The Compendium October 1996 Small Animal

THERAPEUTICS IN PRACTICE V

Nonsteroidal Antiinflammatory Analgesics

to Manage Acute Pain in Dogs and Cats
Karol A. Mathews, DVM, DVSc
Diplomate, ACVECC
Veterinary Teaching Hospital
Ontario Veterinary College
University of Guelph
Guelph, Ontario
Divine is the work to subdue
pain.
—Hippocrates
practice and in the research and
veterinary teaching environ-
ment, where control of nar-
cotics is a major issue. A risk of
severe gastrointestinal and re-
nal problems has been associ-
ated with NSAIAs; however, not
all NSAIAs are created equal in
this regard.
Cats and dogs are more sus-
ceptible than humans to the ad-
gistic with other analgesic drugs
(opioids) or modalities (local, re-
gional, and epidural analgesia).
The new injectable NSAIAs
discussed here (Table One) are
good to excellent for alleviation
of postoperative pain (especially
orthopedic), and in some cases
are superior to opioids. Typical-
ly, NSAIAs take 45 to 60 min-
utes to take effect. Therefore,
United States. These agents can
be used in selected cats and
dogs for management of mod-
erate to severe acute pain (sur-
gical, traumatic, neoplastic, or
inflammatory). The indications
and contraindications for using
NSAIAs are stressed; patient
selection and ulcer prophylaxis
are also discussed. The NSAIAs
that are currently recommend-

D
uring the past decade,
the medical impor-
tance of pain manage-
ment has been realized, and
various therapeutic agents and
methods have been researched
and reported. Nonsteroidal
antiinflammatory analgesics
(NSAIAs) are among the most
widely used drugs in human
medicine. They have been used
verse effects of NSAIAs; there-
fore, an analgesic reported to
be safe for human patients
should not be assumed to be
safe for veterinary patients. Vet-
erinarians therefore must be fa-
miliar with NSAIAs and the po-
tential each has for unwanted
side effects.
Pain is caused by many dif-
ferent factors; veterinarians
postoperative analgesia should ed for long-term use and have
include an opioid to alleviate been used in veterinary patients
pain until the NSAIA becomes for some time (phenylbutazone,
effective. Other indications for aspirin, acetaminophen, and
their use have also been cited. meclofenamic acid) are dis-
Some of these drugs carry a cussed elsewhere. 3 A visual
high risk for gastric ulceration analogue scale with descriptors
■ New nonsteroidal antiinflammatory analgesics
are becoming available to manage acute pain in
KEY POINTS

for centuries for management
of chronic pain but have been
inadequate for the treatment of
moderate to severe acute pain.
With the recent advent of po-
tent injectable and oral formula-
tions of new drugs, the poten-
tial for NSAIAs to control
moderate to severe acute pain
has been realized.
The new NSAIAs compare
favorably with and sometimes
are superior to opioids in hu-
mans and animals. Thus, they
have contributed significantly to
pain management in veterinary
must therefore consider the ap-
propriate analgesic agent and
dose for various types of pain.
Because of the many mediators
and modes of sensory input in-
volved in nociceptive transmis-
sion, pain control is more suc-
cessfully managed when more
than one modality of treatment
is used. The excellent analgesic
properties of opioids and the ef-
fects of local, regional, and
epidural analgesia should be
considered for all surgical pa-
tients.1,2 NSAIAs can be used
alone, but they are also syner-
dogs and cats.
■ Cats and dogs are more susceptible than hu-
mans are to the side effects of these agents.
■ The most significant side effects are gastroin-
testinal ulceration, renal problems, and bleed-
ing.
and nephrotoxicity, so the con- to assist in the assessment of
traindications and benefits ver- animal pain has also been pub-
sus risks should be considered. lished.3
This column presents infor-
mation on currently available Mechanism of Action
parenteral and oral NSAIAs as Nonsteroidal antiinflam-
well as those that will be avail- matory analgesics are, with var-
able soon in Canada and the ious differences, inhibitors of

SERIES Susan E. Johnson, DVM, MS

EDITOR The Ohio State University
Small Animal The Compendium October 1996

TABLE ONE
New Nonsteroidal Antiinflammatory Analgesics
Drug Indication Species, Dose, and Route a Dose Frequency

Ketoprofen Surgical pain Dogs: 2.0 mg/kg IV, SC, IM Initially

Cats: 2.0 mg/kg SC

Dogs and cats: 1.0 mg/kg Subsequent daily doses

Chronic pain Dogs and cats: 2.0 mg/kg PO Initially

Dogs and cats: 1.0 mg/kg Subsequent daily doses

Flunixin meglumine Surgical pain Dogs: 1.0 mg/kg IV, SC, IM Daily

Cats: 0.25 mg/kg SC One dose, can be

repeated in 12 to 24
hours if needed

Pyrexia Dogs and cats: 0.25 mg/kg One dose, can be

IV, SC, IM repeated in 12 to 24
hours if needed

Ophthalmologic procedures Dogs: 0.25–1.0 mg/kg One dose, can be

IV, SC, IM repeated in 12 to 24
hours if needed

Carprofen Surgical pain Dogs: 4.0 mg/kg IV, Initially

SC, IM

Cats: 4 mg/kg SC Repeat in 12 hours if

Dogs only: 2.2 mg/kg PO, needed
IV, SC, IM

Chronic pain Dogs only: 2.2 mg/kg PO Every 12 hours

Ketorolac Surgical pain Dogs: 0.3–0.5 mg/kg IV, IM Every 8 to 12 hours for 1
to 2 treatments

Cats: 0.25 mg/kg IM Every 8 to 12 hours for 1

to 2 treatments

Panosteitis Dogs >30 kg: 10 mg PO Every 12 hours for 6

treatments
Dogs 20–30 kg: 5 mg PO Every 12 hours for 6
treatments

Piroxicam Inflammation of the Dogs: 0.3 mg/kg PO Daily for 2 treatments,

lower urinary tract then every 48 hours
a
IV = intravenously, SC = subcutaneously, IM = intramuscularly, PO = orally.

cyclooxygenase (prostaglandin
synthetase), which is the en-
zyme that ultimately converts
arachidonic acid into pros-
tanoids (thromboxanes, prosta-
cyclin [PGI2], and prostaglan-
dins [PGE2, PGF2, and PGD2]).
These compounds mediate in-
flammation and amplify noci-
ceptive input and transmission
to the spinal cord via sensory
afferents in peripheral nerves.4
Prostaglandins also exert a
powerful effect on spinal noci-
ceptive processing by facilitat-
ing the firing of central neurons
and augmenting neurotransmit-
ter release from primary spinal
sensory afferents.5
Some NSAIAs inhibit both
The Compendium October 1996
cyclooxygenase and lipoxyge-
nase activity. 6 Lipoxygenase
also uses arachidonic acid as a
substrate to produce the leuko-
triene group of inflammatory
mediators. NSAIAs that inhibit
cyclooxygenase divert arachi-
donate to the 5-lipoxygenase
pathway. This creates an exces-
sive production of leukotrienes.
Leukotrienes have been impli-
cated in the creation of NSAIA-
induced ulcers. Pretreatment
with a 5-lipoxygenase inhibitor
prior to administration of in-
domethacin or aspirin has de-
creased the formation of gastric
ulcers.7
There are two isoforms of
cyclooxygenase. Cyclooxyge-
nase 1 (the constitutive or non-
regulated form) maintains
physiologic functions (e.g.,
modulation of renal blood flow
and the synthesis of gastric
mucus) via prostaglandin syn-
thesis. Cyclooxygenase 2 (the
cytokine-induced form) is acti-
vated in damaged or inflamed
tissue and leads to production
of prostaglandins, including
PGE2. Cyclooxygenase 2 is im-
plicated in the hyperalgesia and
pain response experienced af-
ter injury.
Several NSAIAs that have
more than a 1000-fold specifici-
ty for cyclooxygenase 2 over
cyclooxygenase 1 are in the
early stages of drug develop-
ment.8 If these NSAIAs prove to
be as effective in pain control as
the more recently developed
NSAIAs but without the associ-
ated nephrotoxicity and ulcero-
genicity, they will revolutionize
pain management. Currently
available NSAIAs vary in their
inhibition of cyclooxygenase 1
and 2; therefore, their potency
and toxicity will differ.
Because of their high pro-
tein binding, NSAIAs can dis-
place other drugs from their
plasma protein binding sites,
inhibit their metabolism, and
interfere with their renal excre-
tion. Drug interactions must
therefore be considered, espe-
cially if patients have even mild
or potential organ dysfunction
or are receiving medication
with a narrow therapeutic in-
dex.9
Veterinary Use
Flunixin meglumine
Flunixin meglumine is avail-
able as a solution for injection.
It is approved for use in dogs in
Europe. I have also used it in
cats (one intramuscular dose of
0.25 mg/kg). The terminal half-
life in dogs is 4 hours and in
cats is 3 hours. It is reported to
be a good analgesic for acute
and surgical pain.10,11 Flunixin
meglumine also has demon-
strated efficacy in treatment of
canine septic peritonitis.12
The potential for side effects
(e.g., increased alanine amino-
transferase production11, neph-
rotoxicity,11,13,14 and gastric ul-
ceration15) is of major concern.
Flunixin meglumine may also
cause blood to ooze from inci-
sions. On rare occasions be-
fore ketorolac or ketoprofen
became available, I used flunix-
in meglumine for analgesia and
as an antipyretic in cats and
dogs, especially when a septic
dog’s temperature was rising
quickly. Such patients receive
intravenous fluids, and ulcer
prophylaxis is used. In that set-
ting, the benefit outweighs the
risk.
Flunixin meglumine has been
used as an antiinflammatory in
ophthalmology cases and to
help prevent sepsis in selected
surgical candidates. It is ap-
proved for use in horses in
North America.
Carprofen
Carprofen is available as a
solution for injection, in rectal
suppositories, as a paste, and
in tablets. Carprofen is ap-
proved for use in cats and dogs
in Europe. It is recommended
parenterally before and after
surgery and orally for chronic
pain. The mean terminal half-
life in dogs is 8 hours (3.2 to
11.77 hours). Although carpro-
fen is classified as an NSAIA, its
administration to beagles did
not inhibit synthesis of PGE2,
12-hydroxyeicosatetraenoic
acid (12-HETE), or thrombox-
ane B2 in a study of subcuta-
neous tissue cage fluids.16 Evi-
dently, carprofen’s principal
mode of action is by mecha-
nisms other than cyclooxyge-
nase or 12-lipoxygenase inhibi-
tion.
Carprofen is reportedly a
good analgesic for orthopedic
and soft tissue postoperative
pain; it can be effective for up to
18 hours.17,18 It is also reportedly
good for pain associated with
degenerative joint disease.19 I
have used it in a group of dogs
undergoing total hip arthroplas-
ty. Carprofen compared favor-
ably with oxymorphone and pro-
duced no apparent side effects.
So far, no nephrotoxicity,
gastrointestinal bleeding, or
hemostatic deficiencies have
been associated with carprofen,
thus suggesting that constitu-
tive cyclooxygenase 1 function
remains intact. This drug may
be available for use in small ani-
mals in the United States in the
autumn of 1996 and in Canada
in 1997.
Ketoprofen
Ketoprofen is available as a
solution for injection and in
tablets. It is recommended for
postoperative and chronic pain
Small Animal
in dogs and cats. The terminal
half-life in cats and dogs is 2 to
3 hours. Ketoprofen is used ex-
tensively in Europe. Ketoprofen
can be used for several months
for chronic pain in dogs and
cats.20 Ketoprofen is a powerful
inhibitor of cyclooxygenase and
has significant inhibitory effects
on the lipoxygenase pathway.6
Ketoprofen has recently been
approved for use in cats and
dogs in Canada.
Several controlled studies of
pain management involving
clinical cases or research ani-
mals are awaiting publication.
Ongoing studies in Canadaa in-
dicate that ketoprofen is effec-
tive in managing pain in dogs
after orthopedic procedures. I
have found that ketoprofen pro-
vides good analgesia after la-
parotomy in dogs. Serum urea,
creatinine, and alanine amino-
transferase were unchanged at
24 and 48 hours after adminis-
tration.
Hemostasis studies involving
presurgical administration of
ketoprofen are ongoing. Keto-
profen may be inadvisable be-
fore surgical procedures in
which noncompressible hemor-
rhage may be a problem (e.g.,
laparotomy, laminectomy, he-
mangiopericytoma, rhinotomy).
Selected patients undergoing
orthopedic procedures (e.g., in
cases of osteochondritis disse-
cans or repair of fractures or
ruptured cranial cruciate liga-
ment) appear to benefit from
preemptive administration. a
However, it is advisable to re-
strict preemptive use to areas
where a compressible bandage
can be applied.
Ketoprofen (2 mg/kg initially
then 1 mg/kg daily for 7 to 14
a
Pibarot P: Personal communica-
tion, University of Montreal, Mon-
treal, Quebec.
Small Animal
days) has been used as an
analgesic for severe hyper-
trophic osteodystrophy and
panosteitis in dogs.21 In addi-
tion, misoprostol and (where
indicated) sucralfate were also
administered for ulcer prophy-
laxis in these depressed, pyretic
dogs.
Ketoprofen is a good an-
tipyretic in cats.22 Vomiting oc-
casionally results. Ketoprofen is
used extensively for osteo-
arthritic pain in humans and
has a good safety record.
Dipyrone
Dipyrone is available as a so-
lution for injection and in
tablets (325 mg). It is approved
for use in cats and dogs in Eu-
rope and Canada. Dipyrone
should be given intravenously
to avoid the irritation experi-
enced when it is given intra-
muscularly. I have found that
the analgesia produced is inad-
equate for moderate to severe
postoperative pain. I reserve
this agent for use as an an-
tipyretic when other NSAIAs are
contraindicated (see Contraindi-
cations). Nephrotoxicity and
gastrointestinal ulceration are
not a major concern in the
short term.
Extralabel Use
Ketorolac
Available as a solution for in-
jection and in tablet form, ke-
torolac is used in human pa-
tients for moderate to severe
pain.23 It is comparable with
morphine in efficacy. The dura-
tion of effect, depending on the
individual patient and the de-
gree of pain, is approximately 8
to 12 hours. Pharmacokinetic
studies recently performed at
the Ontario Veterinary College
revealed interpatient variability
with a terminal half-life of 6.5 ±
The Compendium October 1996
given for 7 days for ulcer pro-
phylaxis. If patients had re-
ABSOLUTE CONTRAINDICATIONS ceived corticosteroids or other
FOR NONSTEROIDAL ANTIINFLAMMATORY NSAIAs, sucralfate was pre-
ANALGESICS (NSAIAs) scribed for 10 days and ketoro-
lac therapy delayed for 4 days.
■ Renal insufficiency (creatinine level above the
Ketorolac should not be giv-
median for the laboratory after rehydration)
en for longer than 3 days. Dur-
■ Dehydration ing a 2-year period at the On-
■ Hypotension tario Veterinary College, 275
■ Conditions associated with low “effective patients received ketorolac.
circulating volume” (e.g., congestive heart failure, There was one incident of re-
ascites, diuretic therapy) versible renal insufficiency
and one case of gastric hemor-
■ Thrombocytopenia
rhage. The gastric hemorrhage
■ Von Willebrand’s disease occurred after 4 days in a
■ Concurrent use of other NSAIAs (e.g., aspirin) or severely traumatized dog that
corticosteroids was receiving misoprostol. The
■ Evidence of gastric ulceration (vomiting with or dog recovered after oral admin-
without the presence of “coffee ground material,” istration of sucralfate and trans-
melena) fusion of whole blood.
■ Gastrointestinal disorders of any kind
Piroxicam
■ Intervertebral disk disease (laminectomy causes
Piroxicam is available in cap-
bleeding in a noncompressible area, and the
sules of 10 and 20 mg. It is
patients usually receive corticosteroids)
used in human medicine for
■ Liver disease musculoskeletal pain. Its most
valuable use in dogs is the anti-
inflammatory effect on the low-
er urinary tract in patients with
5 hours.24 Ketorolac can cause stomach because undetectable, transitional cell carcinoma or
gastric ulceration and renal in- preexisting gastric erosions cystitis and urethritis. These pa-
sufficiency in geriatric, hypoten- may have occurred secondary tients frequently exhibit acute,
sive, and hypovolemic human to the traumatic incident. Ke- moderate to severe discomfort.
and veterinary patients. torolac should only be used for Dogs (male or female) with
We have used this analgesic one or two treatments in ill pa- strangury due to reflex dyssyn-
for postoperative pain at the tients (i.e., after surgery or in ergia associated with cystitis
Ontario Veterinary College for 4 cases of mastitis). and urethritis have experienced
years. It is an excellent anal- Ketoprofen (2.0 mg/kg) has relief after administration of ap-
gesic for cats and dogs. It is comparable duration and effica- propriate antibiotic therapy,
used when opioid analgesics cy to ketorolac (0.3 mg/kg) in piroxicam, and phenoxybenza-
fail to relieve postoperative pain managing postlaparotomy pain mine. Piroxicam has relieved
adequately, especially orthope- in dogs. Before ketoprofen be- strangury associated with tran-
dic pain. It has proven to be came available, ketorolac was sitional cell carcinoma of the
safer than flunixin meglumine.11 used successfully for treatment bladder and urethra.25
Ketorolac has strong poten- of severe panosteitis in dogs Misoprostol is recommend-
tial for causing gastric ulcera- when all other therapies had ed for patients receiving pir-
tion, but it may be used where failed. I have found that ketoro- oxicam. Clients should be
the benefit outweighs the risk in lac given with food for 3 days instructed to monitor the ani-
a suitable candidate (see Indi- cured approximately 99% of mal’s stool for melena or blood
cations and Relative Contraindi- these dogs; signs recurred and watch the animals for
cations). Sucralfate should be within a few days to months in polyuria and polydipsia. Be-
given to protect the patient’s the other 1%. Misoprostol was cause of its side effects, piroxi-
The Compendium October 1996
TABLE TWO
Ulcer Prophylaxis or Treatmenta
Drug
Sucralfate
Misoprostol
Ranitidine
Omeprazole
a
From Mathews KA: Special report on non-steroidal anti-inflammatory analgesics for pain management in cats and dogs. Can Vet J
37(9):539–545, 1996. Reproduced with permission.
b
IV = intravenously, SC = subcutaneously, IM = intramuscularly, PO = orally
cam is not recommended for
musculoskeletal pain because
other, less toxic NSAIAs are
equally effective.
Indications
The best indication for NSAIA
use is postoperative orthopedic
pain in a well-hydrated, nor-
motensive patient that received
intravenous fluids during sur-
gery. The patient should be a
young to middle-aged dog or
cat with normal renal function
and no hemostatic abnormali-
ties. There should be no evi-
dence of or other predisposition
to gastric ulceration, and the
patient should not be receiving
corticosteroids or aspirin (see
Contraindications).
Indication
Gastric ulcer
prophylaxis; treatment
of gastric or esophageal
erosion
Hemorrhaging ulcer
Ulcer prophylaxis
Treatment of gastric
ulcer or erosion
Gastric ulcer or erosion;
lower esophageal ulcer
or erosion
At the Ontario Veterinary Col-
lege, we prefer to give opioids
immediately after soft tissue or
orthopedic surgery; however,
carprofen, ketoprofen, or ketoro-
lac can be given initially or later
on if opioids prove inadequate in
terms of efficacy or duration of
action. Carprofen can be given
before surgery, as demonstrated
by previous clinical use.10,16
For pain due to meningitis,
bone tumors (especially after
biopsy), soft tissue swelling
(mastitis), or injury (degloving),
ketorolac seems to be more ef-
fective than opioids. Because
patients with these conditions
may be more sensitive to
NSAIA toxicity, the ketorolac
should only be given once or
Species, Dose, and Routeb
Dogs: 0.5–1.0 g PO
Cats: 0.25 g PO
Dogs: 1–2 g PO
Dogs: 0.5–1.0 g PO
Dogs: 2–5 µg/kg PO
Dogs: 1–2 mg/kg PO;
0.5–1.0 mg/kg IV
Cats: 3.5 mg/kg PO;
2.5 mg/kg IV
Dogs <20 kg and cats:
0.7 mg/kg PO
Dogs > 20 kg: 20 mg PO
twice. Ketoprofen or carprofen
may also be appropriate.
The side effects of long-term
use of ketoprofen 20 or car-
profen19 for osteoarthritis are
apparently minimal; however,
the patient should be monitored
for hematochezia or melena,
vomiting, and increased water
consumption.
Other indications for the use
of NSAIAs are panosteitis, hy-
pertrophic osteodystrophy, and
dental pain. NSAIAs should be
used with caution after dental
extractions when bleeding is, or
may be, of concern—or when
creatinine is above the median
for the laboratory and intra-
venous fluids were not given
during anesthesia.
Small Animal
Dose Frequency
Every 8 hours
Every 8 to 12 hours
Initially
Repeat hourly for 3 treat-
ments, tapering off to ev-
ery 4 hours, and then ev-
ery 8 hours for 7 days
Every 8 hours
Every 12 hours
Every 12 hours
Once a day
Once a day
Contraindications
Relative
The use of NSAIAs in geri-
atric patients should be avoid-
ed. Nevertheless, I have used
ketorolac at the lower dose in
older animals when opioids
were not controlling postopera-
tive pain (e.g., after orthopedic
procedures or thoracotomy).
The drug was given only to pa-
tients whose creatinine level
was below 120 µmol/L. These
patients were well hydrated and
were receiving intravenous flu-
ids. Ketorolac was given only if
the geriatric patient had no evi-
dence of gastric ulcer (e.g., vomit-
ing or melena) or other con-
traindications.
Sucralfate (preferably the
Small Animal
suspension [2.5 to 5 ml every 8
hours to a small or large dog])
should be given to these pa-
tients. If the use of NSAIAs is
being considered after trauma,
the patient should be stable
with no evidence of hemor-
rhage (it may take several
hours to determine this) and
maintained on intravenous
crystalloid therapy until ade-
quate fluid intake has been
guaranteed. Opioids may be re-
quired in the interim.
Absolute
There are many absolute
contraindications for the use of
NSAIAs (see the box). Neither
should NSAIAs be given to
shock or trauma patients im-
mediately upon presentation or
to patients with hemorrhage
(e.g., epistaxis, hemangiosarco-
ma, or head trauma). Patients
with severe or poorly controlled
asthma, or other moderate to
severe pulmonary disease, may
deteriorate with use of these
agents (which specific agents in
veterinary patients is unknown)
because PGE2 and prostacyclin
relax bronchial and tracheal
muscle.26 Carprofen apparently
does not inhibit PGE2 produc-
tion and may therefore be ap-
propriate for these patients.
When NSAIA use is being
considered, the laboratory’s
median value for creatinine lev-
el is given as the recommended
upper limit because the labora-
tory’s upper limit of normal
could indicate a two-thirds re-
duction in renal function. How-
ever, each NSAIA has variable
effects on renal function. If the
patient’s creatinine level is
above the median but within the
normal range, the benefit of the
NSAIA might outweigh the risk.
In this situation, only a single
dose should be administered
and the patient should be sup-
ported with intravenous fluids.
Potential NSAIA-induced renal
insufficiency is usually tempo-
rary and reversible with admin-
istration of intravenous fluids.
The safety of the various
NSAIAs may be better elucidat-
ed after further use of these
analgesics in veterinary patients
of various ages and with a
range of painful problems. Until
such reports appear in the sci-
entific literature, careful moni-
toring for possible side effects
should be conducted.
Ulcer Prophylaxis and
Treatment
Table Two lists recommend-
ed drugs and dose regimens for
ulcer prophylaxis.
Sucralfate
Sucralfate is available as
tablets (1 g) or a suspension (1
g per 5 ml). Sucralfate binds to
mucosal defects and provides a
protective barrier against gas-
tric acid; it accelerates healing
of ulcers and erosions directly
as well as indirectly by stimulat-
ing production of local prosta-
glandins.27
All veterinary practices should
stock sucralfate because owners
often give NSAIAs to their pets
and because gastritis (with or
without ulceration) has been as-
sociated with aspirin, ibuprofen,
naproxen, and ketorolac. Sucral-
fate should be prescribed for
concomitant use with some
NSAIAs when gastric erosions
could be present. These ero-
sions are likely in posttrauma
surgical patients, in otherwise
healthy geriatric patients, and in
highly stressed animals.
Although sucralfate is not
generally recommended for ul-
cer prophylaxis, I have found it
to be effective in preventing
clinical signs of gastrointestinal
ulcer (melena, blood or “coffee
ground material” in vomit)
when NSAIAs are used for a
short period in surgical pa-
tients. Sucralfate suspension is
effective for control of major
and minor gastric ulcer hemor-
rhage and is preferable to
tablets in this situation. Consti-
pation is the only reported side
effect. Sucralfate should be giv-
en 1 hour before meals (empty
stomach). To avoid decreased
absorption, other prescribed
oral medication should be given
at least 1 hour before or 2
hours after sucralfate adminis-
tration.
Misoprostol
Misoprostol is available in
100- and 200-µg tablets and is
recommended for concurrent
use with some NSAIAs to en-
hance the natural mucosal de-
fense mechanisms. Misopros-
tol has been demonstrated to
prevent NSAIA-induced ulcers
in dogs.28 Misoprostol can be
prescribed with sucralfate;
however, it should be adminis-
tered at least 1 hour before or 2
hours after sucralfate. It has
provoked epileptic seizures in
humans27; therefore, its use in
epileptic veterinary patients
may be contraindicated unless
the benefit outweighs the risk of
increased seizure activity.
Ranitidine
Ranitidine is available as a
solution for injection (25 mg/
ml), in tablets (150 or 300 mg),
and as syrup (15 mg/ml). Rani-
tidine will not necessarily pre-
vent gastric ulcers but may be
more protective against duode-
nal ulcers.27
Ranitidine is preferred to
cimetidine, another histamine2-
receptor antagonist. Ranitidine
The Compendium October 1996
does not affect microsomal en-
zyme metabolism in the liver
and therefore has fewer drug
interactions. Also, the frequen-
cy of administration is twice a
day instead of four times daily.
Omeprazole
Omeprazole is available as
20-mg capsules. It is indicated
for the treatment, but not pro-
phylaxis, of erosions or ulcers27
except for distal esophageal
stricture associated with ero-
sions.
References
1. Brock N: Treating moderate
and severe pain in small ani-
mals. Can Vet J 36(10):
658–660, 1995.
2. Quandt JE, Rawlings CR: Re-
ducing postoperative pain for
dogs: Local anesthetic and
analgesic techniques. Com-
pend Contin Educ Pract Vet
18(2):101–111, 1996.
3. Mathews KA: Special report
on non-steroidal antiinflam-
matory analgesics for pain
management in cats and dogs.
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