Sugar was on Pemobenden, and I think it helped. She didn't have any of the side effects, and she couldn't take digoxin at all. The other thing that helped her was acupuncture. She was getting for her arthritis, and her acupuncture vet always did a few heart points. Her cardiologist was amazed at the difference it made. I gave her a Pepcid (10mg) every day with the rest of her meds. I figured, since she was on it every day, it didn't matter when it was in relation to her food, it was essentially in her system all the time (learned that from my CRF cat).
I hope Pearl is with you for many years to come.