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Treating incontinence in dogs

Question: Dear Dr; I have a dog with spayed female incontinence. For over a year I have treated her with ppa (acutrim) with total success. Unfortunately, this drug is now unavailable. Hormonal tx is out of the question since she has liver disease. My vet has no answer for me, and I am at my wit's end. Any suggestions? Thanks in advance Annette

Answer: Annette-

I am sorry for the delay in replying to your question. There are several medications that are currently being used to treat incontinence in dogs in an effort to find one that replaces phenylpropanolamine (PPA). They are:

1) Diethylstilbestrol (DES), which is a synthetic form of estrogen. There is some fear of bone marrow suppression when using DES but I do no recall ever experiencing this problem in practice, so I presume it is rare. I know of no reason that DES can not be used when there are changes in liver function, but your vet may know something that I do not. DES is currently only available from compounding pharmacies but all the ones that we deal with have it, so it is readily available.

2) Imipramine (Tofranil Rx), a tricyclic antidepressant, causes urine retention in some patients treated with it, so it is being used in the hopes this effect will occur in patients with incontinence. Initial reports are encouraging, but that is often the case when people are looking for a substitute for a medication and want to have good results.

3) Pseudoephedrine (Sudafed tm) causes similar effects to phenylpropanolamine but has not been used extensively. The dosage is 30mg for small dogs and 60mg for big dogs. I have been using 30 lbs. of bodyweight as the dividing line between large and small. I have not had enough reports back from owners yet to know if this is working at all.

4) Some compounding pharmacies still have phenylpropanolamine powder and can custom make capsules with the appropriate dose for a patient who needs this medication. It is worth calling around to the various compounding pharmacies (or checking online for veterinary compounding pharmacies) to see if one of them has this medication. Your vet should know of some of these, as well. There are several that advertise nationally.

Good luck with this. I hope that one of these suggestions is helpful if you have not already found a solution to the problem.

Mike Richards, DVM 1/8/2001

Phenylpropanolamine's alternatives

Question: Hi, Dr. Mike -

I'm sure I won't be the first, nor the last, of your clients/correspondees to ask just what you will recommend to take the place of the now-defunct phenylpropanolamine. I am just sick that I can no longer obtain Dexatrim, or other OTC meds, to control BOTH Trudi's and her Boxer-sister-Fanci's (Fanci's is the typical spayed-female-leakage, brought on by advancing years) incontinence.

A brief note on our CRF gal, Trudi. Twenty-two months after the original diagnosis of chronic CRF was handed down, she is still doing remarkably well. The herbal iron tonic I discovered about 4 mos. ago has really created a huge improvement in her looks, stamina, eating patterns, demeanor. We continue to have small episodes of pancreatitis, which (so far) can be controlled by removing all food for 24 hrs. Strangely, although she LOOKS so great, her blood chem values have changed little; outwardly, the only sign that she's a CRF gal is her constant-and-profuse shedding.

Dr. Mike, I sure hope you'll be able to give us a tip as to what (either OTC or Rx) we can use to control the incontinence from now on. Thanks in advance.........your advice has always been valuable to us!

Regards, Rozanne

Answer: Rozanne-

Phenylpropanolamine is still available from some compounding pharmacies. I know of at least two in our area that still have the powder to make this medication and I believe that it may remain available through compounding pharmacies.

There are alternatives to phenylpropanolamine. The one currently being talked about the most on the Veterinary Information Network (Veterinary Information Network (VIN) - For Veterinarians, By Veterinarians, a service for veterinarians only) bulletin boards is impramine (Tofranil Rx), 1 to 2mg/kg of body weight every 12 hours, up to 15mg twice a day. I have not used this medication because we have had good success using diethylstilbestrol (DES) and have been able to obtain this medication from our local compounding pharmacy. We usually use 0.5mg per day for 5 days for small dogs, or 1mg per day for large dogs. We then try to lengthen the interval, usually reaching a once weekly or twice weekly dosage in most female patients. We usually try testosterone in male dogs but generally have to combine this with something else, such as phenylpropanolamine, so when our supply of this runs out, we will have to consider other options for our male patients, probably. I am hoping that when we run out of phenylpropanolamine the compounding pharmacies will still be able to get the medication.

Mike Richards, DVM 12/4/2000

Leaking urine and accidents - medication related in Samoyed

Question: Help! My samoyed has suddenly forgotten what it means to be house trained. She is currently on medication for myositis, predinose 30mg every other day, and when she started to leak urine, she was put on phenylpropanolamine (now down to 25mg on the days she gets her prednisone). In the last week, she has started to have accidents in the house, even after she is brought in after being out for a while. I let her out several times during the night and still she slips. Is this related to the medication? Thanks. P.A.

Answer: P.A.-

It is very likely that there is a relationship to the medication with the sudden change in urinary habits. Sometimes prednisone can make it easy for bladder infections to occur, so it would be worth having her checked by your vet for this. Bringing a urine sample that is less than 4 hours old can be helpful, just in case it isn't possible to get a urine sample at the vet's office. Prednisone can also sometimes push a dog with a tendency towards diabetes into exhibiting signs of that disease and the urine will help to rule that out.

If the urination problems are not related to cystitis there is still a chance that the prednisone is contributing, since it does make dogs drink more and urinate more. In that case, it may be necessary to try to find a lower dose that will control the myositis but not induce excessive urination. Sometimes it isn't possible to do that but it is worth trying.

Sometimes when dogs start to have accidents in the house for medical reasons the behavior becomes self supporting since dogs like to urinate where they have urinated before. Cleaning the area carefully with an enzymatic cleaner and working hard to catch her urinating so that you can reinforce that it is not acceptable behavior with a loud "NO" can help to restore her old and better habits.