Side effects caused by 'NSAI's'?

Re: Side effects caused by 'NSAI's'?

Mark Hedberg — Wed, 19 Sep 2012 15:51:18 GMT

[quote user="Martin Atkinson"]

Pup was apparently starting to look ropey but it wasn't my problem at this stage as we were just putting the phones through to the OOH provider.

[/quote]

Re: Side effects caused by 'NSAI's'?

Mark Holmes — Wed, 19 Sep 2012 13:43:33 GMT

[quote user="patrick murphy"]

a former colleague used to swear by 2 teaspoons in a glass of orange juice first thing in the morming for ethanol toxicity

[/quote]

Yes we were advised of that at Uni come to think about it.

Re: Side effects caused by 'NSAI's'?

Martin Atkinson — Wed, 19 Sep 2012 13:03:48 GMT

Someone called last evening his 13 week old Rotty pup had eaten 7 500mg NSAID tabs (can't remember what brand now). He said he didn't know how long ago the pup had eaten them or where he'd got them from because they don't have them in the house, the thought occurred to me if this was the case how did they know what he'd eaten and how many? Pup was apparently starting to look ropey but it wasn't my problem at this stage as we were just putting the phones through to the OOH provider.

Re: Side effects caused by 'NSAI's'?

patrick murphy — Wed, 19 Sep 2012 12:58:24 GMT

a former colleague used to swear by 2 teaspoons in a glass of orange juice first thing in the morming for ethanol toxicity

Re: Side effects caused by 'NSAI's'?

Hannah Wynne Richards — Wed, 19 Sep 2012 09:34:34 GMT

Alex Was he barking?

Wynne

Re: Side effects caused by 'NSAI's'?

Bob Russell — Wed, 19 Sep 2012 09:23:31 GMT

[quote user="alex gough"]

You probably shouldn't take Metacam for those aching bones, Patrick! Save it for the animals. An old colleague, long time ago, apparently used to take phenybutazone off the shelf for his arthritis!

[/quote]

Meloxicam capsules are available for human use! They are bl**dy cheap too if you get them from a human wholesaler!

I have known a few people who were on them (one at my suggestion via GP) and they were doing well. No honey based formulation though!

Re: Side effects caused by 'NSAI's'?

Alex Gough — Wed, 19 Sep 2012 08:41:58 GMT

You probably shouldn't take Metacam for those aching bones, Patrick! Save it for the animals. An old colleague, long time ago, apparently used to take phenybutazone off the shelf for his arthritis!

Re: Side effects caused by 'NSAI's'?

patrick murphy — Tue, 18 Sep 2012 15:43:23 GMT

a fuuny but appropriate study in US by dermoids when dispensing erythromycin split group in 2, telling half of them the gi side effects, and the other half nothing. of course you will guess the result.I do have the odd gi upsets with NSAIS's interesting that I changed to alternative to Metacam and it appeared to be more common, so it is one that I use for the brand's sake.

Re: Side effects caused by 'NSAI's'?

Charlotte Marshall — Tue, 18 Sep 2012 08:27:48 GMT

I would say uncommon to rare as well. I have only seen mild gastrointestinal signs which resolved with cessation of treatment.

We do sometimes do bloods on animals on longterm therapy usually just basic biochem (idexx pre anaesthetic). I have yet to see any changes in an otherwise healthy animal.

One talk I went to said acually we should consider doing haematology as asymptomatic levels of anaemia can be seen in some animals and had been seen to resolve after swopping to a different nsaid.

Re: Side effects caused by 'NSAI's'?

Rajat — Mon, 17 Sep 2012 23:57:23 GMT

[quote user="David Mills"]Confused. BNF quotes upto maximum of 2.4g daily in divided doses. There is some evidence, actually, for starting at a high dose and then decreasing, for want of a better phrase to get on top of the pain.[/quote]

I heard of the 1000mg TID from a dentist. I didn't take it...! I seem to see more NSAID rxns at higher doses - the rimadyl data sheet says : An initial dose of 2 to 4 mg carprofen/kg bodyweight/day is recommended to be given as a single dose or in two equally divided doses. Subject to clinical response the dose may be reduced after 7 days to 2 mg carprofen/kg bodyweight/day given as a single daily dose.

I see more GI signs in dogs receiving 4mg/kg/day for 5d than 2-3mg/kg/day - I have used the latter dose for a coupla years and hardly see it at this dose. but it is just anecdote. I do use the full 4mg/kg by injection on day 1 tho.

Re: Side effects caused by 'NSAI's'?

Utlendigur — Mon, 17 Sep 2012 23:41:18 GMT

[quote user="Clive Ansell"]One would like to think not. My father was prescribed Ibuprofen 800mg tid (2400mg daily!!) by his GP for possible osteoarthritis of his knees with a follow up check in 6 months. He was not even examined, let alone a definitive diagnosis reached - scary. [/quote]

Must be the same doctor my mother had. She slipped on a steep slope landing with all her weight on a hyperflexed knee, which promptly swelled like a football. Was told to take max dose of ibuprofen. When the knee was still massively swollen a week later she was told to add topical ibuprofen gel aswell which did sweet FA. Next time she went back, still unable to weight bear, she told the GP that her daughter thought she might have sustained either a CCL injury or a meniscal tear and would they please refer her for xray and/or arthroscopy - they did. She had a torn meniscus.

Re: Side effects caused by 'NSAI's'?

David Mills — Mon, 17 Sep 2012 22:54:04 GMT

[quote user="Clive Ansell"]

[quote user="Rajat"]

Problem is, we (vets and owners) use them quite frequently. And sometimes inappropriately (like using them at full whack doses for several days in a row- would we take 800-1000mg Ibuprofen tid for 5 days?!)

[/quote]

One would like to think not. My father was prescribed Ibuprofen 800mg tid (2400mg daily!!) by his GP for possible osteoarthritis of his knees with a follow up check in 6 months. He was not even examined, let alone a definitive diagnosis reached - scary.

[/quote]

Confused. BNF quotes upto maximum of 2.4g daily in divided doses. There is some evidence, actually, for starting at a high dose and then decreasing, for want of a better phrase to get on top of the pain. Hence carprofen has a initiation dose of 4mg/kg followed by maintenance of 2mg/kg and meloxicam double doses on first day.

Why is there this inherent fear of high (but within reference range) doses of nsaids?

For the record, side effects vet nsaid very rare and can almost always be attributed to a confounding factor. I think those that are to do with the drug are local mucosal irritation far more than COX-1 mediated.

Re: Side effects caused by 'NSAI's'?

Bob Russell — Mon, 17 Sep 2012 15:19:52 GMT

I don't know how to start one of the 'tick' box questionnaires (Clive may be able to help me!)

I am interested in the broadest of attitudes towards NSAI's rather than any specifics. I was worried to see (not you Martin!) that some are put off NSAI's full stop because of side effects.

I have used a wide variety of NSAI's (mainly meloxicam) for a lot of years and would consider side effects to be rare. Not every vomiting dog is reacting to the NSAI, not every diarrhoea is meloxicam related.

I blood test for Trocoxil because this is advised by the data sheet!

Re: Side effects caused by 'NSAI's'?

Martin Atkinson — Mon, 17 Sep 2012 14:36:42 GMT

[quote user="Bob Russell"]Someone posted that they had seen too many side effects to warrant the standard use of these products after routine surgical procedures.[/quote] Could have been me! As your fourth line doesn't mention species I would say certainly applies to cats, they are given but with care and a single dose only. For dogs I think the word after routine surgery is the crucial one. I never give NSAIDs pre or peri-operatively in case the animal suffers a hypo-volaemic episode, once they've recovered I'm happy., but we've had this discussion before.

Re: Side effects caused by 'NSAI's'?

Rajat — Mon, 17 Sep 2012 13:48:28 GMT

[quote user="Clive Ansell"]

[quote user="Rajat"]

[/quote]

Madness! Very scary indeed.

Re: Side effects caused by 'NSAI's'?

Rob Loxley — Mon, 17 Sep 2012 13:44:14 GMT

More specifically I think we need to also look at severity, rather than just frequency: I'd guess we see some mild side effects but rarely severe ones (where mild are self limiting and severe need treatment possibly hospitalisation).

Re: Side effects caused by 'NSAI's'?

Clive Ansell — Mon, 17 Sep 2012 13:38:48 GMT

[quote user="Rajat"]

[/quote]

Re: Side effects caused by 'NSAI's'?

Clive Ansell — Mon, 17 Sep 2012 13:33:18 GMT

I would say uncommon to rare. See the occasional dog with vomiting and/or diarrhoea, very rarely haemorragic. Not sure about underlying organ damage/disease though? how many people routinely offer screening bloods for patients on long term nsaid's?

Had a case in last week for a medication check. severe osteoarthritis of elbows, hips and stifles. All of the nsaid's tried have really upset this dog with profuse vomiting and diarrhoea, but he seems to be settled and comfortable on a PLT and Tramadol combination.

Re: Side effects caused by 'NSAI's'?

Hannah Wynne Richards — Mon, 17 Sep 2012 13:19:36 GMT

I'd vote for uncommon

Wynne

Re: Side effects caused by 'NSAI's'?

Rajat — Mon, 17 Sep 2012 13:15:35 GMT

As a percentage, I believe rare to uncommon. Problem is, we (vets and owners) use them quite frequently. And sometimes inappropriately (like using them at full whack doses for several days in a row- would we take 800-1000mg Ibuprofen tid for 5 days?!)

It'd be nice to get some numbers, I have called Pfizer and Boehringer to get some numbers on complication rates or adverse event rates - wikipedia reports 6000 adverse events reported on carprofen, over I wonder how many millions of tablets sold! Annoyingly its lunch time/meeting time so I have been told Boehringer will call me later and Pfizer tomorrow...will report back if I find out anything useful!

Re: Side effects caused by 'NSAI's'?

Michael Woodhouse — Mon, 17 Sep 2012 13:13:39 GMT

I would say 'very rare'. Used to get an occasional dog vomit on meloxicam so tend to use generic carprofen as 1st line in dogs.

Re: Side effects caused by 'NSAI's'?

James Laidlaw — Mon, 17 Sep 2012 13:11:26 GMT

10 years experience (give or take), I have seen no major side effects. Occasional v+/d+ or one of these, always advise to monitor for GI side effects, discontinue if these occur and call in to discuss (POC - so no charge if problems with meds).

I don't believe there isn't potential for side effects to occur, but I'd have to see a hell of a lot more to discontinue their use. I have reported about 10 or so SAR forms for vaccine reactions, and none for NSAID's - which I also wonder if those who have had significant problems - have they reported to VMD/SAR form filled in? Can do online - takes no more than 10 minutes.