NSAIDs for Pain Relief Can Cause Problems if Used Together or in Sensitive Animals

We are all interested in reducing pain and inflammation in our pets when it is necessary. Pharmaceutical companies have come up with a variety of medications that help do just that. The downside is that there are a few harmful side effects in a few sensitive animals. Anti-inflammatory drug types are in classes related to aspirin, ibuprofen, naproxen, and cortisone. Non steroidal anti-inflammatory drugs (NSAIDS) include the aspirin, ibuprofen, and naproxen types.

Prednisone is not an NSAID but an anti-inflammatory drug used for allergic reactions, autoimmune problems, and painful chronic joint conditions. I use a cortisone injection and oral prednisone to help with painful itchy skin and ear conditions, severe bowel conditions, and painful joints. I always try to “pulse” the cortisone and prednisone when needed for a few days to a maximum of 2 weeks. It’s always best to use the smallest dose of cortisone every other day to control allergies, chronic diarrhea, or achy joints due to arthritis of old age. A client weaned her German shepherd down to just 5-10 mg every other day to control symptoms of inflammatory bowel disease or food allergy. She used the Prednisone after trying a multitude of foods and home cooking. Her dog weighed 70 pounds and a normal dose of cortisone would usually be at least 20-40 mg once to twice daily for that weight.

From that experience, I realized that the dosage of any pain medication needed (NSAID or steroid like prednisone) may be ultimately dependent on the problem and the individual’s response to the drug. If less medication helps with pain relief, the less chance of side effects!

This is especially important with NSAIDS like aspirin, Rimadyl, Deramaxx, Previcox, Etogesic, Metacam, and the generic forms of these drugs. The warning label for all NSAIDS are  similar and sounds like this.

The most common side effect of NSAIDs is stomach upset, but stomach ulcers may develop, in which case you may see loss of appetite; vomiting; diarrhea; dark, tarry, or bloody stools; or constipation. Side effects involving the kidney include increased thirst and urination, or changes in the urine color or smell. Liver-related side effects include jaundice (yellowing of the gums, skin, or eyes). Other side effects may include pale gums, lethargy, shedding, in-coordination, seizures, or behavioral changes. If any of these side effects are observed, stop treatment and contact your veterinarian.

Liver problems can be serious in sensitive dogs(especially labs)

These drugs are really good for a pet in pain, but remember that they can cause serious side effects in sensitive animals. I often use less than the recommended dose or split the dosage up into twice daily doses for a few days to see how the drug works on a particular patient.

NSAIDS seem to cause the most side effects in stressed animals, especially those recovering from surgery. Surgical patients are commonly given the maximum,  24 hour,   “surgical dose” injection of Rimadyl. I have been giving my surgical patients half that dosage.( the regular twice daily dosage of Rimadyl) I feel that it makes more sense to use a dose that will reduce pain and can be repeated in 12 hours.

NSAIDS work by stopping inflammation-causing prostaglandins present in all cells.  Not all prostaglandins cause inflammation. Some prostaglandins are necessary to prevent acid build up in the stomach and help with normal kidney function (The “happy” types of prostaglandins  are called Cox-1 types, while the “painful or inflammatory” prostaglandin types are called Cox-2). Some NSAIDS can alter the normal balance of the prostaglandins (decrease the happy type needed for a healthy stomach and kidneys) and cause ulcers, kidney problems, or bleeding. NSAIDS more active with stopping Cox-2 prostaglandins are better at pain relief without side effects. For example, aspirin (which stops both prostaglandins) may lower  the “happy”  prostaglandin in the stomach cells causing ulcers. (Remember, prostaglandins are in every cell and have jobs!). This account isn’t entirely biochemically correct but in general describes the scenario.

That being said, NSAIDS are still one of the most common drugs used in veterinary medicine. There are several things you can do to make sure that your pet is not one of the rare patients that will have problems.

Make sure your vet knows about any other medication you have used before starting a course of NSAIDS. Switching from one NSAID to another may need a break of several days to 2 weeks to prevent problems. If a patient has received aspirin or prednisone, NSAIDS and surgery could cause problems. One or two doses of aspirin may not cause concern, but if the patient is older, sensitive, or stressed, two different NSAIDS in a short period of time could cause side effects.

Giving a break between prednisone and other NSAIDS is called the “washout period” to give the stomach, kidneys, liver, and clotting system a breather between different drugs. The body may need a rest between prednisone,aspirin, and the start of NSAIDS. ( Your vet will be able to tell you how much time, if any, to wait between drugs) Your pets sensitivity and reaction to a new NSAID may be more about them as individuals, not the combination. The real facts are really not known. Some literature says 24 hours , 72 hours , and up to two weeks between different drugs!

Try to use the lowest dose that will give relief. In cases of chronic pain you may be able to use the medication daily or every other day instead of twice daily.

Stop giving the drugs if there is nausea, vomiting, diarrhea, jaundice, or other signs or not feeling good!

Fish oils’ omega-3 fatty acids have an anti-inflammatory effect involving the production of protective instead of inflammatory prostaglandins. Using fish oil may help decrease inflammation as well as help nourish the skin!

Remember: Dogs with arthritis need to be on the thin side and may benefit from glucosamine/chondroitin supplements , raw meaty bones, or slow cooked bones and cartilage. Weight loss and a better diet may decrease the need for NSAIDS!

If you want to know more about feeding a better diet, helping dogs with itchy skin, helping cats lose weight, ear problems, seizures, or chronic bowel issues, check out Dog Dish Diet and Feed Your Pet to Avoid the Vet at http://dogdishdiet.com/order-now . Dog Dish Diet talks about helping medical problems with better ingredients and Feed Your Pet teaches you how to easily and economically slow cook food for your dog and cat.(Feed Your Pet also has nutritional tips for your cat)

Dr. Greg’s Dog Dish Diet

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