Drugs - Part 1: Anti-inflammatory

There is no substitute for good veterinary care.
This information is for educational purposes only and should NOT be used in place of consultation with your veterinarian.

Note: We know this may seem very technical! We have tried to simplify the information while still presenting you with the words that your vet may use. 

Intervertebral disc episodes are usually very painful. Signs that your dog may be in pain can be a tight tummy, shivering or shaking, and not wanting to move, lift its head up, go up steps, or go for a walk. Your dog may even cry out or whimper. Dogs are naturally very stoic and will only show pain when they can’t hide it anymore. Usually by the time we become aware they are in pain, the pain is very severe. Severe pain is one of the symptoms that distinguishes a disc episode from other neurological or orthopedic problems that may mimic IVDD. 

What causes the pain?

Spinal cord compression from the bulging or ruptured disc causes trauma resulting in inflammation and pain. The focus of medical management is to relieve the inflammation and control the pain. 

Before starting anti-inflammatories, It is highly recommended to have blood tests to check for pancreas, liver, and kidney function as any existing problem can impact the vet’s decision on which drug to prescribe.

Drugs used to resolve inflammation

There are two types of anti-inflammatories that are often used to resolve the inflammation: glucocorticoids (commonly known as steroids like Prednisone) or non-steroidal anti-inflammatory drugs (NSAIDs such as Rimadyl and Metacam). These steroids are not the steroids that we hear about athletes taking to improve their performance. They are very different as they act like the cortisol that the body makes. 

Steroids and NSAIDs should never be given together or within a short timeframe of each other. Normally one drug is stopped and none given for 4 to 7 days before starting the other. The FDA writes in their paper titled “Treating Pain in Your Dog”: “Never give aspirin or corticosteroids along with an NSAID to your dog.”

http://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm196295.htm

Aspirin is no longer recommended by many vets because it has a higher risk of causing stomach irritation or ulcers and it will make it risky to start any other anti-inflammatory medication without risking stomach/intestinal ulcers.

Steroids, as a drug, are used to fight inflammation and suppress the immune system. Steroids are a much stronger anti-inflammatory than NSAIDs. They should not be stopped suddenly but gradually tapered and then terminated in order to allow the body to restart making its own cortisol which it stopped doing while on steroids. Stopping cold turkey can cause life-threatening complications. Use of steroids may not be advisable to give your dog if your dog has certain medical conditions such as diabetes, Cushing’s disease, liver or kidney disease, pancreatitis, congestive heart failure, glaucoma, and pregnancy. 

Prednisone/Prednisolone: Lower in strength of the steroids. Prednisolone is the precursor to Prednisone so it is already in the form that the body can use and is therefore not as hard on the liver. Prednisone has to be converted to Prednisolone in the liver. As a result, Prednisolone is more readily absorbed by the body and has a slightly better anti-inflammatory effect although not all that significant.

Dexamethasone: One of the highest strengths of steroids.

Possible Side Effects (partial list)

The likelihood of side effects increases with the dosage and strength of the steroid. Keep in mind though, that each dog is different and how their body is affected by medications can also be very different. 

• Most commonly, your dog may

• Be thirstier

• Need to urinate more often

• Be hungrier (please don’t increase food to avoid gaining weight)

• Pant

• Have loose stools, diarrhea or blood in stools

• Vomit

      The risk of these possible side effects increases with longer use of steroids and/or higher doses.

• Dull, dry coat, hair loss

• Depression/behavioral changes including aggression

• Urinary or upper respiratory infections

• Muscle Wasting

• Diabetes

• Pancreatitis

• Cushing’s disease

To learn more about NSAIDs and their possible side effects, please read the following article:

https://www.yumpu.com/en/document/view/13379163/nsaids-and-beyond-hillsvet

Using steroids to treat IVDD is controversial in the vet arena. Some vets use them and some don’t. The debate is based on the lack of studies proving their benefit and the long-term possible side effects. Despite that, many vets do prescribe them and consider them very effective. In the IVDD article on The Animal Medical Center of Southern California’s website, the author wrote: “While some may consider corticosteroid therapy controversial in treating intervertebral disk disease, my personal opinion, based on over 20 years of experience as a board certified surgeon, is to give steroids. Used intelligently and judiciously, my experience is that steroids have absolutely had a positive effect on a substantial number of our spinal patients.”

http://www.animalmedcenter.com/intervertebral-disc-disease/

Interested in reading more?

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/steroid-treatment-long-term-effects-in-dogs/951

http://www.wedgewoodpetrx.com/learning-center/medication-information-for-pet-and-horse-owners/prednisolone-and-prednisone-for-dogs-and-cats.html

http://www.merckmanuals.com/vet/pharmacology/anti-inflammatory_agents/corticosteroids.html?qt=steroids&alt=sh

http://www.vetinfo.com/how-to-taper-off-prednisone-dog-dosage.html

Non-steroidal Anti-inflammatory Drugs (NSAIDs) are drugs that block the body’s response to inflammation. Aspirin is an NSAID and so are Rimadyl (carprofen), Metacam, Deramaxx, and Previcox. They are often prescribed for inflammation and pain. Two NSAIDs should never be given together and an NSAID should never be given with a steroid. Aspirin is no longer considered the safest NSAID to give because dogs are very sensitive to stomach irritation which aspirin can cause quickly. Plus aspirin toxicity occurs at relatively low doses (a regular 320mg aspirin is considered toxic for a 10-pound dog).

Any NSAID can bring the potential for serious side effects and here are some of the symptoms you need to watch for:

• Decrease or increase in appetite

• Vomiting

• Change in bowel movements (such as diarrhea, or black, tarry, or bloody stools)

• Change in behavior (such as decreased or increased activity level, incoordination, seizure or aggression)

• Yellowing of gums, skin, or whites of the eyes (jaundice)

• Change in drinking habits (frequency, amount consumed)

• Change in urination habits (frequency, color, or smell)

• Change in skin (redness, scabs, or scratching)

If you notice any of these possible side effects, stop the medication and contact your veterinarian.

Interested in learning more?

http://www.veterinarypartner.com/Content.plx?P=A&A=2538

http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm055434.htm

http://www.merckmanuals.com/vet/pharmacology/anti-inflammatory_agents/nonsteroidal_anti-inflammatory_drugs.html

http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/700256

Preventing Stomach Irritation/Ulceration

Perhaps stress alone from having an IVDD disc episode makes it more likely for a dog to have stomach irritation. Add in steroids or NSAIDs, and the risk is even higher. Dr Curtis W. Dewey, DVM, ACVIM Neurology Cornell University wrote in “A Practical Guide to Canine and Feline Neurology 2nd edition: “It is important to realize that subclinical gastroduodenal ulceration is likely to be present in dogs with type 1 disk extrusions, even without the administration of potential ulcerogenic drugs (e.g., NSAIDs, glucocorticoids), so the use of such drugs should be minimized if at all possible.”

The Animal Medical Center of Southern California includes gastrointestinal protectants in their medical management of IVDD: “Proper medical therapy for the IVDD patient includes cage rest, non-steroidal anti-inflammatory therapy (deramax, metacam, rimadyl), (OR) corticosteroid therapy (dexamethasone sodium phosphate, solumedrol, prednisolone), muscle relaxants (robaxin), pain management (fentanyl patches, oxymorphone, buprenex, gabapentin, tramadol), and gastrointestinal protectants (famotidine, zantac, pepcid, tagamet).

http://www.animalmedcenter.com/intervertebral-disc-disease

Many vets prescribe Pepcid AC (famotidine) which is an acid reducer when prescribing either steroids or NSAIDs. Famotidine can be purchased inexpensively at Wal-Mart or other discount stores in addition to your local pharmacy. Other acid reducers are Tagamet (cimetidine), Zantac (ranitidine), and Prilosec (omeprazole) but are not prescribed as frequently as Pepcid AC. Please ask your vet for the proper dosages and how many times a day to give an acid reducer.

Acid reducers work best if given on an empty stomach. Giving it 30 minutes before a meal and then giving the medications immediately following the meal may provide the best stomach protection.

Famotidine is not available over the counter in the United Kingdom, but it is in Canada. Ranitidine is available over the counter in the United Kingdom.

An acid reducer such as famotidine is sometimes not enough to prevent stomach/intestinal problems and the dog may develop loose stools, diarrhea, and even blood in the stool/diarrhea. Sucralfate is very effective in preventing and helping treat stomach and intestinal irritation or ulceration. Sucralfate actually coats the stomach and upper intestines to help heal the irritation. It requires a prescription but is available at local pharmacies as it is a human drug.

Read more:

Pain Killers

IVDD Bladder Drugs

Here is a chart to track the drugs you are scheduling for your dog: