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All Non Steroid Anti-inflammatory
Drugs Can Kill
| Rimadyl®,
Etogesic®, Deramaxx®, Metacam® and Zubrin®
all belong to a class of drugs called non-steroid anti-inflammatory
Drugs. The action of these drugs is similar to aspirin, in
that they inhibit inflammatory substances called prostaglandins
(PGEs), which cause pain, inflammation, and fever. These drugs
are safer than aspirin because they are more selective for
the harmful prostaglandins, COX 2 PGEs, and spare certain
prostaglandins, COX 1 PGEs, which are essential to protect
the G.I. tract, kidneys and other organs.
There is risk of liver failure with all NSAIDs. Liver necrosis
in Labrador Retrievers caused by Rimadyl® have been reported
in the largest numbers. The manufacturer of Rimadyl® alleges
these reactions are attributed to the facts that Labs are
the most common Breed, and Rimadyl® was the first and
most commonly prescribed NSAID. Rimadyl® may be getting
a bad rap. Until more information is available, the staff
of Critter Fixer Pet Hospital prefers to exercise caution,
and not to use this drug. All NSAIDs have the potential to
cause liver failure. Blood tests before administration of
NSAIDs cannot predict this liver reaction. The risk of this
reaction is small. (1:10,000 with Rimadyl®)
NSAIDs are relatively new to Veterinary Medicine. Veterinarians
have little clinical experience with these drugs. Although
every manufacturer has data that alleges their drug is safer
than the others, No credible non-manufacturer sponsored data
exists which accurately compares these drugs.
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NSAIDs Dos and Don’ts
Do ask your Vet for a written warning about side
effects, and read this warning. Ask to see the manufacturers package
insert.
Do Test your pet for kidney problems before starting
NSAIDs. This is especially important in older pets, which are
prone to kidney failure. A urinalysis and blood test (BUN, Creatinine)
are essential.
Do Monitor kidney and liver function if your
pet is on these drugs for a prolonged period of time. Monitoring
is recommended whenever the dosage is increased.
Do Give Zantac or other antacid medication daily
to prevent duodenal ulcers, which is a common side effect of all
NSAIDs. Unfortunately this will not prevent gastric ulcers.
Do Give Polysulfated glucosamines, PSGAs, (Adequan,
Glycoflex, or Cosequin)with prolonged use of NSAIDs for arthritis
and degenerative joint disease.
NSAIDs relieve pain, but unfortunately over a long period of time
NSAIDs can contribute to cartilage degeneration. PSGAs help cartilage
to heal.
NSAIDs can cause g.i. ulceration. PSGAs are part of the protectant
lining of the g.i tract. NSAIDs are better tolerated with PSGAs.
PSGAs also protect the kidney.
Do Stop the medication at the first signs of
gastric upset, nausea, and lack of appetite, vomiting or diarrhea.
Dont’s:
Do not mix NSAIDs. Do not give NSAIDs with steroids
like dexamethazone, prednisolone, Vetalog or Depomedrol. Gastrointestinal
ulceration and bleeding can result.
A 3-5 day withdrawal period is necessary if you switch from one
drug to another.
Do not give NSAIDs in patients with known impaired
gastrointestinal, kidney, cardiovascular, or coagulation functions.
If liver enzymes are elevated use only at a lowered dose, and
with liver treatment medication (i.e. SAM E)
Do not give NSAIDs with Enalapril or other ACE
inhibitors, Lasix, or with nephrotoxic drugs like aminoglycoside
antibiotics or psychotropic drugs. (Prozac, Clomiclam)
Do not give NSAIDs in dogs with Cushing’s
disease or other diseases where the patient is predisposed to
thromboembolisms. (blood clots).
Do Not use NSAIDs in trauma patients or critical
care patients due to potential clotting problems and nephrotoxicity.
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A
final note: Relief from pain by NSAIDs is an individual
response. If your pet does not get adequate relief from pain and
return to normal function with one NSAID it is worth trying a different
NSAID.
Reactions to NSAIDs are comparable. If your pet has an adverse reaction
to one NSAID, another NSAID should not be used. Another Class of
pain reliever drugs should be used.
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The
above is the handout I give to all clients to warn them about side effects
of all NSAIDs. All the information came from Dr Dawn Boothe, pharmacologist
professor at Auburn.
Bob Rogers DVM
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"All truth passes through three
stages:
First it is Ridiculed.
Second, it is Violently Opposed.
Third, it is Accepted as being Self-Evident."
~Arthur Schopenhauer~ () |
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