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Dr. Bruce
Dr. Bruce, Veterinarian
Category: Dog Veterinary
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Experience:  15 years of experience as a small animal veterinarian
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My dog just started enalaphril, lasix, spironolactone and vetmedin

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My dog just started enalaphril, lasix, spironolactone and vetmedin for dilated cardiomyopathy. What is the typical frequency and duration of blood tests to check toxicity levels? Will I need to get x-rays every time I return or only if there are still symptoms of respitory issues?

Welcome to Just Answer. At this time, there are no specific blood tests to run to look for toxic levels with enalipril, furosemide (lasix), spironolactone, or pimobenden (vetmedin). These drugs are dosed according the the formularies and then monitored by response to therapy. The correct dosage of lasix is the dose that is needed to help control clinical signs. This is a drug that can be dosed 2 to 3 times a day, or once a day, once every other day, once every couple days, or once in a while. It basically is a diuretic to help remove some of the fluid in the lungs. Ideally the other drugs make the need for the furosemide very little. I'm glad you were able to get the generic forms of the medications. There isn't any difference in the veterinary medications and the human ones - except for the dosing size. The one test that I could say would be nice to evaluate occasionally is a chest radiograph to monitor cardiac size and pulmonary edema. It shouldn't be needed every time of a recheck unless clinically he isn't doing well. Over-all though, response to therapy is going to be the biggest factor to consider.

Dr. Bruce
Customer: replied 7 years ago.
Then why am I being told I need to come back in two weeks to have another blood test run to check liver and kidney functions for toxicity. That doesn't make sense. Is enalapril hard on the liver?
Ok. As far as running blood work to check for any liver or kidney alterations, that is a valid check. I misunderstood that they were checking for actual levels of the drug in the body. Rechecking these values is something that can be done to make sure there is no adverse reaction to the medication. Both of these shouldn't have any specific renal or liver toxicity, but they could cause decreased renal perfusion and mild dehydration that could cause these to be elevated. Actually, the furosemide would be the most likely culprit for any kidney value elevation. I'm sorry about assuming what I did, one of the drugs that some practioners will also utilize is digoxin for dilated cardiomyopathy - and that one has levels that should be checked.

Dr. Bruce
Customer: replied 7 years ago.

Thank you. Just one last question. If everything looks good on the CBC in two weeks, is there any reason I would need to take my dog in more than once every 3-4 months for blood work/x-rays for monitoring purposes. This assumes no noticable issues with breathing, eating, energy levels, etc. I do want him to be checked when starting these, but every two weeks beyond the first check if everything looks good doesn't seem reasonable or warrented and all the research I've done (not just internet marketing from drug companies, but credible sources like AAHA reports, clinical study publications from universities and online vet text) does not site a need for anything more frequent than 3-4 months.

I'm very glad to hear that you're doing all this research. You're getting yourself very familiar with your little one's situation. Knowledge is power. Honestly, if things are going well, I think the every 3 to 4 months would be very adequate as long as everything is going well. In these cases, I will go by clinical signs as a huge indicator if the evaluations need to be more frequent. Monitoring more - not necessarily a bad thing - would help them to stay right on top of things. The choice is always the owners as to how they want to proceed with follow up. I would definitely let your vet know what you've researched and what you feel would be a good follow up protocol in your mind and then hopefully somewhere in the middle you can meet. Remember, they are hopefully just trying to provide the best care for your little one.

Dr. Bruce
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