Pardale-V

RE: Pardale-V

Aine Seavers — Fri, 09 Mar 2018 01:00:23 GMT

Excellent news-I have hated Tramadol from day 1, it was introduced the EBM with zero evidence replacing drugs with proven efficacy and leave a significant portion of dogs in pain as they don't have the receptors to metabolise it. I had 2 specialist pharmacologists do a review on it for dogs some years ago-only one paper on tramadol as epidural showed efficacy leaving the issue of useless positive effect but dangerous side effects when combined with nsaids that do work. We use Metacam, followed by gabapentin and add in Panadol then panadeine closer to the end. In humans, the use on Pentosan Polysulphate injections (oral I find useless in dogs) is now being trialled in a new study here in Australia-with improvements in pain reduction and decreased opiod/ate use. If it does prove successful then maybe the impact of the PPS on other glycosaminoglycan layered / cartilaginous tissue in other body systems can reveal additional therapies for this injection besides joint arthritis.

RE: Pardale-V

Alistair Graham-Evans — Fri, 09 Mar 2018 00:37:20 GMT

http://jav.ma/2FCBn5y

Recent study published in JAVMA indicates Tramadol no more effective than placebo

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rhmrcvs — Thu, 08 Mar 2018 21:46:47 GMT

Its not an nsaid , use together.

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Clive Ansell — Thu, 08 Mar 2018 15:32:38 GMT

I saw an elderly GSD this morning with lumbosacral disease, osteoarthritis in hips and stifles, and advancing CDRM, that is being managed very well (as can be expected) with a combination of Tramadol, Paracetamol, and prednisolone, after finding out that nsaid's aren't tolerated very well.

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Rob Davis — Thu, 08 Mar 2018 14:51:24 GMT

I have also used is several times alongside prednisolone with no problems

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Joyce Whitehead — Thu, 08 Mar 2018 14:06:58 GMT

Yes we have used it with Preds with no issues.

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Aisling McGrath — Thu, 08 Mar 2018 10:44:38 GMT

Bit late to this thread, but been searching for threads on Pardale, as I'm new to the paracetomol brigade!

Can you use it alongside prednisolone just like you can use it alongside NSAIDs?

Have an elderly Boxer with extreme spondylosis and OA, worse case of spondylosis I've ever seen, but coping well on pred/tramadol, but not seeming to help now, so was going to add Pardale to the mix?

RE: Pardale-V

Andrew Mellor — Fri, 23 Dec 2016 18:10:42 GMT

pefalgan should be available from your wholesaler , we use for almost all routine and non-routine ops unless liver impairment, tramadol has to be used at high doses as 90% is removed by first pass metabolism in dogs, I would agree there is somewhat of a placebo effect with it. Pardale v is very useful and we use all the time in combination with nsaid, gabapentin, amitriptyline ketamine injections etc in the really bad cases.

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ChrisBVSc — Fri, 23 Dec 2016 16:28:36 GMT

I use quite a lot of Pardale, but not 1st line for OA unless standard nsaids are contraindicated or causing adverse effects. I think it works reasonably well as an analgesic. Have used it with nsaids without any issues and our nearest referral centre often send them away on an nsaid/pardale combination too. Like others I've never quite understood the 'do not use with other nsaids' warning on the datasheet, because paracetamol is not classed as an nsaid. As far as I'm aware it does have some kind of COX inhibiting effects though, so perhaps there is some rationale to this warning, in theory?? (Any serious pharmacologists out there?!)

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Sarah Keir — Tue, 20 Dec 2016 14:45:27 GMT

I like gabapentin for chronic painful conditions.

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James Dunne — Tue, 20 Dec 2016 12:08:40 GMT

"As an arthritis sufferer myself I know that this is a condition with a natural waxing and waning type of course. Therefore it can be difficult to judge the efficacy of any medication, with the inherent variability of the disease. Perhaps that's why some people seem to think Tramadol is effective in certain cases?"

My limited understanding is that people think Tramadol is effective because it has a rapid onset of action in the dogs it does work in. Coupled with the euphoric effect it also seems to produce, this might convince pet owners that it's a very good drug. In many other dogs sedation occurs and they don't seem painful because they just don't move around enough! I think there are far better drugs out there with less potential problems.

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Bob Russell — Tue, 20 Dec 2016 11:46:07 GMT

I am not so anti tramadol but would agree it is of variable clinical value. Some dogs do seem to benefit or owners think they do!

I do use some for acute pancreatitis cases following (usually) methadone.

It does have a place in practice but I suspect it was largely a fad!

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bob lehner — Mon, 19 Dec 2016 21:46:05 GMT

[quote user="Neil Wheadon"]

'm a confirmed Tramadol hater. I have no idea how it started to be used, probably because the pain relief market in the UK has spiralled down to NSAIDs and there is nothing else to mix in.

Yet it's unlicensed, seems to last no time at all and as I have said in the past it's addictive and is used for suicide. There are 2.2 million dependant people in the USA. I simply can't believe that some of the medications we are dispensing aren't feeding an owners addiction.

[/quote]

Yes - I've been also baffled by the rise of Tramadol - seemed to come out of no where and then suddenly everyone was using it - despite the limited evidence of efficacy in dogs, short half-life, side effects etc.

Just about every practice I visit has bucket loads of it in the CD cabinet - in all manner of different formulations.

As an arthritis sufferer myself I know that this is a condition with a natural waxing and waning type of course. Therefore it can be difficult to judge the efficacy of any medication, with the inherent variability of the disease. Perhaps that's why some people seem to think Tramadol is effective in certain cases?

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Michael Woodhouse — Mon, 19 Dec 2016 20:46:00 GMT

[quote user="Neil Wheadon"]Michael Woodhouse's blood boils when we talk about the cascade, this has far more harmful effects and I'm amazed we are still allowed to dispense it in the quantities we do.[/quote]

It does, but we get through a lot of Pardale V. Happy to use at data sheet doses, rather than the seemingly plucked from the air 10mg/kg in BSAVA formulary. We've had dogs on that dose for years with other NSAIDs and no issues. Make owners aware off licence.

Used to get owners to lower dose of NSAID, but some recent evidence suggests that just goes to put dogs into more pain, so have stopped generally advising it.

I found tramadol quite useful in some dogs that struggle to settle at night. Use a lot less now than we used to.

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emerald — Mon, 19 Dec 2016 20:31:35 GMT

Can you still get i/v paracetamol? We used to be able to get it called Perfalgan, but can't seem to anymore?

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Neil Wheadon — Mon, 19 Dec 2016 14:29:02 GMT

[quote user="James Dunne"]Tramadol works in around 50% of dogs; unfortunately its effect often disappears after about 1 hour or so. On top of that it is associated with gastric disturbance, sedation and addiction. [/quote]

Is it as high as that?

I'm a confirmed Tramadol hater. I have no idea how it started to be used, probably because the pain relief market in the UK has spiralled down to NSAIDs and there is nothing else to mix in.

Michael Woodhouse's blood boils when we talk about the cascade, this has far more harmful effects and I'm amazed we are still allowed to dispense it in the quantities we do.

There rant over

Neil

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James Dunne — Mon, 19 Dec 2016 13:23:20 GMT

No-one really knows where the formulary dose of 10mg/kg came from. The data sheet dose of 33mg/kg is okay, but it seems to be very effective at lower doses. 5 days in a row max but give a break for 2 days and then start again seems to work. The data sheet indicates that it is contra-indicated to use it concurrently with NSAIDs, but most of us do anyway. This is frequently done in humans. Paracetomol has an accumulative hepatotoxicity hence why a break of a few days every 5 or so is sensible. Tramadol works in around 50% of dogs; unfortunately its effect often disappears after about 1 hour or so. On top of that it is associated with gastric disturbance, sedation and addiction.

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Eilidh Corr — Sat, 17 Dec 2016 20:13:57 GMT

Yep I think Pardale is really useful, although it's extremely rare that I'd use the data sheet dosage. I've never had any problems using it alongside NSAIDs.

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Aine Seavers — Sat, 17 Dec 2016 04:58:10 GMT

Hate Tramadol, we use Panadeine forte here in last option cases when the nsaid and gabapentin dont work or in cases of bone rather than joint pain where we have used Fosamax with great care and great results in a small case selection. so I agree with Joyce and Martin et al. We use the 10mg/kg paracetamol dose rate

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Virginia Campbell — Fri, 16 Dec 2016 23:50:42 GMT

The answer is probably lost in the mists of time!

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serena holmes — Fri, 16 Dec 2016 23:22:22 GMT

Any idea why the dose on the pot is so much higher than in the formulary?

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Virginia Campbell — Fri, 16 Dec 2016 22:45:12 GMT

My experience same as Joyce's. We use loads...short term post neuter at or a bit below the licensed dose ( I tend to round down often, I don't think the licensed dose is really necessary for most), for sore ears if it's getting pred, long term at 10mg/kg as adjunct/alternative to NSAIDs in arthritis, often used as a bridge for the washout period if trialling different NSAIDs or needs pred or has episode of D+;; during a flare when we've hoiked the NSAID to the max dose and it needs extra help; and the more end stage ones.

I don't pay too much attention to the " not with NSAIDs". I certainly believe paracetamol to be safe for the GIT. About the only time I fear paracetamol is if the liver is under really really severe pressure and has a lot on its plate. And even then I do occasionally use a little bit. IV paracetamol is very handy to have and not expensive.

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Rob Loxley — Fri, 16 Dec 2016 20:37:46 GMT

We use a lot of paracetamol, often alongside NSAIDs, longterm at 10mg/kg BID

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Beats — Fri, 16 Dec 2016 20:27:37 GMT

Adiditionally to above, tramadol is broken down in humans to an active metabolite that has a 200-times affinity for opioid receptors compared to the parent molecule. Dogs do not have the same metabolic pathway and don't make this metabolite to any significant degree.

Pardale-V contains paracetamol and codeine, neither of which is an "NSAID" - they might not be steroids, but they sure ain't anti-inflammatory either - which means a suggestion not to combine with another NSAID is nonsensical.

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Joyce Whitehead — Fri, 16 Dec 2016 18:00:08 GMT

I was at a pain relief CPD this week delivered by an anaesthesia specialist, he said it is likely that anything under 10mg/kg of tramadol is useless, and some dogs seem to have no response at all. Trials in beagles are very equivocal as to whether it is any help at all. Despite this some owners feel it helps (placebo effect?).