MARIN
Continuous Therapy versus Pulse Therapy
by
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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