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The trouble with NSAIDS

JUL 28, 2009

No discussion of pain relief in pets would be complete without a discussion of the side effects of pain relievers. Because NSAIDs are by far the most commonly prescribed class of drugs for pain, it’s worth spending a whole post (or five!) on their untoward effects.

 

Don’t get me wrong, I’m not advocating anyone go without pain relievers based on the fear of side effects alone. NSAID (non-steroidal anti-inflammatory drug) pain relievers are too crucial for too many of our pets’ comfort to discount their use just because of a possibility that a problem will ensue. 

 

Pets are living much longer these days. And that’s not always the result of our fancy surgeries and better nutrition. In my experience, I can honestly say that pain relievers have made by far the most notable dent in my patients’ quality of life and longevity.

 

Years ago, we euthanized simply because pets could “no longer get up.” And we still do that. But the age at which that happens is delayed by years in many cases. I see more pets granted the “opportunity” of dying from less insidious diseases than arthritis, now that pain relievers have become commonplace additions to older pets’ protocols. 

 

Nonetheless, these drugs come with cautions you should know about. It’s also true that pets whose veterinarians have not delved into the unsavory details of NSAIDs’ downside are more likely to succumb to these drugs’ side effects. 

 

That’s because pet owners who are not prepared to predict and intervene based on explanations of what side effects look like are those whose pets usually DIE from them. 

 

Any pet owner whose pet takes these drugs (Rimadyl, Previcox, Deramaxx, Metacam, Piroxicam, etc.) needs to know a few basic facts. Here they are:

 

  1. Know the side effects of NSAIDs. These primarily include vomiting, regurgitation, diarrhea, lethargy, inappetance, evidence of nausea and dark, tarry stools.  
  2. NSAIDs can damage the liver and/or kidneys. Pets (usually dogs) receiving regular, long-term doses of NSAIDs should have blood testing performed before the drug is initiated: one month afterwards and then every six months thereafter to ensure the liver is not experiencing severe effects from these medications. (Liver toxicity seems to happen to a certain subset of dogs, while kidney failure more often affects cats.)
  3. Beware drug interactions. It’s not unusual for pets taking these medications to wind up at an emergency hospital for some unrelated injury or illness. In these cases, owners MUST inform the new veterinarian of the drugs their pets are taking. That’s true for all drugs, but VERY important for NSAIDs since they cannot be combined with corticosteroids (like Prednisone), which are commonly used in emergency situations. 

 

Makes sense, right? These drugs may be a godsend, but they’re not without their risks. Know what side effects look like, have your pets monitored, and ignore drug interactions at your own peril. Ask your veterinarian for more information that may specifically apply to your pet’s case. 

 

Dr. Patty Khuly

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8 COMMENTS
1
NSAIDS Case History
by Graeme Radcliffe on 07/29/2009 03:12am

Our chocolate labrador, Libby, has osteo arthritis and was prescribed carprophen. The vet also prescribed drugs for anti-nausea and a pick-me-up drug. Essentially he poisoned her system. We very quickly took her to another vet who admitted her to his vet hospital immediately. She was in for 3 days. Was seriously dehydrated, vomiting with very high levels of toxicity in her liver and kineys. He then discovered what he thought was lymphoma. Luckily. after a biposy, it turned out to be lipidinoma ... a benign fattly lump in the lymph node.

Libby has recovered and so far seems to be well on the mend.

Would you sue the first vet - or just send him the bill from the second? What can we now treat the osteo arthritis with?

Graeme

2
Rimadyl
by Pam Thomas on 07/29/2009 08:22am

After the loss of my GSD to Rimadyl, given for post surgical pain, with the Vet not telling me anything about the drug and/or side effects.....my dog started vomiting, excessive drinking and lost complete bladder control after 7 days.......when the Vet was notified she just stated that the dog was old and "probably" in kidney failure. "Probably" wasn't good enough....since the dog was perfectly fine prior to her surgery for removal of a fatty tumor. After researching on the internet I found the Sr. Dog Project.....and read hundreds of stories about RIMADYL victums.....which linked me to the FDA and an Attorney's website.....that was 6 years ago.
We immediately took our dog to Iowa State University and she was admitted to ICU for 3 days.......she was having an adverse reaction to the RIMADYL.
The original VET denied that reactions can occurr and went on to state that you just can't believe what you read on the internet. Her final words to me were.....she did not have a reaction. $10,000 and 18 months later my dog died. Reactions to this drug are REAL and unfortunately, once the damage is done...it can not be reversed. There are plently of negligent and irresponsible VETS out there.....they need to be made to pay for their mistakes!!!!!

3
Rimadyl
by Dolittler (Dr. Patty Khuly) on 07/29/2009 02:02pm

From a legal point of view, the use of any drug should be preceded by a discussion with the owner explaining the benefits and risks. Informed consent is a necessary element when offering any drug or procedure. Some veterinarians offer the package insert with drugs--so that you can become informed. That's one way to do it. Verbalizing the risks, however, is a far better way to handle it. Most veterinarians do this, contrary to the experience Pam and Graeme had. I am truly sorry for your loss.

4
Rimadyl pre-use testing
by Dolittler on 07/29/2009 02:06pm

I forgot to mention that another prerequisite for the use of any NSAID (particularly for long-term use) is pre-exposure bloodwork so we can make a rational decision about whether your pet might tolerate this medication or not. Repeating that labwork every three to six months is recommended for these patients as well. Here's a comprehensive article detailing all the information I like my pet owners to receive when it comes to using NSAIDS. I'm sure that if you'd received this before electing to use the drug you'd feel very differently about your experience.
http://www.VeterinaryPartner.com/Content.plx?P=A&S=0&C=0&A=2508

5
Rimadyl
by Pam Thomas on 07/29/2009 10:22pm

Dr. Patty Khuly, I appreciate how you individually inform your clients about the dangers of NSAIDS.....and allow your clients the CHOICE of whether to proceed or not. However, in my case.....I was not told anything about the drug, nor was I given a package insert.......she dispensed the drug into her own bottles with only the name of the drug and the dose and of course her Clinic name. She had taken care of my dog for 8 plus years.....she knew she was in good health........my dog did not have arthritis.....she was dispensing this "Candy drug" post-operative ......... for pain. Unfortunately, she was incapable of matching the symptoms to the drug. After bringing our dog home from Iowa State Vet Hospital.......10 days later......the surgicial incision was draining pus......and we rushed her to our new vet....who pulled out a piece of the draining tube that had abscessed the entire surgicial site. Due to her compromised liver and kidneys (from the Rimadyl) we had to do low does antibiotics for 20 plus days....and when it still would not heal we returned to Iowa State.....where they had to cut out all the dead tissue and stitch her again. This entire episode was filled with negligence and deceptive practice on the original vet .......she most certainly deserves disciplinary actions by the Iowa Board of Vet Medicine. However, this Board, in the State of Iowa, hides and operates behind closed doors.......shame.....shame....shame on them. Any Vet who makes a mistake and is caught.....the public has a right to know who they are and what they have done .....and it needs to be published in the newspaper....just as it is if a MD, DO, Nurse, CMA, etc., has done. I am sick of their closed door policy.....they need to be held accountable!

6
to Pam
by Dolittler (Dr. Patty Khuly) on 07/31/2009 09:49am

Your comment is duly noted. I, too, lean towards stricter individual sanctions for bad eggs in our profession. You're preaching to the choir.

7
Rimadyl
by Paul Bachmann on 12/27/2009 04:20pm

My boy dog is a doodle. He is 15 yrs old and has arthritis. He was given blood work and is being monitored. The problem is that he is acting very strange. He is very clingy and not wanting to eat any of his treats. Is there anything I need to be aware of?

8
deramaxx
by Joan Reynolds on 03/04/2010 02:21pm

my sister-in-law had her dog operated on today and what appeared to be a number of growth growing out of his body some were becoming bloody so her vet removed them and gave her a script for Deramaxx for post surgury pain . This dog has just had bilateral caterace surgury months of eye drops with predisone in the and is still on predisone eye drops . She reminded the vet of this and the vet told her to still give the dog the medicine my sister-in-law not having a mdeical background at all was talking to myself and I being a nurse wanting to know what the med was I checked into it and found out that the med could not be interacted with the predisone my sister-in -law brought this to the Vets attention by she just brushed it off and told her to just gift. Well I told my sister-in-law not to due too the interaction so she isn't going too.I think vets are just as screwy as some doctors. They should have there licences taken away. Just my opinione

9
deramaxx
by Joan Reynolds on 03/04/2010 02:21pm

my sister-in-law had her dog operated on today and what appeared to be a number of growth growing out of his body some were becoming bloody so her vet removed them and gave her a script for Deramaxx for post surgury pain . This dog has just had bilateral caterace surgury months of eye drops with predisone in the and is still on predisone eye drops . She reminded the vet of this and the vet told her to still give the dog the medicine my sister-in-law not having a mdeical background at all was talking to myself and I being a nurse wanting to know what the med was I checked into it and found out that the med could not be interacted with the predisone my sister-in -law brought this to the Vets attention by she just brushed it off and told her to just gift. Well I told my sister-in-law not to due too the interaction so she isn't going too.I think vets are just as screwy as some doctors. They should have there licences taken away. Just my opinione

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Photo of Patty Khuly

Patty Khuly

VMD, MBA

...is a small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. Apart from her daily blogging here at PetMD's FullyVetted, she authors weekly pet health columns for USA Today and The Miami Herald. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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