Continuous Therapy versus Pulse Therapy
Dr. Karen Tobias
Shunt Management Team
For the UTmost Care
25 July 2007
Question: The following information is provided by the Nutramax company. All the studies on Marin were performed with continuous therapy (effectiveness as well as toxicity). The company recommends continuous therapy until liver function improves. The studies on denosyl (Sam-e), performed in Europe, evaluated "pulse therapy" (though the term is not used). Dogs are placed on daily therapy; as liver function improves, the dose is decreased to every other day, every third day, and so on. If liver enzymes increase, the frequency of treatment increases. If liver enzymes remain normal, the treatment is eventually discontinued.
Answer: No controlled studies have been performed on dogs with portal hypoplasia (MVD) or dogs with shunts. Therefore, we don't know if they need daily or less frequent therapy. The company representative says that it does not hurt to keep dogs on Marin continuously or to use it intermittently. The owners and veterinarians will need to base treatment on clinical response (hair coat, appetite, activity level) and bloodwork (though probably not bile acids).
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