Bova GS-441524 for Cats with FIP

FDA’s Center for Veterinary Medicine (CVM) has notified veterinarians that compounded Bova GS-441524 falls under Guidance For Industry (GFI) #256 and is allowed to be compounded and legally prescribed. Read the CVM’s statement here. 

GS-441524 tablets and suspension were nominated and are on the GFI under review list for the animal drug bulk substances list in regards to GFI #256 office use. This means that Bova GS-441524 tablets and suspension can be sold to hospitals for office use in all states except Arkansas, New Mexico, New York, Oregon, Rhode Island and West Virginia. Veterinarians who work in a state that does not allow USP compounded medications for office use can prescribe the drug in a patient’s name.

10 tablets or 10 mL = $195.00

20 tablets or 20 mL = $325.00

40 tablets or 40 mL = $546.00

These prices do not include shipping + tax when applicable. Our standard 1-2 day shipping is $9.50. Overnight shipping is available upon request of pet owner.

Note: one tablet can be quartered for multiple strengths. Cost of full duration of treatment will vary based on weight changes during treatment and course of treatment. Refer to our Bova GS-441524 dosing calculator below.

Prices subject to change.

Veterinary office orders for Bova GS-441524 tablets are ready to ship same day with 1-2 business days in transit.

Patient prescriptions for both tablets or liquid suspension will ship once we confirm pet owner payment and shipping information. Then it will be 1-2 business days in transit. Overnight shipping is also available upon request.

Currently, we do not ship internationally. However, Bova Global may be able to assist you.  

Outcomes from treatment with Bova GS-441524 as a sole oral treatment are comparable (complete response in 90%+) with combined treatment of remdesivir and Bova GS-441524 or remdesivir alone (Taylor et al, 2023)

The dating on our Bova GS-441524 tablets is 6 months from when they are made but realistically less than this.

The dating on our Bova GS-441524 oral suspension is 90 days from when it is made, but will be less than that when the patient receives the medication.

Our iFill DTO system will have dating of the current lot in stock so when offices place an order, they can take this into consideration.

An FDA registered facility.

• In the first 2-5 days you should see an improvement in demeanor, appetite, resolution of pyrexia, and reduction in abdominal or pleural fluid (if present).
• NB: More clinical signs attributable to FIP may be seen during the initial few days of treatment, i.e., before the medication has had time to take effect. This can include the development or recurrence of pleural fluid which may require drainage (if the cat is at home, advise the owner to measure resting respiratory rate and respiratory effort). Neurological signs or uveitis may also develop (e.g., owners may notice a change in iris color). If neurological or ocular changes are noted, the drug dosage should be reviewed in case an increase is indicated.
• Effusions usually resolve by 2 weeks. If an effusion is still present at 2 weeks, consider increasing the dosage (by 5-10 mg/kg/day and consider splitting into twice daily doses if treated orally once daily).
• Serum albumin increases and globulin decreases (i.e., they normalize) may take several weeks, but note that globulins can initially increase when a large volume effusion is absorbed. In some cases, globulins may remain mildly increased even at the end of a successful treatment course, and this mild hyperglobulinemia has not been associated with relapse in our experience, if all other parameters have normalized.
• Lymphopenia and anemia may take longer to resolve, up to 10 weeks. A lymphocytosis (and eosinophilia) can also occur during successful treatment.
• Enlarged lymph nodes typically reduce in size over a few weeks of treatment, but in some cases, they do not return to normal size nor normal ultrasonographic echogenicity, even by the end of treatment. However, this does not seem to signify FIP relapse if all other parameters have returned to normal, treatment can be stopped as planned and the patient monitored.
• If progress is not as expected, consider reviewing the diagnosis and/or increasing dosage; occasionally other antivirals can be considered.

-Taylor S, Tasker S, Gunn-Moore D, Barker E, Sorrell S (May 2024): An update on treatment of FIP using antiviral drugs in 2024: growing experience but more to learn

Stokes Pharmacy is proud to be the leader of FIP treatment in the US, having successfully treated thousands of patients already with Bova GS-441524.  Stokes has the only oral formula identical to the Bova formula used in clinical studies. Stokes Pharmacy also has the only FIP treatments that are tested against the Bova proven standard. 

No one knows what is in the black market drugs as they are unknown, untested drugs made following no regulations. The Stokes Pharmacy products are tested against a proven standard and compounded by a leading regulated nationwide compounding pharmacy.

Your clients should be under the care of a licensed veterinarian to guide them through their FIP journey. Like other antivirals, Bova GS-441524 should be prescribed by a veterinarian for reasons that include the risk of antimicrobial resistance. Stokes Pharmacy is a leading regulated nationwide compounding pharmacy that is selling the only oral formula identical to the Bova formula used in clinical studies across the globe. Stokes Pharmacy’s Bova GS-441524 is tested by Bova to meet their exact specifications. Read a clinical study on black market drugs.

No, our Bova GS-441524 tablets and oral suspension do not contain fish protein.

At the veterinarian’s discretion, feline caretakers whose cat experiences a relapse or refractory case, and who have purchased a prescription of Bova GS-441524 directly from Stokes Pharmacy, may be eligible for a credit towards the purchase of Bova EIDD-1931 tablets. This credit* will be up to the equivalent dollar amount spent on GS-441524 at Stokes Pharmacy. *Limits may apply

Veterinary feline experts who specialize in FIP, still refer to GS-441524 as the “gold standard” when it comes to treating cats for with FIP. This is due to a number of factors, including a lack of studies on Molnupiravir/EIDD-1931 and the potential side effects of EIDD-1931. It is much safer to increase the dose of GS-441524 than it is to increase the dose of EIDD-1931. There is also evidence in humans treated for COVID that resistance to Molnupiravir/EIDD-1931 develops more quickly than with GS-441524. (Dr. Sally Coggins, FIP Update 2024)

“It doesn’t appear to have the same safety margin as GS-441524….We can’t just keep giving more if it’s not working, whereas with GS441524, quite often we will escalate doses considerably higher than those maintenance doses. With Molnupiravir, we need to be a lot more judicious in terms of the actual dose that the animal’s receiving.” – Dr. Sally Coggins, FIP Update 2024

“My preference is still GS-441524. I do still think that’s the better and probably safer drug. So if it’s not cost prohibitive, keep them on GS-441524 orally” – Dr. Sally Coggins, FIP Update 2024

“It is very important for feline caretakers to weigh cat weekly during treatment, using accurate scales e.g., cat or baby scales. Weight gain and/or growth in kittens will occur with successful treatment necessitating an increase in dose to ensure that the dosage of antiviral administered is still appropriate for the type of FIP being treated.

Not increasing the dose as the kitten grows appears to be one of the most common causes for a poor response to treatment, and treatment failure.”

-Taylor S, Tasker S, Gunn-Moore D, Barker E, Sorrell S (May 2024): An update on treatment of FIP using antiviral drugs in 2024: growing
experience but more to learn

Clinical response is most important to monitor; a failure to improve may necessitate an increase in dosage. Monitoring should be adequate to assess response but, particularly when the cat is doing well, repetition of costly tests that are unlikely to alter treatment (e.g., limiting testing to previously abnormal parameters and basic screen) and multiple, potentially stressful, clinic visits should be limited. Owners should be encouraged to weigh their cat at home (e.g., using inexpensive baby scales) and keep a diary of appetite and demeanor, respiratory rate and other parameters as indicated. The recommendations below will change depending on the cat’s response to treatment:
After 48 hours an improvement in demeanor and normothermia is expected. A verbal report of progress and ease of medicating the cat should be obtained around this time.
· After 2 weeks weight, demeanor, effusions (in- house scanning, abdominal girth measurement) should be reviewed. Additionally, serum biochemistry and hematology can be assessed, adapting to cost constraints as needed (e.g., consider whether measurement of total protein, PCV, and plasma color assessment, using a spun micro-hematocrit tube, could be used as a cost-effective and rapid initial screen to indicate whether additional testing is indicated). Normalization of serum AGP (if elevated before treatment) may be useful to predict remission.
· After 6 weeks the cat should be re-examined and the above assessments repeated.
· After 12 weeks the cat should be examined before stopping treatment and all assessments should ideally be normal. Mild persistent hyperglobulinemia and mild abdominal lymphadenomegaly are sometimes reported and not associated with relapse. If all other parameters are normal (including AGP) then treatment can still be stopped.
· Point-of-care ultrasonography (POCUS) to monitor for effusion resolution and/or lymph node size is useful if available and affordable.

Once treatment is completed (usually 12 weeks’ duration), cats should be monitored for relapse by their owners; loss of appetite, weight changes, or other clinical signs. The clinical signs of relapse may differ from those at initial diagnosis (e.g., neurological signs in cats that previously had effusions). Ideally, the cat is examined ~4 weeks after stopping treatment. Monitoring AGP may provide reassurance if it remains normal. Any clinical signs should be promptly investigated.

-Taylor S, Tasker S, Gunn-Moore D, Barker E, Sorrell S (May 2024): An update on treatment of FIP using antiviral drugs in 2024: growing experience but more to learn

e.g., recurrence or lack of resolution of effusion, pyrexia, development of new ocular or neurological signs, or persistent clinical pathology abnormalities:
· Ensure that you are still confident that the cat has FIP; review diagnosis, look for additional pathology, consider repeat sampling (e.g., external laboratory analysis and culture of any fluid; cytology or biopsy of lymph nodes ± feline coronavirus antigen or RNA detection, but bear-in-mind that finding the virus is more difficult when on treatment), AGP;
· If relapse occurs during treatment; increase the dosage of GS-441524 by 5-10 mg/kg/day and consider spitting into twice daily doses (if treated orally once daily) and monitor as above, ensuring treatment is not stopped before the cat has been normal clinically and on clinical pathology for at least 2 weeks. The increased dosage used will depend on the dosage the cat is on at the time of the relapse, the nature of the relapse and finances, but can be up to that recommended for neurological FIP (see dosage chart) or even higher (please seek guidance when considering this);
· If relapse occurs after completion of treatment; restart GS-441524 course at a higher dosage (by 5-10 mg/kg/day and consider splitting into twice daily doses if treated orally once daily previously); the optimum duration for repeat treatment is not known but 12-weeks repeat treatment has been used successfully. The increased dosage used will depend on the dosage the cat was previously treated with and the nature of the relapse, but can be up to that recommended for neurological FIP;
· Consider TDM, if available, to check serum GS-441524 levels to inform dosing;
· If the cat is already receiving a high dosage of GS-441524 and/or TDM serum levels are
adequate, consider switching to EIDD-1931 and seeking guidance as adjunct treatments such as mefloquine, feline interferon or polyprenyl immunostimulant may be options.

-Taylor S, Tasker S, Gunn-Moore D, Barker E, Sorrell S (May 2024): An update on treatment of FIP using antiviral drugs in 2024: growing experience but more to learn

More information about our Bova GS-441524 formulation can be found via our FAQ sheet and our drug information sheet. There are also numerous studies and upcoming webinars featured on this page.