Molnupiravir for FIP – more information from South Africa

Ref: https://animalcare.my/2023/10/19/a-sharing-of-a-dry-fip-cat-case-treated-with-molnupiravir/

We shared the above about a week ago, and it was good to know that besides the rather expensive GS 441524 drug, we now have Molnupiravir for FIP cats. It is from India and much more affordable than GS.

This morning, I got talking with my friend, Ms Aurora Carreira Miguel, whom I got to know since Zurik’s days. Aurora is from South Africa and is the founder of Project Fight FIP in South Africa and co-founder of FIP Advisory and Care Group.

They are also using Remdesivir and Molnupiravir with great success for FIP cats now.

Please see below, bits of my conversation with her, reproduced with her consent:

How do you use the Molnupiravir?

We’ve been using a combination of Remdesivir and Molnupiravir to treat. Molnupiravir is so much more effective – shortens treatment time in many cases.

We do 3 – 5 days of IV Remdesivir, and then switch to Molnupiravir. There are actually quite a few articles re Molnupiravir. Sydney University (Dr Richard Malik) have been at the forefront of developing the Mol treatment protocol.

I heard that Molnupiravir can use kidney stones, is this true and what about GS, does it cause kidney stones too?

The problem with the kidney issues we are seeing with GS now is the result of purer grade product. There has been a shortage world wide of one of the components due to demand for Covid-19 meds. This has caused a lesser grade component being available – even with the legal product such as Bova GS. Many of the cats are developing CKD, uroliths or crystals. This didn’t happen with the initial product.

Yes, GS can cause kidney issues. But Molnupiravir as far as we have seen does not – so the particular cat may already have had them before. Molnupiravir is mutagenic is high doses, but in treatment for FIP it is not significantly high enough. The one thing that is common throughout the treatments is an elevation of liver values but this resolves as soon as treatment is stopped.

Remdesivir and GS are metabolised through the kidneys which is why the kidney values need to be monitored very closely.

I’m not too sure of the route of take-up of Molnupiravir.

Dosage is very important. If using Molnupiravir, the dosage is:

12mg per kg for wet, but we personally advise 15mg.
Same for uncomplicated dry.

15mg per kg for ocular
20mg per kg for neuro

Give that dose twice a day with food.

In short, it’s 15 mg for all except neuro (2omg).

We have treated numerous cats with Molnupiravir. Our latest, a little neuro girl had perfect blood, within 4 weeks, and we stopped treatment at barely six weeks – so reduced cost, reduced chance of side effects to the meds.

Isn’t the above good news?

Here are more articles shared by Aurora (warning: info overload, but in a helpful way):

https://acrobat.adobe.com/id/urn:aaid:sc:EU:25847eef-f04a-4c71-8543-17e2075d8796

https://www.abcdcatsvets.org/guideline-for-feline-infectious-peritonitis/

https://www.abcdcatsvets.org/portfolio-item/factsheets-tools-for-feline-infectious-peritonitis-fip/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612227/?fbclid=IwAR3JbcCFHT8HfJ0DPTW06BiIcEnH1HydJ1TOu6fzGAmpQ21PZHUBL073UrY

Unlicensed means not licensed for use on cats with FIP. It has been licensed for treating Covid-19 for people.

Molnupiravir is a Covid medication, licensed to treat it in a number of countries, but has also shown in studies to be just as effective for treating FIP, and is excellent as a relapse med, especially for cats initially treated with unlicensed (black market) GS. The difference is that molnup is pharmaceutical grade, regulated, and has consistency in terms of active ingredients. We have some group members who have successfully started on b.m. GS (due to their location), and then switched to molunupiravir, with great results, i.e. healthy cats.

TARGET AUDIENCE – VETERINARY PROFESSIONALS

As many of you are already aware since the SARS-CoV-2 outbreak (Covid-19 pandemic) was declared, numerous antivirals have been brought onto the market. One of them is Molnupiravir (EIDD-2801), manufactured by Merck, currently available under emergency use authorization (EUA) by the FDA to treat COVID-19 in adults.
Molnupiravir is an oral prodrug of the nucleoside analog B-D-N4-hydroxycytidine that increases guanine to adenine and cytosine to uracil nucleotide transition mutations in coronaviruses. Due to the strong potential of Molnupiravir to treat other coronavirus infections, cat owners have been using unlicensed Molnupiravir (or its active metabolite, EIDD-1931) purchased over the internet as a therapy for FIP.
It is worthwhile to note that in many countries Molnupiravir is fully licensed and due to its low cost, it is the medication widely used to treat cats in the recent FIP outbreak in the eastern Mediterranean island of Cyprus.
Want to learn more? Links to two recently released field studies reports. 👇
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612227/
https://onlinelibrary.wiley.com/doi/10.1111/jvim.16832…

https://www.researchgate.net/publication/362580270_Successful_treatment_of_a_South_African_cat_with_effusive_feline_infectious_peritonitis_with_remdesivir?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6InByb2ZpbGUiLCJwYWdlIjoicHJvZmlsZSJ9fQ

Diagnosis_of_feline_systemic_viral_infections Veterinary Internal Medicne – 2023 – Sase

Veterinary Internal Medicne – 2023 – Sase


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