Routine use of gastroprotectants with NSAIDs in dogs

RE: Routine use of gastroprotectants with NSAIDs in dogs

David Mills — Sun, 28 Aug 2016 01:08:39 GMT

Have seen this creeping in. The ironic thing is people who prescribe ranitidine at the formulary doses - around 2mg/kg - good studies show this is no effective than saline at increasing gastric pH (i.e. it doesn't). Again, defensive medicine. Slippery slope.

RE: Routine use of gastroprotectants with NSAIDs in dogs

ChrisBVSc — Thu, 25 Aug 2016 09:58:29 GMT

Never seen this as a routine thing to do & haven't worked with anyone else who has.

When we had Trocoxil we sometimes gave it under the cover of a short gastroprotectant course for dogs that had GI side effects on daily nsaids. The nsaid was still effective & most dogs didn't have GI side effects. However we do not know if they'd have been fine anyway without the GI protectants!!

Never given protectants routinely with nsaids, seems a bit overkill unless you know the patient has had problems in the past! (In which case I'd probably be looking for a different drug anyway!)

RE: Routine use of gastroprotectants with NSAIDs in dogs

Andrew Kent — Wed, 24 Aug 2016 20:42:52 GMT

There is no evidence that using gastroprotectants with high dose steroids reduces the risk so personally I don't use them unless there are any problems.

Andy

RE: Routine use of gastroprotectants with NSAIDs in dogs

Thomas Johnson — Wed, 24 Aug 2016 18:54:22 GMT

I also don't routinely use gastroprotectants with NSAIDs, and I don't think anyone else in our practice does either.

RE: Routine use of gastroprotectants with NSAIDs in dogs

Nicola Cole — Wed, 24 Aug 2016 18:13:30 GMT

I don't routinely use gastroprotectants with NSAIDs either.

RE: Routine use of gastroprotectants with NSAIDs in dogs

Neil Wheadon — Wed, 24 Aug 2016 18:03:23 GMT

Double blind clinical study in many practices

Cases A - everything gets gastroprotectants

Cases B - wrinkly old locum (me) never uses them

Result no difference

Neil

RE: Routine use of gastroprotectants with NSAIDs in dogs

Richard Carter — Wed, 24 Aug 2016 14:31:48 GMT

think it is a spin-off from nhs where prescribing a nsaid = omeprazole. No idea if needed or just fashion as the lectures last year at London Vet show discussed NSAID PG antagonism affecting the ability of the protective lining to repair whereas the omeprazoles etc are not involved with repair in any way.

A further gem (from Cambridge East of England lectures) was the increased level of bacterial complications in cats where pH has been artificially raised with H2 blockers - cats need acid stomachs basically

RE: Routine use of gastroprotectants with NSAIDs in dogs

Braden Collins — Wed, 24 Aug 2016 14:30:21 GMT

Sounds like a pretty bad idea to me. The modern NSAIDs are quite safe, and we don't really know how gastroprotectants will affect absorption or metabolism of the NSAIDs.

Sounds like defensive medicine to me.

RE: Routine use of gastroprotectants with NSAIDs in dogs

Bob Russell — Wed, 24 Aug 2016 14:22:14 GMT

I would have concerns that gastric protectants might affect absorption of the drug. Therefore unless there is a clinical reason to use them it is something I would avoid.

Adverse reactions are really not common and the vast majority are minor!

RE: Routine use of gastroprotectants with NSAIDs in dogs

Rob Loxley — Wed, 24 Aug 2016 13:43:16 GMT

[quote user="Glen McIntosh"]I will always prescribe gastroprotectants in combination with prolonged high dose corticosteroid administration (e.g. immunosuppressive pred courses). I do not do so for NSAID courses under routine circumstances[/quote]

Same here pretty much

[quote user="Glen McIntosh"]Is this now such a common practice that it is approaching the minimum level of care "expected of the average or reasonably competent vet"? [/quote]