Two classes of anti-inflammatory drugs
Learn the huge benefits of anti-inflammatory drugs during an IVDD disc episode. What you do not know about these two classes of drugs could harm your dog.
▪︎ What to expect during the inflammation/swelling phase of a disc episode
▪︎ NSAIDs vs. steroids
▪︎ How long to stay on an anti-inflammatory drug to get the swelling down
▪︎ Why Pepcid AC
Answers about anti-inflammatory drug use
1. Steroids do not require a wash-out period when switching from one steroid to another. Many vets choose to give a steroid shot and send home steroid pills. However, a 5-7 day washout period is necessary when going from a steroid to NSAID, an NSAID to a steroid, OR from one NSAID to a different NSAID. ….Without the 5-7 day washout period, severe GI tract complications can occur. Warnings accompany each medication in the package insert. Look up your dog’s anti-inflammatory package insert.
2. Steroids are the most powerful of anti-inflammatories. Non-steroidal anti-inflammatory drugs (NSAIDs) are less powerful than steroids.
3. When there are solely pain symptoms with a disc episode and no neurological deterioration, many vets often choose an NSAID. Other vets choose to start with a steroid to avoid dealing with the washout issue should the NSAID end up not being enough to deal with the inflammation.
Mild episodes can have the possibility to progress to more severe cases. Should neuro functions begin to deteriorate, then a vet has a very serious decision to make. Usually, a 5-7 day washout period is ideal to avoid double GI tract jeopardy with a switch from the NSAID class to the steroid class. When nerve function is being lost, the spinal cord takes priority over a washout. With an emergency, the GI tract is double protected with not only continued use of Pepcid AC, but also with the addition of sucralfate.
4. All anti-inflammatories, whether they be from the steroid class or the NSAID class, increase the chance of serious GI toxicity such as bleeding and ulceration. A stomach protector such as Pepcid AC (famotidine) suppresses acid production. Pepcid AC is generally considered a safe, over-the-counter stomach acid suppressor for a healthy dog and is good insurance. Dogs don’t speak up at the first signs of trouble like a person does. By the time we notice black or red blood in the stools, things can quickly go from bleeding ulcers to a life threatening perforated stomach.
HOW LONG TO USE test
It can take anywhere from 7-30 days (totaling several courses) for a steroid or a non-steroidal to resolve all swollen tissue around the spinal cord. A vet must take an educated guess on how long it might take to resolve swelling. Often the first course will be a 7- or 14-day anti-inflammatory course. Additional course(s) if there is still pain.
NSAIDS: At the end of a 7-day or 14-day NSAID course, pain meds are also either stopped or backed off. The owner’s job is to observe for surfacing pain and alert their vet for another course of the NSAID. Pain = another course of NSAID.
STEROIDS: The first tapering down day begins the test for pain. Taper days are no longer working on swelling. Pain meds are also stopped or backed down to enable the owner to quickly assess whether there is remaining pain and alert the vet right away. Pain = another course of steroid back up at the “anti inflammatory” level, all pain meds back on board, continued Pepcid AC
NOTE: steroid hormones may not be full-stopped; they require tapering off under the supervision of a vet.
PREP for REMAINING PAIN TEST day
Your job at home will be to assess just how well reduction of swelling is going by observing for any hint of pain (▪︎shivering ▪︎trembling ▪︎yelping when picked up or moved ▪︎reluctant/slow to move head or body ▪︎tight hard tummy, ▪︎holding leg flamingo style not wanting to bear weight).
To avoid being blindfolded by pain meds, the pain meds are also full stopped or backed off on the test date and is your vet’s decision which. Know ahead of time which your vet prefers: full stop of the pain meds or backing them off in mgs/frequency given.
With any pain test, it is always good to have worked out in advance with your vet a “PLAN B” should pain re-surface at night or on the weekend when your vet is not open. Could be an emergency RX script you could fill at local 24 hr pharmacy or some extra pills at home til the vet opens again. An ER visit is very expensive, a “Plan B” is free!
Rule of thumb is:
pain = swelling = another anti-inflammatory course, pain meds and Pepcid AC
No Pain= (if on a steroid complete the taper to conclusion). Complete 8 weeks of crate rest for the disc to heal.
SIX THINGS TO KNOW ABOUT ANTI- INFLAMMATORY DRUG USE
- ▼ ASPIRIN
A range of anti-inflammatories specially formulated for canines with fewer side effects are now available. The metabolism and dosages of drugs for people are much different for dogs.
Aspirin should not be used with other medications due to its lengthy effect of prolonging bleeding (DO NOT use with other NSAIDS, steroid hormones, or joint supplements). At least a 7-14 day washout period is advisable when going from aspirin to another anti-inflammatory medication. Self-prescribing aspirin for your dog is dangerous, plus it can tie your vet’s hands in using the appropriate meds for a disc episode!
- ▼ WASHOUT SAFETY
Depending on a dog’s metabolism, 5-7 days must be given for an NSAID to leave the body before it would be safe to move to the more powerful anti-inflammatory class of steroids.
- ▼ NEURO FUNCTION LOSS EMERGENCY
When there is loss of neurological functions, the lesser of the anti-inflammatories (NSAIDs) are not usually continued. The most powerful of the anti-inflammatories (steroids) is considered. If the vet deems it an emergency to switch from an NSAID to a steroid due to deteriorating neurological functions, a switch can be made without a 5-7 day washout period with the addition of TWO stomach protectors:
- ▼ INAPPROPRIATE USE OF NSAIDS WITH STEROIDS
■ All NSAID package inserts carry a similar FDA required warning: “Should not be given with other NSAIDs (for example, aspirin, carprofen, etodolac, deracoxib, meloxicam, or tepoxalin) or corticosteroids (for example, prednisone, cortisone, dexamethasone, or triamcinolone).” Look up the package insert for your dog’s anti-inflammatory.
■ “The primary cause of adverse effects from NSAIDs is incorrect dosing (eg, concurrent use with corticosteroids or another NSAID, changing NSAID without a suitable washout).8 Washout period (dogs, 5–7 days)”2
2. Guidelines for safe and effective use of NSAIDs in dogs. Lascelles BD, McFarland JM, Swann H. Vet Ther 6:237-251, 2005.
8. Systematic review of nonsteroidal antiinflammatory drug-induced adverse effects in dogs. Monteiro-Steagall BP Steagall PV, Lascelles BD. JVIM 27:1011-1019, 2013.
■ “Let me be crystal clear right from the get-go. A steroid (aka: corticosteroid, glucocorticoid) should rarely be given at the same time as a non-steroidal anti-inflammatory drug (aka: NSAID) prescribed at an anti-inflammatory dose. This is a well-established pharmacologic principle, but for some reason, it is also one I see violated on an almost daily basis. With so many alternatives to help keep patients as comfortable as possible, I’m perpetually flummoxed by this choice of treatment. Thus I’m writing this blog post so pet parents are aware of this important issue and can be proactive advocates for their fur babies.” Christopher G. Byers, DVM, DACVECC, DACVIM (SAIM), CVJ
- ▼ STOMACH PROTECTION
■ “For symptomatic animals, GI protectants are very important…H2 blockers, sucralfate and omeprazole can also be used to manage and/or prevent gastric ulcers.” Sharon Gwaltney-Brant, DVM, PhD, DABVT, DABT. Toxicity of pain medications (Proceedings). 2010. veterinarycalendardvm360
- H2 blocker: FAMOTIDINE– Pepcid AC®, brand X products. Used at the start of any anti inflammatory drugs (non-steroidal or a steroid)
- OMEPRAZOLE– Prilosec®, Losec®, brand X products. Contact your vet for dosing info
- SUCRALFATE– Carafate®; a prescription product. Any sign of GI tract damage, advocate for this to be added to Pepcid AC.