Ondansetron for antinausea for Bella (feline with CKD)

[DayshaG]

I had to bring Bella to the ER vet a few weeks ago due to dehydration and vomiting. I also am working with Hana Makinen for animal communication and end of life aspects of things, as well as Gail Pope. The big in my mind is always "how much times does she have?". Nobody has that answer, I know. It has been an emotional roller coaster! I am looking into other ways to support Bella as she continues to have nausea (confirmed specifically with Hana, and this has been a long running thing since she was diagnosed with kidney disease 4 years ago). I have also started to have a mobile vet come to the house to give subcutaneous fluids, I was hoping twice a week though the vet texted me and said may need to get it once a week. I am not sure we are at that frequency yet, she has good days and bad days. It is just that the bad days make me feel stressed, even though you all have been GREAT in helping me come from a place of love instead of fear, sometimes as this progresses... I just feel scared. It is also triggering memories of my husband's physical decline before he passed not 2 years ago.

My questions for you is about Ondansetron. It was given to her by the ER vet. Along with Cerenia which the taste of that she ends up spitting out, and always has. But I see Ondansetron can cause constipation. Before I read this, I started adding canned plain pumpkin back to Bella's food this AM to help her in that regard. She has started over grooming again and has puked up hair balls over the weekend. If we are talking about palliative care, my friend who uses homeopathy, herbs, and western medicine suggested giving her whatever makes her comfortable. What are your thoughts on this drug, as well as how to ease any constipation.

Also, CBD. I contacted a company recommended by Gail and had a positive experience though didn't make any purchases yet. The vet tech I spoke to suggested Ondansetron as well. I wanted to look further into studies but again, my friend suggested since this is all palliative, give her what will make her more comfortable. I have also been working with my homeopathic vet Dr. Herman.

What is your experience on CBD with cats? Bella does have arthritis as well. Her creatinine also had dropped since Sept 2025 to 2.71.

 

[DayshaG]

P.S. It seems my vet offers a variety of methods to get Ondansetron, including transdermal gel. Thoughts?

 

[HA! Support]

@Dr. Jean Hofve @Dr. Jeff @Dr. Christina

 

[Dr. Jean Hofve]

Hi, Daysha, sorry to hear Bella is not doing well. You have given her such a great life and more time than anyone could have hoped! So along with the sadness, please give yourself a big hug for how well she has done with you!

A compounding pharmacy will happily put anything in a transdermal gel, but only a few drugs are well absorbed through that route. Ondansetron is not one of them. Don't bother with that formulation, it will not work.

It makes sense, of course, that anything that affects the GI tract like that can cause constipation. Ondansetron is milder than Cerenia but needs more frequent administration (3-4 times a day). I'm sure Dr. Herman can recommend a homeopathic or two that would be helpful for nausea. If Bella does need stronger meds then I still like good old Vaseline for constipation.

Constipated Cats | Little Big Cat - Dr. Jean Hofve
How to Use Vaseline for Cats | Little Big Cat - Dr. Jean Hofve

Don't forget the good old stand-by therapies like massage/hands-on energy (you don't need special training, just intention and love), play if she's up for it, EFT, and for sure flower essences to help ease her days.

 

[Dr. Jeff]

Hey Daysha!

Thank you for continuing to support Bella and Maya on their journeys home.

suggested giving her whatever makes her comfortable. What are your thoughts

I agree!

Regarding the meds, do they work to decrease her nausea? Have you seen them cause her to become constipated. If not, don't worry about what Dr. Goggle says Check with Sage (the HA! AI concierge) first.

What is your experience on CBD with cats?

It helps some cats. Tho it seems to be less effective in cats than dogs.

Her creatinine also had dropped since Sept 2025 to 2.71.

Yay! The body can do some amazing things. My kitty' red blood cell count went from life threatening anemia (HCT=14) to a normal HCT in only 2 weeks. Only homeopathic stimulation of the body's innate wisdom...

To paraphrase Gail, the smartest doctor in the world is Dr. Mother Nature.

For fun, I asked Sage your questions. Here's what she said:
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

You’re doing a loving, thoughtful job for Bella, and it’s completely normal to feel waves of fear alongside love—especially with the memories you’re carrying. Let’s focus on keeping her comfortable day to day while you and your team guide the bigger picture.

Ondansetron, Cerenia, and constipation

• Ondansetron: Often helpful for nausea in kidney disease. It can contribute to constipation in some patients.
• Cerenia (maropitant): Also effective for nausea but many cats dislike the taste. If it helps but oral dosing is a struggle, ask your vet about alternative forms or administration tips.
• Palliative lens: Using the medicine that eases her nausea and improves BEAM is appropriate. Just watch stools and comfort, and adjust as needed with your vet.

Easing or preventing constipation while using anti‑nausea meds

• Moisture first: Add warm water or broth to every meal; continue/subcutaneous fluids per your vet’s plan (frequency can be adjusted by BEAM, hydration checks, and stool quality).
• Gentle fiber and soothing GI support:
  • Pumpkin or mashed yam: start 1/2–1 tsp per meal, adjust based on stool.
  • Pectin: 1/8–1/4 tsp mixed into food.
  • Marshmallow root (gentle mucilage) or slippery elm (more astringent) to lubricate/soothe.
  • Aloe vera inner fillet juice (pet‑safe, no latex), tiny amounts if tolerated.
• Digestive partners:
  • Probiotics and plain digestive enzymes can support motility and stool quality.
  • Omega‑3s (sardine/anchovy oil) a few drops with meals may aid stool passage and joint comfort.
• Litterbox setup: super‑clean, easy access, quiet location to reduce “holding.”
• When to loop your vet: if stools remain hard after 7–10 days of the above, if there’s straining, yowling, blood, vomiting, or less‑than‑daily stools.

CBD for cats (including arthritis and nausea/anxiety)

• Safety and potential benefits: CBD products with <0.3% THC appear to be safe for dogs and generally well‑tolerated in cats; studies remain limited. Many guardians report calmer behavior, less anxiety, and improved comfort.
• Quality matters: Choose products with a third‑party certificate of analysis confirming purity and active ingredient levels; avoid contaminants (e.g., heavy metals).
• Drug interactions: CBD is metabolized by cytochrome P450 enzymes (which cats lack) and can change the effect of some meds (e.g., certain antibiotics, NSAIDs, Tramadol, gabapentin, Trazodone, antidepressants, antipsychotics, warfarin, tacrolimus, theophylline, zonisamide, ketoconazole). Let Dr. Herman and your mobile vet know before starting so they can watch for interactions and adjust doses if needed.
• Practical tip: Start low, go slow, and track BEAM, nausea episodes, stool, and comfort.

If you’d like, share the exact CBD product you’re considering and Bella’s current meds, and I can help outline a conservative start-and-monitor plan. You’re doing a thoughtful job advocating for her comfort—keep it up.

Hairballs and over‑grooming uptick

• Hydration and gentle fiber (as above) help hair transit.
• Add probiotics/enzymes and a bit of omega‑3 oil to reduce GI irritation and support coat/skin.
• Keep stress low; offer quiet grooming sessions if she enjoys them.

Subcutaneous fluids frequency

• Let BEAM, hydration checks (moist gums, skin turgor), appetite, and nausea guide frequency with your vet. It’s okay to adjust week‑to‑week: more often during rough patches, less when she’s stable.

A simple daily comfort plan you can start now

• Morning/evening: anti‑nausea med that she tolerates best; meals well‑hydrated; tiny pumpkin or pectin; probiotic/enzymes.
• Midday: short Reiki/quiet time; gentle grooming if welcome.
• Evening: small moisture‑rich “mini‑meal” if evenings are her tough time; omega‑3 drops; calm routine (low light, soft music).
• Journal BEAM, stools, vomiting/nausea cues, and response to meds/CBD to share with Dr. Herman.

You’re honoring Bella with presence and thoughtful care. Keep leaning on your team and your routines; we can keep fine‑tuning based on her daily signals. If you’d like, share her current meds/supplements and a 3‑day BEAM/stool log, and I’ll help tailor her constipation support and CBD start plan. You and Bella are not alone—you’re doing beautifully in a very tender time.
You’re doing a loving, thoughtful job for Bella, and it’s completely normal to feel waves of fear alongside love—especially with the memories you’re carrying. Let’s focus on keeping her comfortable day to day while you and your team guide the bigger picture.

 

[DayshaG]

Hi, Daysha, sorry to hear Bella is not doing well. You have given her such a great life and more time than anyone could have hoped! So along with the sadness, please give yourself a big hug for how well she has done with you!

A compounding pharmacy will happily put anything in a transdermal gel, but only a few drugs are well absorbed through that route. Ondansetron is not one of them. Don't bother with that formulation, it will not work.

It makes sense, of course, that anything that affects the GI tract like that can cause constipation. Ondansetron is milder than Cerenia but needs more frequent administration (3-4 times a day). I'm sure Dr. Herman can recommend a homeopathic or two that would be helpful for nausea. If Bella does need stronger meds then I still like good old Vaseline for constipation.

Constipated Cats | Little Big Cat - Dr. Jean Hofve
How to Use Vaseline for Cats | Little Big Cat - Dr. Jean Hofve

Don't forget the good old stand-by therapies like massage/hands-on energy (you don't need special training, just intention and love), play if she's up for it, EFT, and for sure flower essences to help ease her days.

@Dr. Jean Hofve and now we are back to a spurt of good days...I will take them! I have my mobile vet coming after work to check for dehydration with Bella. It is the ups and downs now 4 years in with kidney dis-ease. Though I have noticed today her sister Maya, who is showing signs of kidney disease in her blood work a few years after Bella, was just straining in the litter box for a minute before a single, loud drop of a poop came out. I have the brand Tomyln hairball gel from my local pet food store, and it has White Petrolatum USP: 1285 mg in it. Wondering if kidney disease can lead to the dehydration as well? I do lightly cook a raw food diet for both kitties and the last few days have added a little canned pumpkin. Bella has had slow bowel movements as well. I read the articles you shared. Thanks!!

 

[Dr. Jeff]

Wondering if kidney disease can lead to the dehydration as well?

Yes!

The kidneys regulate most of the water balance in the body.

 

[DayshaG]

@Dr. Jean Hofve and now we are back to a spurt of good days...I will take them! I have my mobile vet coming after work to check for dehydration with Bella. It is the ups and downs now 4 years in with kidney dis-ease. Though I have noticed today her sister Maya, who is showing signs of kidney disease in her blood work a few years after Bella, was just straining in the litter box for a minute before a single, loud drop of a poop came out. I have the brand Tomyln hairball gel from my local pet food store, and it has White Petrolatum USP: 1285 mg in it. Wondering if kidney disease can lead to the dehydration as well? I do lightly cook a raw food diet for both kitties and the last few days have added a little canned pumpkin. Bella has had slow bowel movements as well. I read the articles you shared. Thanks!!

@Dr. Jeff that is amazing that Sage came up with such an awesome response earlier! Thank you. Bella and Maya gave me a run for my money this AM, just like siblings will do. One wanted the others bed, some hissing ensued, and then at one point today each of them wanted to sit on my closet shelf while I worked in the same room. Knowing how fragile Bella is, I had hoped she would wait for me to help her down like Maya will do (Maya knows to meow and wait for me to help her down to the ground). Bella didn't quite get the message and jumped over 4 feet from the closet shelf down to my hope chest that is wood with a thin pet bed on top of it. Argh! It was a loud thud but she seems fine although I am sure physically it didn't feel all that great. She appears to be walking with her usual stiffness, nothing looks different. When my chiropractic vet can finally make her way to me on Memorial Day I will have her assess Bella's frame. Do you think that kind of jump would be OK? Like other pet parents but not all...I admit I tend to worry sometimes for nothing. I have been laying her heatable bean bags against her lower half. My other mobile vet is coming later and could do red light therapy or needle acupuncture.