As much as we hate to see our dogs in pain, you can’t assume the pain relievers we take ourselves are effective, or more importantly, are safe drugs for our dogs.

The answers to the questions “Can I give my dog Tylenol for pain?” and “How much Tylenol can I give my dog?” are short and simple: No and none.

Pain should always be diagnosed by a veterinarian before treatment, and the veterinarian will advise you as to the best and safest way to treat pain in your dog.

Why say ‘no’ to Tylenol and Acetaminophen

While sometimes used in veterinary medicine for dogs under strict guidelines, Tylenol, a common over-the-counter pain reliever for humans, can kill your dog.

When ingested, according to the FDA, acetaminophen can cause severe damage in dogs including:

1. Liver damage, the higher the dose, the worse the damage and risk of liver failure.
2. Red blood cell damage, which causes these cells to lose their capability to carry oxygen throughout the dog’s body.

According to the American College of Veterinary Pharmacists (ACVP), “It is important to note that acetaminophen may be present in multi-symptom cold and allergy products.” Any accidental ingestions of one of these types medications should be reported to your veterinarian immediately. Early intervention can significantly improve the chances of recovery, so if you suspect your dog has ingested Tylenol/acetaminophen, contact your veterinarian or a pet-poison hotline, like:
• ASPCA Animal Poison Control Center, a 24-hour hotline at (888) 426-4435

• Pet Poison Helpline, 24-hour animal poison control service at (855) 764-7661

There may be a charge for these calls.

Signs and symptoms of toxicity, according to ACVP, include weakness, rapid breathing, shortness of breath, blue/purple discoloration of skin or mucous membranes, jaundice, vomiting, significant decrease in body temperature, and facial or paw swelling.

Alternatives to Tylenol

The FDA suggests that veterinarians advise clients about controlling dog pain with NSAIDs (nonsteroidal anti-inflammatory drugs), which include these approved-for-dogs drugs:

• Carprofen (brand and generic names)
• Deracoxib (Deramaxx)
• Firocoxib (Previcox)
• Grapiprant (Galliprant)
• Meloxicam (Metacam and generics)
• Robenacoxib (Onsior)

Consult our online guide to pain medications, “Dog Pain Medication: A Guide to Common Drugs,” by Dr. Jennifer Bailey, for more information.

While not as toxic as acetaminophen, these are prescription drugs, so follow your veterinarian’s guidance. Monitor your dog while he is taking any of the NSAID listed above and for a little while after he or she has taken it.

“Every year veterinarians prescribe millions of doses of NSAIDs for dogs with good reason — but many side effects occur. As a group, NSAIDs may affect the kidneys, liver, and gastrointestinal tract. The FDA lists reported side effects in dogs and cats as “vomiting, diarrhea, loss of appetite, depression, and lethargy.”

Most of these side effects are mild, but serious side effects may occur, especially if the drug is not used according to the label. These side effect include gastrointestinal ulcers and perforations and kidney and liver problems that, in some cases, can result in death.

If your pet experiences more severe reactions (e.g., seizures, is unconscious or losing consciousness, or having difficulty breathing), take your dog to your veterinarian or emergency veterinary clinic, along with the bottle that the drug came from. And always keep both prescription and over-the-counter medications stored in a place your dog can’t access.

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Pain medications for dogs are not interchangeable. Some pain relievers that you use for yourself can be harmful or even toxic to dogs. And an analgesic that was prescribed for another pet in the home may not be the right type or dose for the one who is currently exhibiting pain. When choosing the most effective medication for your dog, your veterinarian will weigh a number of factors, including your dog’s:

• Age
• Weight
• Breed
• Overall health
• Kidney and liver function (based on blood test results)
• The cause of the pain (arthritis, trauma, surgery?)
• The part of the body that is affected (joints, musculoskeletal system, abdomen)
• The type of pain (acute or chronic)
• The intensity of the pain as evidenced by the dog’s behavior
• The length of time that the dog is expected to need pain relief

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Inflammation is the body’s response to an injury or osteoarthritis (the breakdown of joint cartilage). Inflammation can be identified in the dog by five clinical signs: heat, redness, swelling, pain, and loss of function. When the insult to the body is acute, the inflammatory response causes blood vessels in the troubled area to dilate and increases their permeability. This allows protein-rich fluid to flood into the interstitial spaces, causing the tissue to swell. This fluid contains a mixture of components that help repair cellular damage and helps flush away injured and damaged cells – but sometimes this immune-system response may be excessive, causing more harm than good. Prolonged inflammation can cause persistent pain or swelling. Chronic inflammation can cause tissue destruction and fibrosis (tissue thickening or scarring).

NSAIDs reduce inflammation, which will often relieve the pain caused by the inflammation.

Using an NSAID dog pain medication is not without risk, but when given at an appropriate dose and used for as short a period as possible, the risk of developing side effects is low. Giving more than the labeled dose for any length of time increases the risk of an adverse event, such as gastrointestinal ulcers, liver damage, or kidney damage. Each NSAID has a narrow dosing range; never give more than the dose your veterinarian has prescribed.

A dog who is receiving an NSAID should not receive any other NSAID or a corticosteroid (such as prednisone) at the same time. It takes several days for a dog to clear the last dose of any NSAID from his body. A washout period of 5 to 7 days is recommended between stopping one NSAID and starting a different NSAID.

NSAIDs should be used cautiously or not at all in dogs who have kidney disease or liver disease. Your veterinarian will recommend a baseline chemistry panel to check for elevated kidney values or liver enzymes before prescribing an NSAID. Dogs receiving an NSAID daily for several weeks or more should have their bloodwork checked at regular intervals to ensure that their kidney values and liver enzymes remain stable.

Analgesic Medications for Dogs

Analgesics provide pain relief by binding to pain receptors in the body. Unlike NSAIDs, analgesics do not reduce the inflammation that causes pain. But analgesics can be used very effectively when combined synergistically with NSAIDs to provide more complete pain relief. Using an analgesic with an NSAID can also reduce the amount of NSAID required or how often an NSAID is given.

It seems logical that if analgesics only relieve pain and NSAIDs relieve that inflammation that causes pain that giving an NSAID would always be an appropriate choice. But there are health conditions in which giving an NSAID is contraindicated. Your veterinarian may prescribe one or more analgesics in these circumstances.

Some analgesics used in dogs are controlled substances – medications that have been identified by the United States Drug Enforcement Agency (DEA) as having a high potential for abuse by humans. There are limits on how much of a controlled substance can be prescribed at one time. Pharmacies cannot accept a telephone request for a prescription for a controlled substance from a veterinarian; instead, a written script must be physically presented to the pharmacist filling the prescription.

The post Dog Pain Medication: A Guide to Common Drugs appeared first on Whole Dog Journal.

Pill Disguises

The most common method is to bury the pill in an irresistable treat. The more high-value and tastier the treat, the better. High-value treats include:

• Canned dog or cat food
• Baby food
• Baked chicken that is moist enough to engulf the pill
• Soft cheese, like string cheese
• Hot dogs
• Pill pockets (homemade or commercial)

If the pill is large, cut it into multiple pieces and place them in several treats. You can also pulverize the pill and mix it into canned food.

Try a Pet Piller

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Sometimes a pet piller can help, especially if your dog will not take it in food. Manually pilling your dog may become necessary if he is not willing to swallow the pill on his own, and a pet piller like the VetOne Pet Piller can help if your dog still refuses the pill in a treat. After using the piller to get the pill in the back of your dog’s throat, you can massage his throat after he begins the swallowing process to stimulate swallowing

When learning how to give your dog a pill, aim to complete the experience as positively as possible, and this video from a veterinary clinic does an excellent job showing you exactly how to do both give pills and keep things positive. Remember to follow the pilled treat with a regular treat and lots of praise.

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If, in contrast, your dog normally has a good appetite, but suddenly stops eating his food, you should be concerned – and even more so if you dog has any other signs of illness, such as lethargy, panting, fever, signs of pain or discomfort, or diarrhea. In that case, get him to a vet! Any time our dogs change their normal behavior, there is likely something wrong that needs investigation. Ignoring early symptoms usually costs us, and our dogs.

Potential causes of a lack of appetite

There are many reasons why a dog may be reluctant to eat:

• Dental disease, including broken teeth and infected gums, may cause pain when eating.
• Ear infections are another source of pain that can lead to reluctance to eat, especially hard food.
• Other forms of pain can cause a dog to stop eating. Panting, trembling, walking hunched over, sleeping more than usual, reluctance to run or jump, and irritability can all be signs of pain.
• Dogs who are sick, including dogs with cancer and those undergoing chemotherapy, are often reluctant to eat. Kidney disease, for example, can cause nausea and gastric ulceration due to excess acidity.
• If you recently opened a new bag of your dog’s regular food and he turns up his nose at it, pay attention; this could be a sign that the food is spoiled or moldy, and possibly dangerous. Do not add flavor enhancers or human meal leftovers to tempt him into eating the food he rejected, because if it turns out that the food is dangerous, he may be harmed by eating it! Even if only one dog in your household doesn’t want to eat and the rest are fine with the food, it would be safer to get a new bag and see if that solves the problem. If your dog eagerly accepts the new food, take the rejected food back to the store!
• Many medications list nausea and anorexia as potential side effects. If your dog is on medication and becomes reluctant to eat, talk to your vet to see if a substitute is available, or if there is a way to make the pills easier on your dog’s stomach. For example, some meds that are normally given away from meals can be given with food instead to help with stomach upset.

Warning: In some cases, loss of appetite can be a symptom that the medication you are giving is dangerous. This is especially true in the case of NSAIDs (non-steroidal anti-inflammatory drugs) such as Rimadyl, Deramaxx, and even aspirin. Corticosteroids such as prednisone can cause gastrointestinal ulceration and associated inappetence.

If your dog is on any of these drugs and stops eating, you should discontinue the medication immediately (don’t stop prednisone without your vet’s OK). Get your dog to the vet, especially if other symptoms are present, such as vomiting, diarrhea, black or tarry stools, or lethargy.

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1. Proestrus: Starts with swelling of the vulva and bloody vaginal discharge. This lasts an average of 9 days, with a range of 0 to 27 days.
2. Estrus: The period in which the female is receptive to mating. Ovulation occurs. Duration of estrus averages 9 days, with an average of 2 to 24 days.
3. Diestrus: The female is unreceptive to mating. Late in diestrus, mammary glands can enlarge, even if the female is not pregnant. This part of the cycle lasts for about 2 months.
4. Anestrus: The hormonally quiet period between cycles. This can last 4 to 13 months.

Using a Progesterone Test for Dogs to Determine Breeding Times

A breeder will want to know the optimal time for mating or artificial insemination to plan for breeding-related travel and to maximize litter size. This is most easily done by monitoring circulating progesterone levels using a progesterone test for dogs. During most of proestrus, progesterone hormone levels are low. Just before ovulation, progesterone levels rise precipitously, which corresponds with a surge in luteinizing hormone.

Usually, serial progesterone levels are measured every other day starting from when the bloody vaginal discharge starts, and when the progesterone is greater than 2.0 ng/mL, assume ovulation has occurred. Most progesterone tests are done through the veterinary office, using radioimmunoassay (gold standard) or chemiluminescence immunoassay.

When You Need a Progesterone Test for Dogs

Home progesterone kits measure progesterone, and while the perspective mother might be more comfortable being able to stay at home instead of traveling for a veterinary appointment, the home kits are not as accurate as the test through the veterinary office, and they will still require a blood sample.

Whichever method of progesterone testing a breeder decides upon, when measuring serial progesterone levels, it is important for accuracy to use the same lab for all the tests and pull the blood sample at the same time of day for all the tests.

Another advantage of knowing ovulation date via progesterone testing, is that the breeder will have a much better idea of whelping date (65 +/- 2 days after ovulation). This gives the breeder a time frame in which to be more vigilant in monitoring their pregnant dog and informs future puppy owners when they might be able to take their new family member home.

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Some antibiotics are better suited for certain types of infections than others. Your veterinarian will select an antibiotic based on the type of infection your dog has and where that infection is located. The results of a bacterial culture and sensitivity test, when available, can also help direct the antibiotic selection.

Other considerations for antibiotic selection include which formulation is easiest to give your dog (liquid versus tablet), how much your dog weighs, how often the antibiotic needs to be given, what medications your dog is currently being given, and any reactions your dog has had to medications in the past.

You must give antibiotics exactly as prescribed by your veterinarian; there are serious consequences for antibiotic misuse for dogs. Always complete the full course of treatment, even if your dog seems to be feeling better. Contact your veterinarian if your dog experiences one or more side effects from the antibiotic. Your veterinarian may prescribe something to help alleviate the side effect or may prescribe a different antibiotic.

The following is an information guide to the most common antibiotics that are used in dogs.

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The simple answer is that it can be difficult. Most of the supplements available for canine joint disease lack evidence-based medicine to support use. Most supplements are based on anecdotal evidence or studies in vitro (in a laboratory rather than in “real life”). Below is a list of common supplements for dogs with joint pain.

A List of Joint Supplements for Dogs:

Glucosamine chondroitin

Perhaps the most used supplement, GC was popularized because of its application in human medicine. Glucosamine and chondroitin are sourced from sea life (lobsters, crabs, and shrimp). Together, they are theorized to inhibit breakdown of the joint and have mild anti-inflammatory effects. Studies have not shown marked improvement in dogs with joint disease, but these products are safe and without significant side effects. As a result, they are frequently recommended as an adjunctive treatment. Cosequin is a labeled veterinary product with some published data. Keep in mind, it is always important to evaluate who did the study and why.

Fish oil

Fish oil can be tricky! They are an excellent source of fatty acids, which are critical for canine health. Dogs cannot synthesize enough of their own, so fatty acids must be supplemented through diet. Deficiencies can lead to coat, skin, joint, and reproductive problems. Usually, supplementation is accomplished through using an AAFCO- and WSAVA-approved dog food. Recently, the dog food market has been flooded with boutique brands that do not necessarily adhere to these testing and recommendation guidelines. So choosing a diet carefully and with veterinary assistance is imperative.

Fish oil may improve joint health, although as with many of these products, strong evidence is lacking. If you choose to use a fish oil product, consult with your veterinarian first! A reduction or change in food may be required, as some diets are very rich in fatty acids. This can lead to inadvertent weight gain and possible toxicity. Fish oil capsules are also hard to dose in large dogs because of the relatively small amount found in capsules.

Green-lipped mussels (Perna canaliculus)

While the name is attention-grabbing, GLMs are not new to the treatment of arthritis. Like their GC cousins, these medications are derived from sea creatures. Most studies have not shown much difference between placebo and GLMs, but there is a veterinary approved product with good oral absorption called Glycoflex. Research papers on this product are available at www.vetriscience.com.

Turmeric (curcumin) and Boswellia serrata

Phytotherapy (“plant medicine”) is as old as humankind. Turmeric is a powerful spice and has recently received a great deal of attention in human medicine. It is considered a strong anti-inflammatory and antioxidant. Studies in veterinary medicine are lacking, but it is safe to use (in a veterinary product) and may prove a useful adjunct. Because it has poor oral bioavailability, look for veterinary specific products such as Dasuquin Advanced, Synovi-G4, and Curcuvet.

In humans, Boswellia serrata (frankincense) has excellent evidence for reduction of pain and improved function in arthritis. Data is lacking in dogs, but Boswellia is frequently included in veterinary products such as Dasuquin.

See more options for plant-based arthritis relief here.

Microlactin

This product is advertised as a “nutritional aid” containing dried milk protein that may help with inflammation. The science behind this is hard to understand and honestly, it’s a bit hazy. Though there are several products that fall into this category, there is no available, unbiased scientific evidence to support its use. The published data has been financed by the companies producing the product.

Cannabinoids/CBD

Research into the use of cannabinoids for pain control in humans are ongoing. Research in veterinary medicine is lacking due to federal regulations regarding the uses of cannabinoids. This is changing. At this time, there are no dosing recommendations and CBD oil and other products cannot be recommended.

Important Considerations When Choosing Joint Supplements for Dogs

If using a human grade product, look for the logo of the United States Pharmacopeia Dietary Supplement Verification Program. This company tests “human dietary supplements for ingredients, concentrations, dissolvability, and contaminants” per the Cummings School of Veterinary Medicine website. Another excellent resource is ConsumerLab.com which tests BOTH human and pet supplements for ingredients.

When in doubt, before purchasing a product, check with your veterinarian. Supplements can be quite pricey, but often the profit is spent on flashy advertising rather than on rigorous quality control and efficacy testing. Your veterinarian can consult with a nutritionist regarding supplements and help you choose one that is right (and useful!) for your dog.

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Adverse Events Defined

Animal drugs, vaccines, and pesticides are subjected to tests to establish their safety and efficacy. However, this evaluation process is typically conducted on a relatively small number of animals prior to being approved and marketed. As a result, there is potential for previously unobserved problems to emerge after the product is approved, goes on the market, and is administered to a larger population of animals.
An adverse event (AE) in animals is any unfavorable or unintended occurrence that happens during or after use of an animal drug or veterinary product or device. Suspected lack of efficacy and reactions by humans exposed to the product or treated animals also qualify as adverse events.

Adverse Events or Side Effects?

It is important to clarify the difference between adverse events and side effects. Side effects are secondary undesired effects that may occur when using a specific drug and have been shown to be associated with the product by scientific studies. Side effects are tracked and investigated extensively during clinical trials before entering the market. In contrast, adverse events are not consistent with applicable product information or characteristics of the drug.

It is important to consult with your veterinarian about potential side effects associated with a product prior to use. For example, a lump forming at the site of a vaccination is a known side effect; it is not an adverse event. If your dog does experience a serious issue after a vaccine, the administration of a drug or pesticide treatment, or eating pet food or treats, contact your veterinarian or veterinary emergency clinic immediately.

Reporting side effects is still a good idea, however. Even though side effects may be known, reporting these can be an effective means of heightening awareness of a particular issue with the product and could possibly lead to additional product review, especially if the side effects are serious.

When Should You File a Report?

One of the responsibilities of the U.S. federal government is ensuring the safe and healthful use of products within the United States. If your pet experiences a serious side effect or an adverse event, a report should be filed with the appropriate governing agency.

If you’re uncertain about whether you should file a report or the process, ask your veterinarian for guidance. Often veterinarians themselves will handle it; if this occurs, there is no need for you to report the incident. If your veterinarian has not reported the AE or was not involved, you should make the report yourself. In either case, it is important to report it as soon as possible, as timely reporting enables agencies to take any necessary action quickly.

There are several government agencies that oversee the reporting of veterinary adverse events and the process varies with each department. Regardless of the government agency involved, the manufacturer of the product should also be notified of the adverse event.

Animal Drugs

All veterinary drugs (and devices) are regulated by the Food and Drug Administration’s (FDA) Center for Veterinary Medicine (CVM) under the Food, Drug, and Cosmetic Act. New veterinary drugs must first be approved for use by the CVM. The CVM evaluates the product and establishes the safety, effectiveness, and conditions of use; this information is required to be on the product labeling. After approval, the CVM will continue to monitor the use of these products to ensure that they remain safe and effective; this monitoring activity is referred to pharmacovigilance.

Thousands of drugs are administered to pets every day. There are often side effects, but hopefully those are known, minor, and temporary. When a pet has an unexpected reaction to a veterinary drug, it is important to file an Adverse Drug Event (ADE) report. This report can be filed directly with the FDA by pet owners.

There you will find the link to download the PDF Form FDA 1932a, “Adverse Experience, Lack of Effectiveness or Product Defect Report.” This form is used to report adverse drug experiences for any animal drug (whether the drug is FDA-approved or not).

The CVM requests that the report be as detailed as possible and include everything from the brand of food and treats your pet eats, to any supplements your pet is given, along with your pet’s medical history (including names and amounts of all drugs, information about any recent surgeries or procedures, veterinary test results and examination findings), as well as any other relevant information. The more details you provide, the more information the CVM has available to research the issue. Upon completion, email the form to CVM1932a@fda.hhs.gov.

Both the CVM and the American Veterinary Medical Association (AVMA) recommend also reporting any adverse drug events directly to the manufacturer. Manufacturers are required to report any adverse drug experiences to the FDA. The drug manufacturer’s information is usually on the product packaging, including prescription bottles received from the pharmacy. You may also report the event directly to the CVM.

Pet Food and Treats

Adverse events related to pet food and treats also fall under the CVM’s jurisdiction. The responsibilities of the CVM include ensuring that pet food “is safe, made under sanitary conditions, and properly labeled” as well verifying that a “food additive for use in food for animals is safe and effective before approving it.” Reports regarding pet food and treats can be filed electronically using the CVM’s Safety Reporting Portal.

Problems such as mold or foreign objects in food should also be reported as they can pose a health and safety issue for other pets.

The other option for reporting issues with pet food and treats is to call your state’s FDA Consumer Complaint Coordinator. You can use this link to find your representative.

Before you call or start your online report, assemble all the relevant data. A detailed list of the information you should have on hand to complete your report is listed here.

Animal Vaccines

Vaccines for pets are regulated by the U.S. Department of Agriculture via the Center for Veterinary Biologics (CVB). The CVB is involved with the regulation of products that diagnose, prevent, or treat animal diseases as well as ensuring that veterinary biologics, such as vaccines, are safe and effective. Detailed information about reporting vaccine-related AEs can be found here.

The preferred method for reporting an adverse event associated with a vaccine is through the CVB’s online reporting system.

Reports may also be submitted by telephone by calling the CVB at (800) 752-6255, or by downloading the Adverse Report Form and faxing it to (515) 337-6120, or sending via mail to Center for Veterinary Biologics, 1920 Dayton Avenue, PO Box 844, Ames, Iowa 50010.

Again, it is recommended that vaccine-related adverse events also be submitted directly to the vaccine manufacturer. In addition to simply taking the report, many of these manufacturers have in-house veterinary services departments that not only receive such reports but also may be able to provide diagnostic advice, treatment recommendations, and guidance on product use.

Pesticides

There are a number of pest-control products used in association with our pets, especially for eradication of ectoparasites and insects. The FDA regulates the flea and tick products that are given orally (making them qualify as a medication), including Bravecto, Nexgard, Simparica, and Credelio.

If a product is regulated by the FDA, it may be labeled with the statement “Approved by the FDA” followed by a six-digit New Animal Drug Application (NADA) number or, for generic drugs, an Abbreviated New Animal Drug Application (ANADA) number on the packaging or label. If the product’s registration number does not appear on the label, it may take some research to find the number; it’s not required to be present on the label.

Adverse events associated with oral medications that kill internal or external parasites may be reported by the same process as animal drugs (see above), using form FDA 1932a, “Adverse Experience, Lack of Effectiveness or Product Defect Report.”

Topical products, however, are regulated by the Environmental Protection Agency (EPA), under the Federal Insecticide Fungicide and Rodenticide Act. These can be identified by the EPA Registration Number (sometimes written as EPA Reg. No.) printed on the label.

Look for an EPA registration number on the package, usually near the manufacturer’s information. Adverse events associated with these products, as well as other pesticides, are reported to the National Pesticide Information Center (NPIC).

However, the NPIC electronic reporting system is restricted for use by qualified professionals, such as veterinarians or their staff. Pet owners can still report an adverse effect by a pesticide on their pet by calling the NPIC directly at (800) 858-7378 and filing a report over the phone.

What Happens with the Reports?

The governing agencies all have differing approaches to handling Adverse Event Reports, but in general, these reports are reviewed and evaluated for risks to animal (and/or public) health.

Every report is important; if the AE is assessed to be of concern, the initial review leads to follow-up activity. Products that have caused or may cause a serious illness, injury, or a life-threatening situation are given priority. While monitoring continues indefinitely, the FDA pays particularly close attention to adverse event reports submitted in the first three years following approval of a product.

The CVM has created a database – the Cumulative Adverse Drug Event Summaries Report – “so that veterinarians and animal owners can have easily available access to information about signs that have been associated with drugs.”

The database lists the numbers of ADEs received for a particular drug, by species, and route of administration. Sounds great! But at present, the database contains only the cumulative summaries of the data received on paper reports for the period between 1987 and April 30, 2013. ADEs have been submitted electronically since then, but the task of collating the paper reports with the electronically submitted reports is not yet complete.

The plan is to eventually have the database brought current and updated monthly – but we aren’t holding our breath. A note on the webpage above says, “We anticipate having updated adverse event information available in late 2017 or early 2018.”

Why Report Adverse Events?

In March 2017, the CVM distributed a “Dear Doctor” letter to veterinarian professionals in response to their findings from the examination of three reported cases of hyperthyroidism in dogs of varying ages and in separate households that were fed canned dog food from at least one of two companies (FDA Dear Doctor letter, “Exogenous Hyperthyroidism and Thyroid in Pet Food,” March 27, 2017).

The CVM’s research into these three cases found that it warranted widespread notification and the resulting letter detailed their research, findings, and actions. It was determined that the pet food contained exogenous sources of thyroid hormone, capable of causing clinical signs. The manufacturer recalled the implicated lots of the two foods that had been fed to the affected dogs. (The health of the dogs improved after eating different food.)

By reporting AEs and other problems experienced with animal products, pet owners, veterinary professionals, and manufacturers play a valuable role in maintaining health and safety. Reports act as an alert system, not only for the governing agency, but also for pet owners and veterinary professionals. The government, manufacturers, and veterinarians receive critical information to determine if further investigation is warranted.

When it happens to our pets, naturally we feel it is warranted. As evident in the example above, the reporting of just three cases resulted in an investigation and recall, demonstrating that reporting is effective and can contribute to our pets’ health and welfare.

Investigations triggered by AEs can lead to changes in a product’s labeling or use, the release of safety warnings and communications, product recalls, and even the rescinding of agency approval or permanent withdrawal of a product from the market. Again, reporting adverse events can be invaluable.

The reporting systems do have some deficiencies. Being “passive surveillance systems,” there is no active search for cases but rather the reliance on obtaining initial data from the reports submitted. This type of system can suffer from under-reporting (reports aren’t submitted) or over-reporting (reports submitted are not related to the suspected product). Furthermore, receipt of a report does not necessarily mean that the product caused an adverse event, or even that a particular event actually occurred.

If your pet experiences an adverse event, seek veterinary treatment. If you suspect it is due to a drug, food or treats, vaccine, or pesticide, you may want to consider obtaining special diagnostics, such as having a pet food tested by a private laboratory. Be aware, however, that these expenses will not be covered by the regulating agency, but may assist in the treatment of your pet and add valuable data to your report.

Barbara Dobbins, a former dog trainer, writes about dogs and studies canine ethology. She lives in the San Francisco Bay area with her dogs, Tico and Parker.

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Uses for Steroids

Anti-Itch

One of the most general uses of steroids is in fighting “the itch” (pruritus) caused by allergies. Allergies are common in dogs, especially breeds like Boxers, Labradors, Maltese, West Highland White Terriers, Bulldogs, and pit bulls. These allergies can be food- and flea-related, or caused by seasonal allergens – a condition called atopy. The mechanism by which steroids control itching is complicated, but it includes decreasing the number of allergen-fighting cells (mast cells) in circulation and suppressing release of histamine. Histamine is one of the substances that leads to the formation of itchy hives and wheals. For allergies, only short-term doses of steroids are recommended. Itching should be controlled while the inciting cause is identified and secondary infections treated, and then the steroids should be tapered off slowly. Newer drugs such as Apoquel (oral) and Cytopoint (injection) are slowly supplanting the regular use of steroids for itching.

The most commonly used oral steroids for allergies are prednisone and Temaril-P. Some veterinarians use longer-acting injections such as Vetalog, as well. Long-acting steroid injections can cause more pronounced side effects than their oral counterparts. Their use is becoming less common as other methods of itch control and more allergy management options become available. Topical steroids for both the skin and ears have extensive uses and may prove to be a better option than oral medications, as they cause fewer side effects. Topical use can decrease inflammation and itching. This is important within the ear canal, as less inflammation allows ear medications to penetrate deeper. It also damps down itching, so dogs are not continuously self-traumatizing.

Anti-Inflammatory

In conditions such as inflammatory bowel disease (IBD), steroid-responsive meningitis, and intervertebral disc disease, inflammatory cells dominate, causing redness, swelling, and pain. Steroids decrease inflammation by lowering white blood cell release from the bone marrow, among several other pathways. This effect is helpful for addressing IBD and steroid-responsive meningitis. Doctors find steroids useful for treating intervertebral disc disease in humans, and anecdotally, some veterinarians report success with steroids for the same condition in their canine patients, but the scientific literature isn’t really clear either way. The anti-inflammatory dose of steroids is generally fairly low, but side effects are still noted. Prednisone is used most often for this problem.

Immunosuppression

Autoimmune (AI) disease, a general term describing a variety of ways that the body attacks itself, is common in dogs. The triggers for AI disease are poorly understood. Some antibiotics like cephalosporins have been implicated, as well as vaccines. Cancer also can induce autoimmune processes. In most cases, an underlying cause is never identified. The list of autoimmune diseases are too numerous for this article, but they can affect all of the organ systems in the body, including the skin, brain, blood cells, joints, and other internal organs. Some of the more commonly seen disorders in veterinary medicine are immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (ITP), brain and spinal cord diseases such as meningitis, and skin diseases like pemphigus foliaceous and lupoid onychodystrophy. ITP is an example of a well-known and frequently seen autoimmune disease, in which the body turns its defenses on its own platelets. Platelets are important in the first step of clotting. As the body attacks and destroys them, the platelet numbers drop rapidly. Bruises become visible on the skin and gums.

Steroids treat this and other immune diseases by suppressing the body’s immune system, its natural defense against infection and illness. In these cases, steroids are started at very high levels (as much as 2 to 4 mg/kg body per day). As the symptoms improve, the steroids are slowly tapered to the lowest dose possible. This is to keep the autoimmune disease in check while avoiding the worst side effects of steroids. Most dogs with an autoimmune disease will remain on steroids or other immunosuppressive medication for life.

Steroid Insufficiency

Another common condition in dogs is Addison’s disease. The body of a dog with Addison’s does not produce enough steroids and/or mineralocorticoids (responsible for water and electrolyte balance within the body). Cortisol and mineralocorticoids are essential for life, and when a dog’s body is not producing them, serious illness results. The general symptoms of Addison’s are waxing and waning GI signs: weight loss, vomiting, diarrhea, and picky appetite. Addison’s is often called the “great pretender” because it can look like many other diseases and can be difficult to diagnose. In these cases, steroids are indicated to replace those that the body is not making, as well as supplementation with a medication called Percorten or Florinef to replace the other corticoids. A few rare dogs with Addison’s can be maintained on Percorten alone; however, in times of stress or illness, they would require prednisone as well. Some dogs are affected by atypical Addison’s disease, in which only the cortisol levels are low. These patients can be even more difficult to diagnose, as the characteristic electrolyte changes on bloodwork are absent. Once diagnosed, these dogs must remain on a steroid for the rest of their lives. In this case, the steroids are usually administered on a twice daily to daily basis. The most commonly used steroid for this is prednisone, an inexpensive tablet.

Lymphoma/Cancer Treatment

Several cancers respond to steroids by shrinking. Lymphoma is a frequent cancer of dogs. The earliest symptoms are usually general malaise and enlarged peripheral lymph nodes (found underneath the jaw, in front of the shoulder blade, in the groin area, and behind the knee). Lymphoma is highly sensitive to chemotherapy and carries a good prognosis if treated aggressively. Many owners opt for palliative care however, for a variety of reasons, including cost and concern for quality of life. Prednisone is an excellent palliative agent for lymphoma and can often keep it in remission for weeks to months. However, it is important to know that prednisone will interfere with chemotherapy. If your dog has been diagnosed with lymphoma, and you are considering chemotherapy, prednisone should not be started until speaking with an oncologist. Many other cancers are often treated with oral steroids, as well. These are usually used adjunct to chemotherapy and/or radiation. Doses are higher than with anti-inflammation and anti-pruritus, usually in the range of 2 mg/kg of body weight per day or higher.

When Should Steroids Not Be Used on Dogs?

There are many cases where steroids are not an appropriate treatment. For some of the following examples, steroids remain controversial. Some veterinarians continue to use them based on years of experience (anecdotal), while others have discontinued use based on the same reasoning. Scientific data is somewhat conflicting and lacking on the subject, but these are the most current thoughts on steroid in certain situations:

Shock

Steroids were once a common and well-accepted treatment in cases of shock. For example, if a dog was hit by a car, one of the first ministrations would be a large dose of steroids given by injection. Over the years, it has become apparent in human medicine that steroids during shock are not helpful and are likely detrimental. They can downregulate important enzymes throughout the body, leading to worsening of low oxygen conditions (hypoxia, present during shock).This can lead to kidney and gastrointestinal damage as evidenced by bloody diarrhea and vomiting. Steroids should no longer be used to treat shock. Instead, treatment should focus on oxygen therapy, pain relief, control of hemorrhage, and intravenous (IV) fluids.

In Combination with NSAIDs

Non-steroidal anti-inflammatory drugs are very common in veterinary medicine and have a similar action in certain parts of the body. NSAIDs include meloxicam, carprofen, deracoxib, firocoxib, and several others. Using them with steroids can compound negative side effects and lead to gastrointestinal ulcers, hemorrhage, kidney damage, and in extreme cases, death. They should almost never be administered in tandem. The one exception is in the case of immune-mediated hemolytic anemia (IMHA). Patients with IMHA are prone to blood clot formation, so while steroids are used for immuno-suppression, very low dose aspirin also may be used to prevent clot formation. If a switch is required between these drugs, a wash-out period of at least two to three days is recommended to avoid these interactions. It is also critical to tell your veterinarian if you are administering any medications to your dog, especially over-the-counter pain relievers like canine aspirin (or human aspirin).

Snakebites

Even today, steroids are still used to treat snakebite victims. It has become apparent through research that steroids do not provide much (if any) benefit for these patients. The cases in which they might be useful are upper airway swelling as occurs with a bite to the mouth or neck or during an allergic reaction to antivenin. Otherwise, steroids are not indicated.

Side Effects of Steroids on Dogs

There are many well-known side effects of steroids. In the short term, dogs will drink and urinate excessively. A previously house-trained dog may start having accidents in the house. Dogs also will eat more. Often, heavy panting occurs. Restlessness and pacing are also side effects. Occasionally, dogs will behave in an agitated or aggressive way (the well-known “‘roid rage” syndrome noted in humans). If steroids are used long term, symptoms become more pronounced, and your dog may develop iatrogenic (caused by medication) Cushing’s disease.

Cushing’s disease occurs naturally when the adrenal glands overproduce cortisol (it is the opposite of Addison’s disease), the body’s natural steroid. This can occur due to either a brain tumor called a pituitary adenoma or an adrenal tumor. The symptoms of Cushing’s are weight gain, hair loss, panting, restlessness, frequent skin and urinary tract infections, and dramatic increases in urination and drinking. If oral or injectable steroids are administered frequently over extended periods of time, this syndrome can occur. Discontinuation of the steroids will reverse this. Steroids should never be stopped abruptly. When steroids are taken orally or by injection, the body’s natural steroid levels drop. If the exogenous (originating from outside the body) source is stopped, the body needs time to recover and resume making its own (endogenous) cortisol. In this gap, patients can develop a steroid insufficiency and exhibit signs of Addison’s disease: vomiting, diarrhea, weight loss, and anorexia. Because of this, steroids should always be tapered slowly. Most courses will go from twice a day, to once a day, to every other day.

Bottom Line

Steroids are very useful and important medications. But, as with any medication, using them correctly is critical to success. They have many side effects. Make sure to work closely with your veterinarian to ensure that steroids are the best option, as many medications are now available to take their place.

STEROIDS FOR DOGS: OVERVIEW

1. If your veterinarian recommends or prescribes a corticosteroid, make sure you have informed her about every drug and supplement you give your dog, to ensure there are no adverse drug reactions caused by incompatible medications. 2. Be sure you understand the dosing amounts and schedule, particularly when it comes to “weaning” your dog off of the medication. 3. Don’t ask or allow your veterinarian to prescribe steroids for the long-term management of allergies; this use in particular can cause the development of other, even more serious health problems. Allergies are better addressed by applying oneself to discovering the offending allergen(s) and managing your dog’s exposure, and using steroids only to control an acute flare-up of a “hot spot,” for example, and just on a short-term basis. Catherine Ashe, DVM, graduated the University of Tennessee College of Veterinary Medicine in 2008. After a small-animal intensive emergency internship, she practiced ER medicine for nine years. She is now working as a relief veterinarian in Asheville, North Carolina, and loves the GP side of medicine. In her spare time, she spends time with her family and reads voraciously.

The post Steroids for Dogs: Pros & Cons appeared first on Whole Dog Journal.

As with last month’s installment in this mini-series on flea-control options, the descriptions of these products should not be taken as a recommendation or endorsement. (For more about this, see “Panacea or Poison?” in this issue.)

These products are already purchased by dog owners by the millions. Our intent in describing them by chemical class is to inform owners how they work, and what dogs they are indicated for and, more importantly, contraindicated for. Contraindications are conditions under which something should never be used; in our experience, owners and veterinarians alike are often completely unaware that these ubiquitous medications shouldn’t be given to certain dogs.

This way, if your veterinarian recommends their use, or you somehow run across them, you’ll know what they are and whether or not they’re right for your dog. As you can see from the comments already generated below, these products incite real passion–for and, especially, against. Our purpose is to keep you informed so you can form better judgments…so please don’t assume Whole Dog Journal recommends these products just because we’re running this piece. We simply want to serve readers by telling you what’s out there.

A caveat: The dosages of the products discussed here cover a wide range of weights. A dog at the low end of the weight range indicated for either dose might receive five times as much medication as needed. If your dog is at the low end of the weight range, consider doing the math and splitting the chew or tablet to give your dog an effective dose that’s more appropriate for her size.

For example, the minimum dose of Capstar is 0.45 mg per pound of the dog’s body weight. A dog who weighs six pounds would need only 2.7 mg of nitenpyram. The smallest tablet of Capstar delivers 11.4 mg of nitenpyram. You could give the dog a quarter of a tablet (2.8 mg) with equal benefit and less risk.

Note: Last month, we said that we would discuss both OTC oral flea-killing medications, as well as prescription medications that help control fleas through the use of insect-growth regulators, in this article. Instead, we’ve broken these two topics into their own separate pieces. We will discuss the products containing insect-growth regulators in another issue.

Over-the-Counter Oral Flea-Killing Medications

Neonicotinoids

The oral flea-killing products that have been approved for OTC sale in the United States are in a class of chemicals called neonicotinoids.

Insects and mammals alike have nicotinic acetylcholine receptors (nAChRs) in the cells in their central nervous systems (mammals also contain these receptors in their peripheral nervous systems). Neonicotinoids bind to these receptors, overstimulating them to the point that they cause paralysis and death. The chemicals bind more strongly to insect neuron receptors than mammal neuron receptors, making them more toxic to insects than mammals. Neonicotinoids are widely used in agriculture to control insects.

Three of the four OTC oral flea-killing products on the market contain nitenpyram, a neonicotinoid chemical that gets rapidly absorbed into the dog’s bloodstream from his gastrointestinal tract, and clears rapidly, too. On average, the peak blood concentration is reached in one hour (range: 15 to 90 minutes) after administration, and the elimination half-life is about three hours. These products work fast, but only for about 24 hours; more than 90 percent of the nitenpyram is eliminated in the urine within one day in dogs.

Because they are so fast-acting and have such a short span of activity in the dog’s body, these medications are commonly used when a dog who is heavily flea-infested needs to be cleared of fleas fast – perhaps so he could be transported or kenneled without fear of introducing fleas into a previously flea-free environment. These products are also a good choice to eliminate fleas quickly, without leaving a pesticide on or in the dog’s body for weeks to come.

The fourth product contains imidacloprid, one of the most heavily used agricultural insecticides in the world. Imidacloprid has been used in the “spot on” topical flea-killing product Advantage since 1996. Imidacloprid is considered to be “low” in toxicity via dermal (skin) exposure, but moderately toxic when ingested, which makes its introduction in an oral product counter-intuitive. It, too, has a short half-life (2.2 hours) and reaches its peak blood concentration quickly – 1.3 hours.

1. Capstar, Capguard, and FastCaps

The active ingredient in all three of these products is nitenpyram; it’s included in each of the products in the same amount, so we will discuss all three together.

Because it’s so fast-acting, shelters and rescue groups have long used Capstar when they received an animal who was so heavily infested with fleas that handling, kenneling, or transporting the animal puts other animals at risk of infestation.

Each of the drugs comes in the form of a tablet, and each is offered in two dosage sizes: a tablet containing 11.4 mg of nitenpyram, meant for dogs weighing from two to 25 pounds, and a tablet containing 57 mg of nitenpyram, meant for dogs weighing from 25.1 to 125 pounds. The minimum dose is 1.0 mg/kg (0.45 mg/lb) of the dog’s body weight.

Adverse reactions that may occur in dogs include lethargy/depression, vomiting, itching, decreased appetite, diarrhea, hyperactivity, incoordination, trembling, seizures, panting, allergic reactions, including hives, vocalization, salivation, fever, and nervousness.

The frequency of serious signs, including neurologic signs and death, was greater in animals under two pounds of body weight, less than eight weeks of age, and/or reported to be in poor body condition. In some instances, birth defects and fetal/neonatal loss were reported after treatment of pregnant and/or lactating animals.

These products are said to be safe when used concurrently with other products, including heartworm preventatives, corticosteroids, antibiotics, vaccines, deworming medications, and other flea products.

2. advantus

Bayer Healthcare spells the name of this product with a small a. The product represents a very new application of imidacloprid – to our knowledge, the first oral use of imidacloprid as an insecticide for animals. The FDA granted Bayer a three-year period of marketing exclusivity from the date of its approval (in 2015).

Advantus does not contain any animal proteins, making it suitable for dogs with animal-protein food allergies.

The drug is delivered in the form of a soft chew. Bayer suggests that the ideal or target dose of imidacloprid is 0.34 mg/lb (0.75 mg/kg). Advantus is offered in two dosage sizes: a chew containing 7.5 mg of imidacloprid, meant for dogs weighing from four to 22 pounds, and a chew containing 37.5 mg of imidacloprid, meant for dogs weighing from 23 to 110 pounds.

Adverse reactions to advantus that may occur in dogs include vomiting, decreased appetite, decreased energy, soft stools, and difficulty walking.

Advantus is said to be safe when used concurrently with other products, including heartworm preventatives, corticosteroids, antibiotics, vaccines, and deworming medications.

A relatively small number of dogs and puppies are used in pre-approval studies to determine a product’s safety. For this reason, we’ve never encouraged dog owners to rush to try newly approved products; dogs owned by early adopters, in essence, become the next generation of test dogs. For this reason, and because this is the first drug to use imidacloprid in this way, we’d recommend holding off on buying or using this product until more is known about its safety.

Nancy Kerns is the editor of WDJ.

The post Over-the-Counter Flea Medicine for Dogs appeared first on Whole Dog Journal.

Dogs and dog owners have suffered from flea bites for all of their shared history, but in the past 20 years or so, scientists have been developing more and better tools that modern dog owners can use to defeat fleas. The development of these products has always been a balancing act – the goal is to find the most effective flea killers that cause the least amount of harm to the dog, her family, and the environment at large.

To help dog owners understand the flea-control options that are available to them, we have published a number of articles describing how various types of flea-control products work. These include the products described in this article, oral medications that kill fleas and that are available by veterinary prescription only, as well as the following:

• Topical pesticides that are meant to be applied monthly (February 2002).
• Over-the-counter oral flea-killing medications (October 2017).
• How to clean your home and use “insect growth regulators” to interrupt the flea’s life cycle (December 2017).
• How to best manage the war on fleas in your home safely and effectively (January 2014).

Why Use Prescription-Only Oral Medications?

For several reasons, many veterinarians tend to put the most stock in prescription-only oral medications (at least, until recently; we will see what develops in light of the September 2018 FDA communication regarding these drugs and their potential for causing seizures in dogs and cats). In fact, these products are highly effective solutions for killing fleas – but they do pose significant potential side effects.

In our opinion, oral flea control medication should be reserved for dogs who have severe flea allergy, live in an area where fleas are a constant threat, who suffer serious adverse reactions to topical flea-killing pesticides, and who have taken these oral products previously without any adverse reactions. And at most, they should represent only a partof a dog owner’s efforts to control fleas.

Why would a veterinarian recommend such products? Well, take the case of the Great Dane I fostered in the summer of 2016, who had an incredibly thin coat and who was very itchy. When I took her to a veterinarian for a complete examination and discussion of what we could do for her itching, the vet essentially refused to consider any sort of allergy diagnosis or treatment until the dog had been on an oral flea-prevention medication for a minimum of three months.

She said, that in her opinion and experience, “only longer-term oral medications offer enough protection from fleas to rule out an allergy to fleas as the cause of persistent itching.” To that end, she prescribed a medication called Bravecto, a drug that can kill any fleas that bite the dog for as long as 12 weeks after the dog is dosed.

I countered that I could repeat topical insecticides at regular intervals. But the veterinarian was firm in her belief that only a dose of Bravecto would ensure that there would be no gap in flea prevention for long enough to ensure that the Dane’s itching was not caused by fleas.

Merck, the maker of Bravecto, strongly promotes this point, taking slightly different tacks on its product website pages for owners and veterinarians. Owners are told that Bravecto makes flea control easy: “With Bravecto Chew, dogs get 12 weeks of flea and tick protection with a single treatment. That’s nearly three times longer than monthly treatments. This makes it easy for you to provide long-lasting coverage to your dog, without having to worry about remembering frequent treatments.”

On Merck’s pages for veterinarians, the most-promoted benefit is owner compliance: “Convenient long-lasting protection means less chance of noncompliance,” it says on one page. “Bravecto makes all the difference in improving pet-owner compliance,” it says on another.

Edible Flea Control VS. Topical

There are a number of other advantages to using an oral flea-control product over a topical product:

– If you or your children pet the dog, you may prefer not to have contact with a topical product. This could also be true in a multi-pet household where pets groom each other.

– Dogs with longer coats often sport a “greasy spot” for several days after topicals have been applied, increasing the concern of petting the dog and coming into contact with the pesticide.

– Owners of dogs with skin problems, or who have had a reaction in the past to any sort of topical product, might prefer to use an oral one.

– Bathing or even swimming too soon after application may reduce the effectiveness of topicals.

– Some ingredients used to kill ticks, such as permethrin (used in K9 Advantix and other products) and amitraz (used in Certifect and the Preventic collar), are toxic to cats, which can be a problem in a household that includes both, especially if they are friendly with each other. In that case, giving the dog an oral product would be safer for the cat.

– Because the insecticides in the newer oral products haven’t been used for very long, they can be more effective in areas where fleas and ticks may have built up some resistance to the older topical products.

– Last but not least, oral flea-control medications have been proven to be more effective than topical pesticides in both killing fleas and helping to control a household infestation more quickly.

Disadvantages of Oral Flea-Killing Medications

Every product you feed or use on your dog poses some amount of risk, and some percentage of dogs will react badly to any product.

The most significant disadvantage of these medications is that, once a dog digests one, it’s in his system for as long as it’s designed to be. If he has an adverse reaction, veterinary attention may be required to treat his symptoms, but there is little that can be done to mitigate or halt the overall reaction. In contrast, if a dog has an adverse reaction to a topical pesticide, his owner can immediately bathe him to reduce the adverse effects. The effects of an oral medication can’t be mitigated in this way.

Dog deaths and seizures have been reported from the use of these products. The product manufacturers (and, until recently, the FDA) have indicated that these most serious adverse effects are very rare – not numerous enough to be listed among the most common adverse side effects on the package inserts. We are awaiting updated information regarding the adverse drug experience (ADE) reports that have been collected by the FDA since the introduction of these products to the market.

The most common adverse side effects of oral flea-control medication are stomach upset and vomiting. The very fact that a dog can vomit up the medication – and the possibility that he might do so without you being aware of this – is a fairly significant disadvantage, too. If you don’t find the vomit, you may think the product was just plain ineffective. And then there is the possibility the vomit is discovered and eaten by another one of your dogs!

It should also be noted that while all of these products are formulated with palatants to entice a dog to chew them up and eat them, some dogs may refuse. In this case, you will be forced to either sneak the medication into the dog’s food or give it to him like any other pill – and you’d have to break the larger doses for large dogs into pieces to “pill” them.

Finally, but not insignificantly, prescription oral flea-killing medications can compromise the integrity of a necessarily strict food-allergy trial.

Isoxazolines: The Newest Class of Flea-Killing Drugs

There are not that many medications approved by the FDA for controlling fleas on dogs. Most products contain one significant “active ingredient” that controls fleas, although a few contain more than one.

The newest class of insecticides are isoxazolines, chemicals that are selectively toxic to insects (fleas) and acarines (mites and ticks) in a way that is not supposed to pose a risk to mammals. Isoxazolines kill fleas and ticks by inhibiting their ligand-gated chloride channels, in particular, those gated by the GABA neurotransmitter. This blocks pre- and post-synaptic transfer of chloride ions across cell membranes, resulting in uncontrolled activity of the fleas’ and ticks’ central nervous system (CNS) and death.

In plain English? The operation of many physiological processes rely on ion channels, chemical pathways where charged ions from dissolved salts (including sodium, potassium, calcium, and chloride) pass through otherwise impermeable cell membranes. Most of these channels are gated, opening and closing in response to certain stimuli. Isoxazolines close the chemical gates on chloride channels that are essential for the CNS of fleas and ticks, resulting in their death.

What follows is a description of each of the isoxazoline-containing products and information from their product inserts.

Keep in mind as you read that, as stated earlier, WDJ recommends the use of these products only under certain circumstances (specified above), for a limited amount of time. The information is presented so that owners understand what these products are, how they work, and how they differ from each other.

Bravecto

The active ingredient in Bravecto, a product introduced by Merck Animal Health in early 2014, is an isoxazoline chemical called fluralaner. It is given once every three months. Each Bravecto treatment kills fleas and certain species of ticks (black-legged tick, American dog tick, and brown dog tick) for 12 weeks, three times longer than any other oral flea treatment. It kills the lone star tick for eight weeks. It also kills the mite responsible for demodectic mange, though it has not yet received FDA approval for this use. Studies indicate that Bravecto kills more than 98 percent of fleas, and 100 percent of ticks, in less than 12 hours after administration.

Bravecto should be administered with food to maximize the bioavailability of the active ingredient.

The most common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia (excessive drinking), and flatulence.

Although its maker offers no specific warning about this in its product literature, Bravecto should be used with caution in dogs with a history of seizures, similar to other drugs in this class.

Bravecto is said to be safe for pregnant, breeding, and lactating dogs, dogs weighing at least 4.4 pounds, and for puppies who are at least six months old (and 4.4 pounds). No adverse reactions were observed in pre-approval studies when Bravecto was used concurrently with other medications such as vaccines, de-wormers, antibiotics, and steroids.

Credelio

This is the most recently introduced oral flea-killing medication to the market; Credelio, made by Elanco, was approved for use in January 2018. Its active ingredient is an isoxazoline chemical called lotilaner. It is given once a month. Credelio kills fleas, the Lone Star tick, American dog tick, black-legged tick, and brown dog tick.

Studies indicate Credelio begins to kill fleas within four hours of administration, and is 100 percent effective against fleas within 24 hours. It is 97 percent effective against ticks within 48 hours.

Due to reduced drug bioavailability in the fasted state, Credelio must be administered with a meal or within 30 minutes after feeding.

The most common adverse reactions recorded in clinical trial were weight loss, elevated blood urea nitrogen (BUN), polyuria (excessive production of dilute urine), and diarrhea.

Credelio is said to be safe for dogs and puppies who weigh a minimum of 4.4 pounds and who are eight weeks of age or older. No adverse reactions were observed from the concomitant use of Credelio with vaccines, anthelmintics (dewormers), antibiotics, steroids, NSAIDS, anesthetics, or antihistamines. The safe use of Credelio in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures.

NexGard

The active ingredient in NexGard, a product introduced by Frontline Vet Labs, a division of Merial, Inc., in 2013, is an isoxazoline chemical called afoxolaner. It is given once a month. Each NexGard treatment kills fleas and the black-legged tick, American dog tick, Lone Star tick, and brown dog tick. It also kills the mite responsible for demodectic mange, though it has not yet received FDA approval for this use.

In July 2018, Nexgard was approved by the FDA for the prevention of the infection that causes Lyme disease in dogs. Lyme disease is caused by a bacterium, Borrelia burgdorferi (B. burgdorferi), that is carried by certain species of ticks. The data presented by Merial in the supplemental application measured the transmission of B. burgdorferi to dogs after exposure to infected Ixodes scapularis ticks, and demonstrated that transmission was prevented as a direct result of killing the ticks. The study did not measure whether the product affected rates of illness from Lyme disease in dogs.

Studies indicate NexGard was 100 percent effective against fleas within 24 hours, and more than 97 percent effective against American dog ticks and Lone Star ticks, 94 percent effective against black-legged ticks, and 93 percent effective against brown dog ticks.

NexGard can be given with food or on an empty stomach.

The most common adverse reactions recorded in clinical trials were vomiting, itching, diarrhea, lethargy, and lack of appetite.

Nexgard is said to be safe for dogs and puppies who weigh four pounds or more and who are at least eight weeks of age. No adverse reactions were observed in preapproval studies when NexGard was used concomitantly with other medications, such as vaccines, dewormers, antibiotics, steroids, NSAIDS, anesthetics, and antihistamines. The safe use of NexGard in pregnant, breeding, or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures.

Simparica

The active ingredient in Simparica, a product introduced by Zoetis in 2016, is an isoxazoline chemical called sarolaner. It is given once every month. Each Simparica treatment kills fleas (100 percent within 24 hours) and certain species of ticks (almost 97 percent of Lone Star tick, Gulf Coast tick, American dog tick, black-legged tick, and brown dog tick) for one month.

Simparica also kills the mites responsible for demodectic mange (demodex), sarcoptic mange (scabies), and otodectic mange (ear mites), though it has not yet received FDA approval for these uses. (We’ve seen reports from veterinarians who are using it for this off-label use with success.) Its claim to fame is its speed; Zoetis claims that Simparica starts killing fleas within three hours and ticks within eight hours of administration.

Simparica may be administered with or without food.

Simparica may cause abnormal neurologic signs such as tremors, unsteadiness, and/or seizures. Simparica has not been evaluated in dogs who are pregnant, breeding, or lactating. Simparica has been safely used in dogs treated with commonly prescribed vaccines, parasiticides and other medications. The most frequently reported adverse reactions were vomiting and diarrhea.

Simparica is said to be safe for dogs weighing at least 2.8 pounds, and for puppies who are at least six months old (and 2.8 pounds).

Next Flea Medication Class: Spinosyns

This class of chemicals does not kill ticks, only fleas. Spinosyns work in a similar fashion as the isoxazolines, in that they activate reactions in the flea’s cellular ion channels (in this case, the nicotinic acetylcholine receptors or nAChRs), causing a fatal CNS reaction in the fleas. Insects treated with spinosyns show involuntary muscle contractions and tremors resulting from activation of motor neurons. Prolonged spinosad-induced hyperexcitation results in prostration, paralysis, and flea death. The selective toxicity of spinosad between insects and vertebrates may be conferred by the differential sensitivity of the insect versus vertebrate nAChRs.

The prescription oral flea-killing products in this class of medications all utilize a spinosyn called spinosad.

Comfortis/AcuGuard

These products are the same thing; Elanco makes AcuGuard for the VCA chain of veterinary hospitals under the Vethical brand.

As previously mentioned, the active ingredient in Comfortis and AcuGuard is spinosad. These products were FDA-approved in 2007. They are given once every month. Each treatment kills fleas for one month. Flea count reductions of 97.9 percent were observed one month after the first treatment and 99.9 percent after three monthly treatments with Comfortis or AcuGuard.

Administer these products with food for maximum effectiveness.

The most common adverse reaction reported from Comfortis/AcuGuard is vomiting. Other adverse reactions reported in decreasing order of frequency are: depression/lethargy, decreased appetite (anorexia), incoordination (ataxia), diarrhea, itching (pruritis), trembling, excessive salivation, and seizures.

Following concomitant extra-label use of ivermectin (very high doses used to treat mange) with Comfortis/AcuGuard, some dogs have experienced the following clinical signs: trembling/twitching, salivation/drooling, seizures, incoordination (ataxia), excessive dilation of pupils (mydriasis), blindness, and disorientation. Products containing spinosad should be safe when used along with the normal heartworm preventive dosage of ivermectin or milbemycin oxime, but use with caution in dogs who have or may have the MDR1 mutation that causes sensitivity to certain drugs.

Neither should these products be combined with high doses of milbemycim oxime (Interceptor, Sentinel), used to treat demodectic and sarcoptic mange, as this combination can cause serious adverse neurological effects.

While Elanco says these products can be combined with other flea and tick products, we wouldn’t recommend it. Nor should Comfortis/NexGuard be used for dogs with epilepsy or other seizure disorders.

Use with caution in breeding females. The safe use of Comfortis/AcuGuard in breeding males has not been evaluated.

Comfortis/AcuGuard is approved for use in dogs 14 weeks of age or older and 3.3 pounds of body weight or greater.

Trifexis/ComboGuard

These products are the same thing; Elanco makes ComboGuard for the VCA chain of veterinary hospitals under the Vethical brand.

Trifexis and ComboGuard combine spinosad with milbemycin oxime, a chemical that is used as a heartworm-preventive and is effective against intestinal parasites (hookworms, roundworms, and whipworms).

Trifexis/ComboGuard is approved for use in dogs and puppies eight weeks of age or older and five pounds of body weight or greater.

Administer these medications with food for maximum effectiveness.

Treatment with fewer than three monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of Trifexis/ComboGuard, dogs should be tested for existing heartworm infection. Use with caution in breeding females. The safe use of these medications in breeding males has not been evaluated.

Use with caution in dogs with pre-existing epilepsy.

What Elanco calls “mild, transient hypersensitivity reactions manifested as labored respiration, vomiting, salivation, and lethargy” have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating heartworm microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae. Milbemycin oxime is more effective against microfilariae than most other heartworm prevention medications (including ivermection) and may therefore cause anaphylaxsis if given to a heartworm-positive dog.

Just as with Comfortis and AcuGuard, following concomitant extra-label use of ivermectin with spinosad, some dogs have experienced the following clinical signs: trembling/twitching, salivation/drooling, seizures, incoordination (ataxia), excessive dilation of pupils (mydriasis), blindness and disorientation. Spinosad alone has been shown to be safe when administered concurrently with heartworm preventatives at label directions.

Again, products containing spinosad should be safe when used along with the normal heartworm preventive dosage of ivermectin or milbemycin oxime, but use with caution in dogs who have or may have the MDR1 mutation that causes sensitivity to certain drugs.

The most common adverse reactions reported are vomiting, depression/lethargy, itching (pruritic), decreased appetite (anorexia), diarrhea, trembling/shaking, ataxia, seizures, hypersalivation, and skin reddening. Puppies less than 14 weeks of age may experience a higher rate of vomiting.

Tips for Medication Use

It bears repeating: We do not recommend the use of these prescription-only flea-killing medications. However, if your dog is highly allergic to fleas, you live in an area where fleas are a chronic threat, your dog suffers from adverse reactions to topical pesticides, and he has not reacted to these medications in the past, use the products with these safety tips in mind:

1. Read all medication directions before giving to your dog.

Always read the instructions for use carefully before administering to your dog, especially the cautions and contraindications. It’s always shocking when we hear that someone gave their dog a medication without reading the instructions – and often refusing to take responsibility. “My veterinarian prescribed it! How was I supposed to know it could make my dog sick?” While it’s true that a veterinarian should inform her clients about the contraindications of any product she recommends, in reality, few vets have or take the time. If you read something in the product insert’s cautions and contraindications that seems like it would apply to your dog and concerns you, call your veterinary hospital and ask for the vet to call you back to discuss it – again, before you give the product to your dog.

2. Pay attention to the instructions.

Always follow the directions carefully. Products for cats and dogs are not interchangeable; a number of products for dogs are potentially fatal for cats. Topical products should not be ingested. Pay special attention to weight and age minimums for safe use, as well as the cautions regarding administration to sick, weak, old, medicated, pregnant, or nursing dogs.

3. Observe your dog carefully after administering a flea-control medication.

Most adverse reactions happen within a few hours. Contact your veterinarian with a speed that is congruent with the seriousness of your dog’s symptoms. (Serious? Go the to veterinary ER! Mild? Call your vet the next day to report and ask the staff to note this in your dog’s chart.)

4. Start a flea control calendar.

Keep track of when you administer a flea-control product to your dog. It’s advisable to write the date, time, product, and dosage on a calendar that you can easily refer to if your dog has an adverse reaction and you need to recount details to your veterinarian. Also note any abnormalities you may notice in your dog’s health, appetite, digestion, and demeanor after administration.

Nancy Kerns is the editor of WDJ.

The post Prescription Oral Flea Control Medication for Dogs appeared first on Whole Dog Journal.

For many veterinarians, prescription drugs are a first choice for the treatment of chronic pain, while for some they are a last resort. Used well, drugs can make a world of difference for our older companions, but they are controversial because of their documented side effects. Would prescription meds improve your best friend’s life?

Many WDJ articles about aging dogs have explored nutritional, herbal, aromatherapy, and exercise treatments for arthritis. According to holistic veterinarians, these and other drug-free approaches are worth trying. Unfortunately, they don’t work for every dog, and they may not work quickly.

In his book, Dr. Petty’s Pain Relief for Dogs: The Complete Medical and Integrative Guide to Treating Pain, (Countryman Press, 2016), Michael C. Petty, DVM, calls attention to pain symptoms that readers may not notice or consider important.

This is a mistake, he warns, because pain interferes with every aspect of a dog’s life. He begins the book by noting that most veterinarians who practice pain management have a story about their relationship with pain. His began in 1984, when his 64-year-old mother died in agony from breast cancer while her physician refused to prescribe morphine to ease her final hours. “I vowed that as a caretaker and steward entrusted with an animal’s health,” he writes, “I would never be indifferent to pain.”

As Denise Flaim explained in 2015, pain in animals used to be ignored, but attitudes are changing. Increasingly, veterinarians and pet owners are sensitive to their animals’ pain and motivated to relieve it. In fact, pain management for pets has become a medical specialty. (Click here to find veterinarians who belong to the International Veterinary Academy of Pain Management.)

How to Recognize Pain in Dogs

A major problem in the diagnosis and treatment of canine pain is that many dog owners don’t notice its symptoms, or they notice the dog is slowing down but don’t understand why. Another is that not everyone takes canine pain seriously, so it’s easy to overlook.

You can help your dog live a pain-free life by noticing changes in posture, gait, and activity level. Tell your veterinarian if your dog exhibits any of the following symptoms of pain:

• Shows reluctance to walk on or difficulty getting up and down on slippery surfaces.
• Struggles to walk up or down stairs.
• No longer jumps onto or off furniture or car seats.
• Gets up from a down position with the front legs first.
• Seems to have trouble lying down or finding a comfortable position.
• Declines to participate in favorite activities, especially running and jumping.
• Develops abnormal wear on nails, or tends to walk with a foot turned under or dragging.
• Seems reluctant to play or no longer initiates play
• Starts taking exception to being groomed or petted.
• Experiences sleep interruptions.
• Develops a decreased appetite.
• Begins experiencing “accidents” or incontinence in the house.

For more information on signs of pain in dogs, read our article Dog in Pain: 12 Signs and What You Can Do to Help.

A comprehensive pain exam, Dr. Petty explains, involves a visual inspection of your dog’s posture and gait, followed by a thorough hands-on exam and appropriate lab work in order to determine the pain’s underlying cause. “When it comes to signs of chronic or even short-term persistent pain,” he says, “simply treating the signs of pain with medications is not enough. In circumstances like this a proper diagnosis is required.”

Chronic pain can be caused by osteoarthritis, neurological disorders, injuries, and illnesses. Often, a condition has been progressing for months or even years before a caregiver notices a symptom for the first time, such as limping or a reluctance to chase a ball.

Even when a dog is favoring one leg or obviously limping, her pain may be caused by something far from the leg, such as a disc in the neck. As Dr. Petty explains, a ruptured cruciate ligament in the knee, spinal arthritis, bone cancer, a severe muscle injury, or disc disease are impossible to distinguish from one another by observation only. A pain-oriented veterinarian asks detailed questions, examines the dog with careful palpation, takes x-rays as needed, and does a neurological exam to determine the pain’s cause and best treatment.

The most common canine illness is osteoarthritis, which affects four out of five dogs. But arthritis has many possible causes, making it a complex problem involving not only joints but also their surrounding structures. Osteoarthritis develops slowly, so it’s often not noticed until it has progressed to an advanced stage. There is no magic cure for osteoarthritis, and its management usually depends on a combination of treatments that continue through the dog’s life.

For more on diagnosing arthritis in dogs, read our article Identifying Arthritis in Dogs. 

FDA-Approved Pain Medications for Dogs

Hundreds of drugs developed for human pain are used by veterinarians to treat chronic pain in dogs, but only nonsteroidal anti-inflammatory drugs (abbreviated as NSAIDs and pronounced “EN-seds”) and two non-NSAID prescription drugs (Galliprant and Adequan) have been approved by the U.S. Food and Drug Administration (FDA) for canine use.

The most familiar NSAID is aspirin, which is effective in the treatment of pain associated with canine arthritis. However, although there are numerous “dog aspirin” products on the market, aspirin is not FDA-approved for use in dogs. According to Dr. Petty, “the administration of even a few doses of aspirin has been shown to cause inflammation of the gastric mucosa or lining of the stomach.” He considers all types of aspirin (plain, buffered, or coated) too dangerous for canine use.

If your veterinarian prescribes aspirin for your dog, be sure to discuss its dosage, potential side effects, and cautions before using it.

The FDA approved the first NSAID for use in dogs (carprofen, brand name Rimadyl, manufactured by Pfizer) 20 years ago. Since then, several other NSAIDs have been developed for dogs.

FDA-approved NSAIDs for dogs include etodolac (Etogesic), meloxicam (Metacam), deracoxib (Deramaxx), firocoxib (Previcox), tepoxalin (Zubrin), and carprofen (Novox, Vetprofen, and Rimadyl). These drugs have similar actions, contraindications, benefits, and side effects. Their primary influence is on the cyclooxygenase or COX pathway, in which chemical reactions create prostanoids, a family of lipid mediators that cause pain and inflammation in nerve endings and in the spinal cord.

COX-inhibiting NSAIDs help block this reaction, thus reducing pain. But some chemicals created through the COX pathway are important to proper kidney function and protection of the gastrointestinal tract. Reducing the body’s prostanoids reduces pain but contributes to the most common adverse reactions associated with NSAIDs. These include gastrointestinal ulceration, kidney failure in dogs with kidney disease, liver failure in dogs with liver disease, and liver failure in some dogs with no previous liver problems.

Symptoms include vomiting, diarrhea, loss of appetite, and depression, all of which should be watched for and if noticed, reported to your veterinarian, and the medication should be stopped at once.

Today, carprofen is very commonly prescribed for canine pain, but its ubiquity doesn’t mean it’s not without the potential for drastic and even fatal side effects due to liver or kidney problems, sometimes causing death within days. Any breed of dog can react to carprofen, but reportedly, Labrador Retrievers are more commonly affected than other breeds.

Problems with carprofen and other NSAIDs most often occur shortly after starting the drug. It has been observed that carprofen has caused a disproportionate number of NSAID-related dog deaths, although this could be because it is prescribed more than other NSAIDs.

NSAIDs should never be combined with corticosteroids (such as prednisone), aspirin, or other NSAIDs, or herbs that may contribute to bleeding or ulceration, such as white willow bark (Salix alba, the original aspirin).

Despite their potential side effects, NSAIDs are an effective first treatment for many dogs with osteoarthritis. By reducing the dog’s pain, they help increase activity and exercise, which slows the progression of arthritis.

While NSAIDs should not be combined with each other, they are often combined with other drugs for improved results. In many cases, adding a compatible drug may permit the reduction of the dosage or frequency of the NSAID without a loss of effectiveness.

To ensure an NSAID does not adversely affect the liver or kidneys, it’s recommended to have blood tests done prior to medication and again two to four weeks after starting the NSAID. Blood tests should be repeated every three months to a year while your dog is being given an NSAID.

It can be dangerous to switch from one NSAID (including aspirin) to another, or from an NSAID to prednisone or vice versa. It’s best to wait at least a week in between, and preferably longer, before starting the new drug. This is particularly important when you are switching from one of the older-generation NSAIDs, including aspirin and white willow bark. If you switch from NSAIDs to prednisone, a three-day waiting period is considered sufficient.

Galliprant

Aratana Therapeutics’ Galliprant was approved by the FDA in March 2016 for treating canine osteoarthritis. Galliprant is a piprant antagonist drug that inhibits the production of prostaglandins (lipid compounds with diverse hormone-like effects). NSAIDs target the entire cyclooxygenase or COX pathway, including the pathway’s protective functions, which explains most of their adverse side effects. By contrast, Galliprant specifically blocks the EP4 receptor, which is the primary mediator of canine osteoarthritis pain and inflammation, without involving the COX pathway.

Because of its documented safety, Galliprant does not require expensive monitoring the way NSAIDs do, and it is said to relieve pain in dogs who are not able to tolerate NSAIDs. It is considered safe for dogs age nine months and older. Appropriate monitoring is recommended for long-term use.

Galliprant should not be used in combination with COX-inhibiting NSAIDs or corticosteroids. Its most common side effects, all of which are reported to be mild and infrequent, include vomiting, diarrhea, decreased appetite, and lethargy.

Adequan

An injectable joint protectant, Adequan Canine (polysulfated glycos-aminoglycan, or PSGAG) from Luitpold Pharmaceuticals, Inc., is the only FDA-approved injectable, disease-modifying drug for canine osteoarthritis. Injected intramuscularly, Adequan stimulates cartilage repair, soothes and lubricates joints, reduces joint damage, and relieves pain.

Adequan travels to joints within two hours of injection and remains in joints for three days. It is administered twice weekly for up to four weeks with a maximum of eight injections. Signs of improvement usually appear within one month.

The drug’s most common side effects are stinging at the injection site and (less common) an upset stomach, vomiting, diarrhea, depression, or abnormal bleeding. Adequan should not be used in dogs showing hypersensitivity to PSGAG or dogs with kidney disease, liver disease, or known or suspected bleeding disorders.

Although such treatment is considered “off-label” because it differs from the manufacturer’s protocol, some veterinarians continue to give Adequan injections at monthly intervals, or they repeat the prescribed protocol whenever the dog’s symptoms return.

It may not be necessary to inject this drug into muscles. Some veterinarians inject it subcutaneously, which is less painful for the dog and easier for owners to do themselves at home. A similar product, Cartrophen Vet, which is sold in Canada and other countries, is given subcutaneously.

Tramadol and Other Opioid Drugs

Tramadol (Ultram) is a synthetic opioid that appears to be safer than most narcotics and can be used for long-term chronic pain treatment. While not FDA approved for dogs, it’s widely prescribed by veterinarians.

Tramadol’s main action in dogs is as a serotonin and norepinephine reuptake inhibitor. Serotonin and norepinephrine are neurotransmitters, substances that carry impulses from one nerve to another. Tramadol’s effect on neurotransmitters interrupts the transmission of pain signals. It acts on pain symptoms only and does not reduce inflammation. Tramadol is considered safe to combine with NSAIDs or with prednisone.

Tramadol should not be given with Monoamine oxidase inhibitors (MAOIs). Examples include Anipryl/l-deprenyl/selegiline, and the Preventic tick collar, which contains Amitraz, another MAOI. It may also be dangerous to combine tramadol with St. John’s wort (Hypericum perforatum). In addition, tramadol should be used with caution in combination with selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, and Paxil, as well as tricyclic antidepressants such as Elavil and Clomicalm.

Because tramadol is metabolized through the liver and kidneys, its dosage must be reduced for dogs with liver or kidney disease. High doses may trigger seizures; it should be used with extreme caution in seizure-prone dogs.

Ultracet, which is tramadol combined with acetaminophen (Tylenol) for humans, can be dangerous for dogs.

Studies of tramadol’s long-term effectiveness have shown possible problems with absorption from the stomach or a decrease in the liver’s ability to utilize the drug. Recent research shows that tramadol may not work as well for dogs as it does for people. Higher doses, given more often, may be needed for adequate pain control, and it may work better for some types of pain than for others. Tramadol works best when combined with NSAIDs rather than used in place of them.

Opioid drugs (narcotics) are not FDA approved for canine use, but many veterinarians prescribe them for pain relief. Examples include oral hydrocodone (which can be combined with NSAIDs for additional pain relief), Vicodin (a combination of hydrocodone and acetaminophen, which cannot be combined with NSAIDs), codeine, oxycodone, and transdermal fentanyl (Duragesic) patches. Their narcotic effects make these drugs best for short-term use.

Corticosteroids

The strongest anti-inflammatory drugs are corticosteroids such as prednisone, methylprednisolone (Medrol), and dexamethasone, but their significant side effects make them most appropriate for short-term use. Corticosteroids are not FDA-approved for canine use but are widely prescribed by veterinarians.

Steroids can suppress the immune system, increase appetite (causing weight gain), increase thirst and urination, lead to muscle loss and weakness, and cause gastric ulcers.

NSAIDs are not compatible with steroids and should be discontinued at least 72 hours before beginning steroid treatment. Steroids can be combined with other pain medications mentioned here except for Galliprant.

Prednisone and other corticosteroids are usually given in large initial doses, then gradually reduced to the lowest dose that controls symptoms. Giving them every other day and giving them with food helps reduce side effects. Steroids should never be stopped abruptly but rather tapered off.

Long-time WDJ contributor Mary Straus had a Shar-Pei, Piglet, who lived to be 17 and was mobile to the end, thanks to Mary’s attentive care and frequent trips to the veterinarian to adjust Piglet’s medication regimen. Straus turned to prednisone in what turned out to be Piglet’s last six months, explaining, “This allowed her to continue to be mobile after NSAIDs were no longer effective.”

Medical Marijuana

Even though marijuana (Cannabis sativa) has gained public acceptance and is legal for medical and recreational use in several states, a confusing array of federal, state, and local regulations, and a lack of scientific studies, make its use controversial.

When it comes to treating canine pain, marijuana and other cannabis products have a following among pet owners and veterinarians. In 2013, Mary Straus described the benefits of marijuana for canine pain control and the pioneering work of Doug Kramer, DVM, whose Enlightened Veterinary Therapeutics clinic in California offered medical marijuana protocols for pets in his palliative and hospice care practice. Sadly, Dr. Kramer died in August 2013 before he completed a clinical trial, and his clinic closed.

Given the dearth of studies, there is no reliable information about what dosage of marijuana is safe and effective for pets. Concentrated forms (such as oils, tinctures, and other extracts) in particular can cause toxicity even in small amounts. This problem is further complicated by the variation in strengths for each of these based on the strain of marijuana grown, the timing of the harvest, and the preparation of the medical product.

Marijuana contains more than 60 chemicals called cannabinoids, the most important of which are cannabidiol (CBD), which has therapeutic properties, and tetrahydrocannabinol (THC), which is psychoactive but may provide additional benefits when small amounts are combined with CBD.

Because of its very low THC content, hemp (a Cannabis sativa plant traditionally used for making rope, paper, and fabric) is not considered intoxicating. Instead, its cannabinoids are known for their anti-inflammatory, analgesic, and anti-spasmodic properties. Hemp capsules, oils, and other products containing cannabinoids derived from hemp are sold throughout the U.S. for human and canine use without restriction.

Doxycycline

The familiar tetracycline antibiotic doxycycline, which is widely used to treat bacterial infections, especially those carried by ticks, has been shown to have anti-inflammatory properties and actually reduce the production of enzymes that lead to the progression of arthritis.

The discovery that human patients with arthritis improved while taking tetracycline drugs led to clinical trials, including some with dogs. Other trials have shown improvement in knee cartilage, other joints, and cartilage ulceration in both humans and dogs taking low doses of doxycycline.

The mechanism that causes improvement is not well understood. Researchers theorize that human rheumatoid arthritis is triggered by the immune system battling infection, and when antibiotics clear the infection, symptoms improve. Although some studies have shown little or no improvement in humans with osteoarthritis, some canine studies show a good response to that disease.

Gabapentin

Gabapentin (Neurontin) is an anticonvulsant and pain relief medicine intended for the relief of neuropathy (nerve pain). It is similar in structure to GABA, a chemical messenger found in the brain, and it relieves or reduces pain by inhibiting the release of glutamate, which is a type of neurotransmitter. Gabapentin has been shown to be effective in combination with NSAID medications.

Because gabapentin can cause deficiencies of vitamins D, B1, and folate as well as calcium, it is important to provide a high-quality canine vitamin-mineral supplement in combination with the drug.

Gabapentin for dogs is administered in tablets or capsules. Do not administer liquid formulations intended for humans, as they may contain Xylitol, which is toxic to dogs.

Note: Most dogs build a tolerance to Gabapentin over time so that the starting dose becomes ineffective. Higher doses are then prescribed.

Amantidine

Originally developed as an antiviral drug to prevent Asian influenza, amantidine (Symmetrel) found success as a treatment for the symptoms of Parkinson’s disease. More recently, veterinarians began prescribing amantadine for chronic pain in dogs with arthritis, cancer, and disc disease. It has been shown to improve the effectiveness of NSAID medications when combined with them. Amantidine is administered daily for one to two weeks, at which point it can be discontinued or resumed. Dogs with kidney problems receive lower doses. Reported side effects include agitation, diarrhea, flatulence, and dizziness. If any of these symptoms occur, the medication should be discontinued and your veterinarian notified.

Amantidine can interact with heart medications, antibiotics, and diuretics, any of which can reduce the drug’s effectiveness, while antihistamines can increase its effects and induce a state of agitation.

Other Drugs

Used alone or combined with narcotics, NSAIDs, or steroids, some antidepressants relieve pain and discomfort in dogs with arthritis. These medications are not FDA approved for canine use but are prescribed by many veterinarians. Drugs in this category include amitriptyline (Elavil Rx) and other tricyclic antidepressants such as clomipramine (Clomicalm).

These medications should be administered under veterinary supervision as they require careful study, especially if they are used in combination with other drugs.

What You Can Do for Your Dog With Arthritis

1. Schedule a veterinary exam as soon as you notice signs of pain or lameness in your dog.

2. Before giving any medication to your dog, ask your veterinarian about any possible drug interactions or contraindications.

3. Note your dog’s responses (good or bad) to any prescribed medications on a calendar or journal. Memory is fallible, and your vet needs solid information in order to tailor doses and changes in dosing frequency for maximum benefit to your dog.

Montana resident CJ Puotinen is the author of The Encyclopedia of Natural Pet Care and other books.

The post Prescription Drugs for Dog Arthritis Pain Relief appeared first on Whole Dog Journal.