Guidelines for the use of NSAIDs to treat chronic pain in cats

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Non-steroidal anti-inflammatory drugs (NSAIDs) are the most used medication for cats.¹ However, felines have a unique metabolism that should be considered when prescribing NSAIDs.² Moreover, careful adherence to dosage regimens and knowledge of contraindications for NSAID use are crucial for maintaining the health safety of cats.² To assist veterinary professionals in making informed decisions regarding the prescription of NSAIDs in cats, specific to its long-term use to manage chronic pain, the International Society of Feline Medicine (ISFM) and the American Association of Feline Practitioners (AAFP) developed the “2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats.”²

“We are thrilled to announce the release of these new guidelines addressing long-term use of NSAIDs in cats,” said Heather O’Steen, CEO of AAFP in a news release.³ “With a focus on safety, efficacy, and responsible medication management, these guidelines aim to enhance the quality of life for cats while minimizing potential risks. We believe that these guidelines will serve as a vital resource in ensuring the optimal care and wellbeing of cats receiving long-term NSAID therapy.”

The guidelines offer comprehensive information including research, figures, and charts on the following in relation to the long-term use of NSAIDs in felines^2,3:

1. Mechanism of action
2. Indications for use
3. Screening prior to prescription
4. Use in the presence of comorbidities
5. Monitoring of efficacy
6. Avoidance and management of adverse effects
7. Considerations for anesthesia and surgery in cats receiving long-term NSAID therapy
8. Cat-friendly techniques to reduce chronic pain in the clinic and at home

“The first NSAID guidelines were published in 2010. Since then, multiple studies have examined the use of NSAIDs in cats, particularly those with comorbidities. These guidelines have examined this evidence and aim to provide practitioners with practical information on using NSAIDs for chronic pain management, along with tips and advice on working with caregivers to provide the best care for their cat,” Sam Taylor, BVetMed(Hons), CertSAM, DipECVIM-CA, MANZCVS, FRCVS, head of veterinary specialists at ISFM, and contributing author, explained in the news release.³

Contraindications

The 26-page guidelines also included information on contraindications to the use of NSAIDs. Contraindications were divided into “absolute contraindications” and cases where “caution [is] required.”² According to the guidelines, absolute contraindications include the following²:

• Hypovolaemia
• Dehydration
• Hypotension
• Advanced kidney disease – IRIS stage 4
• Progressive/unstable kidney disease
• Concurrent treatment with drugs that affect renal function (eg, aminoglycosides)
• Liver dysfunction/failure (eg, hepatic lipidosis)
• Concurrent corticosteroid treatment
• Anorexia, vomiting, melena, and/or diarrhea
• Acute gastrointestinal disease, gastrointestinal disease with compromised mucosa

Cases where caution is required before administering NSAIDs include²:

• Advanced age, such as ‘super’-senior cats aged more than 15 years
• Stable CKD – IRIS stage 1, 2, or 3
• Anaemia or thrombocytopenia
• Other gastrointestinal disease without mucosal compromise
• Bleeding disorders
• Concurrent treatment with other drugs, such as ACE inhibitors/angiotensin receptor blockers, diuretics, anticoagulants; and highly protein-bound drugs such as warfarin, digoxin and anticonvulsants

Furthermore, the authors emphasized the harm of administering human NSAID drugs to felines. “Human NSAID products given to cats are likely to cause severe toxicity,” the authors wrote. “Any NSAID can induce significant adverse effects when dosage regimens are not followed or contraindications for use exist… The risk of NSAID-induced adverse effects is minimized by judicious selection of patients, consideration of concurrent medications, frequent monitoring, accurate drug administration and caregiver education,” they added.

Resources to provide feline caregivers with

In congruence with the guidelines’ section on cat-friendly advice and suggestions to support caregivers, the ISFM created “cat carer guides”⁴ that cover a wide range of topics such as how to increase water intake, care for a new kitten, recognize acute pain, and taking feline companions to veterinary visits. The AAFP also offers a client pamphlet on managing chronic pain in cats taking NSAIDs.⁵

References

1. Mallat J. The 9 most common cat medications. Catster. April 13, 2024. Accessed June 14, 2024. https://www.catster.com/cat-health-care/common-cat-medications/
2. Taylor S, Gruen M, KuKanich K, et al. 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats. Journal of Feline Medicine and Surgery. 2024;26(4):1-26. https://journals.sagepub.com/doi/epdf/10.1177/1098612X241241951
3. ISFM and the AAFP release new guidelines on the long-term use of NSAIDs in cats. News release. International Cat Care. April 10, 2024. Accessed June 14, 2024. https://icatcare.org/isfm-and-the-aafp-release-new-guidelines-on-the-long-term-use-of-nsaids-in-cats/
4. Cat carer guides. International Cat Care. Accessed June 14, 2024. https://icatcare.org/advice-cat-carer-guides/
5. ISFM, AAFP update guidelines on long-term NSAID use in cats. American Veterinary Medical Association. June 13, 2024. Accessed June 14, 2024. https://www.avma.org/news/isfm-aafp-update-guidelines-long-term-nsaid-use-cats?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news