Two weeks ago I wrote an article discussing how to recognize the many different signs of nausea in dogs. Now I'd like to share what I typically feel is most successful for treating nausea and inappetence in dogs.
If you remember from the previous article, a nauseous dog may demonstrate lip-smacking, excessive drooling, decreased appetite, lethargy, or may walk over to the food bowl then walk away without eating. Vomiting is the last sign of nausea, which we always want to avoid if possible.
The following recommendations are most appropriate if your dog is nauseous due to a medication or an underlying disease condition such as cancer. If you're not sure why your dog is nauseous, call your veterinarian and seek guidance, there are some situations where nausea (especially with vomiting) is an emergency.
A general recommendation is to withhold food and water if your dog is actively vomiting. Ideally, you would wait at least 6 hours to offer food or water after vomiting has occurred. If you offer food or water too soon (and your dog is still nauseous), he's only going to vomit again, which is not helpful.
Be certain to wait at least until all signs of nausea have resolved before offering food (this means that drooling and lip-smacking have stopped, energy appears more normal). Just think about how you feel when you're nauseous; the last thing you want to do is smell food - it just makes you more nauseous. Your dog is the same way, so just give him time to feel better. He'll be fine if he doesn't eat for a few hours (or an entire day). Don't force this.
To treat nausea I recommend Cerenia (maropitant). This is an excellent anti-nausea medication that is administered once daily. Once nausea and vomiting are controlled, I typically recommend giving Cerenia 30-60 minutes prior to feeding (give it time to start working before you offer food) for the next few days. Ondansetron is an alternative to Cerenia (and often less expensive), but only lasts 12 hours, so it needs to be given twice daily.
Some patients may also benefit from an appetite stimulant such as Entyce (capromorelin) or mirtazapine, but this is not often necessary. It's always best to avoid trying two new medications at exactly the same time.
When you finally introduce food, you can offer him his normal diet, or consider something bland but palatable such as boiled chicken and rice. He may not yet feel well enough to eat his regular food, so tempting him with something more enticing may encourage eating. Be certain to avoid foods that are high in fat during this time since they can be a trigger for pancreatitis.
If your dog still won't eat at that point, again try chicken and rice, try other bland but palatable people food, try canned food, try baby food, or even cat food. There are occasions (especially for a dog receiving chemotherapy) when dogs develop an aversion to the taste of metal. Consider offering food on a paper plate or in a glass or ceramic dish to determine if your dog has developed this aversion.
If there has been active vomiting, your dog may need outpatient supportive care from your local veterinarian to help them feel well enough to eat. For these patients, giving a Cerenia injection and subcutaneous fluids (fluids under the skin) can often do the trick. I always recommend continuing with a few days of oral Cerenia at home for these patients as well.
The key to treating nausea in dogs is to be able to recognize the earliest signs of nausea and start treatment as soon as possible. If your dog is nauseous from a medication, let your veterinarian know so they can consider stopping or adjusting that medication. If your dog is nauseous from an underlying disease condition, it may mean that the current treatment is not working well enough and a new treatment plan is needed. If your dog is nauseous due to chemotherapy, giving Cerenia as soon as possible will typically resolve nausea help them feel better in a few hours. If your dog isn't feeling well, call your veterinarian and get him the help he needs - they want your dog to feel well too!
Dr. Lori Cesario
Board Certified Veterinary Oncologist
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