Metronidazole and liver disease.

Dr. Marie replied:

Oh, I am sorry to hear that this happened to Louie.

I can understand why you are unsure about the Metronidazole as the information that is available about Metronidazole is confusing.

Metronidazole is actually commonly given to animals with liver disease. It is known to help fight the type of bacteria that can complicate liver disease and also helps with inflammation in the liver as well. It's really a good drug to help the liver.

Metronidazole can cause liver enzymes to appear artificially higher than they are, but this doesn't mean that it is damaging the liver.

However, an important thing to note is that when we use Metronidazole for a dog with liver disease we tend to use a lower dose than we would with a healthy animal. So, let's assume your dog weighs 25 lbs. In a healthy dog I would be prescribing approximately 250mg metronidazole twice daily. But for a dog with some liver problems I would be using 27-100 mg twice daily.

If a dog with liver disease was receiving too much metronidazole, it doesn't make the liver disease worse. Instead, the diseased liver is not able to metabolize the metronidazole properly and so it is similar to a dog receiving way too high a dose. The symptoms we would see would be neurological symptoms like tremors and seizures, but not vomiting.

I don't think we can blame the metronidazole for Louie's vomiting. I know he is on a lot of medicines already but you may want to ask your vet about putting him on an anti-vomiting medicine. Sucralfate does have some protective effect on the stomach, but there are other drugs that can help with the vomiting and nausea as well.




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Dr. Marie replied:

200mg of metronidazole every 12 hours is a little higher than I would normally give to a dog with liver disease.

You may want to ask your vet if they would recommend lowering the dose. The dose that I use for dogs with liver disease is 7.5mg/kg twice daily. This would be closer to 125 mg twice daily. However, the extra 75 mg is really not likely to be causing problems.

Poor Louie. The head pressing is a cause for concern. This can mean that the liver is not detoxifying ammonia properly. You may want to ask your vet about adding some lactulose which is a medication that can help to fight that.

Keep fighting with Louie! I pray that he makes a full recovery. The liver is an amazing organ and if there is any healthy liver present then there is a chance for recovery.

Dr. Marie replied:

Thanks for the kind words! Feel free to come back if you have more questions!!!