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Gibbons March 26th, 2008 04:03 PM

NSAIDs - Non Steroidal Anti Inflammatory Drugs - Answered by Dr. Lee
Sorry this is long- I just want to make it clear what's going on.

My pup is Schroder, a 10+ yr old beagle cross with three legs and some arthritis. Up until recently, he was taking 100 mg of Rimadyl x 1/ day That prescription ran out, the vet refill was 25 mg of Deramaxx x1/day.

I don't know if it's related to the switch in pills, which happened last monday if memory serves, but he's been acting "off" since Monday, I guess.

He often refuses some walks with hubby (he usually goes for 10 min. walks 4 times daily - although he can take as long as he wants on them, and has lots of opportunites to stop and sniff, etc) but used to always go with me. Usually when anyone comes over to him - morning/ night/ whatever, he either wiggles up to them to greet them, or rolls over for belly rubs.

This Monday, he refused his pain pill- I figured no big deal, he's missed a day here and there before without it being a big problem (i.e., I couldn't tell he'd missed it at all, then hubby realizes at 10 pm that he forgot to give the pain pill). Schroder refused his two later walks with hubby- no big deal, he's been doing that a lot more recently, just pees and comes right back in. He didn't eat too much either, as far as I can tell. He seemed lethargic, but I assumed he was just a bit uncomfortable.

Tuesday morning, I go over to wake him up for his walk, and he can't sit up or even roll over, he just seemed too weak. I figured he was in pain from missing his pain pill and brought one to him. Later afternoon, he seemed alright. My husband took him on the two two mid-day walks. He refused his late-night walk - again, normal.

Same thing again this morning- couldn't push up into a sit, couldn't seem to roll over for belly-rubs, but an hour or two later he seems better but not the same.

Currently, he's wobblier than usual, he falls down more and seems to put more effort into getting up again, and he seems REALLY tired. Usually on our walks, he goes a good 3-4 houses and stops and sniffs, but never seems overly exhausted. Now he goes 5-10 feet (slowly) and stops and pants and rests for a bit, and then goes a bit further. He used to look happy on walks and motor along, now he's definitely hobbling and looks uncomfortable.

I called the rescue and left a voicemail today, I didn't want to do anything without their OK- but I plan on calling the vet tomorrow morning (no outgoing phones here at work, my cell has no service, etc) and I'm at work until midnight.

What do you think? I'm really concerned, and he just looks so sad (okay, he's a beagle... they always look sad.. but still!)

Dr Lee March 26th, 2008 06:39 PM

Sorry to hear about Schroder. One question, why did your veterinarian switch from Rimadyl to Deramaxx? Was there a 'wash out' period of two weeks prior to the switch?

My thoughts are that either 1) the signs may be related to the medication switch or 2) it is unrelated. To rule out the later, I would recommend that you contact your vet as you have planned. If it is the former, I will explain some information for general switching of the this medication class but would still recommend you contact your vet.

Deramaxx, Rimadyl, Metacam, Previcox, Zubrin, Ketoprofen are all part of a drug class called NSAIDs (Non Steroidal Anti Inflammatory Drugs). There are many examples in human medicine (>30) which include: aspirin, tylenol, advil, celebrex etc... NSAIDs interact with two receptors: Cox 1 and Cox2. Cox 2 is related to pain and inflammation. This is why the medications help relieve these symptoms. Cox 1 receptors are involved with homeostasis (keeping the good things running in your body) such as kidney blood flow, stomach mucous production and stomach acidity. The goal of all companies is to create a NSAID that does not touch Cox1 - so far the companies have made ones that are more 'Cox-1' sparing than before but there are none that are completely without Cox-1 effects.

Why do we care about Cox-1? For a variety of reasons, but in this case it is important to realize that the 'pain' effects (Cox-2) are affected by the NSAIDs for 12-24 hours. The medication however can have lasting effects on Cox-1 for up to two weeks (this is a common period accepted by most specialists). When you combine any two NSAIDs - their negative effects on Cox-1 can be anywhere up to TEN TIMES worse than if you just doubled the dose of one of the drugs by itself. While each combination is different, the take home point is that there can be interaction which is worse when combined. When switching from one NSAID to another it is generally recommended to have a two week 'wash out' period. Obviously for reasons of patient comfort, this is not always done. Usually you can switch from one to another with little problem. So, if a vet does not do this, it is not necessarily wrong. Immediate switching can cause some problems and the most common is stomach upset. For mild problems, this can often be treated with pepcid (famotidine). For schroder I assume he is approximately 50lbs? For a 50lb dog, a dose of famotidine is 20mg by mouth every 24 hours. Please check with your veterinarian prior to administering this however!

Now, which NSAID is the BEST??! If there was one which worked best, there would not be so many on the market. There are some that have higher safety ranges and may be more Cox 1 sparing. But importantly, one may work great in one dog and poorly in another. Just like people - most people like advil for one thing, aspirin or pamprin for another. Also some come in various forms (chewable, non chewable, honey flavored liquid or dissolving tablet). So the big question is which one is best for you and your pet. This will be determined on three factors: 1) one that makes the pet feel better, 2) a form that the owner finds compliance easy, 3) one that does not negatively interact with the pet (this should be determined by blood testing with your veterinarian).

FWIW - there was a head to head test on Deramaxx, Rimadyl, Metacam and Previcox. Please note that the test was paid for by the makers of Previcox however usually when the data does not add up to what the makers like - they just do not release the information (as opposed to 'tampering' with data). Thus previcox came out with highest safety ranges. Also the oral tablet takes faster action than Rimadyl injectable. Metacam was the next safest, then Rimadyl and last Deramaxx. Safeness was determined by lowest number of side effects add a higher than normal dosing along with range of safety. As far as pain relief they all had similar effects with metacam and previcox as slightly higher. What was interesting was that the previcox longer term (over 2 months) had better pain effects than all the others. With that said, because of higher cost and it being a newer medication - it is not seen widely. I carry it but honestly prescribe Metacam the most. I like it because the liquid form is highly palatable and easy to dose with weight. I also have patients on Rimadyl (one of my own dogs - didn't switch her from it because she has always responded so well to it) and also patients on Deramaxx.

Final thought on human NSAIDs - please do NOT use these alone or especially in conjunction with the dog NSAIDs. Aspirin has long been used in dogs - I wish it was not used at all for pain. The dose we use to interfere with platelet function (where we want to help stop clot formation) is TEN times LESS than the dose needed for relief of pain. There was a study done that suggests that all dogs on pain doses of aspirin have some form of intestinal bleeding regardless of how 'normal' they are acting. As I am sure the other members here will also recommend is that to use the concurrent use of glucosamine, chondroitin, MSM and Omega 3 fatty acid (especially those that have high levels of EPA in them). If all of these are not enough and no surgery is indicated by your veterinarian, then tramadol is a great, safe, inexpensive pain medication that CAN be given with NSAIDs.

Good luck with Schroder! Let us know what your veterinarian says!:pawprint:

Gibbons March 26th, 2008 06:52 PM

I don't actually know why the switch. The person at the counter, the vet tech, I guess? who gave me the meds told me she'd prefer I speak to the rescue about it first, as they are in charge of his care - which is definitely true.

We also didn't do a "wash out" period. I asked 'is it safe to just switch totally?" and the vet tech said it shouldn't be a problem. So Sunday was Rimadyl, Monday was Deramaxx.

Is it safe to use supplements in conjunction with the meds he's on right now? I don't want to take him off his meds and start supplementing w/out the permission of the rescue I'm working with, but if supplementing is safe then I'll definitely start doing so. I'll obviously ask the vet as well tomorrow, but I just wasn't sure how it all works so I hadn't done anything yet.

Dr Lee March 27th, 2008 12:56 AM

The key to managing osteoarthritis is to use multimodality. Multimodality is best for two reasons: 1) by using multiple methods to reduce inflammation and pain we achieve better pain relief in our patients :thumbs up and 2) by using various methods together we can use less of each individual one. This last reason is important when we start thinking of strong drugs.

Glucosamine, chondroitin, MSM, etc… these are cartilage precursors and building blocks. They help repair the cartilage as well as reduce inflammation. This is a holistic method to help improve pain relief and reduce the progression of osteoarthritis. Two notes: 60 minutes did a segment last year that the average amount of glucosamine and chondroitin in over the counter tablets was 15% of what was on the label. So if you think you are getting 1000mg, you are probably only getting 150mg!!!! A good company is DMV products, they make a great chewable called Synovi G3 with all three: glucosamine, chondroitin and MSM along with antioxidants and omega 3’s. Also you can ask your herbalist or veterinarian for a product that they really trust. Also please do NOT use shark cartilage – two reasons: 1) it does not work as well in studies and 2) it is bad for the sharks! The average age of the shark taken in a fishing boat is 2 years younger than its sexual maturity – for this reason much of the shark sources are from illegal fisheries that are going to endanger the sharks. Sorry, I got …:offtopic:

Omega 3’s. :lovestruck: Specifically EPA – when taken in high enough levels, EPA stays in the joint and after two weeks of sufficient levels, the joints stop releasing various inflammatory mediators. This helps 1) reduce inflammation and pain and 2) reduce the progression of the osteoarthritis. Additionally the other forms of omega 3’s help the rest of the body and germane to this topic – they help naturally improve kidney blood flow which if we remember from above, is important when we are using high levels of a Cox1 interacting drug such as rimadyl or deramaxx.

NSAIDs – reduce inflammation and pain as we previously discussed.
Tramadol. This medication helps with the pain as it is an opioid but does NOT help with the inflammation nor affect the progression of osteoarthritis. Think of tramadol as a big happy band-aid. Makes things feel and look better but does not address anything underlying. For this reason I add this on last and only in conjunction with the above medications/holistic remedies.

Other options. Antioxidants can be very helpful in all forms of inflammation. Maintaining proper weight is very important. Exercise – low impact exercise such as swimming. Physical therapy and massage can be helpful. Magnet therapy and K Lasers therapy have proven themselves very helpful. Fentanyl patches and morphine can also be used for pain. And the list goes on….

Again, multimodality is the key. :highfive:It is like having many friends – the support becomes synergistic.:grouphug:

I hope this helps. :pawprint:

Gibbons March 28th, 2008 04:52 PM

Hi Dr Lee, and thanks for the help! I'm saving this link in my "helpful dog info" file I've got on my computer, so I can refer back to it as needed.

We saw the vet today at noon. She said that we should probably try putting him back on the Rimadyl and see if that makes much of an improvement.

And before I could even ask about supplementing, she told me to do it anyway! She said I should definitely get him on something to protect his joints and work hand-in-hand with the anti-inflammatory effects of the Rimadyl.

So I got this powder stuff to put on their food (they = Schroder and his much younger "sister" to keep her joints healthy) which is MSM, omega 3's, Chondroitin, Glucosamine and some other stuff I can't remember.

I like this vet. She gave him a very thorough check over, gave advice to help me with lugging him around all day (trouble walking = me making my hubby and room mates carry Schroder all over the house, since I can't lift him), suggested "passive extension" (I thinks she said?) exercises to help strengthen his back leg. He's 47.8 lbs, she says he's a bit on the thin side but that's probably good considering how weak his back leg is (kind of odd, when you think about it... ) She also suggested a grain-free food to help control the inflammation, but we're already doing that.

Anyway! Very long way of saying thank you! I feel very knowledgeable now, and confident that we're doing all we can for him.

TeriM March 28th, 2008 05:36 PM

Wow, thanks very much Dr. Lee. Those were very imformative posts :thumbs up.

Gibbons, I hope Schroeder feels better with the med change :fingerscr.

phumbaa March 24th, 2010 07:43 AM

appropriate washout times when switching from one NSAID to another
Hi there, I am new here. I found this forum whilst I was searching for the answer to my above title. I have a further question though to what was already discussed. Nala, my beloved 3 year old Boerboel/Mastiff has been on Previcox since last Sept '09 as she tore her knee ligament and we were unable to afford the operation. Previous to that she had the other hip operated on. They cut off the ball joint at the top of her hip and bothced the job. We went thru 8 months of hydrotheraphy to help her build up the muscle around it.

Three weeks ago, she tore the other knee "crucite" and this time we were on medical aid and she had the operation - "Cranial Cruciate Ligament Rupture". They put a steel plate in her leg with 6 screws. The surgeon changed the medication to Rimadyl and Ranclav. After the first week when we ran out of meds, our vet gave us more Rimadyl & Tramal-Hexal Capsules. We have been on these now for the next 2 weeks.

My question is this - my vet has now said that we must give the meds a break before going back on the Previcox but I am VERY concerned as it has only been 3 weeks, she still has the torn knee ligament on the other leg. Surely she cannot be without pain meds just so we can satisfy the vet saying we need a "wash out period"?

Please can somebody let us know what the absolute minumum time is for us to switch from the Rimadyl to the Previcox?

hazelrunpack March 24th, 2010 09:55 AM

You might want to track down a veterinary pharmacist and ask the question.

How long did your vet recommend? I know the wash out period for Rimadyl is at least a week--and depending on what you're switching [I]to[/I], that time might vary. :shrug:

Sounds like you and Nala have been through the wringer together :grouphug: I hope she's feeling better soon! :goodvibes:

phumbaa March 25th, 2010 12:59 AM

Rimadyl to Previcox
Thanks for the advice. They are all saying 2 weeks for the wash out period but my baby is in pain so surely this is cruel:cry:

hazelrunpack March 25th, 2010 08:32 AM

There's a good reason for waiting, though, phumbaa--starting the new meds too early can lead to dangerous bleeding. So although she's ailing, it's necessary. :(

I'm thinking that tramadol might be safe to use, though. Have you asked your vet if there are any other pain meds that could be used?

phumbaa March 25th, 2010 10:40 AM

Rimadyl to Previcox
Thanks again for the reply. Unfortunately my vet won't give me anything esle - he says I must wait. Do you REALLY think there would be problems if I have only waited 3 days so far?

hazelrunpack March 25th, 2010 12:32 PM

As I understand it, it can dramatically increase the chances of complications if you [I]don't [/I]wait. All of these drugs are hard on the internal organs and the lining of the stomach. As hard as it is to watch, discomfort is easier to get over than organ damage/failure or a bleeding ulcer. :grouphug:

pugsrule March 25th, 2010 12:51 PM

another drug we have been using for the last 10 months, is cartrophen. This is NOT related to the painkiller cartrofen. Cartrophen was originally developed for cystitis, but now is being perscribed for arthritis as well as bladder troubles. It has the same beneficial effect on the cartilage in joints as it does on the bladder wall. No side effects. It is more of a cure type remedy than a fix for the pain of arthritis.

I have 5 of my pugs on this, we start with one injection per wk for 4 weeks, t, and then once a month after that. It is easy to give the subcutaneous shots, I just use my insulin syringes. It is doubly good for us, not only for arthritis, but also for the bladder issues we are constantly running into with handicapped dogs. The one we have with interstitial cystitis is finally showing signs of imporvement with this therapy.

FFMLYRIC June 10th, 2013 11:57 AM

Is Long Term Use of Rimadyl Safe?
My dog, Kellie, suffers from hip displasia and arthritis. She had an episode last September (2012) that caused me to take her to the emergency vet late at night. She had been playing (jumping back and forth on the patio) and apparently hurt herself. The trip to the emergency vet resulted in her being placed on Rimadyl -- 100 mgs. She takes it everyday, but now I've cut her back to 50 mg per day -- with Gabapentin as a rescue medicine. She's doing great with 50 mg per day and uses Gabapentin if she's overdone it during playtime.

Kellie is a senior dog (almost 9) and will probably need pain medication or an anti-inflammatory for the rest of her life. I'm concerned with the long term use of Rimadyl as I've heard it may cause liver damage with prolonged use. Kellie has been on it now for about 9 months. Is it safe to continue with Rimadyl long term? Should I try another pain medication or anti-inflammatory?

MaxaLisa June 10th, 2013 03:28 PM

[QUOTE=FFMLYRIC;1058502]My dog, Kellie, suffers from hip displasia and arthritis. She had an episode last September (2012) that caused me to take her to the emergency vet late at night. She had been playing (jumping back and forth on the patio) and apparently hurt herself. The trip to the emergency vet resulted in her being placed on Rimadyl -- 100 mgs. She takes it everyday, but now I've cut her back to 50 mg per day -- with Gabapentin as a rescue medicine. She's doing great with 50 mg per day and uses Gabapentin if she's overdone it during playtime.

Kellie is a senior dog (almost 9) and will probably need pain medication or an anti-inflammatory for the rest of her life. I'm concerned with the long term use of Rimadyl as I've heard it may cause liver damage with prolonged use. Kellie has been on it now for about 9 months. Is it safe to continue with Rimadyl long term? Should I try another pain medication or anti-inflammatory?[/QUOTE]

You will get mixed opinions this. Some breeds may be at more risk, like Labs or Retrievers, from anectodal stories over the years.

The vet is supposed to do an initial blood test, and then regular monitoring. I would start any dog given these meds liver support. My favorite has always been Country Life's "Liver Support Factors".

Before I resort to daily NSAID meds, I look to all other options, which usually consists of combination joint products - a good quality glucosamine and chondroitin product as Dr. Lee mentions - I have used Cosequin with success, and I like to add that with a more whole food suppplement, like perna mussel, hyaluronic acid, glycflex, etc. Injections of adequan (in short supply right now perhaps) or cartrophen (not rimadyl, like adequan, in the UK or Canada) help a lot. Some dogs are helped a lot by the addition of things like omega-3 fatty acids, b-vitamins, etc. You can take that further and add in acupuncture and/or chiropractor. In many dogs, you can completely eliminate the need for drugs, though often, at some point, they might be needed.

NSAIDs further deteroriate the joint. Supplements slow deterioration, and some studies suggest there may be some rebuilding.

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