Gabapentin Pain Med - Question Dr. Lee

[TeriM]

Lucy (13 year old yellow lab) was recently (about a month) on gabapentin as an additional pain management drug with previcox. Lucy has increased pain and stiffness from arthritis. My vet had very good success with one of her own dogs (bone cancer) with this drug. We considered using tramadol but there are some considerations that perhaps tramadol is not compatible with SamE (Denosyl) which Lucy also takes.

My question is that Lucy seems to have suddenly had severe hearing loss. I know that her hearing was not as strong as it once was but I have noticed in the past week or so that she seems almost totally deaf. It suddenly occured to me today that perhaps this was a side effect of the medication? I tried to call my vet but she is out of town until wednesday next week .

She is 65lbs and currently takes 300mg of gabapentin twice a day as well as a 1/2 tablet of previcox. We also give glucosamine, salmon oil etc and she has Gunn IMS procedures (intramuscular stimulation using acupuncture needles - a technique used to release chronic muscle tone and to restore fluid movement patterns) done regularly (which help her a lot). I believe she has been more comfortable with her pain on gabapentin but if this is a possible side effect then I would definately prefer to try a different medication.

Thoughts?

[Dr Lee]

Originally Posted by TeriM

We considered using tramadol but there are some considerations that perhaps tramadol is not compatible with SamE (Denosyl) which Lucy also takes.

...totally deaf. It suddenly occured to me today that perhaps this was a side effect of the medication?

She is 65lbs and currently takes 300mg of gabapentin twice a day as well as a 1/2 tablet of previcox. We also give glucosamine, salmon oil etc and she has Gunn IMS procedures (intramuscular stimulation using acupuncture needles - a technique used to release chronic muscle tone and to restore fluid movement patterns) done regularly (which help her a lot). I believe she has been more comfortable with her pain on gabapentin but if this is a possible side effect then I would definately prefer to try a different medication.

Thoughts?

Tramadol, SAMe, Gabapentin and Previcox.

All great medications!

Tramadol is a wonderful pain medication that is both very safe and inexpensive. The one disadvantage is that unlike previcox, it has no anti-inflammatory properties - tramadol is a pure pain medication. "Theoretically concurrent use of SAME with tramadol.... could cause additive serotonergic effects." - Plumb's Veterinary Handbook Fifth Edition. Serotonin Syndrome (wikipedia link) is a potentially life threatening situation. Unfortunately how 'realistically' (versus "theoretically") a threat this combination is, is unknown. I do not know if we will find out this information any time soon. Some clinicians recommend a slow introduction however I would definitely ask your veterinarian FIRST! As a side note: I do know many clinicians that are not aware of this theoretic possibility (so kudos to your vet!) and have seen pets on this combination. I do not know that that is necessarily reason to try it though.

Gabapentin is also a great medication. Like all medications, it has pros and cons and should be used in accordance to how it works. Gabapentin helps with neurologic pain and is not a best choice for orthopedic pain. Also Dr. James Chan, a human neurosurgeon in southern California, states that in humans the effect of gabapentin lasts about four to six hours. InPlumb's Veterinary Handbook Fifth Edition, the gabapentin dose is recommended once daily for pain. In Plumb and the North American Formulary, gabapentin is recommened every 8 hours for anticonvulsant reasons. Just FYI.

I cannot find hearing loss as an adverse effects of gabapentin, tramadol, SAMe or Previcox. Unfortunately gabapentin is not yet widely used in veterinary medicine. While adverse effects exist, in the proper therapeutic dose - all of these are very safe medications (perhaps not tramadol and SAMe together though!) Tri-Otic and Otomax have been associated with hearing loss.

Here is the list of "Adverse Effects" of Gabapentin in Plumb, "The adverse effect profile of this drug in dogs or cats is not well defined. Sedation is probably the most likely adverse effect that would be seen. In humans, the most common adverse effects associated with gabapentin therapy are dizziness, somnolence, and peripheral edema." (these effects resolve, when the patient is taken off the medication).

Hope that helps.

[TeriM]

Thanks Dr. Lee, I appreciate your time . I found some references to hearing loss as an uncommon side effect with humans taking the gabapentin. I know that human reactions don't always translate to dog reactions but I think I might wean off the gabapentin over the next week or so to see if there is any difference. If I cut her dose in half would that be to sudden of a change?

Also, is there any other pain meds that might be compatible with SamE and previcox? I will definately discuss with my vet when she is back but I always like some info going it to these types of conversations .

[Dr Lee]

Since gabapentin works with nerves and hearing is very much a nerve generated function, it is not terribly surprising that it is possible. Do date however, I have not ever heard this from a veterinarian as even an anecdotal finding however it is interstesting that it is present with humans.

Weaning off is a good idea. In humans, there is a small incidence of seizures with stopping immediately - however this is typically those that are using it for antileptic reasons.

You had touched on the salmon oil. In Hill's J/D there is such a large level of EPA that it stops a large amount of joint inflammation and reduces pain. I know that Science Diet is not popular here, but I have success with this diet. There are NO preservatives in this diet (it is preserved with tocopherol (from soy beans), rosemary extract and citric acid). There is NO ethoxyquin in the menhaden fish used. For the average dog to obtain a similar level of EPA, a medium to large dog would need to eat approximately 33 regular strength fish oil capsules per day. Drawback of this diet: high in calories. It is recommended against in overweight patients, those with a history of pancreatitis and certain food allergies.

I do recommend acupuncture - as you have already instituted. K-Lasers and magnetic therapy has shown promise. Perhaps a holistic doctor for herbal analgesics.

Here is a link for Chronic Pain Management from a reputable source: VASG

Unfortunately many of the other medications are not always practical. In many cases, if glucosamine/chondroitin, EPA (either from salmon oils, j/d, etc...), NSAID and other adjunct therapy is not working, then perhaps a surgical solution should be evaluated for. Perhaps an examination with veterinary orthopedic specialist might be worthwhile. I realize that 13 is up there but I would hope that there are many years ahead! Surgery may not be a good option here but just a thought.

Take care.

[TeriM]

Thanks for the information and that link Dr. Lee .

If you are interested, I will let you know if there is any difference to her hearing when I wean her off the gabapentin.

Perhaps a holistic doctor for herbal analgesics.

I am also considering that. I have heard some good things about arnica and zeel .

[growler~GateKeeper]

Originally Posted by TeriM

I am also considering that. I have heard some good things about arnica and zeel .

I haven't used zeel, but have used Arnica with Duffy - that was her pain managment after her dental w/extractions last year she had no issues & no pain/tenderness while on it