Practical Matters: NSAIDs and corticosteroids are a risky combination

Both corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain, particularly spinal pain, in dogs. Dogs referred to North Carolina State University's Integrated Pain Management Service often have a history of receiving systemic corticosteroids and NSAIDs concurrently. This drug combination may alleviate pain, but it exposes animals to a markedly increased risk of gastrointestinal bleeding and perforation. In addition, if dogs with intervertebral disk disease are given this combination and are not rigorously cage-confined, they risk further disk herniation and paralysis.

For animals with suspected intervertebral disk herniation, a better course of action is to treat pain with NSAIDs and institute strict cage confinement. If the pain does not respond to NSAIDs, diagnostic tests to identify the cause of the pain are indicated. If the owner declines diagnostic testing, drugs that you can add to reduce pain include opioids, tramadol hydrochloride (4 to 6 mg/kg every six to 12 hours),1 or gabapentin (3 to 10 mg/kg every six to 12 hours).2 Reserve corticosteroids as drugs of last resort, and warn owners of the risks. If corticosteroids are given, NSAIDs should be stopped.

REFERENCES

1.

KuKanich B, Papich MG. Pharmacokinetics of tramadol and the metabolite O-desmethyltramadol in dogs.

J Vet Pharmacol Ther

2004;27(4):239-246.

2. Radulovic LL, Turck D, von Hodenberg A, et al. Disposition of gabapentin (neurontin) in mice, rats, dogs, and monkeys. Drug Metab Dispos 1995;23:441-448.

Elizabeth M. Hardie, DVM, DACVS

Department of Small Animal Surgery

College of Veterinary Medicine

North Carolina State University

Raleigh, NC 27606