Eluracat™ frequently asked questions
General
Ghrelin is a hormone that is produced predominantly in the stomach in response to fasting. It is the endogenous (made by the body) ligand for the growth hormone (GH) secretagogue receptor (GHS-R). Once produced, ghrelin is secreted into the circulation and binds to receptors in the hypothalamus and pituitary to stimulate appetite and enhance the release of growth hormone (GH) from the pituitary.
Ghrelin administration activates neurons in the hypothalamus directly, and indirectly through the vagus nerve to trigger the sensation of hunger and enhance feeding. In turn, GH promotes the release of insulin-like growth factor 1 (IGF-1) from the liver.
GH and IGF-1 are involved in the maintenance of appetite, lean body mass, bone mineral density, glucose homeostasis, immune function, and cognitive function.
Zollers, B. et al. 2016. “Capromorelin increases food consumption, body weight, growth hormone, and sustained insulin-like growth factor 1 concentrations when administered to healthy adult Beagle dogs.” J. vet. Pharmacol. Therap. 40, 140-147. doi: 10.1111/jvp.12344.
Wofford, J.A. et al. 2018. “Evaluation of the safety of daily administration of capromorelin in cats.” J vet Pharmacol Therap. 41:324–333.
Yes. Several studies have identified an association between low body weight or weight loss and decreased survival in cats with CKD, cancer, & heart failure. In companion animals, weight loss and decreased appetite could also decrease survival time indirectly because of their role in the euthanasia decision for many owners.
The syndrome of cachexia appears to be common in companion animals with chronic diseases, such as CHF, CKD, and cancer. A sick animal is losing weight in a very different way compared to how healthy animals are losing weight and muscle mass. Patients with chronic diseases are at an increased risk for muscle loss via 2 distinct mechanisms: Sarcopenia, defined as the age-associated decrease in muscle mass related to changes in muscle synthesis signaling pathways, and cachexia, defined as the loss of lean body mass (with or without loss of fat mass) that occurs in association with chronic diseases like CHF, CKD, and cancer (cytokine-mediated).
Weight loss in cats with CKD is important because it can negatively impact survival time through direct effects of weight and muscle loss (e.g. weakness and impaired immune function) that have been identified in people with CKD and other chronic diseases.
Cats may start losing weight unintentionally up to 3 years prior to CKD diagnosis and weight loss accelerates thereafter.
Weight and muscle loss associated with CKD and other chronic diseases in humans has also been shown to negatively impact survival time.
Studies have identified an association between low body weight or weight loss and survival in cats with heart failure and cats with cancer.
Freeman, L.M. Cachexia and Sarcopenia: Emerging Syndromes of Importance in Dogs and Cats, journal of Veterinary Internal Medicine, 2012, pp. 3–17
Freeman, L.M. et al. 2016. “Evaluation of Weight Loss Over Time in Cats with Chronic Kidney Disease.” J Vet Intern Med 2016;30:1661–1666.
Peterson M et al. Evaluation of Body Weight, Body Condition, and Muscle Condition in Cats with hyperthyroidism Journal of Veterinary Internal Medicine 2016
Weight loss and loss of lean body mass have direct and deleterious effects on strength, immune function, wound healing, and survival of cats, therefore both diagnosing the underlying cause and identifying weight loss are important.
After identifying changes in eating behavior and body weight, vets can initiate weight management plan, while addressing the underlying conditions.
Freeman, L.M. Cachexia and Sarcopenia: Emerging Syndromes of Importance in Dogs and Cats, journal of Veterinary Internal Medicine, 2012, pp. 3–17
IRIS (International Renal Interest Society) recommends an appetite stimulant for all stage 3 and 4 CKD cats. As cats reach IRIS CKD Stages 3 and 4 they start to lose weight, eat less and vomit.
Inappetence and weight loss appear to be more common in IRIS CKD stages 3 and 4 than does vomiting, which is seen in 1 in 3 cases or fewer.
It is assumed that poor appetite leading to reduced food intake and weight loss in cats with IRIS CKD Stages 3 and 4 is related to accumulated waste products that interact centrally or peripherally with the nervous system to trigger the vomiting reflex and the sensation of nausea.
Cats may start losing weight unintentionally up to 3 years prior to CKD diagnosis and weight loss accelerates thereafter.
Elliot, J. International Renal Interest Society. “Treatment of Vomiting, Nausea and Inappetence in Cats with Chronic Kidney Disease”. http://www.iriskidney.com/education/treatment_of_vomiting.html [For technical reviewer: paragraph 1 +4]
Freeman, L.M. et al. 2016. “Evaluation of Weight Loss Over Time in Cats with Chronic Kidney Disease.” J Vet Intern Med 2016;30:1661–1666.
The effectiveness study enrolled 176 client-owned cats with ≥5% unintended weight loss and a history of chronic kidney disease.
CKD stage was determined based on creatinine at screening according to the International RenalInterest Society (IRIS) 2015 guidelines. All stages were enrolled.
Capromorelin group at enrollment:
- 10.17% of the cats were in Stage 1 CKD
- 66.95% were in Stage 2
- 22.03% were in Stage 3
- 0.85% were in Stage 4
Wofford JA, Milliken MacKinnon A, Heinen E. Capromorelin promotes weight gain in cats with unintended weight loss: a randomized, masked, placebo-controlled clinical trial. Journal of Feline Medicine and Surgery. 2025;27(11). doi:10.1177/1098612X251379924
There are no restrictions listed in the SPC. All stages of CKD were enrolled in the field study. The effectiveness study enrolled 176 client-owned cats with ≥5% unintended weight loss and a history of chronic kidney disease. CKD stage was determined based on creatinine at screening according to the International Renal Interest Society (IRIS) 2015 guidelines.
Capromorelin group at enrollment:
- 10.17% of the cats were in Stage 1 CKD
- 66.95% were in Stage 2
- 22.03% were in Stage 3
- 0.85% were in Stage 4
Wofford JA, Milliken MacKinnon A, Heinen E. Capromorelin promotes weight gain in cats with unintended weight loss: a randomized, masked, placebo-controlled clinical trial. Journal of Feline Medicine and Surgery. 2025;27(11). doi:10.1177/1098612X251379924
Formulation, Indications and Dosing
Eluracat 20mg/ml oral solution contains Capromorelin, a ghrelin receptor agonist, and is indicated for body weight gain in cats experiencing poor appetite or unintended weight loss resulting from chronic medical conditions at a dose of 2 mg/kg body weight once daily (0.1ml/kg).
Eluracat contains vanilla flavouring
The 15ml bottle of Eluracat comes with a 1.0 ml dosing syringe.
To administer the product:
- Remove the cap, insert the dosing syringe, invert the bottle, withdraw the appropriate amount of solution using a ml scale syringe.
- Return the bottle to the upright position, remove the syringe, replace the cap tightly.
- Administer the solution into the cat’s mouth.
- Rinse the syringe and the plunger with water and leave apart to dry.
Do not use in cases of hypersensitivity to the active substance or to any of the excipients.
Do not use in patients with severe haemodynamic instability or in patients with hypersomatotropism (Acromegaly).
Shelf life after first opening the immediate packaging: 3 months. Do not store above 30 ºC.
The recommended dose is 2 mg/kg body weight which is equivalent to 0.1 ml/kg body weight. The product should be administered once daily directly into the mouth.
The safety in cats less than 10 months old or with less than 2 kg body weight has not been evaluated. In addition, the efficacy in cats less than 6 years old or less than 2 kg body weight has not been evaluated.
A risk/benefit assessment on behalf of the attending veterinarian is always recommended.
Based on the recommended dose of 2mg/kg (equivalent to 0.1ml/kg), a 15ml bottle will last 30 days for a 5kg cat
Mode of action and Metabolism
The clinical effects of Eluracat (capromorelin) are thought to be due to a combination of increased food intake and metabolic changes resulting in weight gain.
Capromorelin is a selective ghrelin receptor agonist. The ghrelin receptor is found in many tissues in various species and may have effects in the central nervous system, gastrointestinal tract, cardiovascular system and energy homeostasis. Capromorelin binds to ghrelin receptors in the hypothalamus to stimulate appetite and in the pituitary to stimulate secretion of growth hormone (GH). Increased GH stimulates release of insulin like growth factor 1 (IGF-1) from the liver, which in turn stimulates weight gain.
Eluracat™ can be used daily and has no restrictions on the duration of use. However, as safety studies were limited to 90 days, use beyond this should be based on a risk:benefit analysis by the prescribing vet.
Eluracat SPC
FDA FOI NADA 141- 536 (2020).
While the metabolism and elimination of capromorelin in cats has not been investigated, it is likely to be primarily:
• Hepatic metabolism
• Faecal elimination
After oral administration, capromorelin was rapidly absorbed in cats with a Tmax of 0.35 hours (without food). The mean half-life of capromorelin in serum following intravenous and oral administration is 0.9 and 1.1 hours
CVMP assessment report for Eluracat (EMEA/V/C/005948/0000)
Eluracat SPC
Whilst there are no restrictions on duration of use, as safety studies were limited to 90 days, use beyond this should be based on a risk:benefit analysis by the prescribing vet. Duration of use will depend on the response observed to treatment. Longer term administration of Eluracat will depend on the underlying cause of weight loss and/or inappetence as many chronic medical conditions are progressive in nature and weight loss is expected to continue if not addressed.
It is important to remember that you are NOT treating the underlining chronic medical condition with Eluracat.
Efficacy
In the pivotal field study, use of Eluracat in cats with CKD led to maintaining or gaining weight in more than 80% of treated cats over the 56-day study period, compared to cats without treatment which continued to lose weight (difference between Eluracat/Vehicle Control = +6.8%) Significant weight gain was recognized by day 15 (percent weight change from Day 0 to Day 15 was +3.3%).
Wofford JA, et al. Journal of Feline Medicine and Surgery. 2025;27(11). doi:10.1177/1098612X251379924
Monitoring
There are no specific recommendations on the SPC, so this is at the discretion of the prescribing veterinarian.
It will vary case by case and will depend on the cat, the underlying chronic condition, the stage of the disease, other concomitant conditions that may be present, and how the cat is doing clinically.
On the Eluracat SPC, hypersalivation is described as:
‘very common’ (>1 animal/ 10 animals treated)*
*at the time of dosing and resolved within a few minutes.
It is not a lasting or consistent response, however, advising the pet owner that hypersalivation can occur with Eluracat use may help to lessen any concerns should their cat experience this.
In the pivotal field study, hypersalivation was reported for 25/118 (21.19%) of cats and no control cats. Where specified, observations were associated with dosing and generally resolved within a few minutes.
It is possible that hypersalivation is a physiological response due to the presence of ghrelin receptors in the oral cavity. In humans, it is noted that the ghrelin receptor has been shown to be present in the salivary glands however this has not yet been demonstrated in cats.
Wofford, J.A. et al. 2018. “Evaluation of the safety of daily administration of capromorelin in cats.” J vet Pharmacol Therap. 41:324–333.3.
Michael Gröschl, Hans G Topf, Jörg Bohlender, Johannes Zenk, Sven Klussmann, Jörg Dötsch, Wolfgang Rascher, Manfred Rauh, Identification of Ghrelin in Human Saliva: Production by the Salivary Glands and Potential Role in Proliferation of Oral Keratinocytes, Clinical Chemistry, Volume 51, Issue 6, 1 June 2005, Pages 997–1006, https://doi.org/10.1373/clinchem.2004.040667
Miscellaneous
Eluracat can cause transient decreases in blood pressure and heart rate for up to several hours after dosing. Therefore, concurrent use of other drugs that cause reductions in blood pressure and/or heart rate (e.g. sedatives, anaesthetic agents, prazosin, ACE inhibitors) should only be according to a benefit-risk evaluation by the responsible veterinary surgeon.
Eluracat can also cause transient elevations in serum glucose levels and insulin resistance in cats. Therefore, concurrent use of other drugs that cause such effects (e.g. steroids) should only be according to a benefit-risk evaluation by the responsible veterinary surgeon.
No, Eluracat does not cause diabetes.
As per the SPC precaution, the product has been shown to increase serum glucose levels in cats, with highly variable effects on individual cats. However, in non-diabetic cats homeostatic mechanisms adapt to maintain blood glucose levels within normal ranges after a few days. Use in cats with diabetes mellitus has not been evaluated. In cases of diabetes mellitus, use only according to the benefit/risk assessment by the responsible veterinary surgeon.
Eluracat™ Oral Suspension for Cats. Contains Capromorelin. Legal category POM-V in UK.
Further information can be found in the Summary of Product Characteristics. Use medicines responsibly (UK): NOAH. Advice should be sought from the prescriber prior to use. Prescription decisions are for the person issuing the prescription alone.
Eluracat™, Elanco™ and the diagonal bar logo are trademarks of Elanco or its affiliates.
PM-IE-26-0168
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Telephone: 01256 353131, selecting option 1 for technical services
Email: ElancoVets@elanco.com*
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