Felycin for Cats— A Vet’s Perspective

Well, hey you guys, and welcome to The Longevity Vet. I'm glad you're here. Today we're going to take a deep dive into Felicin for cats, the new medication for hypertrophic cardiomyopathy that's just been out on the US market for the last 2 months or so. I'm Dr. Kevin Toman Toman. I've been a veterinarian for almost 40 years, and I am a pet longevity specialist. I run a website called www.helpingpetslivelonger.com, and that's exactly what I do. 7 days a week. I'll bet you a 6-pack of beer that I sell more Felicin than virtually any other veterinarian in the United States, and as a result, I get the same questions day in and day out. This video is simply my effort to answer as many questions as I can for you in video form, but here's the thing. I am a veterinarian. I'm not a YouTube guy, and so you can expect some stuttering and stammering. If you're okay with that, then let's get to work. Question number 1: Is Felicyn actually available here in the United States? Because my veterinarian says they can't get it in. And the answer to that is yes, Felicyn is available in the United States, but unfortunately there's been a pretty significant shortage up to this point, and I think that's because there's more demand from HCM kitty parents like you than manufacturer had anticipated, and so right now Felicin is on a 2 to 3 month backorder from most veterinary suppliers. In other words, your veterinarian may not have any Felicin for the next 2 to 3 months. If that's a problem for you, please reach out to me at helpingpetslivelonger.com and I will help you if I can. Question number 2: Where can we ship Felicin these days? And right now we are shipping to the US, we are shipping to the UK, and we're shipping to Canada on a 5-day-a-week basis. We cannot ship to the EU and we cannot ship to Australia because of your current customs regulations. Question number 3: How can I buy Felicin for my cats? And listen, kids, here's the answer. Felicin is a prescription drug, and so if you're not buying it from your local veterinarian, you need to ask that local veterinarian for a prescription to send to somebody like me so that I can send it to you. The other alternative for you here at helpingpetslivelonger.com is that we can set you up for a longevity consult, which will also enable me to send Felicin your way for a kitty that has HCM. Question number 4: Felicin or generic Rapamycin? And here's the context for that. I've been selling generic Rapamycin tabs in delayed release form and also oral oil— let me try that again— oral liquid oil-based suspension. Try to say that 3 times fast. For kitties with HCM for about the last 3 years, and I've seen some dramatic results. Specifically, about 80% of kitties that have HCM and were started on rapamycin have shown either stable disease or in 10 to 15% of cases, actually improvement in ventricular function and measurement once they were started on our generic Rapamycin tablets or the oral oil suspension. And listen, I believe that Felicin will be every bit as good. Now, is Felicin going to be better than the generic Rapamycin? I don't know. I honestly don't know because in theory they're the very same drug. And so what I'm telling cat parents at this point in time is if you, if your kitty has been on a generic Rapamycin product from us either the delayed release tablets or the oral oil suspension, and you have seen a benefit to your kitty as verified by, by an echo exam, then the reality is I would not change at this point in time. I simply wouldn't do it. If you're one of the kitties, uh, excuse me, if your cat is one of the 20% that has not improved on our generic tablets, on our generic oral oil suspension, then yes, it would be very logical for you to consider Felicyn usage at this point in time. But again, is Felicin better than the generic? I simply don't know, and as I do learn, I'll be posting further videos down the road. One thing I should mention, and I want to emphasize this to everybody, is that Felicin and Rapamycin do not work 100% of the time to help kitties with HCM, and the same thing applies to every drug that you put in your mouth, that I put in my mouth, or any other drug for kitties. There is simply no drug that is 100% effective, But I'm going to talk a little bit more about safety here in just one minute, and the fact that Rapamycin and Felicin are so safe for kitties and can be used with other drugs that you and I treat with HCM with without creating any problem. I'm going to skew the risk-benefit ratio way over to the benefit side. If you have a kitty, they should be started on Felicin, they should be started on our generic Rapamycin tablets, and hopefully they're one of the 80%. Okay, moving right along. Question number 5 is dosing, and the same thing applies to every rapamycin product, whether it be the new Felicin, whether it be our delayed-release generic tabs, or the oral oil suspension. We think that the correct dose at this point in time for kitties with HCM is 0.3 milligrams per kilogram given once weekly. And in a perfect world, you would give that rapamycin or that Felicin dose with a little bit of oil. That could be either fish oil or olive oil, because we think giving it, giving any rapamycin product with a little bit of oil will actually increase its absorption from the intestine, so you'll get higher blood levels like that. One thing you should understand is that our generic rapamycin tablets are dosed, are, have different strengths than Felicin, and this may enable you to fine-tune your kitty's 0.3 milligram dose, uh, very very specifically. So our Rapamycin tablets, for instance, are 1mg and 2mg strength, and I'll throw the 0.5mg. We have 0.5mg, 1mg, and 2mg strength, but for all practical purposes, we sell the 1mg for 7-pound cats and the 2mg for 14-pound cats to treat HCM. Felicin, on the other hand, has strengths of 0.5mg, 1.2, and 2.4 milligrams, and that 1.2 milligram dose would treat an 8.8 pound cat. The 2.4 milligram dose would treat a 17.6 milligram cat. So if you and I looked at this in stair-step form, our 1 milligram tablets would treat a 7 pound cat. Felicin 1.2 milligram tablets would treat an 8.8 pound cat, and our 2mg tablets would treat a 14-pound cat, and the Felicyn 2.4mg tablets would treat a 17.6-pound cat. Hopefully I didn't confuse you with that, but the point is that we can use these different products to fine-tune your kitty's specific dose. The one thing you should understand, and, and is a strong advantage for our generic oral oil suspension that can be flavored so that your cat hopefully accepts it a little bit better, is that we can nail your kitty's dose down to brass tacks. If cat weighs 10.4 pounds, we can give them an exact dose. If your catty— excuse me— if your cat weighs 6.1 pounds, we can give them an exact dose, and that's something that cannot typically be achieved just simply with tablets in either Felicin or our generic tablet, generic Rapamycin tablets. So I hope that made sense to you. Question number 6: safety of Felicin, safety of Rapamycin. And here's the good news, kids. I mean, we just don't see problems with it. I have used— excuse me— I've used the generic Rapamycin products, your delayed release version or the oral oil suspension, in over 200 cats, and we just— to date, and I'm knocking on wood as I say this— we have not seen any issues with this. 3 to 5% of cats seem to have some GI sensitivity to Rapamycin products. Every once in a while that creates vomiting, but more commonly that creates just some soft poop. And here's the thing, that soft poop typically does not require treatment after 1 or 2 or 3 doses of rapamycin. As your kitty's intestines get used to that product, uh, the soft poop disappears and normal bowel movements remain. And so I'm assuming the same thing will be true of Felicin. Only time will tell. How long does rapamycin take to work, or how long does Felicin take to work? One of the things you should understand about either Felicin or Rapamycin is this: in the original Trivium study, they found that some cats did not respond until after 6 months of Rapamycin therapy. And so if you have an HCM kitty, you need to understand that your Felicin or your Rapamycin journey will be at least 6 months long. And at this point, we believe that both drugs should be continued for life to help prevent the progression of HCM in kitties. Question number 8: Is Rapamycin or Felicin safe with diabetic cats? And here's the basis for that question. In the original Trivium study with Felicin, they had one cat that developed significant diabetic ketoacidosis, which is a really severe complication of diabetes, and that cat unfortunately ended up dying. So people are a little goosey about using this in, in their kitties with diabetes. That concern is borne out because at higher doses of Rapamycin, used most commonly in immune suppressive therapy for human patients, they also, they found an increase in blood sugar levels when a patient was on Rapamycin therapy. But here's the thing, at the low dose that you and I are giving our cats, the 0.3 milligrams per kilogram of Rapamycin or Felicin given once weekly, We just haven't seen any, any effects like that. We have, to the best of my knowledge, we have had 7 cats, 7 diabetic cats on therapy with— let me try that again— we've had 7 diabetic cats with hypertrophic cardiomyopathy on our generic rapamycin, and in only one case did we have to increase the insulin dosage, and that was simply by 1 unit. And so if you have a diabetic cat that also has hypertrophic cardiomyopathy, talk about being unlucky, I would tell you that there's no reason not to try Felicin and/or our generic rapamycin tablets on that cat of yours. But here's the deal. You want to have your veterinarian measure blood sugar within 24 hours after taking that initial dose, and then 24 hours after the next 2 doses. So let's say you're giving it weekly. 1, 7, and 14 days, you want to have your veterinarian measure blood sugar on that kitty at 24-hour intervals after taking each one of those doses. I'm betting, based on our experience, that you're going to be fine, but if you need to bump an insulin dose one way or the other as a result, that'll be your opportunity. Okay, question number 9: Is Felicin safe with other drugs that are typically used in hypertrophic cardiomyopathy? And our answer to that, based on my experience with the generic Rapamycin tablets and the oral oil suspension that we've carried to date, is absolutely yes. To date, we've seen no meaningful interaction between Rapamycin that we have provided and any of the drugs that are commonly used to treat kitties with HCM. Atenolol to reduce blood pressure or to reduce heart rate, uh, benazepril if you're running into proteinuria or blood pressure issues, amlodipine for blood pressure issues, pimobendan in more advanced cases of HCM, clopidogrel, rivaroxaban for clotting. We just simply have not seen any interaction between our rapamycin products and those drugs. And I'm gonna make the statement that Felicin should, uh, follow that pattern as well for you. Now, there is the theoretical, uh, concern that atenolol and rapamycin products are metabolized by the same pathway in the liver. And in theory, if your kitty's on both atenolol and rapamycin, the fact that, that, uh, the two drugs are competing for that, uh, for that pathway means that your blood levels of rapamycin could increase a little bit. In other words, the, the excretion of rapamycin could be delayed by the fact that your kitty's on atenolol. However, we have not seen any complications as a result of that. And to my mind, that is a, That's a hypothetical issue that is much less important than treating your kitty with HCM as fully as possible. Okay, question number 10: What diet should I feed my cat if they're on Felicin for HCM? And the first thing I'm going to tell you is this: the primary concern that you and I have in feeding a kitty with HCM is maintaining their appetite. And some cats are picky enough eaters that if you and I change their diet, they will go off their feed, and that's the last thing we want for kitties with HCM. However, in a perfect world, if your cat has read the same books that I have, you would know that we want to keep the dietary sodium below 0.27% on a dry matter basis. Why? We think diets with higher sodium or higher salt contents could create high blood pressure in your kitty, which will therefore screw with their heart function, or for that matter, their kidney function. And so let me repeat what I just mentioned in a different set of verbiage, and that is feed your cat what they want. We need to make sure that they do not go off their feed and that they maintain their body weight. However, in a perfect world, we should try them on a low sodium diet, and by that I mean a diet that has less than 0.27% sodium on a dry matter basis, and a list of these diets can be found on the Tufts University website. Okay, question number 11: Are there supplements that we should use alongside Felicin for the treatment of HCM?, and we sell two different supplements that we use for kitties with HCM, and they are both safe to be used right alongside Felicin or the generic Rapamycin, or for that matter, the oral oil-based suspension that we sell. The first is a product that we call, uh, HCM Cardio Support, and that contains two different natural supplements, one called nattokinase, and the second is rutin. And the nattokinase in particular has been proven to be a natural Clot Buster, a natural thrombolytic agent which will help to minimize the chances of your kitty developing a left atrial or a femoral clot. But here's one thing you absolutely need to know. If you don't listen to anything else that I have told you in this YouTube video, please do not think that you can use nattokinase or any other natural supplement in place of clopidogrel, aka Plavix, or rivaroxaban, aka Xarelto. Your kitty needs drugs to help minimize the chances of this clotting disease from taking place, and a natural supplement, even one like ours with nattokinase, will not substitute adequately for that. The other ingredient alongside the nattokinase is a product called rutin, and there are studies that show that rutin helps to reduce fluid accumulation and helps to stabilize blood vessels, both of which might be a theoretical benefit to your kitties with congestive heart failure. I'm going to circle back around— do not use nattokinase in place of clopidogrel or Xarelto, guys. It just isn't going to work, and you could be running into a problem with your cat. The second supplement that works very well with Felicin or the generic Rapamycin products that we carry is fish oil. And there are a list of studies that show fish oil is a benefit anytime you have impaired cardiac function and anytime you have inflammation in your system. And so we sell that in both oral and— excuse me— oral liquid and tablet forms. See, let me try that again. Oral, liquid, and capsule forms for your cat. Okay, question number 12: monitoring of your cat on, on Felicin, or for that matter, our generic Rapamycin. And the sad but true truth is that there's only one way to determine whether Felicin or our generic products have benefited your kitty's HCM, and that is with a recheck echo exam. There are no blood tests. The BNP blood test that you and I use as a screening test for HCM will not typically show improvement once a kitty is started on Felicin or rapamycin. And so the echo exams are really the only way to fly. And remember what I told you a little bit earlier, according to the original Trivium study, there's a percentage of these cats, you know, with HCM that were started on rapamycin that did not improve for up to 6 months after beginning rapamycin. And so if your kitty is stable, I would advocate for an echo exam 6 months after beginning that rapamycin. If your cat is not doing well, then work with your cardiologist to solve it on, on the timetable that they set. Okay, the last thing, question number 13, 14, wherever we're at at this point in time, is how big are the Felicyn tablets. And listen, I filmed this same video about 15 minutes ago and stumbled and stammered my way through the, uh, the unboxing, as it were, because the, these foil, uh, the foil enclosure on Felicyn was so difficult to, uh, to open. I had to look away and, you know, just, it was a nightmare. And so I took the liberty of grabbing a baby aspirin and a Felicin tablet, a Felicin 1.2 milligram tablet, and you're gonna find that that yellow baby aspirin and the Felicin 1.2 milligram tablet are virtually identical in size. And so what this means is that for the average, that, that 8.8 pound cat that the 1.2 milligram Felicin should dose You shouldn't have any difficulty getting that into a cat, whether you mix it in with a small amount of canned food, whether you have to use a Chewaroo or perhaps a Pill Pocket to get it in. It is the size of a baby aspirin, and so go into your medicine cabinet, have a look at the size of your baby aspirin, and that should reassure you that you should be able to dose your kitty with Felicin and help minimize their HCM progression like that. So I promised stuttering and stammering, and that's exactly what you got, but hopefully you also got the, the most concise summary of Felicin in your cats that is available anywhere on YouTube right now. And the most important part of things is to remember that you're not in this alone. I'm Dr. Kevin Toman Toman. You can reach me at helpingpetslivelonger.com, and I will help you if I can. We're all in this together, so let's take the very best care possible of our kitties with HCM. Thanks and have a great day.