Update
When Chiana's FeLV viral load started rising after going into regressive status on 25 mg/day, many people recommended increasing the dose of raltegravir to 100 mg and testing more frequently than every three months. We followed part of that advice.
We only increased the dosage from 25 mg once a day to 50 mg per day: 25 mg in the morning and 25 mg in the evening, rather than jumping directly to 80 or 100 mg per day. We knew this might not be enough, but due to cost, the fact that she has no symptoms, and our regular testing, we decided to increase the dose more gradually.
Unfortunately, this approach hasn’t worked yet, and her numbers have increased again.
Test Results
| Date | Status | Viral Load |
|---|---|---|
| 1/2/24 | Progressive | 6.32 x 10⁶ = 6,320,000 |
| 2/29/24 | Progressive | 8.51 x 10⁶ = 8,510,000 |
Analysis
While this increase was slower than before, it's still a snapshot in time. Here’s what we don’t know: the trajectory. Are the numbers going up or down? The assumption is that they’re going up, but since we’re not testing more frequently, it’s hard to tell.
We’ve realized we have three options:
- Keep her on 50 mg total per day and test her again in a month to see if her viral load increases or decreases.
- Raise the dosage to 75 mg (25 mg three times a day), which is similar to the Brazilian study that used 40 mg twice a day.
- Increase to 100 mg (50 mg twice a day). Retest in two months.
So, what’s next? We decided to follow the original advice (#3) and increase her dose to 100 mg/day (50 mg in the morning and 50 mg in the evening). We started this a few days after receiving the latest test results and plan to retest either the week of April 14 or April 28.
Cost Considerations
With the dosage increase comes a rise in cost. Each 100 mg pill costs about $10 USD. We’ve been using GoodRx to get it at a reduced price, but it’s still a lot for us. GoodRx website
Because of this—and since we’re still unsure about the right dosage for her 14 lb size—we’re exploring ways to get the drug cheaper outside the USA. While looking into that option, we need to reconsider which version of raltegravir we’re giving her.
There are two forms of raltegravir. One is the pediatric chewable pill (100 mg), which is what we’ve been giving her. There’s also an adult version, which comes in 400 mg pills. The challenge with the adult version is figuring out how to split a 400 mg pill. We’ll figure that out when we get there. Fortunately, she takes the pill pretty easily and doesn’t fight it too much.
Update 3/16/24
We recently learned of someone splitting the 400 mg pills for FeLV+ cats with no issues. We’ll be investigating this option further.
Since we’re in the Twin Cities, MN, USA, getting the drug cheaper from Canada has become a viable option due to our proximity.
One option was having a cat-loving cousin in Canada pick it up from a pharmacy and send it to us. Unfortunately, we found out this is illegal.
Another option is finding an online Canadian pharmacy to fill the prescription and ship it to us. We’re currently looking into this and will share more information once we have it.
The good news is we have time to explore these options, and because we love Chiana dearly, we’ll do everything we can to fight this illness.
