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Old June 26th, 2008, 11:53 AM
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Dr.Lee and others , Deramaxx versus Metacam

Sorry if this question has already been asked. Do any of you knows which one is stronger ? Weeks ago , I tried Deramaxx for Sam , after 3 days I saw much improvement. (the vet did tell me I should see after 3 days) I had to stop because of the $$$. I have some now , he's been on it since Saturday but it's doing nothing , and I'm afraid that Sam is getting worse. :sad: the lump is so big , I don't know how much it weights but it's so big :sad:

So should I give it more days ? Or just stop the Deramaxx and start with the Metacam instead ?

It breaks my heart to see Sam like this right now , he still plays with Nelly , still eats with appetite , he is not giving up !

Thanks for your opinions.
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Old June 26th, 2008, 01:36 PM
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Frenchy, I don't know if one is stronger than the other but I *think* that Metacam is safer.

Good luck with Sam .....I hope you can make him feel more comfortable.
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Old June 26th, 2008, 02:11 PM
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Quote:
Originally Posted by Frenchy View Post
Sorry if this question has already been asked. Do any of you knows which one is stronger ?
When dealing with NSAIDs (Rimadyl, Deramaxx, Metacam, Zubrin, Previcox, etc..) it is not so much a question of which is stronger but which one does a particular pet respond to. The pain relief of head to head testing places them fairly similar. Previcox did seem to have additional benefits when given for a longer period of time (2 months) compared to the others; but in general they were close. Previcox and Metacam did come out on top of this close race though, FWIW.

When it comes to patient safety, there is a little more of a range and Previcox and Metacam appeared to have a higher safety range. However if a patient responds well to any of the NSAIDs and there are no changes on the follow up blood work then I do not recommend changing what is working safely.

I recommend for most all osteoarthritic patients to be on glucosamine/chondroitin/MSM supplements and on Omega 3 fatty acids with high EPA levels.

If prescription NSAIDs are too expensive there are alternatives. Please do NOT use aspirin or other OTC NSAIDs. Data is ever more supportive of their lack of safety in dogs.

Tramadol is a wonderful medication. It is very safe. It is metabolized through a variety of methods in the body. It is also a very effective pain medication. And last but not least, it is CHEAP. What is the downside to this? Well, it is a pain reliever but unlike glucosamine/NSAIDs/Omega 3's, it has does not relieve inflammation or help the joints. Tramadol only relieves pain. It does it well though!

There are some other options but if you are using the omegas and the joint supplements for the inflammation and joint repair, then tramadol can often take care of the pain.

Let me know if this helps out.
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Old June 26th, 2008, 08:48 PM
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It does help but now I'm not sure between Tramadol / Metacam. Oh and Sam has been on gluco / chondro since I adopted him , 2 1/2 years ago , he was 8 yr old , very overweight and would walk dragging his hind legs. Got him as a foster but decided to adopt him myself.

He is now almost 11 years old , and doesn't have much time. I should have mentioned : Sam was diagnose with cancer , fibrosarcoma last December. The lump is right under his ... anus. It was the size of a grapefruit back then. I couldn't see it because he's a golden and has a lot of fur. Vet gave him 2 to 6 months to live. It has been 6 months , he was doing good all this time. But now the lump must put some weight on his back end and he 's having a harder time getting back up and walking. It breaks my heart to see him this way , but other than that , he eats well , plays with the others , always happy , he is not sick from his cancer. He has a hard time when he goes pooping because it takes him more time and he can't stand in this way for too long. I sometimes have to clean him. So even if these meds are not good long term ... it doesn't really matter :sad:

I think I will try Metacam and see .... do you know when can I expect to see results ?

Thank so much Dr.Lee.
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Old June 26th, 2008, 08:57 PM
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Frenchy, I think you have to be careful when switching his medications. I believe you are supposed to do a minimum period of 3-5 days in between with no medications when switching. I will see if I can find the information.
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Last edited by TeriM; June 26th, 2008 at 09:09 PM.
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Old June 26th, 2008, 09:00 PM
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This was a great post from Dr. Lee where he gave some advice on switching meds.
http://www.pets.ca/forum/showthread.php?p=570597
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Old June 26th, 2008, 09:06 PM
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Frenchy, I am so genuinely sorry to hear of Sam's discomfort :sad: I know how much you would like to resolve this safely for Sam.

Right before Christmas we put Ginger on 20ml of Metacam a day and saw results within a day or two. By the end of May she was up to 30 ml a day and we felt that it was not helping anymore. As she was at the max dosage for her weight the vet suggested that we could try Deramax but to wait at least five days before starting her on it. Somewhere else I had read to stop at least two weeks before changing to clear the system.

I don't know if the same is true in this case but perhaps check with the vet before changing immediately.

I hope that there is something that will make Sam comfortable for a long time.
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Old June 26th, 2008, 09:11 PM
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Quote:
Originally Posted by TeriM View Post
This was a great post from Dr. Lee where he gave some advice on switching meds.
http://www.pets.ca/forum/showthread.php?p=570597
Thanks TeriM , a bit too much infos for me at this time of the evening

I don't want to wait 2 weeks before starting the Metacam , like I mentioned , Sam doesn't have much time.
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Old June 26th, 2008, 09:11 PM
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Perhaps you should check with your vet and see if you can add the tramadol with the deramaxx ??? I believe I read that it can be used in addition to the other meds but I would definately check first .
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Old June 26th, 2008, 09:16 PM
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Originally Posted by diandpat View Post
but to wait at least five days before starting her on it. Somewhere else I had read to stop at least two weeks before changing to clear the system.
I don't know how much time he has left. From what I'm reading , I should just forget about these meds.
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Old June 26th, 2008, 09:24 PM
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Found the following:

Quote:
Drugs such as Tramadol, amantadine, gabapentin, and narcotics can be used in combination with NSAIDs, or instead of NSAIDs, to control the pain of cancer or osteoarthritis.
I found quite a few references to tramadol and deramaxx being used together so that sounds like it might be a good option.

I know it is so hard for you to see Sam so uncomfortable :sad:.
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Old June 26th, 2008, 09:31 PM
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Originally Posted by TeriM View Post
I know it is so hard for you to see Sam so uncomfortable :sad:.
Thanks TeriM , I just get so mad , it hasn't even been 2 years that I lost Daisy to the same thing , now it's starting all over again. Why my dogs ? :sad: I was ok before , even if I knew Sam would leave soon , but he was ok .... not so much anymore.
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Old June 27th, 2008, 12:29 AM
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Originally Posted by Frenchy View Post
It does help but now I'm not sure between Tramadol / Metacam... I think I will try Metacam and see .... do you know when can I expect to see results ?
Metacam should show clinical benefits within a few days.

Also the wonderful thing about tramadol is that you can use it with an NSAID. To maximize comfort, I advocate multi modality for pain relief. You can use glucosamine etc.... along with omega 3, along with Metacam, along with tramadol!

I am so very sorry for all that you are going through. It must be a very difficult time for you.
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Old June 27th, 2008, 09:03 AM
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Frenchy, my heart is just aching for you and Sam

I hope the combination of meds will help make him more comfortable!

Good boy, Sam
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Old June 27th, 2008, 09:24 AM
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I am so sorry, Frenchy. We know the time is coming but that doesn't make it any easier!

You are in a very difficult position - literally between a rock and a hard place trying to decide what is best for Sam and I can only pray you are comfortable with your decision of whether to stop his meds or try something else. Whatever you do - Sam and you know you are doing the best you can.

My prayers are with you both.
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Old June 27th, 2008, 11:23 AM
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Thanks everyone.

I called my vet this morning , to find out the right dosage of Metacam and Tramadol I should give Sam. When he found out I switched meds , he asked me if I was trying to kill my dog so Sam can only take Tramadol for the next week , no Metacam. have to wait a week for the Metacam. N

Now , I told him I didn't have too much Tramadol and I would need a prescription for it .... he said he doesn't work with Tramadol so doesn't feel like prescribing it for Sam

Why does it have to be this difficult ? I'm only trying to give Sam a break. Because , you would think after being in 4 different families in his life , he would get a break , but nope , he got cancer instead.

Last edited by Frenchy; June 27th, 2008 at 08:25 PM.
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Old June 27th, 2008, 12:15 PM
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Frenchy stay strong! dont let this get you down...Sam will know it if your feeling under the weather! I dont know what to tell you but maybe Dr Lee has some suggestion on where you could get some of this or perhaps something that is close to it!

Check your PM in a minute..

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Old June 27th, 2008, 01:08 PM
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Originally Posted by Frenchy View Post
Now , I told him I didn't have too much Tramadol and I would need a prescription for it .... he said he doesn't work with Tramadol so doesn't feel like prescribing it for Sam

....he doesn't "feel" like prescribing it ??? WTF !!!

Will LP's vet prescribe it for you?

I agree with Winston - you need to try and stay strong for Sam so he doesn't pick up on your vibes.
I understand what you're going through.....I lost my last two huskies to cancer 9 months apart. :sad:

Hugs for you and Sam and we're all here for you.
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Old June 27th, 2008, 06:24 PM
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for you to stay positive, sam follows you around so much and needs those from you my prayers are with you and he he is such a doll that the meds help him with any discomfort, his spirit seems bright and strong
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Old June 27th, 2008, 06:59 PM
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Frenchy.....ah, I don't even have anything useful to say, but I'm so sorry you're having to deal with all this frustration. If there is anything I can do to help (other than rob a pharmacy) let me know.
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Old June 27th, 2008, 08:28 PM
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(other than rob a pharmacy)
We could rob Hazel's

Thank you everyone for your kind words. I think Sam is doing better today so now I have to decide , continue the Deramaxx or keep him off meds for a week to try the Metacam. I wish someone could make the decision for me.

Sam can't be better today just because he had Metacam for the first time this morning , right ?

I'm thinking it must be the Deramaxx kicking in ? After 6 days ?
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Old June 27th, 2008, 08:31 PM
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....he doesn't "feel" like prescribing it ??? WTF !!!
My vet doesn't seem to like it when I know my stuff. It's a small , rural clinic , people around here ... only know about the basics , so to have a smart a** like me as a costumer , makes him feel less needed ?
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Old June 27th, 2008, 11:00 PM
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Quote:
Originally Posted by Frenchy View Post
We could rob Hazel's

If I had any Tramadol I'd send it to you in an instant!!

Thank you everyone for your kind words. I think Sam is doing better today so now I have to decide , continue the Deramaxx or keep him off meds for a week to try the Metacam. I wish someone could make the decision for me.

Sam can't be better today just because he had Metacam for the first time this morning , right ?

He could very well be better today because he had both meds! What is your vet thinking? Is he worried about long-term organ damage? Sam needs this now, to ease his last days. I don't think long-term damage is going to be a factor here... :sad: There's just no logic to it. Maybe rainbow's right--maybe a second opinion from LP's vet?

I'm thinking it must be the Deramaxx kicking in ? After 6 days ?
IMO, 6 days would be an awfully long time for the Deramaxx to be kicking in...
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Old June 27th, 2008, 11:05 PM
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My dog has been on both Deramaxx and Tramadol. Originally, she was on Deramaxx for about two years. The day after I first gave her Deramaxx, I saw a marked difference. She was active like a puppy again! However, as she aged, her problems changed, and we added Tramadol into the mix four months ago.

I was told Tramadol was safe and had few side effects. Well, to make a long story short, the Tramadol made Maggie sick and she had no appetite. I took her off all meds and her appetite came back. Then, after about 10 days, I put her back on the Tramadol alone, and BAM! Appetite loss was back. Well, she hasn't been on the Tramadol since and is back to eating like a horse.

We determined that she no longer needed pain meds, so it all worked out for the best. I have some Tramadol left over if anyone wants it. Just shoot me an email and it's yours.
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Old June 28th, 2008, 08:06 AM
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metcalm

so sorry frenchy... I was hoping for better news, when i last spoke to you, I have Ben on 25 mlg a day god that stuff is expensive!! but without it he cant walk, with it he plays and moves so much better, i dont want to know what will happen if it stops working for him, he still has trouble getting up I have to help him most times but the difference in his personality is amazing !! like hes saying thank you so much!! What the hell kinda vet is he??? your dog should be as pain free as possible .I know how you feel and my prayers are with you.
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Old June 28th, 2008, 09:07 AM
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I have Ben on 25 mlg a day god that stuff is expensive!!
I remember how Ben was always happy considering , you can clearly see he's eager to run like a puppy and gives his 100%

I called the pharmacy yesterday to see if they had any Tramadol (my vet thought not too many of them carried it) and guess what ? The first pharmacy I called had Tramadol since I would have to give 2 per day , it's about as expensive as the Deramaxx.

Thanks for all the offers guys Big Dog Mom , that is really nice of you , have you tried to get a refund for this meds from your vet ? Because they usually can.

I'm pretty sure I can get some from the same girl who brought me the other meds.

So I didn't give anything to Sam this morning , I might try the Tramadol alone since this one is ok to give.
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Old June 28th, 2008, 09:29 AM
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Yes, my vet will refund me for the unused Tramadol, but I would rather help someone out who needs it rather than get a few bucks back. So seriously, if anyone needs some, I have about two dozen tablets left. I'm happy to send them to anyone who needs them and otherwise might not be able to help their dog without them.

But there is something someone said above that IMO is just not accurate.
Tramadol is super cheap compared to Deramaxx. If someone is getting quotes where the pricing on the two drugs is comparable, something's wrong with that picture.
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Old June 28th, 2008, 10:17 AM
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Might be the difference between US and Canadian pricing.
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Old June 28th, 2008, 12:09 PM
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Might be the difference between US and Canadian pricing.
It could be. Because my vet sells Deramaxx for about $3.40 a pill ( + $5.00 each time you buy more )

The pharmacy sells the Tramadol for $1.40 a pill but for a dog Sam's size , it's 2-3 pills a day.
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Old June 28th, 2008, 12:52 PM
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Especially in the age of online ordering, tramadol should definitely be cheaper than a prescription NSAID. I would think Canada would have better tramadol pricing than the US since so many US clients purchase online medications from Canada.

As far as your veterinarian not wanting to use it out of lack of familiarity, this is sad. If every veterinarian only practices the medicine that they have been comfortable with, then they are out of date. Medicine is constantly evolving. Also how does this vet ever use or become familiar with a new medication? ...and tramadol has been around for a very long time.

As far as backing two NSAIDs back to back... Yes this is not recommended however sometimes it becomes necessary. The problem is that the COX-1 negative side effects can be worse with two NSAIDs than just one, sometimes up to 20x as bad. Also the non-analgesic effects of NSAIDs can persist for up to two weeks in some cases. Can we still do it? Yes, but it depends upon each case. If there are liver or kidney concerns, then it may be best to wait the full two weeks for proper 'dry out' period. However the use of SAMe or Milk thistle can help the liver deal with NSAIDs. If we are not worried about the liver or kidneys, then a 2 week course of pepcid (famotidine) can help reduce the risk of any stomach problems. If your vet is still concerned about stomach issues, then sucralfate (carafate) can also be given to help the patient handle the second NSAID. Also, this is were I come back to tramadol again. If we need a dry out period, then a different analgesic can really help this patient. If your veterinarian does not like tramadol then perhaps ask about a fentanyl patch during this interim time. Fentanyl patches provide excellent analgesic effects for several days. They are not used for long term use typically due to their cost and the constant need of a sticky patch on the skin and risk of ingestion, etc...

Also, there are many veterinarians out there that use tramadol and are not shy of 'new medications'. Just FWIW.

Again, best wishes. I am very sorry for all that you are going through.
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