# metoclopramide concern - need some insight



## Aki (May 22, 2016)

So, two weeks ago Aki went into stasis again. I gave her Emeprid (Reglan), Metacam and water. After 24h, she was passing some small poops and didn't seem in pain anymore.
I stopped Metacam and gave less Emeprid as she was eating leafy greens and passing a decent amount of poops (small, misshapen and dry but still). I stopped Emeprid and gave Fibreplex (fibers and probiotics) to try to coax some bigger poops out of her. On Saturday, I talked to Aki's vet who told me to give Emeprid again as small poops meant that the system wasn't OK. I gave Emeprid 3 times on Saturday and tons of grass (that, she ate). By evening, she was fine, eating hay and pooping. Considering she's easily stressed, I reduced the Emeprid to twice on Sunday and stopped on Monday.
She continued to behave normally, eat everything and poop.
On friday morning I noticed a smaller poop outside of the litter box but I wasn't that concerned because there were lots of bigger ones (like usual, Aki lives with Tybalt so it's hard to know who poops/eats what) and that she was acting normal. Thinking back, I saw her twice in her litterbox just standing there not eating hay like she normally does when she's pooping. So maybe she was having trouble pooping. In the evening, I saw her eat lettuce and parsnip no problem when I gave them their dinner.
Yesterday morning (Saturday) she seemed uncomfortable and refused to eat. I gave her Metacam and Emeprid. One hour later she was back to her normal self pooping normal (maybe a little on the smallish side ? I'm not sure at that point... ^^') poops and eating dandelions.
I still took her to the vet, thinking she might have an underlying problem I hadn't noticed. He looked at her teeth, eyes, ears, stomach, bladder (ultrasound), listened to her heart, weighted her...
And she's absolutely fine - not deshydrated, no blockage, the stomach wasn't even full... The vet complimented me on her stellar state. She even GAINED 50g since December. 
He told me that her guts were just a little slower than they used to be because my rabbit was getting older (she's almost 7) and that I could just give Emeprid until she was stable and offer her a variety of hay piled on the floor for easy access.

Here are my concerns:

- I'm leaving for a 4 and a half day trip on Wednesday. The petsitter comes twice a day, but she doesn't know the first thing about rabbits and I wouldn't trust her to treat Aki. I'm scared as soon as the Emeprid stops, so will Aki's stomach
- When Aki had stasis in December, her stomach was gurgling loudly and I could feel it rumbling when I massaged her. This time, I feel nothing and there is no gurgling whatsoever. But clearly her system is not stopped as she is pooping.
- I've talked to two vets about metoclopramide and they told me I could give it for as long as it took and that it had no ill side-effects. Since, I've looked on the Internet and found some horror stories (but you can always find horror stories about EVERYTHING on the internet) saying that rabbits became dependant on metoclopramide very quickly and that some of them couldn't digest on their own after taking it for a few weeks and that their stomach stopped every time you tried to stop the Emeprid. 

I don't really know what to do. Right now, there is hay everywhere in the room (timothy, orchard and organic second crop). I also give a big handful of grass from the garden with their vegetables (3/4 leafy greens) and once during the day. Aki has taken Emeprid 3 times yesterday, twice today (one to go tonight). She doesn't take anything else as she doesn't seem to be in pain and she's eating. I massage her tummy everytime.
Does her tummy being quite still (I think?) means that it's not really going again? Is it dangerous to keep giving her the Emeprid and should I diminish it each day until I leave (3 days from now) or give the full amount and stop brutally when I leave? (that's what the vet said to do - he's a decent vet, the best around here, but not a super specialist of rabbit like the ones I had access to when I lived in Paris).
I'm kinda panicking. WHY does it always happen just before I leave? I'm not leaving for longer than 24h in a row before OCTOBER after next week but nope, she chose just before THIS trip. 

Any insight? I'm getting really tired, stressed and weepy by now (my dog has ALSO been ill all of last week, and woke me up like 3 times a night to go potty... he's better now, even if it's not 100% but it definitely didn't help).


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## Happi Bun (May 28, 2016)

Hi, sorry no one responded to this! Were you able to sort things out with Aki?


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## Aki (May 29, 2016)

I've been gone since Thursday afternoon (gave her a last dose of metoclopramide just before leaving) and just came home. I'm dead tired and I really don't want to deal with another bout of stasis. Aki doesn't look in pain and moves like normal, but 2 weeks ago it took 5 days for the effect of the slow down to show after stopping the Emeprid. Now it's only been 3 and half a day. I'm gonna wash the litterbox tomorrow and put her in the cage for 10 mn to see how her poop looks like. But what can I do if it shows signs of slow guts? I don't like the idea of giving Emeprid again and I don't think I can do more than I do now without giving meds. I mean, she's got tons of different hays (I even ordered a 4th kind yesterday), and mainly eats wet leafy greens outside of that. She eats maybe 5 pellets a day so that's definitely not a problem. Would giving Cisaprid be a good idea?


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## JBun (May 29, 2016)

Sorry I didn't see this before your trip. 

I haven't ever used metoclopramide or cisapride, so can't comment on any difficulty with those particular meds personally, but I do know of other rabbit owners that have had to use them long term and it hasn't seemed to cause issues. The gut stimulant my vet uses is called trimebutine. When I do have to give it and when eventually taking the rabbit off of it, I always make sure to gradually taper off the dose over several days time, to try and avoid the type of problem you are concerned about. So far I've never encountered any issue with taking my rabbits off of it.

If I had a rabbit with repeated bouts of stasis, I would be looking very closely at any health, environmental, or dietary factors that might be causing it. Environmental things like the possibility of ingesting foreign objects, paper products, leaded paint, other animals or pets around that might be stressing your rabbit, sounds or smells causing stress, changes causing stress, etc. If your rabbit is allowed yard access, consuming plants that could be causing digestive upset. 

For dietary I would consider if the pellets were causing digestive upset(have had one rabbit that would go into stasis if he had pellets at all), maybe a veggie/leafy green that is causing gas/upset particularly cruciferous veg, or I've even read accounts of some rabbits being sensitive to a particular type of hay or hay that was too green/rich. Then there is examining hay quality and making sure it isn't spoiled at all with mold, and that there are no weeds in it that your rabbit might be eating that could be causing the stasis.

If you can't find an environmental or dietary cause, there are also health issues that can lead to a rabbit having stasis such as dental problems, urinary problems, or basically anything that causes a rabbit pain and/or discomfort. So there could be some sort of underlying health problem that is leading to the stasis setting in. Your vet seems to have done a thorough check, but things can be missed. If your vet didn't do xrays or blood tests, those might be a next step to try. One possibility at your rabbits age, is arthritis pain. If you think that this might be the case, daily metacam can help. I've also known of rabbits that have had chronic digestive issues where the rabbit has had to remain on gut stimulants permanently, and has seemed to do fine remaining on the med. It's not something you want to do if you don't have to, but I would much rather give it if needed, then have a rabbit go into full blown stasis. In the UK, I've read of cases where the rabbit(particularly stressy rabbits) had stomach acid issues and were regularly given ranitidine(zantac), to help reduce the excess acid and also it is a gut stimulant. So that might be another option for you.

It can be tricky trying to pinpoint the problem and really requires a lot of careful observation of your rabbits behavior and eating, to see if you can pick up on other clues that might help you determine what might be causing the problem. Things like acting uncomfortable not long after feeding a certain food. That's how I discovered that pellets were causing digestive upset for my rabbit. Within an hour of eating them, I noticed him belly pressing and squinting his eyes. So I stopped pellets completely with him and he never had a bout of stasis again. I know it's hard though when you have a rabbit continuing to get sick and don't know what's causing it.


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## Aki (May 30, 2016)

Hello,

thank you for your reply. I also think there must be something causing the problem, but I can't pinpoint what it is. My rabbits have been living in the same room for a year and a half, they've been living together for almost 3 years and get on well. I have a dog but he doesn't have access to the rabbit and has been there for almost 2 years. I live alone in a very quiet place so I don't think there is anything stressing Aki especially since the conditions didn't change at all since I moved.
For the dietary thing, the rabbits' room is just for them so no books, no carpet, nothing except one cardboard house and I don't think Aki eats it (Tybalt does and is just fine ^^').
I control every plant they eat. She's been eating every rabbit friendly vegetable under the sun since she was 4 months old with no problem. Aki doesn't seem to have gas either, during this stasis horror I've never felt or heard any gas in her stomach. She eats maybe 4 or 5 pellets a day of the pellets she's been eating for the past 7 years, can that much cause stasis? I give them in the morning and the stasis always seem to happen at night (I discovered it when I went to give them breakfast every single time). The hay is fine, I went through like 5 bags trying to get her to eat it and it smells good (there is Oxbow and other good european brands - she won't touch the oxbow ^^'). I also give hand picked fresh grass from the garden trying to encourage her to eat more fibers.

The thing that stumps me is that she acts normal and eats normal as far as I can tell (I always stay a while after giving pellets or veggies to check both of my rabbits eat and see her with hay in her mouth during the day even though I don't know how much she eats) and one morning, she will look in pain, pressing her belly against the floor. I give her Emeprid and a dose of Metacam and one hour later she's back to her happy self. As long as I give Emeprid she's fine, when I stop she's fine a few days before the poops start getting small and one morning, we're back to square one. That's been going on for three weeks now. She was perfectly fine before.
What I don't understand is : clearly, she's eating normal at least for a while so WHY is the system slowing again? I think she progressively eats less hay but I don't get why.
I thought about the teeth problem, but when you give her Emeprid (I never gave Metacam more than once, on the first day of each bout of stasis because as soon as her belly stops being full, she's clearly not in pain anymore which rules out the arthritis - she's also washing well, running around and standing on her hind legs with no problem) she's eating normally and doesn't seem bothered by anything. The vet looked at her teeth (perfectly aligned), tongue and jaws and told me there was nothing. Her eyes are not weepy and she doesn't drool either. Her husbunny is interacting normally with her.
As I said, she's always well hydrated and has even gained a little weight (that would probably change if I didn't treat the stasis immediatly everytime but it means that she's eating / drinking like normal during the 5 days which seem to separate every bout of stasis).
She has no freaking symptom except for the slowing / stopping of her digestion process. I thought about the urinary infection, but the vet said it couldn't be that because no pain / clean vent area. I'm frustrated to death. I so regret my rabbit specialist vet from Paris, but I don't think a day with 6 hours of walking across the city / train / noisy underground is going to do much good...


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## ts786 (May 30, 2016)

I think the metoclopramide horror stories are often not the outcome of the metoclopramide, but the outcome of serious diseases that are difficult to manage. Some may also be the outcome of incorrect dosing or unnecessary usage. When it comes to stasis, I justify the risks in the same fashion I would with vancomycin for people. Vancomycin can have some serious side effects, including kidney and eye damage. However, they don't give out Vanc for a sinus infection...it is used as an antibiotic of last resort to treat resistant pathogens that are likely to be fatal if not treated. Given how serious stasis can be and how rapidly things can go downhill, if the metoclopramide prevents a rabbit from crossing a point of illness that there is no coming back from, it is my personal opinion that the benefits outweigh the risks. And I have seen metoclopramide do this first-hand (the same goes for cisapride.) Over the years I have noticed that stasis can linger with some rabbits, and I think many Vets are moving in the direction of dosing with metoclopramide or cisapride for a longer duration than was once standard, and instead of out outright discontinuing the medication, progressively tapering the dose may have several benefits.

If you are worried about metoclopramide, could cisapride be a potential alternative? While the efficacy studies I have reviewed that compare cisapride and metoclopramide have often yielded inconsistent results, cisapride seems to be slightly more widespectrum in terms of functions and it almost eliminates some of the brain risks seen with metoclopramide. (_However, cisapride likely has some degree of cardiac risks, which is probably pretty low, but research in this area is lacking and many people have concluded that adverse cardiac events do not occur with the veterinary usage of cisapride, which is almost certainly not correct._)

While you are away, will your absence cause stress? I ask this because my current rabbit becomes VERY unhappy when alone, which is partly why I take her most places with me now. Do you trust the sitter to be able to correctly dose and administer all medication reliably? Do you think they can spot a potential problem, such as a decrease in water consumption or a change in poop characteristics? Should SHTF, do you trust that they will seek prompt Vet care?


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## doodlebugger (May 31, 2016)

We have had to treat one of our rabbits for a long stretch on metoclopromide several times. We have one rabbit who gets rotating antibiotics every two weeks for a chronic health problem, and occasionally he has to get shots of Flocillin if things get particularly bad. When that happens, we have had to deal with stasis. If the metoclopromide doesn't work after the first dose, we have to take our rabbit to our vet to get inject able medication. One of our other rabbits had a bad urinary infection, and they discovered arthritis. He peed outside of his litter box, and would not poop at all. We had him on metoclopromide for a week without any problem. We did taper him off of it. We do have him on daily pain meds because of the arthritis now, and we have not had another incident. There were no signs or symptoms of this urinary problem until he started peeing outside of his litter box however. They are a prey animal, so they won't show pain the way we would expect. Our vet told us that she has some clients who use it daily for their rabbits with no issue, but we try not to rely on it often. My big concern would be making sure there is no underlying issue. Why would she not be eating as much hay? That is what she needs the most right now.....so maybe consider cutting back on pellets and veggies and see if she eats more hay? I hope you get it figured out!

I also wanted to add - perhaps it's something in the garden grass?


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## squidpop (Jun 1, 2016)

Just read though this and don't really have any advice but really identify with the problem. I had a beloved bunny that went of food and had a bout of stasis and then got better but small poo and wouldn't eat the things he used to eat normally like hay and grass. I had his teeth checked by a specialist back molars and they found nothing. For months I was doing things to coax him to eat more hay and fibre and then finally he started eating like normal bunnies and his poo got bigger and he started back to eating grass and hay with enthusiasm. I think something had been stuck in his system, maybe some sort of partial blockage for a long time, that finally passed and he got better. Can't think of what else it could have been that got better on its own.


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## Aki (Jun 1, 2016)

Thank you for the replies.
My trip was last week, I came back on Sunday night (and no, I wouldn't trust the petsitter to ever administer medication or even catch the rabbit, but I live in a small town and finding a petsitter is really hard, as is finding a competent vet... and those are business trips, I'm a full-time novelist and I have to go to book fairs or to schools when I'm invited, I can't cancel unless one of my animals is really dying because I'm paid to go to those). I'm leaving three times in June but never for a time period between 12h and 36h so I think it will be fine. Then, I'm staying with the rabbits until october.

Aki has been without medication for 6 days now. She looks fine (still hard to tell what she's eating with her avoiding me like the plague, Tybalt eating like a pig and all) and I put her in the cage during 2-3 minutes the day before yesterday - she did normal poops. Still, I can't help but feel like there is something unresolved here. 
Obviously she eats, but when I put hay in front of her face she will cut a blade or two with her teeth without eating it. She seems to eat second crop organic timothy better and she eats grass. I see her hop around around the hay pile I leave on the floor but I never see her eat it (don't know if it's because she doesn't or if she just stops when I come because she's afraid I'm going to torture her with meds). I can't help but feel like it might be a dental problem but the vet was really dismissive - he looked at her teeth with something he put inside her mouth and said there was absolutely no malocclusion nor spikes, he palpated her jaw and said no pain = no abcess, and the fact that she eats grass and hard vegetables was for him the sign that there was no discomfort. 
But then, WHY?

Sometimes I think "dental problem" but then she will eat a piece of carrot no problem. Sometimes I think "arthritis" because she doesn't seem to want to eat from her hay rack but she washes herself just fine, eats her caecotrophes and will stand on her hindlegs when I have a piece of vegetable to give (she also runs like the devil is after her when I try to catch her).
I read good stuffs about cunipic dental helping with tooth problems, thought I might give it a try just in case. A lot of people said it helped lots with transit too. Does someone knows about it?

Of course if she goes into stasis I will give Emeprid again, I'm not against meds. I just don't want to provoke a dependency issue if it can be avoided especially since Aki isn't that old.


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