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Introduction
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • The Science—How NSAIDs Work
  • Side Effects
    • The Digestive Tract (Stomach and Intestines)
    • Kidneys
    • Liver

FDA-Canonical NSAIDs for Pets

  • Benefits
  • A Balancing Deed—Benefits versus Risks
  • Risk Reduction

Over-the-Counter Pain Relievers for People—Are They Safe for Pets?
What Should Y'all Do?
Resource for You
For More Information
References

Your 8-year-sometime xanthous Lab Tinker Bell just came in from the backyard and you notice she'due south limping on one of her back legs. You check the medicine cabinet in your bathroom to see what medications you have that may aid her feel better. You run across bottles of aspirin, ibuprofen, naproxen, and acetaminophen—all pain relievers for people. You also have a few tablets of RIMADYL left over from when your other dog had knee surgery. Earlier reaching for any of the bottles, STOP and call your veterinarian. A hurting reliever meant for you lot or even for your other dog may not be right for Tinker Bell and may even hurt her.

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Nonsteroidal Anti-Inflammatory Drugs

With the notable exception of acetaminophen, all the medications listed in the introduction are nonsteroidal anti-inflammatory drugs, unremarkably called NSAIDs. These drugs are widely used in both people and animals for their hurting relieving, anti-inflammatory, and anti-fever backdrop. Veterinarians often prescribe NSAIDS for dogs with osteoarthritis, a condition where cartilage - the protective cloth that cushions a joint - breaks down over fourth dimension, causing the basic to rub against each other. This rubbing can permanently damage the articulation and cause pain, inflammation, and lameness. Veterinarians likewise frequently utilize NSAIDs to manage pain after surgery in both dogs and cats.

The Science—How NSAIDs Piece of work

Nonsteroidal anti-inflammatory drugs affect substances chosen prostaglandins that the trunk releases in response to irritation or injury. When a cell is damaged, an enzyme chosen cyclooxygenase (COX) is activated. An enzyme is a poly peptide made by the body that speeds up a chemic reaction. The enzyme itself remains unchanged during the reaction. Essential to all trunk functions, enzymes are very specific—each enzyme stimulates a specific reaction that causes a specific result.

In the case of the enzyme COX, information technology stimulates cells to produce several substances, including prostaglandins, after the cells are damaged. COX is nowadays in most body tissues, including the digestive tract (stomach and intestines) and kidneys.

Cell damage occurs - The enzyme COX is activated - COX stimulates the damaged cell to produce prostaglandins.

Prostaglandins are nowadays throughout the body and have several of import functions. These substances:

  • Contribute to pain, inflammation, and fever;
  • Protect the lining of the stomach and intestines;
  • Assist maintain blood catamenia to the kidneys; and
  • Support platelet function (platelets are establish in the blood of all mammals and help with blood clotting).

Many NSAIDs work past blocking COX, and then fewer prostaglandins are produced:

Schematic showing that many NSAIDs work by blocking COX: Cell damage occurs - NSAID blocks the enzyme COX - The damaged cell produces fewer prostaglandins - Pain, inflammation, and fever are reduced.

Other NSAIDs work by blocking some activeness of certain prostaglandins:

Schematic showing that other NSAIDs work by blocking some activity of certain prostaglandins: Cell damage occurs - COX is activated - Prostaglandins are produced - NSAID blocks some prostaglandin activity - Pain and inflammation are reduced

By either blocking COX or blocking some activeness of sure prostaglandins, NSAIDs reduce ongoing pain and inflammation in animals. But considering these drugs also interfere with the other positive functions of prostaglandins, they can cause side effects, some of which are serious.

Side Effects

Some of the most mutual side effects of NSAIDs in animals reported to FDA's Center for Veterinary Medicine are:

  • Airsickness;
  • Decreased to no appetite;
  • Decreased activity level; and
  • Diarrhea.

Other reported side effects in animals include tummy and intestinal ulcers, stomach and intestinal perforations (holes in the wall of the stomach or intestines), kidney failure, liver failure, and death.

The side effects of NSAIDs are mainly seen in the digestive tract, kidneys, and liver.

The Digestive Tract (Stomach and Intestines)

Nonsteroidal anti-inflammatory drugs can cause side effects in the digestive tract both directly and indirectly. The direct effects are related to the drugs' concrete properties. Many NSAIDs go trapped in the stomach and are slightly acidic, so they directly irritate the stomach lining.

The indirect furnishings are due to NSAIDs either preventing the body from making prostaglandins or blocking the protective activity of these substances. Remember, besides contributing to pain, inflammation, and fever, prostaglandins also protect the lining of the tum and intestines. When fewer prostaglandins are produced or some of their activity is blocked, the entire digestive tract may be more prone to damage. This can lead to ulcers and perforations (holes) in the tummy and intestines.

Giving an animal two NSAIDs at the same fourth dimension, or an NSAID with a steroid such as prednisone, increases the take a chance of side effects in the digestive tract and should be avoided.

Kidneys

During periods of decreased blood flow to the kidneys—such as when an creature is dehydrated, under anesthesia, or has kidney affliction—prostaglandins cause the arteries going to the kidneys to open. This helps keep blood flowing to these vital organs.

Blood flow to the kidneys is decreased - Prostaglandins are produced - Blood flow to the kidneys increases.

Because NSAIDS forestall the production of prostaglandins or cake some prostaglandin activeness, these drugs tin can reduce blood menstruum to the kidneys, possibly causing kidney harm and leading to sudden-onset kidney failure.

Blood flow to the kidneys is decreased - NSAIDs cause fewer prostaglandins to be produced or block some activity of prostaglandins - Blood flow to the kidneys does NOT increase.

NSAIDs should be used charily in animals that may already have kidney affliction or other atmospheric condition that cause reduced blood period to the kidneys, like dehydration and daze. If an NSAID is used around the time of surgery, intravenous (IV) fluids are generally recommended earlier, during, and later anesthesia to maintain blood menstruum to the kidneys, hopefully reducing potential kidney complications.

Liver

The side effects of NSAIDs on the liver can be divided into 2 categories: (1) dose-dependent toxicity; and (2) dose-independent toxicity.

Equally the proper noun implies, dose-dependent liver toxicity is related to the dose—the higher the dose of the NSAID, the worse the liver damage. Dose-dependent liver toxicity is typically caused past a massive NSAID overdose, such as a domestic dog eating an entire bottle of his possessor'due south ibuprofen. (The ASPCA Creature Toxicant Control Middle receives hundreds of calls each year involving dogs and cats that accidentally eat nonsteroidal anti-inflammatory drugs.)

Call back to keep all medications—for both people and pets—in a secure location out of achieve of children, dogs, cats, and other animals to prevent accidental ingestion or overdose.

Dose-contained liver toxicity can occur at whatever dose, even the correct one, and is an unpredictable reaction where the patient's liver has an abnormal sensitivity to the NSAID. Nigh NSAID-associated liver harm occurs inside the kickoff three weeks of starting the medication.

NSAIDs should be used cautiously in animals that may already have liver affliction.

Blood Tests are Helpful

For a dog taking an NSAID long-term for osteoarthritis, it'south expert to check his or her liver and kidney role by doing blood tests before starting the medication then repeating the claret tests on a regular basis.

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FDA-Canonical NSAIDs for Pets

FDA has approved several nonsteroidal anti-inflammatory drugs for dogs to control pain and inflammation associated with osteoarthritis; and to control pain and inflammation after soft tissue and orthopedic surgery. [Orthopedic pertains to bones and muscles; soft tissue is everything else. Repairing a canis familiaris's torn ACL (anterior cruciate ligament) in her knee is an orthopedic surgery; removing a brawl from a canis familiaris'southward breadbasket is a soft tissue surgery.]

Table 1: Some FDA-Approved Nonsteroidal Anti-Inflammatory Drugs for Dogs

Active Ingredient Brand Names
Carprofen Marketed under multiple trade names
Deracoxib DERAMAXX, DOXIDYL*
Firocoxib PREVICOX
Grapiprant GALLIPRANT
Meloxicam Marketed under multiple trade names
Robenacoxib ONSIOR (for a maximum of 3 days)

*Indicates an FDA-approved generic animal drug.

All NSAIDs for dogs are given either past mouth (oral) or by injection.

Different the other NSAIDs listed in the higher up table, ONSIOR (robenacoxib) is not approved for long-term use in dogs with osteoarthritis. It should only be used for a maximum of iii days to control pain and inflammation after soft tissue surgery.

But two NSAIDs are FDA-canonical for cats: meloxicam (sold nether several make names) and robenacoxib (sold under the brand name ONSIOR).

Meloxicam is approved for cats equally a i-time-only injection to control pain and inflammation afterwards spaying, neutering, and orthopedic surgery; the injection is given under the cat'due south skin earlier surgery.

Robenacoxib is also approved for cats to control pain and inflammation after spaying, neutering, and orthopedic surgery. The drug should exist used once daily for no more than than three days and is available as either a tablet given by mouth or an injection given under the true cat's pare.

Currently, no NSAIDs are canonical for long-term use in cats. More one dose of meloxicam in cats tin cause kidney failure or death, and the effects of long-term use of other NSAIDs in cats are unknown. Cats are more sensitive than dogs to the side furnishings of NSAIDs because they tin can't break down the drugs also.

All FDA-approved NSAIDs for dogs and cats are by a veterinarian'due south prescription just.

Benefits

A main benefit of an FDA-approved nonsteroidal anti-inflammatory drug for dogs or cats is that it has been shown to be prophylactic and effective in that species when used co-ordinate to the characterization. Pain relievers for people don't accept the same assurances of safety and effectiveness in pets and could be harmful.

A second main do good is that the label for an FDA-approved NSAID for dogs or cats is written specifically for that species. The characterization includes all the information veterinarians demand to utilise the drug safely and effectively in that species.

A Balancing Human action—Benefits versus Risks

FDA-approved nonsteroidal anti-inflammatory drugs offer pain relief for many dogs with osteoarthritis. These drugs too help veterinarians effectively manage pain after surgery in both dogs and cats. However, at that place are risks.

NSAIDs business relationship for a large number of animal drug side effects reported to FDA'south Center for Veterinary Medicine. If you consider the two about mutual groups of pets that receive NSAIDs, you lot tin come across why there are so many reported side effects:

  • Dogs with osteoarthritis. These dogs are usually older and often have some other affliction in addition to osteoarthritis, such as kidney or liver disease.
  • Surgery patients. These dogs and cats were recently nether anesthesia which reduces blood flow to the kidneys.

Chance Reduction

All drugs can crusade side furnishings. FDA'due south Center for Veterinarian Medicine tries to reduce the risks of side effects associated with NSAIDs by working with drug companies to write clear, thorough drug labels for veterinarians and Client Data Sheets for owners.

Every oral NSAID approved for dogs and cats has an accompanying Customer Information Canvass for veterinarians to give owners thestart time the prescription is filled and each time it'south refilled. This sheet summarizes important safety information about the drug and serves as an easy reference for yous at home.

The label of every approved injectable NSAID for pets has a section called "Information for Dog Owners" or "Data for Cat Owners." Earlier using the drug in your pet, your veterinarian should hash out the data in this department with you lot.

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Over-the-Counter Pain Relievers for People—Are They Prophylactic for Pets?

Dogs are Non Small-scale People.

Tinker Bell's possessor isn't lone. When owners come across their dog or cat limping or showing other signs of hurting, they ofttimes think about giving their pet an over-the-counter pain reliever for people. But fifty-fifty if data show an NSAID is safe and effective in people, the drug may not be safe and effective in dogs because the drug may:

  • Last longer;
  • Exist absorbed faster by the tum and intestines; and
  • Accomplish higher blood levels.

Cats are Not Small People or Modest Dogs.

You take to be fifty-fifty more careful with cats. Compared to other species, cats have a reduced ability to pause down NSAIDs.

These differences may pb to toxic effects in pets, such as ulcers and perforations (holes) in the digestive tract as well every bit liver and kidney damage.

Table 2: Mutual Over-the-Counter Pain Relievers for People

Active Ingredient Some Common Brand Names
Aspirin ASCRIPTIN, BAYER, BUFFERIN, ECOTRIN
Ibuprofen ADVIL, MOTRIN
Naproxen sodium ALEVE, MIDOL EXTENDED RELIEF, NAPROSYN
Acetaminophen (non an NSAID) TYLENOL

Acetaminophen is not a nonsteroidal anti-inflammatory drug and doesn't take much anti-inflammatory activity. Scientists don't fully sympathise how acetaminophen works. The drug seems to have more than than 1 way of action to reduce fever and relieve pain.

Acetaminophen has 2 main forms of toxicity:

  • Dose-dependent liver toxicity—meaning the college the dose, the worse the liver damage—that may lead to liver failure; and
  • Cherry blood jail cell damage that causes these cells to lose their ability to deport oxygen.

Dogs and cats can develop both forms of acetaminophen toxicity, but cats are more than prone to blood-red claret cell damage while dogs are more likely to become liver impairment.

Acetaminophen is fatal to cats. Cats should never be given acetaminophen considering they lack sure enzymes that the liver needs to safely interruption down the drug.

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What Should You Practice?

  • Before giving any NSAID to your dog or true cat, talk with your veterinarian. Tell him or her if your pet:
    • Has a history of digestive issues, such as stomach or intestinal ulcers, or has had surgery on the tummy or intestines. Even if your pet hasn't had any digestive problems in the past, that doesn't mean he or she has a healthy digestive tract. Dogs and cats tin can have stomach and intestinal ulcers without showing signs.
    • Is on whatsoever other medication. It'southward non recommended to give two dissimilar NSAIDs, or an NSAID and a steroid, at the same fourth dimension.
  • During and afterward NSAID therapy, monitor your pet for side effects, such as airsickness, diarrhea, bloody or tar-colored stool, decreased appetite, decreased activity level, yellowing of the whites of the eyes, and yellowing of the gums. These signs can occur even in a previously healthy pet. If you notice any side effects, stop giving the drug and call your veterinarian.
  • If your pet experiences side effects from an NSAID, FDA'due south Center for Veterinary Medicine encourages you to work with your veterinarian to report the problem.
  • Before starting your domestic dog on an NSAID long-term for osteoarthritis, ask your veterinarian virtually performing baseline blood tests. Talk to your veterinarian about how frequently to recheck your dog'due south claret tests.
  • No NSAID is currently FDA-approved for long-term utilise in cats.
  • Going dorsum to Tinker Bell, you shouldn't give her annihilation in your medicine chiffonier until you talk to your veterinary.

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Resources for You

  • Veterinary Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Treating Pain in Your Dog – Keeping Your Best Friend Active, Rubber, And Pain Free
  • NSAID Labels - Currently Canonical Labels for Companion Animal Not-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Medications for your Pet…Questions for Your Vet
  • Hurting Medicines for Pets: Know the Risks

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For More Information

Contact FDA'southward Middle for Veterinary Medicine at either AskCVM@fda.hhs.gov or 240-402-7002.

References

  • Khan SA, McLean MK. Toxicology of ofttimes encountered nonsteroidal anti-inflammatory drugs in dogs and cats. Vet Clin North Am Small Anim Pract 2012;42:289-306.
  • KuKanich B, Bidgood T, Knesl O. Clinical pharmacology of nonsteroidal anti-inflammatory drugs in dogs. Vet Anaesth and Analg 2012;39:69-90.
  • Lascelles BD, McFarland JM, Swann H. Guidelines for rubber and constructive utilise of NSAIDs in dogs. Vet Ther 2005;6:237-251.
  • Meadows I, Gwaltney-Brant S. The 10 most common toxicoses in dogs. Vet Med 2006;101:142-148.
  • Plunkett SJ. Emergency Procedures for the Small Fauna Veterinary. 2nd ed. London: WB Saunders, 2001.

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