COMMON MEDICATIONS
Anti-inflammatory medications, known as nonsteroidal anti-inflammatory drugs (NSAIDs), are frequently used to manage your dog’s condition and can offer a dramatic improvement in mobility and quality of life. There are many licenced drugs available that come in different formulations and are given in different ways and generally they are very well tolerated. However, as with all medications, side-effects can happen, but following advised dosing, as well as keeping a close eye on your dog’s appetite, toileting and thirst will significantly reduce the likelihood of them occurring.
NSAIDs reduce the production of prostaglandins which drive inflammation associated with arthritis. They do this by blocking an enzyme called cyclooxygenase. However, there are at least two forms of this enzyme cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), and it is cox-2 which is believed to be the chief culprit for creating these inflammatory prostaglandins. COX-1 is recognised to produce prostaglandins that are beneficial within the body as they protect the stomach lining, aid in kidney function and help in clotting. Developments in NSAIDs in the last decade have created more COX-2 selective drugs which should reduce the side effects seen, however adverse reactions can still happen.
Owners are often hesitant to use NSAIDs due to publicity regarding potential side-effects, and will seek alternative options for pain control. CAM fully supports their choice as long as the treatment chosen offers effective pain control to that dog. We strongly suggest using a means of measuring pain before the treatment and after to ensure the goals of using it are met. Leaving a dog in pain for whatever reason is not acceptable, and will lead to the condition worsening rapidly. Combining a number of treatments is recognised as the most effective way of controlling pain with minimum side-effects.
using a NSAID effectively
- Always use a NSAID with the guidance of your vet.
- Do not use medication designed for humans as these can be fatal to dogs.
- Follow your label instructions regarding dosing, and check that it is compatible with any other medication being used. (A recent study of 29 severe side-effects seen in dogs showed the majority were due to inappropriate dosing, or combining unsuitable medications).
- Follow advice on how to give it, such as with food.
- Don’t give a dose if your dog is behaving strangely, reluctant to eat, has vomited or has diarrhoea. Contact your vet to discuss further.
- Initially plan to give the NSAID for 2-3 weeks to see the best effect. Reassess his pain status then and plan further management. Providing just a few days NSAID will not be effective in controlling chronic pain and will lead you to feeling they have been ineffective.
- If prescribed for long-term dosing, observe your dog’s chronic pain indicators to attempt to reduce the daily dose of the NSAID. Especially as you and your dog change your lifestyle.
- NSAIDs have been found to be more effective and safe for chronic pain if given regularly as prescribed, however they can be stopped and restarted. So if your dog’s pain status and mobility has improved significantly, and you have reduced the dose with no deterioration, stop the NSAID and continue to monitor. It can always be restarted.
- It is well recognised that a dog’s response to an NSAID is individual. An otherwise healthy dog may not tolerate one NSAID but have no side-effects with another. If your dog needs anti-inflammatory support, but has reacted to one NSAID, it does not mean they can’t be effectively treated with a different one.
- If changing from one NSAID to another, wait at least 48 hours after stopping one before starting the new one.
- Have regular blood samples (6-monthly) taken to ensure other conditions have not developed which could mean an NSAID should no longer be given.
Other pain management anti-inflammatories
In addition to licensed NSAIDS, other medications are often used in managing the pain of arthritis.
A new non-steroid anti-inflammatory is now available in the UK that it more targeted in its action and thus has less side effects than traditional NSAIDs called cyclo-oxygenase inhibitors (COX).
Grapiprant acts by directly blocking a specific receptor, the EP4 receptor, resulting in a reduction of pain and inflammation. This selectivity results in a lower or no effect on renal function, blood clotting and gastric ulceration compared to COX inhibitor NSAIDs which have a much broader effect.
Clinical research trials have tested Grapiprant at very high doses. However, a common clinical sign is vomiting, soft stools or diarrhoea, and lowered appetite. Such gastro-intestinal side effects are not associated with damage to the lining of the gut. Grapiprant is licensed for pain due to mild-moderate osteoarthritis in dogs and may be used with certain other veterinary prescribed pain relief medications in more severely affected dogs though the manufacturer recommends it is not used alongside NSAIDs. Grapiprant is most well absorbed when given on an empty stomach at least 1 hour before feeding.
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The use of monoclonal antibodies is becoming more mainstream in human medicine, but is very novel in veterinary medicine. A monoclonal antibody that has been in mainstream veterinary circulation for a while is lokivetmab which acts against a protein called IL-31 known to be involved in allergic skin disease. By reducing the levels of IL-31 in circulation through the use of monoclonal antibodies against it the symptoms of the disease can be reduced.
The same approach has been applied to nerve growth factor, a protein known to sensitise nerve receptors that detect noxious stimuli which is ultimately perceived by the brain as pain. Dramatically simplifying their complex action, through reducing the levels of nerve growth factor the nerve receptors are less likely to fire signals to the brain that convey messages of pain.
Bedinvetmab is very new and a lot more data will be collected and processed over the coming years regarding its action, effect and adverse events. It is believed it may become a foundational intervention against osteoarthritis in dogs and cats. Speak to your veterinarian for more advice.
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This readily available drug is often prescribed by vets as an alternative to NSAIDs or in addition to them. It has been found to have minimal anti-inflammatory effect so is often not suited to be used alone for management of arthritis (and should NEVER be given to a CAT). There is a veterinary licensed product which is a combination of paracetamol with codeine and is called Pardale-V.
Pardale-V is the only product licensed for dogs that contains paracetamol, but it also contains codeine, and so, if a vet wants to avoid prescribing codeine for a dog, they may choose to prescribe a human paracetamol-only product.
Paracetamol should never be given without your veterinarian’s guidance as there may be concerns that contradict its use.
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This injectable treatment is considered by some to have anti-inflammatory properties, as well as disease modifying capabilities. However, it is not considered a reliable and rapid acting source of pain relief.
It is generally given weekly for 4 consecutive weeks and can be repeated up to three times per year.
There is mild evidence it can be beneficial in managing arthritis, but often the response is unique to the dog so it must be used alongside good observational skills looking for improvement.
There is no evidence to support its use as one injection on a monthly basis.
A similar compound routinely used in the US is polysulfated glycosaminoglycan (Adequan). This has a different dosing schedule.
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These are very powerful anti-inflammatories, and are used to manage immune-mediated arthritis. They were used historically to manage osteoarthritis when NSAIDs did not exist. A common medication prescribed was prednoleucotropin also known as PLT. However, they have been superseded by the NSAIDs and piprants because they have significant side-effects on the body.
They are recognised for having profound initial short term improvement but overtime can lead to the condition worsening due to steroid-induced weakening of muscle and soft tissues that support the joint. They can also affect your dog’s hormone balance which will encourage them to eat and drink more, urinate more, gain weight and often excessively pant.
They are occasionally used palliatively in a terminally ill patient.
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This easily accessible anti-inflammatory was historically used in cats and dogs, but it is associated with significant vomiting and diarrhoea episodes, and has been replaced by COX -2 selective NSAIDs and piprants which are known to be more efficacious and have less side effects.
DO NOT GIVE YOUR DOG OR CAT ASPIRIN - SPEAK TO YOUR VET!
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