Is my cat’s sudden lethargy a drug side effect?

Dear Most Esteemed and Knowledgeable Kitties:

My husband and I took our cat to the vet last week because she has tiny sores around her neck. We expected to find out that they were caused by allergies. Imagine my surprise when we were told they were caused by lack of hormones, and she was put on birth control pills. I can’t make out a couple of the letters, but it looks like the name of the medication is megace zomgrio. We’ve given her 1/2 pill four times. She received the last one this past Saturday, and she won’t receive another one till this coming Saturday. The sores are smaller now, but today she seems to have become lethargic. Could that be a side effect of the pills? If she is still lethargic in the morning I do plan to call the vet’s office, but I wanted to find out your opinion.

~ Carol

Siouxsie: Carol, there is a drug called megestrol acetate, which goes by the brand names Megace or Ovaban (depending on which company makes the medication).  Megace is a progestin, a synthetic hormone which stops ovulation by making the body think it’s pregnant–hence its use as a birth control method.

Thomas: Megace is one medication vets use to treat a condition called feline acquired symmetrical alopecia, formerly known as feline endocrine alopecia, a type of balding seen most often in neutered male cats and spayed middle-age females.

Dahlia: The symptoms of feline acquired symmetrical alopecia (FASA) are symmetrical hair loss on the back of thighs, abdomen, and genital areas; and hair that easily pulls out. There is no itching associated with this condition.

Siouxsie: However, FASA is a very rare condition and it is generally a “diagnosis of exclusion,” which means your would most likely perform a number of diagnostic tests including skin scrapings, hair analysis, and blood tests, to rule out other causes for your cat’s condition.

Thomas: Some vets have had success using Megace to treat psychogenic alopecia, baldness caused stress-related overgrooming. However, Megace does have some potentially serious side effects which lead the authors of the Cat Owner’s Home Veterinary Handbook to say “Treatment with sex hormones is not recommended because of serious side effects, which include liver and bone marrow toxicity.”

Dahlia: Other side effects of Megace include “decrease in certain hormones, diabetes (elevated blood glucose), increased thirst, increased urination, personality changes, increased weight, cancer, and rare liver problems,” according to one veterinary pharmaceutical reference guide.

Siouxsie: Megace appears to work by eliminating the itching and irritation associated with skin allergies or other conditions, which reduces a cat’s urge to scratch. Vets typically recommend short courses of treatment with anti-anxiety drugs such as amitryptiline, busprione (Buspar), or fluoxetine (Prozac) to treat psychologically caused overgrooming because the side effects are not as potentially severe as those of drugs like Megace.

Thomas: We’d recommend that you talk with your vet about your cat’s condition and various treatment options. Don’t be afraid to ask questions and get as much information as you can. You’re also free to get a second opinion about your cat’s condition and treatment options. No vet should “cop an attitude” about a client wanting a second opinion, and if yours does, it’s not your problem. This is your cat, he’s your responsibility, and you have the right to be sure she gets the most appropriate treatment.

Dahlia: Although lethargy isn’t listed as a common side effect of Megace, our neighbor’s cat become very lethargic after an injection of sex hormones to treat severe allergies.

Siouxsie: Just in case you’re curious, we did find a table listing various causes of hair loss in cats, with a list of symptoms, diagnostic tests used to determine each condition, and recommended treatment.

Thomas: Good luck, Carol. We hope your kitty gets back to her itch-free and active state soon!

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