Paracetamol and its uses in dogs...

RE: Paracetamol and its uses in dogs...

Lucy Fleming — Tue, 21 Jun 2016 17:29:44 GMT

I'm starting to use paracetamol more and more. Primarily I use it as an occasional adjunct in animals that are on NSAID and tramadol (or gabapentin) but are suffering from breakthrough pain - the owner gives on an 'as needed' basis. Dose rate I tend to stick around to 10mg/kg as a starting point, especially if the owners are likely to give it regularly. If it is only going to be occasional I will tend to go a bit higher, but I must admit choice is often driven by a sensible tablet/ half tablet etc interval as much as anything else.

In dogs that don't tolerate nsaid but have had an acutely painful episode I use pardale v at the label dose rate for around 5 days or so. My understanding is that this dose is ok for short periods but as an ongoing treatment the 10mg/kg dose rate is preferred (i must admit I didn't ask for a reference for this!)

I have advised it in the past as a sole agent for the owner of an elderly arthritic dog who could not afford a licensed nsaid but wanted something to improve the dogs QOL (looking at euthanasia as an alternative option)

RE: Paracetamol and its uses in dogs...

Stuart Jackson — Tue, 21 Jun 2016 14:14:31 GMT

[quote user="bob lehner"]

[quote user="sajackson"]Hmmm...placebo effect in dogs and cats. First prove there is one then use it as evidence[/quote]

I suspect it's the owner's perception of a 'good result' which is meant by placebo effect in this sort of situation.

[/quote]

Hmmm....owner's perception is often used as evidence in clinical trials....it's not clinical evidence tho

RE: Paracetamol and its uses in dogs...

bob lehner — Tue, 21 Jun 2016 14:04:39 GMT

[quote user="sajackson"]Hmmm...placebo effect in dogs and cats. First prove there is one then use it as evidence[/quote]

I suspect it's the owner's perception of a 'good result' which is meant by placebo effect in this sort of situation.

RE: Paracetamol and its uses in dogs...

Stuart Jackson — Tue, 21 Jun 2016 11:07:47 GMT

[quote user="joanne mcallister"]

I have stopped using Tramadol based on this info below from a cpd talk by Jo Murrell:

...However it is worth noting that the evidence base for Tramadol in both cats and dogs for the management of chronic pain is very weak to non existent, and owner reported efficacy of a treatment, due to the placebo effect, is not the most robust means to assess efficacy of an analgesic treatment.

The analgesia provided by Tramadol is dependent on the action of the parent drug (which provides mainly non opioid mediated analgesia) and the production of metabolites (which probably provide opioid mediated analgesia). However in dogs, metabolism of tramadol is very variable, with a range of different metabolites being produced. Furthermore, many dogs produce very little of the metabolite that mediates opioid analgesia, limiting the analgesic efficacy of the drug in these dogs.

[/quote]

Hmmm...placebo effect in dogs and cats. First prove there is one then use it as evidence

RE: Paracetamol and its uses in dogs...

joanne mcallister — Tue, 21 Jun 2016 11:04:33 GMT

I have stopped using Tramadol based on this info below from a cpd talk by Jo Murrell:

RE: Paracetamol and its uses in dogs...

Noweia — Tue, 21 Jun 2016 00:34:23 GMT

I use it as 10mg/kg as per the BSAVA formulary. I tend to use it alongside NSAIDs and tramadol, or in cases where the dog is sensitive to NSAIDs and tramadol alone isn't cutting it. As far as I'm aware there are no contraindications with kidney disease, but use with caution in dogs with liver disease.

I've seen a response in most dogs I've used it in, but the level of response varies.

RE: Paracetamol and its uses in dogs...

Utlendigur — Mon, 20 Jun 2016 22:50:08 GMT

[quote user="Beats"]I suspect most useful in visceral analgesia, but that's just a gut feeling. [/quote]

Not sure if that was an intentional pun or not

RE: Paracetamol and its uses in dogs...

Michael Woodhouse — Mon, 20 Jun 2016 22:26:23 GMT

We use it a lot in small animals. Have animals on it long term with both steroids and NSAIDs. Warn owners it is off licence, but works amazingly well. We use at the Pardale V licensed dose rate of 33.3mg/kg of paracetamol. I have no idea and can find no reference where BSAVA plucked 10mg/kg from. If you use it at the low dose it doesn't work very well (what do we expect?!). Longer term some dogs drop down to bid dosing. Warn owners it's off licence in combination and with longer courses, but never had the slightest problem.

The ambulance service is using it IV and finding that it will control pain in some patients as well as morphine or they find it very morphine sparing. If dosed appropriately then I'm happy it is a good analgesic - particularly alongside more conventional NSAIDs. I'd have the injection in stock if I didn't have to buy 12 bottles at once. If I want injected analgesia we generally go NSAID/methadone/ketamine.

We've had some dogs respond well to tramadol. Ie they stop limping on NSAID and tramadol and start limping when the tramadol runs out. I did a long walk on Saturday and I can personally vouch that my knee hurts less after 1000mg of paracetamol on top of the 400mg of ibuprofen.

Very unexciting, but an excellent drug.

RE: Paracetamol and its uses in dogs...

Beats — Mon, 20 Jun 2016 22:05:45 GMT

[quote user="Emily Rainbow"]I've often wondered if I could utilise paracetamol more often in a multimodal analgesia sense but wondered in what sort of situations it would be most suitable?[/quote]

I suspect most useful in visceral analgesia, but that's just a gut feeling. Practically, I use it in dogs where NSAIDs aren't advisable, or as additional analgesia in perhaps a case of pancreatitis or something - but no idea if it actually objectively helps or not (other than helping with pyrexia).

Is also usually my first additional analgesic in chronic pain cases such as djd after NSAID - again not sure if objectively helps or not.

[quote user="Emily Rainbow"]Eg is it safe alongside NSAIDs long term in arthritic dogs?[/quote]

In my experience, yes. I tend to advise at 10mg/kg q12hrs for this. Unaware of any clinical problems that have resulted from this.

[quote user="Emily Rainbow"]can you use it concurrently with steroids or is it still a no as per proper NSAIDs? Ditto in renal patients or patients with GI upset?[/quote]

I believe it to be safe to use in all those instances. A classic use for me is where I have a pyrexic patient that I believe to be most likley immune-mediated, but before starting on immunosuppressive doses of preds I want to rule out bacterial infection or whatever and want something that I can give for the pyrexia without worrying about causing problems if need to administer a steroid later on. I think liver pathology likely to be biggest contra-indication?

[quote user="Emily Rainbow"]what doses are you using?[/quote]

10-30mg/kg q8-12hrs. Generally use the lower end of that dose spectrum either as injectable (iv, sc) or when giving chronically. Higher end if administration oral and for few days only.

[quote user="Emily Rainbow"]most recently I've used it in post-op (ortho) cases where the tramadol has made the dogs dysphoric but more than just an NSAID alone was needed.[/quote]

I don't rate tramadol any higher. (though like paracetamol do use it). I don't use it (H&S concerns), but wonder if the transdermal fentanyl solution is the best for this (I had little faith in the patches when I used them in years gone by)? I tend to keep in clinic on injectable buprenorphine until happy can be managed reasonably on NSAID alone, but obviously that's not always a good option for all dogs.

RE: Paracetamol and its uses in dogs...

Beats — Mon, 20 Jun 2016 21:48:24 GMT

[quote user="George Cooper"]Paracetamol - does it EVER provide relief from pain?[/quote]

Jury's out for me.

Is an excellent anti-pyretic however for dogs.

RE: Paracetamol and its uses in dogs...

George Cooper — Mon, 20 Jun 2016 20:49:49 GMT

Paracetamol - does it EVER provide relief from pain?