USE OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
The NSAID class of drugs includes aspirin, acetaminophen (Tylenol) and ibuprofen, as well as many newer and safer drugs such as Rimadyl, Deramaxx and Metacam. Many of our clients have concerns about the safety of these medications but most of the time these newer drugs are extremely safe for both humans and animals. Many people use the internet to research their pets’ medications and find information that is biased, inflammatory and often downright untrue. Before you panic about how these medications will affect your pet, read on.
Safety concerns for older drugs such as aspirin are very real. In humans, use of aspirin is responsible for thousands of deaths a year, mostly from kidney failure or perforated gastric ulcers. Tylenol can cause liver failure when taken with alcoholic beverages. Most of us have taken these medications many times in our lives without terrible consequences and without a second thought. However, the risks are very real and can be very serious. In dogs, the dose of aspirin that controls pain is higher than the amount necessary to cause stomach ulcers.Virtually every dog that gets aspirin for more than a few days at a dose that will control pain develops stomach ulcers. Even a tiny dose of acetaminophen can be fatal for cats.
Our newer Cox-2 specific non-steroidal drugs are several orders of magnitude safer than these older drugs. The risks for kidney or liver damage are only 1 in 10,000 patients, and gastric ulcers are much less likely with these drugs as well.
This doesn’t mean that your pet won’t have side effects but they are usually mild and if caught early they are completely reversible. Ulcers are likely only if the medication is given at too high a dosage or along with other steroid or nonsteroidal drugs. (You should never give your pet, or take yourself, two drugs in these categories at the same time.)
There are many of these Cox-2 drugs on the market now. Every pet (and human) is a little different as to how they will respond to an individual drug. We generally pick the safest or least expensive alternative, but if one drug has side effects or doesn’t work well for a particular pet we will try another. We most commonly use Rimadyl (carprofen) or miloxicam (Metacam) as our first choice and try something different if side effects or problems occur. The most common side effects are nausea and diarrhea. Most dogs will tolerate at least one drug in this class of medications without these problems. We only have two products currently available for cats, so sometimes we have to substitute a different type of pain medication for the NSAIDs if necessary.
You may wonder, since we have alternatives, why we use these drugs at all. It’s because nothing reduces inflammation quite as well. We can use narcotic or opioid drugs (morphine, hydrocodone, tramadol, fentanyl) for pain relief but those don’t help at all with redness, swelling or wound healing. Keep in mind that all drugs can have side effects, so we would be swapping a lower risk for liver or kidney problems for higher risks for nausea, lethargy and other side effects instead, and the expense may be higher as well. Many of these alternatives are controlled substances with the potential for human abuse and strict record keeping and disposal requirements. Steroids, our other anti-inflammatory
alternative, are not very good at controlling pain and have much higher risk for side effects. They are also not very safe for long term use because side effects worsen over time.
The main thing to remember is that all drugs, including NSAIDs, should be used properly according to the dosing instructions on the bottle, and safety monitoring should be done as recommended. If we are on the look-out for side effects and catch them early, no harm will come to the pet. Compared to the suffering your cat or dog would endure without pain medication, the benefits far outweigh the risk of side effects.