Practical Matters: Prudent NSAID use helps prevent adverse effects

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics but, in rare cases, can cause serious side effects including gastrointestinal ulceration, renal failure, platelet dysfunction, and hepatotoxicosis.1-3 Newer-generation NSAIDs approved for use in dogs and cats are selective or preferential cyclooxygenase or cyclooxygenase and lipoxygenase inhibitors. They have a reported risk of side effects that are generally dose-related. However, adverse effects may be unpredictable. Clinical experience has demonstrated that a single dose of an NSAID in a stable cat undergoing anesthesia for an ovariohysterectomy can result in renal failure.

Conditions that exacerbate NSAID toxicity include hypotension, hypovolemia, dehydration, and preexisting organ disease. A thorough physical examination, a detailed patient history, and baseline laboratory values may help you identify whether a patient is at risk. Avoid NSAIDs in patients with preexisting renal or hepatic disease, gastrointestinal disease, pregnancy, a low volume state (e.g. cardiovascular disease), or a coagulopathy. In addition, avoid NSAIDs in patients undergoing anesthesia in which hypotension is a risk. Do not administer NSAIDs to patients receiving corticosteroids, other NSAIDs, some herbs such as Boswellia and Ginkgo species, or aspirin.When NSAIDs are used in patients for more than a few days or in patients at risk-such as cats, cats or dogs recovering from a traumatic event, and cats or dogs that have previously received corticosteroids or NSAIDs-inform pet owners of the potential side effects. Vomiting or diarrhea or any change in attitude, behavior, or appetite should prompt owners to discontinue the medication and contact you immediately. Periodic reexamination and laboratory monitoring may identify early signs of NSAID toxicosis and reduce the incidence of illness.

Elke Rudloff, DVM, DACVECC

Editors’ note: For a client handout on using NSAIDs safely in pets, go towww.fda.gov/cvm/Documents/NSAIDBrochure.pdf

REFERENCES

1. Enberg T, Braun L, Kuzma A. Gastrointestinal perforation in five dogs associated with the administration of meloxicam. J Vet Emerg Crit Care 2006;16(1):34–43.

2. Mathews KA. Nonsteroidal anti-inflammatory analgesics. Indications and contraindications for pain management in dogs and cats. Vet Clin North Am Small Anim Pract 2000;30(4):783-804.

3. Mathews K. Non-steroidal anti-inflammatory analgesics: a review of current practice. J Vet Emerg Crit Care 2002;12(2):89.

SUGGESTED READING

1. Carroll GL, Simonson SM. Recent developments in nonsteroidal antiinflammatory drugs in cats. J Am Anim Hosp Assoc 2005;41(6):347-354.

2. Curry SL, Cogar SM, Cook JL. Nonsteroidal antiinflammatory drugs: a review. J Am Anim Hosp Assoc 2005;41(5):298-309.

Elke Rudloff, DVM, DACVECC

Animal Emgeracy Center and Specialty Services

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