# Using Nystatin & Metoclopramide



## Bella_F (Nov 29, 2008)

Hey guys,

I had my very first case of trying to help a bird that was vomiting this week, but sadly the vomiting just got worse & little one passed away. The experience highlighted some areas where I am not very strong & I'd like to learn more about two meds in particular, Nilstat (Nystatin), and Metoclopramide. 

Can anyone spare a moment to help me please?

Regarding Nilstat (Nystatin), I was using this in case of a fungal infection. However I have read information that suggests that Fluconazole is more effective. Can anyone share their experiences with Nystatin or other antifungals? Is it possible for an antifungal to encounter a resistant fungus, that would require a change in meds (similar to canker?).

The other med I used for the first time was Metoclopramide. I attempted to use it for the purpose of stopping the vomiting long enough for the bird to eat and absorb its meds. It seemed to work for keeping the meds down, but the bird remained off its food. Also, in Australia its mixed with paracetomol (tylenol), so not ideal. I spoke to my doctor yesterday and I got a script for the pure form. 

Is this the correct purpose for Metoclopramide or are there better ways to stop vomiting? Also, sorry to ask so many questions, but how does it work for sour crop? Is it a harsh drug that should be used alone, or safe with other drugs?

Any info would be much appreciated!

Thankyou


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## PigeonQueen (Aug 13, 2006)

Hello can't answer all your questions but I use Metoclopramide for sour crop and vomiting and it works well for both of these problems.

I have used Metoclopramide with Baytril and also with Nystatin. Never had any problems. Usual dose of Metoclopramide is 0.2 three times a day for average size pigeon.

I think Fluconazole might be a more risky drug to give than Nystatin and it might be stronger and more effective You have to be careful not to give it to pigeons with liver problems. Nystatin is a old fashioned 'reliable' drug. I think some vets might use more modern equivalents now.

This is what my Vet told me. Im based in UK

Maybe others can give their views


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## Bella_F (Nov 29, 2008)

Thanks so much for your feedback PigeonQueen.

May I ask you, when you used the metocopramide, did you have to administer it before the Baytril, to give it time to work? Or does it work quickly?


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## PigeonQueen (Aug 13, 2006)

Well I give the Baytril with a little water and give the Metoclopramide right afterwards. I have never waited . I use Baytril as a single dose usually in the mornings, the other two doses of Metoclopramide I give on their own.
However I have give Nystatin also straight after giving Metoclopramide though that might be best given a couple of hours afterwards.

The vet tells me once the crop starts moving and the bird stops vomiting to stop using the Metoclopramide. I usually only give for about four days.

Sometimes when the crop is full up and hard and the pigeon is dehydrated, giving Metoclopramide sometimes makes the pigeon throw up whatever is causing the problem. So it actually can make the pigeon sick to clear the obstruction or blockage of something eaten which it shouldn't have.

I find Metoclopramide works within 24-48 hours of giving the medication depending on whatever is wrong.


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## Dobato (Jul 3, 2008)

Because the Metoclopramide is a GI motility stimulant, and needs to be up taken by the body to exert its affect and it's strongest shortly after taking, it's best to give this medicine 30-45 minutes before either giving medicine or or food in order for it to help move the food/meds quicker through and reduce the chance of regurgitation taking place.

Karyn


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## Pidgey (May 20, 2005)

Nystatin isn't absorbed through the lining of the GI tract so it only works within it--that is to say that it's not a "systemic medicine" that gets carried to some or all other parts of the body through the blood. It only inhibits fungal growth on contact.

Fluconazole and several other "systemic" antifungals DO travel through the body and inhibit fungal problems in other places.

Pidgey


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## Bella_F (Nov 29, 2008)

Pidgey said:


> Fluconazole and several other "systemic" antifungals DO travel through the body and inhibit fungal problems in other places.
> 
> Pidgey


Thanks Pidgey, that explains a lot about the differences.

Are there any common places where fungus can cause illness, that's not in the GI tract? Say, is usual for it to get into the respiratory system/air sacs etc?


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## Pidgey (May 20, 2005)

Well... yes, but not usually with a normal immune system. That is, an immuno-compromised bird can get foci of some fungi in odd places like the kidneys, the liver and such under weird circumstances, but that's not normal. And they're usually not going to make it when they do start that downhill battle, too.

If you want them to get an antifungal working IN their lungs, you're going to have to go with a systemic. Aspergillosis is one of those that is more in the lungs than anywhere. Asper is "ubiquitous", which means it's pretty much everywhere, and you only come down with clinical disease when you're immunocompromised, OR...

...when you get a heckuva' dose all at once, like breathing in the middle of a virtual cloud of the spores. That happens. That's one of the reasons to keep a pigeon loft bone dry, by the way--that and a few other such things.

Anyhow... so how does one actually diagnose Aspergillosis in the lungs? Usually by breathing sounds and an X-Ray, and probably more after a course of antibiotics. It's not something that we normally see around here, actually. Occasionally a vet or a rehabber will make the call to give a systemic antifungal and a bird that's been sick, sick, sick will make a rapid recovery--we see that very rarely. A lot of systemic antifungals require that the vet actually watch the bloodwork closely to see if the danger zone is being approached (organ damage due to the medication), so we don't see them used that much. Some are much worse than others, of course.

Pidgey


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## Bella_F (Nov 29, 2008)

Thanks SO much for your detailed explanation Pidgey.


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## Bella_F (Nov 29, 2008)

PigeonQueen said:


> Sometimes when the crop is full up and hard and the pigeon is dehydrated, giving Metoclopramide sometimes makes the pigeon throw up whatever is causing the problem. So it actually can make the pigeon sick to clear the obstruction or blockage of something eaten which it shouldn't have.
> 
> .


Thanks PQ, I was wondering about whether Metoclopramide would inhibit `good' regurgitation, like when the birds needs to get something out. Its interesting to hear that the bird will still get sick if it needs to.


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## John_D (Jan 24, 2002)

Re antifungals, for what it's worth ... 

Our 'Blind Pew' had a bad respiratory problem a couple of months back, when still a squeaker. He was having bouts of what sounded like severe congestion like a person with a very bad cold, initially at odd times like the middle of the night. When he exercised, he would be gasping and breathing with open beak. These were, as I say, in bouts rather than constant.

Avian vet sounded everything and could hear no sign of a problem, and provided Baytril for a start. I had already given him Spartrix. After a couple of weeks he was not sounding much better and I took him to our other vet when I went to Cynthia's place. She also checked him, and though there _may_ have been a very slight clicking (as in airsac mites, maybe) there was really nothing concrete to go on. Anyway, she gave me Itrafungol (Itraconazole) and Flagyl. Can't say for sure, but I do believe that it was _probably_ the Itrafungol which cleared it up. A fungal infection seemed to be the likely suspect after two good examinations.


Wikipedia (some of it's stuff over my head but not Pidgey's I bet 



> Itraconazole has a broader spectrum of activity than fluconazole (but not as broad as voriconazole or posaconazole). In particular, it is active against Aspergillus, which fluconazole is not. It is also licenced for use in blastomycosis, histoplasmosis and onychomycosis. Itraconazole is over 99% protein bound and has virtually no penetration intocerebrospinal fluid. Therefore, it should never be used to treat meningitis or other central nervous systeminfections.[1] According to the Johns Hopkins Abx Guide, it has "negligible CSF penetration, however treatment has been successful for cryptococcal and coccidioidal meningitis".[2] It is also prescribed for systemic infections such as aspergillosis, candidiasis and cryptococcosis where otherantifungal drugs are inappropriate or ineffective.


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## Bella_F (Nov 29, 2008)

John,

That's very interesting. With Blind pew, how were his droppings during the suspected respiratory illness?


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## John_D (Jan 24, 2002)

That was one very odd thing - his droppings have been absolutely fine all the way along - neat, small, rounded and firm.


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## Bella_F (Nov 29, 2008)

What a difficult case to figure out , and I'm glad you did. Cynthia has good instincts, huh?

I have a rescued racing pigeon here that still pants after short flights intermittently . Its a frustrating symptom to deal with.


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