employ the cytochrome p450 system are the anti-fungals: itraconazole, ketoconazole, and fluconazole.

CAUTIONS AND CONCERNS

Short version (to help us
comply with "Lizzie's Law")

Page posted: 4/30/2019
Page last updated: 10/17/2021