Okay, so which NSAID is best?

Re: Okay, so which NSAID is best?

Gillian Mostyn — Wed, 02 May 2012 22:49:24 GMT

Yeah - I make sure when dispensing metacam for rabbits to reassure the owner that I did mean for them to give the 20kg level on the syringe to their 4kg rabbit.

Re: Okay, so which NSAID is best?

Rob Loxley — Wed, 02 May 2012 21:13:53 GMT

It's when you're dispensing 180ml bottles of Metacam to rabbits you think you've made some sort of mistake!

Re: Okay, so which NSAID is best?

Utlendigur — Wed, 02 May 2012 20:38:50 GMT

Thanks for that. I remember trying to find a dose a few weeks ago and thinking the dose rate must be an error....obviously not! Bit like medetomidine - it seems ridiculous to be giving the sort of dose you'd give to a dog to a bunny.

Re: Okay, so which NSAID is best?

James Laidlaw — Wed, 02 May 2012 18:01:06 GMT

[quote user="Sarah Keir"]

[quote user="Utlendigur"]

What is the latest dose of metacam for rabbits?

[/quote]

0.3-0.6mg/kg every 12-24 hours (source - some well respected exoctics vet CPD I did a few months back ).

Huge dose isn't it!

Sarah

[/quote] I use 0.5 mg/kg BID after hearing from a few referral people that all they do with a lot of their rabbit cases from first opinion practices is increase the metacam (if at the 0.3 dose, or only sid) and see improvements. I've seen this in cases in practice too. Seems good pain relief helps-who'd have thought it! All this NSAID stuff does my head in...

Re: Okay, so which NSAID is best?

Sarah Keir — Wed, 02 May 2012 17:03:51 GMT

[quote user="Utlendigur"]

What is the latest dose of metacam for rabbits?

[/quote]

0.3-0.6mg/kg every 12-24 hours (source - some well respected exoctics vet CPD I did a few months back ).

Huge dose isn't it!

Sarah

Re: Okay, so which NSAID is best?

Utlendigur — Tue, 01 May 2012 22:24:23 GMT

[quote user="Alet Engelbrecht"]Do you mean that you would use Pardale alongside an NSAID? I thought it is contraindicated?[/quote]

So did I, but it was recommended at a CPD lecture on chronic pain that I went to last year. Haven't tried it yet though. Pardale's also supposed to be useful for cases with renal insufficiency, where it's apparently safer than nsaids

What is the latest dose of metacam for rabbits?

Re: Okay, so which NSAID is best?

Laurence Webb — Tue, 01 May 2012 21:28:41 GMT

Yes, I use them alongside. It is contraindicated in the datasheet although I did discuss it with the manufacturers once who accepted that the data sheet was written around 20 years ago and has probably not been reviewed for years. Using it in combination follows a discussion with the owner about quality of life vs possible side effects but I find the combination can be quite effective. I use it at a paracetemol dose rate of 10mg/kg rather than the data sheet amount of around 3 times that.

In human medicine paracetemol is a mainstay of analgesia and, as you say, used in combination with NSAIDs and has been reclassified in a group of its own. It is fairly non-irritant to the stomach and relatively safe with renal impairment. The codine component is fairly small and does not appear to be associated with and particular side effects.

As a precaution we have "Do NOT give to cats" printed on the dispensing labels. No accidents so far...

Re: Okay, so which NSAID is best?

Alet Engelbrecht — Tue, 01 May 2012 20:09:27 GMT

[quote user="Laurence Webb"]3) Add in Tramadol or Pardale - I'm using more Pardale as time goes on.[/quote]

Do you mean that you would use Pardale alongside an NSAID? I thought it is contraindicated?

I think paracetamol has been reclassified in human medicine and I know they use it alongside conventional NSAIDs all the time, but I have limited experience of using it in veterinary medicine - mainly overdoses where clients used it without veterinary advice in small dogs (and cats - goes without saying), which gave me a fright for life. And, although we all know cats are not small dogs, clients do treat everything as (not so small) humans and often dose them (cats, dogs, etc) the same. Has no one else had any problems?

Re: Okay, so which NSAID is best?

James Allsop — Tue, 01 May 2012 19:01:17 GMT

the dose of metacam recommended in rabbits seems to be getting higher and higher - can we therefore assume that at the previous doses the effect was placebo?

Re: Okay, so which NSAID is best?

Anthony Todd — Sat, 28 Apr 2012 00:25:34 GMT

[quote user="robloxley"]1) I assume paracetamol is a typo, since PLT contains none[/quote]

Whoops, sorry, they used to be cheap and white, now they're expensive and "fawn".

and they were called "Prednoleucotrophen", shortened to PLT, and I don't remember "Cinchophen" at all.....

Forget what I said, they're not the same so I can't comment and should have checked!

Perhaps it's the minimal prednisolone anyway....

Re: Okay, so which NSAID is best?

Laurence Webb — Sat, 28 Apr 2012 00:13:54 GMT

1) Any NSAID (generally Metacam or generics). I've not had any problems in cats so far.

2) Try another NSAID. Sometimes it works! Not sure one is better than another

3) Add in Tramadol or Pardale - I'm using more Pardale as time goes on.

4) Add in the other one

5) More opiates, gabapentin

6) Pentobarb.

I've not used amantidine but I've very interested in the intermittent ketamine idea. With a wife who has many chronically painful conditions and is on a combination of all of the above (and then some) I'm always interested making my patients as comfortable as possible.

Re: Okay, so which NSAID is best?

John Rimmer — Fri, 27 Apr 2012 20:44:41 GMT

Economies of scale. Use em or lose em.

Re: Okay, so which NSAID is best?

Rob Loxley — Fri, 27 Apr 2012 19:45:06 GMT

[quote user="Anthony Todd"]

I put it on PLT...

... it was an old drug and had a bit of pred in it as well as the paracetamol.

[/quote]

1) I assume paracetamol is a typo, since PLT contains none
2) I agree that some dogs doing poorly on 'standard' NSAIDS do great on PLT
3) I do however balk at the cost of the good old Poorly Leg Tablets

Re: Okay, so which NSAID is best?

Hannah Wynne Richards — Fri, 27 Apr 2012 15:33:28 GMT

I've used it for the 1st time in a chronic pain dog today I'll let you know what I think

Wynne

Re: Okay, so which NSAID is best?

Alet Engelbrecht — Fri, 27 Apr 2012 08:45:57 GMT

[quote user="David Mills"]ever taken ketamine? Can assure the effects, by report, last much longer than this '20 minutes' baloney. Resetting the button - this is the 21st century[/quote]

Ketamine in low doses is well recognised as an extremely good adjunct in a multimodal analgesic approach. From Trocoxyl propoganda, central sensitisation is foremost in most of our minds. I do not see the criticism - I found it a very useful contribution and I would like to try it. For one, I think ketamine has infinitely fewer side effects in our patients (low dose, occasional use as recommended) than long term high dose nsaids in an older animal.

Another thing - I've seen (and used in patients myself occasionally) ketamine used on its own at 5mg/kg im in fractious cats to take blood samples - it does not seem to elicit a strong reaction on injection without the dom/torb addition and provides enough time to take samples and clip nails (old cats) without dropping the BP. [I have seen a hyperthyroid cat drop dead after getting extremely worked up during restraint for conscious b/s].

I find ketamine a very useful drug in veterinary medicine (perhaps because I haven't yet experienced the effects personally?)

Re: Okay, so which NSAID is best?

Richard Larkin — Fri, 27 Apr 2012 08:02:54 GMT

[quote user="Mark Holmes"][quote user="David Mills"]

[/quote] I am getting tired of people being miserable rude and arrogant on this forum. 1) we are talking about using incredibly low doses. 2) it is well known that different species have different rates of sensitivity and drug metabolism. Take rabbits and NSAIDS for example or the differing effects of immobillon on man and horses. 3) I am just relaying the mode of action as described to me by somebody infinately better qualified in anaesthesia than you and A DIPLOMA HOLDER, good friend and lecturer who offers pain clinics on a referral basis 4) I was trying to be helpful and relay a tip which I have appreciated and found helpful 5) Get some manners.

[/quote]

Did the kids keep you up last night Mark? Impressed by the generation of so much anger by 7 am!!!

Am in agreement

Re: Okay, so which NSAID is best?

Mark Holmes — Fri, 27 Apr 2012 07:23:12 GMT

[quote user="David Mills"]

For the dinosaurs, suggest you look up the pain relief review paper in JFMS, free to download on google. Renal disease and cats- no proven decrease in renal function at low doses of meloxicam especially (though effective pain relief)

Paracetamol is underused, alongside nsaids.

Mr Holmes, ever taken ketamine? Can assure the effects, by report, last much longer than this '20 minutes' baloney. Resetting the button - this is the 21st century

Re: Okay, so which NSAID is best?

Anthony Todd — Fri, 27 Apr 2012 02:03:41 GMT

[quote user="David Mills"]Renal disease and cats[/quote]

I was talking about dogs. It is encouraging to hear that meloxicam doesn't cause decrease in renal function in cats but I'll bet no one has compared it's effective pain relief in dogs with paracetamol.

I can only remember anecdotal evidence of a number of cases which showed improvement.

Re: Okay, so which NSAID is best?

David Mills — Fri, 27 Apr 2012 00:53:00 GMT

Paracetamol is underused, alongside nsaids.

Mr Holmes, ever taken ketamine? Can assure the effects, by report, last much longer than this '20 minutes' baloney. Resetting the button - this is the 21st century

Re: Okay, so which NSAID is best?

Anthony Todd — Fri, 27 Apr 2012 00:34:19 GMT

[quote user="Cat Henstridge"] Metacam[/quote]

"Oh hell, here's the bloody dinosaur again". I can hear the groans here in Queensland.

When a client came in moaning that the dog on Metacam was no better I put it on PLT.

Response was dramatic.

I could only sort of nod and say it was an old drug and had a bit of pred in it as well as the paracetamol.

I think Pardale is licensed and contains paracetamol.

and it was cheap.

Re: Okay, so which NSAID is best?

Cat Henstridge — Thu, 26 Apr 2012 22:15:48 GMT

I am a Metacam girl! It is my first line treatment for arthritis in both cats and dogs, I have found it safe, palatable and very effective until, in dogs, things get worse and I add in Tramadol. I particularly like the flexible dosing and have never seen any significant side effects or long term problems, even in cats.

Re: Okay, so which NSAID is best?

Utlendigur — Thu, 26 Apr 2012 22:15:11 GMT

[quote user="Mark Holmes"]Not CRI but I have given 0.5 mg/kg IM on closure.[/quote]

Ditto (but tend to give it at start of op) and have found it works really well. Also quite good for those occasional bitch spays that starting puffing, despite premed analgesia, when you pull on their ovaries.

Re: Okay, so which NSAID is best?

Mark Holmes — Thu, 26 Apr 2012 21:57:55 GMT

[quote user="Malcolm Ness"]

[quote user="Alet Engelbrecht"][quote user="Mark Holmes"]apparently works by resetting the wind up process[/quote][/quote]

Is it only in the land of the Geordie that "wind up process" means something different? (elaborate practical joke, typically with an especially gullible victim)

Then again, perhaps it doesn't.

[/quote] I guess it would respond similarly to Ketamine.

Re: Okay, so which NSAID is best?

Malcolm Ness — Thu, 26 Apr 2012 21:51:06 GMT

[quote user="Alet Engelbrecht"][quote user="Mark Holmes"]apparently works by resetting the wind up process[/quote][/quote]

Is it only in the land of the Geordie that "wind up process" means something different? (elaborate practical joke, typically with an especially gullible victim)

Then again, perhaps it doesn't.

Re: Okay, so which NSAID is best?

Mark Holmes — Thu, 26 Apr 2012 21:48:03 GMT

[quote user="Alet Engelbrecht"]

[quote user="Mark Holmes"]apparently works by resetting the wind up process[/quote]

They did that on the TV series 'House'!

I find this very interesting and will definitely give it a try. I've used ketamine peri-operatively for orthopaedic cases for a while now and I have been very satisfied with the results. Since I started, I thought my cruciate repairs have been getting ahead of my 'rehab schedule' - specifically when I compared one dog where I used it during the 2nd repair (the other leg of course).

I think there was a BSAVA congress lecture a few years back that suggested to use a constant rate infusion of ketamine for bitch spays as well. Has anyone got any experience/thoughts on it? Sorry, I digress.

[/quote] Not CRI but I have given 0.5 mg/kg IM on closure.