Veterinary Surgical Services
A WARNING CONCERNING ARTHRITIS MEDICATION
Etogesic (etodolac) tablet, Rimadyl (carprofen) caplet, chewable tablet or injection, Deramaxx (deracoxib) chewable tablet, Metacam (meloxicam) oral drop or injection, Zubrin (tepoxalin) disintegrating tablet, Previcox (firocoxib) chewable tablet and Novox (generic carprofen) caplet all belong to a class of drugs called non-steroid anti-inflammatory drugs. The action of these drugs is similar to aspirin, which is also a NSAID. It should be given under the advice of a veterinarian since overdoses can cause symptoms of bleeding and stomach ulcers. Aspirin can 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 has been reported in large numbers. The manufacturer of Rimadyl alleges these reactions are attributed to the fact that Labs are the most common breed, and Rimadyl was the first and most commonly prescribed NSAID. All NSAIDs have the potential to cause liver failure and other side effects. Blood tests before administration of NSAIDs can not 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 creditable non-manufacturer sponsored data exists which accurately compares these drugs. NSAIDs DOs Do you ask your Vet for a written warning about side effects, and read this warning. Ask to see the manufacturer’s 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 a series of blood tests called an “NSAID Profile” are essential. The NSAID Profile checks the BUN, ALT, urine specific gravity, and Complete Blood Count. Do monitor kidney and liver function IF YOUR PET IS ON THESE DRUGS FOR A PROLONGED PERIOD OF TIME. An NSAID Profile is mandatory every year, and strongly recommended every six months. Do give Pepsid AC® 10mg tablet every time you administer an NSAID in order to prevent duodenal ulcers and diarrhea, which are common side effects of all NSAIDs. Unfortunately, this antacid will not prevent gastric ulcers. Do give Polysulfated glucosamines, also called PSGAGs (Chondroprotec, Chondroflex, 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. PSGAGs help cartilage to heal. NSAIDs can cause ulceration of the gasrto-intestinal tract. PSGAGs are part of the protectant lining of the gastro-intestinal tract. NSAIDs are tolerated with PSGAGs. PSGAGs also protect the kidney.
Do stop the medication at the first signs of gastric upset, nausea, lack of appetite, vomiting, or diarrhea. Advise your boarding kennel of this important fact. NSAIDs DON’Ts Do not mix NSAIDs. Do not give NSAIDs with steroids like dexamethasone, prednisone, Vetalog or Depomedrol. Gastro-intestinal ulceration and bleeding can result. A 3-5 day withdrawal period is necessary if you switch from one NSAID to another. A 14 day withdrawal period is necessary if switching to an NSAID from a steroid such as aspirin. Tramadol can be used for pain during the withdrawal period. Do not give NSAIDs in patients with unknown impaired gastro-intestinal, kidney, cardiovascular, or coagulation functions. If liver enzymes are evaluated, use only at a lowered dose and with liver treatment medication (i.e. SAM-E). In these cases, Tramadol can be used as a substitute pain reliever. Do not give NSAIDs with Enalapril or other ACE inhibitors, Lasix, or with nephrotoxic drugs like aminoglycoside antibiotics, or psycotropic drugs such as Prozac or Clomicalm. Do not give NSAIDs in dogs with Cushing’s disease, Heartworm disease, Immune Mediated Hemolytic Anemia or other diseases where the patient is predisposed to blood clots called thromboembolisms. Etodolac has been shown to cause Kerato conjunctivitis Sicca, also known as dry eye. Watch for signs of sqinting or a white discharge coming from the eyes. If these symptoms occur, stop the drug immediately and call your veterinarian. 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. Never increase the dose on your own or give another drug for pain without first discussing with your veterinarians. 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 drug (Tramadol) should be used.
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