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Common drugs used to treat IVDD

and avoiding their adverse reactions

rev. June 2010

Dachshunds being treated for disc disease, either with surgery or conventional treatment are likely to be administered some of the medications discussed here. These drugs control inflammation or pain and sometimes both. Many dogs have safely benefited from these drugs, but some have been the victims of adverse reactions, ranging from mild to serious and in some instances death. This information is provided for the purpose of encouraging discussion between the client and the veterinarian, so that individuals can be involved with the pet health-care provider in making an informed decision that weighs the potential risks with the possible benefits for the individual dog involved. It is also hoped that it will provide the individual owner with a starting point to further research treatments prescribed for their dog.

Table of Contents:

NSAIDS Rimadyl® (Carprofen) Deramaxx® (Deracoxib) Metacam® (Meloxicam) Previcox® (firocoxib) EtoGesic® (Etodolac) Piroxicam® (Feldene) Phenylbutazone® Ketoprofen® Zubrin	Drugs Used to Control Pain Duragesic® (Fentanyl Patch) Torbutrol®, Torbugesic® (Butorphanol Tartrate) Valium® (Diazepam) Robaxin® (Methocarbamol) Tramadol Neurontin® (Gabapentin)
Steroids (Glucocorticords) Prednisone/Prednisolone Azium®, Voren® (Dexamethason)	Stomach Protection Good Sites for Drug Information Avoiding Adverse Drug Reactions

Frequently non-steroidal anti-inflammatory drugs or NSAIDS are prescribed and these control both inflammation and pain. While there are several on the market, they share many characteristics. These drugs can have a very definite upside and can be quite effective in managing pain and inflammation. They all have been marketed and advertised as safe. They can all cause adverse reactions which include vomiting, diarrhea, weight loss, nausea, gastrointestinal ulceration and perforation, lethargy, weakness, seizure, aggression, tremor, glazed eyes, urinary tract infection, urinary incontinence, renal failure, coughing, fever, facial/muzzle edema and moist dermatitis. People are advised to watch closely for vomiting, loss of appetite, change in urination habits, change in urine odor or color, diarrhea, or red blood or black or tarry blood in the stool. Medications should be discontinued immediately and the vet should be contacted. NSAIDS should not be combined with another NSAID, and manufacturers recommend they be used with steroids only with extreme caution if at all. It is also recommended that dogs should receive a thorough examination, and in some cases blood screening before receiving these medications. Several manufacturers have provided veterinarians with "Dear Client" letters, to be handed out when NSAIDS are prescribed. These letters outline signs of adverse reactions and potential risks. Unfortunately, vets seldom pass this information on to their clients. Each NSAID has a slightly different recommended washout period, which is the amount of time that one can change from one NSAID to another or from a NSAID to a steroid. This information can be found on the package insert.

The most familiar NSAID is aspirin. Because we are so familiar with it, we often assume it is safe for our dogs as well as ourselves. Now there are NSAIDs especially formulated for dogs which are potentially safer than using aspirin. Dogs can experience some of the same adverse reactions with aspirin as stated above. If your dog is taking aspirin, it is important that your vet be aware of it.

For the most comprehensive list of NSAIDS and the FDA information on them:

• http://www.fda.gov/cvm/nsaids.htm
• http://www.fda.gov/cvm/currentlabels.html
• http://www.pueblo.gsa.gov/cic_text/misc/dog/treatdog.htm

Rimadyl® (Carprofen) Manufactured by Pfizer

Pfizer recommends a complete history and physical examination before starting Rimadyl®, including blood tests to determine hematological and serum biochemistry prior to and periodically during administration. If your dog is taking Phenobarbital, it is especially important that appropriate liver monitoring be performed. ACE inhibitors used in the treatment of heart failure such as Enalapril or Captopril may not be as evocative in the presence of Rimadyl®. Generic Rimadyl is Novox

If you suspect an adverse reaction, Pfizer can be contacted at 800 366-5288

Rimadyl® package insert: http://www.rimadyl.com
Click on Rimadyl® product information on left
Click on US prescribing information on left

Rimadyl® dog owner information: http://www.rimadyl.com
Click on dog owner information on left

Additional Information: http://srdogs.com/Pages/rimadyl.html

Previcox (firocoxib) Manufactured by Merial

Previcox is one of the newest NSAIDS and is manufactured by Merial.  Merial recommends that all dogs should undergo a thorough history and physical examination before the beginning NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline date is recommended prior to and periodically during use. Should not be used with dogs less than 12.5 pounds. Possible side effects include vomiting, diarrhea, decreased appetite, lethargy, increased thirst and increased urination. Discontinue and contact your veterinarian immediately if these or other adverse reactions are noted.

http://www.previcox.com

Deramaxx® (Deracoxib) Manufactured by Novartis

Novartis recommends veterinarians conduct appropriate laboratory tests in dogs that may be at risk including seniors, pets with a history of liver disease, inflammatory bowel disease, renal disease or any chronic conditions. Owners are advised to watch for vomiting, diarrhea, lack of appetite, and should contact vet and discontinue use immediately. Veterinarians are encouraged to provide owners with Deramaxx® Owner Information Sheet and discuss potential benefits and risks. Deramaxx® should not be used with patients sensitive to sulfa-containing drugs. Caution should be used if Deramaxx® is used with antibiotics of the sulfa class.

Deramaxx® package insert: http://www.deramaxx.com
Understanding Deramaxx®: http://www.vetnsaids.com

EtoGesic® (Etodolac) Manufactured by Fort Dodge

Due to tablet size and scoring, dogs weighing less then eleven pounds cannot be accurately dosed. Vets are asked to conduct appropriate physical examinations of all dogs before administering or prescribing and obtaining appropriate diagnostic support, laboratory tests, for animals that may be at a higher risk. This would include geriatric dogs, dogs with a history of liver disease, inflammatory bowel disease, renal disease, or other chronic conditions. Owners should discontinue if they see unusual or unexpected changes in their dog. 

If you suspect an adverse reaction Fort Dodge Animal Health can be reached at 800 477-1365

http://www.peteducation.com/article.cfm?articleid=1410

Metacam® (Meloxicam) Manufactured by Boehringer Ingelheim UK

Metacam® is an oral suspension, or liquid as opposed to pill form. This has an advantage as it allows the dose to be accurately reduced. The manufacturer recommends that Metacam® be given with food. Manufacturer’s package insert recommends "Metacam® oral suspension should not be administered concurrently with steroidal or other non-steroidal anti-inflammatory drugs, amino glycoside antibiotics or anti-coagulant agents." Adverse reactions include loss of appetite, vomiting, diarrhea and apathy. This drug is contra-indicated in animals suffering from cardiac or renal disease.

Metacam® package insert: http://www.ingleburnvet.com.au/xmetacam.htm

Each of the above manufacturers has received letters from the FDA about their marketing practices concerning these drugs. The FDA has stated that some of the marketing claims are unproven or untrue. These letters can be viewed at the FDA website.

There are several less commonly used NSAIDS that have a greater risk of adverse reactions. The information below includes a few.


Piroxicam® (Feldene)

COX-2 selective NSAIDS have made drugs like Piroxicam® less popular. Piroxicam® has anecdotally been shown to inhibit the growth of some cancers in dogs. It is used primarily now for the treatment of Transitional Cell Carcinoma of the urinary bladder, mammary Aden carcinoma, and squamous cell carcinoma.

General information: http://www.marvistavet.com/html/body_piroxicam.html


Phenylbutazone®

Another early NSAID that has become less popular since the COX-2 selective NSAIDS have become available and considered to be not as safe.


Ketoprofen®

Although not approved for dogs, it was used frequently prior to the new generation of NSAIDS.  Ketoprofen® has a higher occurrence of bleeding problems.

 Zubrin

Zubrin is used to treat pain and inflammation associated with osteoarthritis in dogs.  It is formulated in a tablet that will dissolve in the mouth. It is best to give Zubrin either with food or within 1 to 2 hours of feeding.  Possible side effects include loss of appetite, vomiting, diarrhea, dark or tarry stools, bloody stools, increased thirst, increased urination, pale gums, jaundice, lethargy, fast or heavy breathing, or incoordination. If you observe any of these reactions are observed, stop treatment and contact your veterinarian immediately.

http://www.zubrinus.com

STEROIDS (Glucocorticords)

Frequently Dachshunds are treated for IVDD with Glucocorticords, more commonly know as steroids, a group of drugs that are anti-inflammatory but do not control pain. Steroids can be given orally, by injection or IV. Methylprednisolone administered by IV can be very effective at controlling spinal inflammation and swelling, but needs to be started as quickly as possible and requires a stay at the vets.

Steroids also have side effects. In higher doses they can suppress the immune system, or unmask latent infections. When doses are immune-suppressive and the use is chronic (a period of months) side effects and concerns are different. Long term use or immune-suppressive doses are not used generally in the treatment of IVDD. Steroids are often accompanied by GI protectant drugs, to ease potential stomach problems. Side effects: panting, increase in thirst and urine. Adverse side effects to immediately notify vet: upset stomach, diarreah with red blood or black blood, vomiting with or without blood, seizures, depressed and subdued.

Glucocorticords should NOT be used with medications from the NSAIDS group which includes Rimadyl®, Deramaxx®, Zubrin®, Metacam®, EtoGesic®, aspirin and others.

Very informative site that includes general information about Glucocorticords
http://www.elephantcare.org/Drugs/glucocor.htm


Prednisone/Prednisolone

Prednisone and prednisolone are considered intermediate acting steroids. After two weeks or more of use, it is recommended to taper the dose. Prednisone use leads to conservation of salt which creates excessive thirst and excessive urination. Because of the retention of salt, prednisone may not be suitable for heart patients. Prednisone can cause change in liver enzyme blood testing and interfere with testing for thyroid disease. Diabetic patients should not use this drug.

General information: http://www.marvistavet.com/html/body_prednisone.html


Azium®, Voren® (Dexamethason)

Dexamethasone is considered to be a long acting steroid, meaning that a dose can last up to 2 and a half days. Dexamethasone is roughly ten times stronger then Prednisone. Excessive thirst and urination are usually less pronounced then seen with Prednisone. Because of the retention of salt, Dexamethasone® may not be suitable for patients with heart disease. Dexamethasone may change liver enzyme blood testing and interfere with testing for thyroid disease. Dexamethasone should not be used by diabetic patients.

General information: http://www.marvistavet.com/html/body_dexamethasone.html

Good information on the use of steroids  http://www.peteducation.com/article.cfm?articleid=1422

Drugs Used to Control Pain

 Tramadol

Tramadol acts like an opiod, controlling pain by stimulating opiate receptors in the brain.  Tramadol may be an especially good option for a dog who is experiencing an IVDD episode since it can be used with steroids such as prednisone or with NSAIDs.  Reactions and side effects with Tramadol are generally considered rare and are usually mild. It is important to notify your vet immediately of any unusual behavior. If your dog appears sedated or demonstrates bizarre behavior the dose should be reduced.  Panting and constipation can occur in some dogs and will resolve when the drug is discontinued.  Tramadol does not cause gastric bleeding, but a few dogs have experienced nausea.  Dogs being treated with L-Deprenyl for Cushings Disease or cognitive disorders should not take Tramadol.  Not for use with dogs taking serotonin reuptake inhibitors, ononamine oxidase inhibitors or certain antidepressant drugs. Tramadol may decrease seizure threshold, so make sure your veterinarian is aware if your dog has a history of seizures.

http://www.marvistavet.com/html/body_tramadol.html

Robaxin® (Methocarbamol)

Methocarbamol is a muscle relaxant that is FDA approved for veterinary medicine. It is very effective for treatment of muscle spasms associated with IVDD. Methocarbamol should be used with caution in animals with kidney disease. Methocarbamol may cause a darkening of urine, but this is not a cause for concern. Methocarbamol may interact with other medications such as sedatives, barbiturates and other muscle relaxants.The sedative side effect of Methocarbamol is exaggerated when using other medications with sedative properties.

http://www.elephantcare.org/Drugs/methocar.htm
http://www.marvistavet.com/html/body_methocarbamol.html

 Duragesic® (Fentanyl Patch)

The Fentanyl Patch is used to provide a continuous pain relief and is often used after surgery or for management of severe pain. Fentanyl is not FDA approved for use in veterinary medicine, although its use is a common and accepted practice for pain control. Surgical patients are frequently sent home with a Fentanyl Patch. Fentanyl is a narcotic, so proper disposal of patches is important.

The response to the patch can vary, so animals should be closely monitored. Use with caution in animals with liver, kidney, or heart/lung disease. Do not use in patients allergic to other opiad medications. The patch should not be near a heating source such as a heating pad, electric blanket, heating vent or heated water bed. The application of heat to a Fentanyl Patch may increase the uptake of Fentanyl to dangerous levels.

If a rash is seen where the patch is located, contact your vet immediately. The most serious side effect is slowed breathing and heart rate. Remove the patch immediately and contact your veterinarian. Fentanyl is not a sedative, but some sedation such as a wobbly gait may occur. The patch should be used cautiously in combination with medications that have sedative properties. Contact your veterinarian at the first sign of unusual behavior.

http://www.akitarescue.com/for.htm:
http://www.peteducation.com enter fentanyl in search
http://www.marvistavet.com/html/body_fendanyl.html


Torbutrol®, Torbugesic® (Butorphanol Tartrate)

Torbutrol® is an opioid pain reliever. It is FDA approved for pain relief in cats and for chronic coughing in dogs. It is common and accepted to use off label for pain in dogs.

Torbutrol® is not for use in patients with heartworm disease. Use with caution in patients with liver or kidney disease. Contact your veterinarian if you see vomiting, diarrhea, seizures or signs of sedation. Signs of overdose or toxicity include decreased heart rate or decreased respiratory rate. Naloxone is used to treat overdoses. Use with caution when combining with medications that have sedative properties.

http://www.peteducation.com enter Torbutrol in search


Valium® (Diazepam)
 
Diazepam is used as a sedative, to treat convulsions, and as a muscle relaxant. It can be used to treat muscle spasms associated with inter-vertebral disc disease. Diazepam is not FDA approved for use in veterinary medicine, but can be prescribed by a veterinarian as an extra-label drug. Common side effects include weakness, drowsiness, and loss of coordination. Rarely aggression or unusual behavior can occur.

Diazepam should be used with caution with geriatric animals, animals with decreased kidney or liver function or animals with respiratory depression.

Diazepam has sedative properties, and combining with other drugs that have sedative characteristics should be done only with extreme caution. Diazepam may interact with other drugs such as certain antibiotics, narcotics, propranol, digoxin and barbiturates.

The effects of Diazepam may be much stronger then expected if used with Cimetidine (Tagamet®). If antacids must be used, separate the medications by at least two hours.

http://www.wedgewoodpharmacy.com/diazepam.asp
http://www.marvistavet.com/html/body_valium.html

Neurontin® (Gabapentin):
CAUTION: The commercially available human liquid product contains xylitol which can be toxic to dogs. It is possible to have a special formulation made at a pharmacy that does drug compounding so that it does not contain xylitol.

Like many other human drugs, Gabapentin started to be used in veterinary medicine to control seizures and in helping to control neuropathic pain (the burning and tingling sensations that come from damaged nerves) associated with spinal cord damage such as IVDD disc herniations. For pain control, Gabapentin is usually used in conjunction with other pain relievers which may later be tapered away. Gabapentin is also used preoperatively to minimize pain experienced after surgery.

Gabapentin should be used with caution in animals with decreased liver or renal function. It should only be used during pregnancy or lactation when the benefits outweigh the potential risks. The most common side effects are sedation, drowsiness, loss of balance, and rarely vomiting and diarrhea. Gabapentin can also cause a false positive reading on urine dipstick tests for urinary protein.

Oral antacids will hinder absorption of Gabapentin so it is important to give the two medications at least 2 hours apart. Taking hydrocodone or morphine may increase the effectiveness of Gabapentin and the likelihood of side effects. Gabapentin will reduce the effectiveness of hydrocodone.
Gabapentin should NOT be discontinued abruptly because withdrawal may precipitate seizures or rebound pain. The dosage should be decreased over the course of two to three weeks.

http://www.wedgewoodpharmacy.com/monographs/gabapentin.asp
http://marvistavet.com/html/gabapentin.html
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2764
http://www.drsfostersmith.com/Rx_Info_Sheets/rx_gabapentin.pdf
http://www.drugs.com/pro/gabapentin.html

Drugs That Treat Gastrointestinal Upset

Pepcid AC® (Famotidine)

Famotidine is a newer generation antihistaine used to combat stomach acids with fewer drug interactions and longer lasting than previous generations such as cimetidine (Tagment) and ranitidine (Zantac). There have been some reports of exacerbating heart rhythm problems in patients who already have heart rhythm problems, so it may be prudent to choose another means of stomach acid control in heart patients.The dose of famotidine may require reduction in patients with liver or kidney disease as these diseases tend to prolong drug activities.

Carafate® (Sucralfate)

Sucralfate is a drug used in the treatment of stomach and intestinal ulcers. It promotes healing in animals with ulcers and is useful in preventing stomach inflammation caused from other drugs. Sucralfate is a prescription drug, and must be obtained from a veterinarian as an extra-label drug. Sucralfate is not FDA approved for use in veterinary medicine.

Sucralfate is best used on an empty stomach and given 30 minutes before administering an antacid. Sucralfate may interact with other drugs including cimetidine and digoxin. Advise your veterinarian of any other medications or nutritional supplements your dog is taking. Sucralfate can cause mild constipation

http://www.marvistavet.com/html/body_sucralfate.html


Zantac® (Ranitidine)

Ranitidine blocks acid secretion in the stomach and is used in the treatment and prevention of stomach and intestinal ulcers. This drug has not been FDA approved for use in animals. Ranitidine can be obtained over the counter, but should not be administered without first consulting your veterinarian. Your veterinarian will also give you correct dose amounts.

Ranitidine should be avoided in animals with liver or kidney disease. Ranitidine may interact with other medications such as Theophylline and certain antacids. Advise your veterinarian of all medications and nutritional supplements your dog is taking .

http://www.veterinarypartner.com   enter Zantac in the search

Tagamet® (Cimetidine)

Tagamet® is used in the treatment and prevention of stomach and gastric ulcers. This drug is not FDA approved for use in animals. Tagamet® is available over the counter but should not be administered without first consulting a veterinarian. Tagamet® may interact with other medications such as antacids, Metoclopramide, Sucralfate, Digoxin and Diazepam. Use with caution in animals with kidney or liver disease.

http://www.peteducation.com    enter Cimetidine in search


Prilosec® (Omeprazole)

Prilosec® is a potent inhibitor of gastric acid production. Available over the counter, Prilosec® is not FDA approved for use in animals. Do not administer without consulting your veterinarian. Side effects could include anorexia, nausea, vomiting and diarrhea. Adverse effects on the bone marrow are possible as has rarely been seen in human patients treated. Prilosec® may cause increased liver enzymes. Prilosec takes 3-5 days to reach 65% bioavailability. Until Prilosec reaches a more optimal effect another anti-acid such as Pepcid AC should be considered..

http://www.elephantcare.org/Drugs/omeprazo.htm

Package inserts contain extensive information, but can sometimes be found only on the manufacturer’s site.

Good sites for drug information

http://www.marvistavet.com
http://www.veterinarypartner.com
http://www.peteducation.com
http://www.drsfostersmith.com  By using the pharmacy tab and the search engine, you can get a patient information sheet on all their drugs

Avoiding Adverse Drug Reactions

1. Keep your dog fit and in good weight.
2. Consider annual wellness exams with blood panels. Detecting signs of early liver or kidney disease could prevent an unusual response to a drug.
3. Inform your veterinarian of any medications, vitamins, or nutritional supplements your dog is taking.
4. Inform your veterinarian of any health problems your dog has.
5. Ask your veterinarian about signs of adverse reactions.
6. Ask your veterinarian if any client information is available from the manufacturer.
7. Ask your veterinarian if your dog should have blood tests prior to administering any new medications.
8. Contact your veterinarian immediately if there are any signs of unusual behavior.

Disclaimer:
This information is presented for educational purposes and as a resource for the Dachshund community. The coordinators are not veterinarians or health care professionals. Nothing herein should be interpreted as medical advice and all should contact their pet care professionals for advice. The coordinators are not responsible for the substance and content contained herein and do not advocate any particular product, item or position contained herein.