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Common drugs used to treat IVDD
and avoiding their adverse reactions

rev. Jan. 2016

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. Individuals should be involved with the pet health-care provider in making an informed decision that weighs the potential risks with the possible benefits for the dog. 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

Frequently non-steroidal anti-inflammatory drugs or NSAIDS are prescribed for inflammation. With a disc episode it may take 7-30 days to resolve the painful spinal cord inflammation.  They all have been marketed and advertised as safe. However, they ALL can 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. If you suspect a possible side effect to an NSAID, STOP giving the drug to your dog and call your veterinarian immediately! Never give aspirin or corticosteroids along with an NSAID to your dog.  It is also recommended that dogs should receive a thorough examination and blood test before receiving these medications to verify health of organs.   In general there should be a 4-7 days washout before the start of a different brand NSAID or the start of a steroid or switching from a steroid to a NSAID.

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:
What are NSAIDs: What to know and watch for  
Points about NSAIDs your vet should go over with you
Manufacturer's package Inserts for NSAID brands









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 Novox Imadyl, Novox, Imafen and Rovera, Vetprofen.


Important Safety information: As a class, NSAIDS may be associated with

gastrointestinal, kidney and liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including RIMADYL. Use with other NSAIDS or corticosteroids should be avoided


If you suspect an adverse reaction, Pfizer can be contacted at 800 366-5288
Rimadyl® package insert PDF:   
Rimadyl PDF to downloadRimadyl PDF to download
Mar Vista Veterinary "Rimadyl" http://marvistavet.com/carprofen.pml

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.  As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX. Use with other NSAIDs, corticosteroids or nephrotoxic medication should be avoided. 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.












Important Safety Information

As with all drugs in this class, side effects involving the digestive system, kidneys or liver may occur. These are normally mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including DERAMAXX (deracoxib). Use with other NSAIDs or corticosteroids should be avoided.

Important Safety Information As with all drugs in this class, side effects involving the digestive system, kidneys or liver may occur. These are normally mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including DERAMAXX (deracoxib). Use with other NSAIDs or corticosteroids should be avoided.


Deramaxx® package insert: http://www.deramaxx.com/en/pdf/productlabel.pdf

Mar Vista Veterinary "Deramaxx"  http://marvistavet.com/deracoxib.pml

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 

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.  Piroxicam should not be used in combination with other NSAIDs nor with steroids.  Evidence from observational studies suggests that piroxicam may be associated with a high risk of serious GI toxicity, relative to other NSAIDs.
General information: http://marvistavet.com/piroxicam.pml

Package insert: https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=2138

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.




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. The lower anti-inflammatory doses are used during conservative treatment are often accompanied by GI protectant drugs, to avoid potential stomach problems. Side effects: panting, increase in thirst and urine. Adverse side effects to immediately notify vet: not eating/drinking, loose stools, diarrhea 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.


Steroids must be tapered to signal the body to again produce its own steroid hormone, cortisol.  The steroid taper is also a window to assess if all the painful spinal cord swelling has been resolved. Veterinarians may choose to guess at the 7 or 14 day point that pain might be resolved. At the start of the steroid taper, vets will also either stop or back of pain-masking pain meds to quickly determine if another course of steroid would be needed. At home the owner alerts the vet ASAP if pain should surface.
General information about Glucocorticords  http://www.elephantcare.org/Drugs/glucocor.htm

Steroid potency comparison chart


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://marvistavet.com/prednisone.pml

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://marvistavet.com/dexamethasone.pml

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://marvistavet.com/tramadol.pml



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://marvistavet.com/methocarbamol.pml

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


 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.drsfostersmith.com/Rx_Info_Sheets/rx_fentanyl_patch.pdf




Mar Vista Veterinary "Fentanyl Patch" http://marvistavet.com/fentanyl-patch.pml







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
Mar Vista Veterinary "Torbutrol"  http://marvistavet.com/butorphanol-tartrate.pml


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







Mar Vista Veterianary "Diazepam" http://marvistavet.com/diazepam.pml

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.  Specifically ask/confirm with the pharmacist as the label will not likely list xylitol.
 
Hu



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 kidney, 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 (products that are aluminum, magnesium based such as, Sucralfate, Mylanta, Milk of Magnesia etc.) 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.

Oral Bioavailability. Gabapentin bioavailability is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of Gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively.


Mar Vista Veterinary "Gabapentin" http://marvistavet.com/gabapentin.pml
http://www.drsfostersmith.com/Rx_Info_Sheets/rx_gabapentin.pdf
http://www.drugs.com/pro/gabapentin.html


Amantadine a drug to add an extra dimension of pain relief.when gabapentin, tramadol and methocarbamol combo is not fully controlling pain. It is in an arsenal of pain meds to consider when trying to manage pain.


Mar Vista Veterinary "Amantadine" explains how this med works:  http://marvistavet.com/amantadine.pml



Drugs That Treat Gastrointestinal Upset

Pepcid AC® (Famotidine)

Famotidine is a newer generation antihistamine used to suppress stomach acid production 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.

Mar Vista Veterianry "Famotidine" http://marvistavet.com/famotidine.pml

http://www.1800petmeds.com/Famotidine-prod11171.html




Carafate® (Sucralfate)

Sucralfate is a sucrose aluminum hydroxide compound that forms a gel-like webbing over ulcerated or eroded tissues, thus serving as a sort of a bandage. It is effective in the upper GI tract: stomach, duodenum (upper small intestine), and esophagus. 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 acid suppressor such as Pepcid AC.. 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 

Mar Vista Veterinary "Sucralfate"  http://marvistavet.com/sucralfate.pml


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 .
Mar Vista Veterinary "Rantidine"  http://marvistavet.com/ranitidine.pml

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® is contraindicated with a great number of medications such as  Sucralfate, Digoxin and Diazepam, dexamethasone, prednisone, fentanyl, . Use with caution in animals with kidney or liver disease.

Mar Vista Veterinary "Cimetidine"

http://www.drsfostersmith.com/Rx_Info_Sheets/rx_cimetidine.pdf

List of contra-indicated meds: http://reference.medscape.com/drug/tagamet-cimetidine-341984#3


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..

Mar Vista Veterinary "Omeprazole"  http://marvistavet.com/omeprazole.pml

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

Mar Vista Veterinary: http://marvistavet.com/pharmacy-center.pml
http://www.veterinarypartner.com/Content.plx?P=SRC&S=1&SourceID=52
http://www.peteducation.com/category.cfm?c=0+1303
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.




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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.

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