PLT tablets

RE: PLT tablets

peter chalkley — Thu, 24 Aug 2017 15:31:09 GMT

As far I am aware from my last conversation with a tech vet is that PLT is gone and not coming back. surely it cant be that hard to make.................

RE: PLT tablets

Thomas Johnson — Tue, 22 Aug 2017 15:05:39 GMT

[quote user="Beats"]

[quote user="George Cooper"]Because nothing appears to have been written about where to go with these cases that benefit from its use, I've developed a system that is almost to effect. Most of the dogs that end up on it as a treatment of last resort are of the larger variety, though not necessarily obese, and we now follow a regime of four weekly injections, followed by two fortnightly and eventually either every month or every three weeks to demand. Owners stop giving NSAID, or the steroid the day before and after, always assuming that it is aving some.[/quote]

This is not what I'm led to believe the manufacturers recommend. I believe they recommend a course of 4 weekly injections and then repeat a course of 4 weekly injections again when required. I was also told by the vet trying to sell it to me that it doesn't work if given with NSAIDs... or if you give too much of it... I listened, had to agree that in my limited experience the drug had never been used as she presently recommended it, and remained highly skeptical at the end.

[/quote]

From the Cartrophen datasheet:

Mild signs of OA – 1 course* every 12 months
Moderate signs of OA – 1 course* every 6 months (2 courses per 12 months)
Chronic and severe signs of OA – 1 course* every 4 months (3 courses per 12 months)
* course = administration every 5-7 days on four occasions.

RE: PLT tablets

Charlotte Marshall — Sun, 20 Aug 2017 19:06:02 GMT

I am also missing PLT tablets as I found them really useful. Have we any idea when they may be back or more worryingly if?

RE: PLT tablets

David Mills — Fri, 18 Aug 2017 22:04:07 GMT

[quote user="James Dunne"]

Hi David

I have used both capsules and tablets over the years. We mainly stock tramadol tablets nowadays for ease of dosing should they need to be split. I'll PM you what I have regarding evidence and try to compile a list of cases - maybe it is all in my own head. What I didn't say regarding dex - I agree it is more ulcerogenic than prednisolone - but meant to was that almost every colleague who fell victim to this made a comment along the lines 'this never happened before'...some of them have made the comment more than once over the years. I guess we can all compartmentalise things in and out of our minds so I take your point that record-keeping and examining our own data would be useful.

[/quote]

Sorry if I came across as aggressive, reading my reply back it maybe did. It wasn't. Just genuinely interested. Because it's something of a dogma at university (even now, and I'm 9 years out) but I looked into this recently and I couldn't find ANY veterinary reference re steroids/nsaids apart from a paper from 1974.

The normal recommendation for dex was 2-3mg/kg for spinal issues. For inflammation its 18-300 (!) times less at 0.01-0.16mg/kg. And dex is not a chronically used therapy.

If you wanted to put together a case series I'd be happy to help. As said was nothing personal but the different experiences are interesting.

RE: PLT tablets

David Mills — Fri, 18 Aug 2017 21:54:41 GMT

[quote user="George Cooper"]Someone, somewhere in this thread mentioned in a whisper, the word Cartrophen, something that I've been using increasingly over the past few years, with, largely, satisfactory results[/quote]

The only paper assessing it in dogs bases its efficacy on subjective, mainly owner determined outcome measures such as "stiffness". Lameness and functionalith remained unchanged vs placebo. It was also funded (AFAIK) by the manufacturers. There are some papers measuring surrogate outcomes, again flawed.

I have zero faith in it. It's a neutraceitical.

RE: PLT tablets

Mark Hedberg — Fri, 18 Aug 2017 21:02:45 GMT

Odd - i somehow had it in my head that it was 4 weekly injections, then monthly injections for up to 6 months...I find it works well for mild/moderate arthritis, but end stage arthritis not so much.

(anecdote alert of course!)

RE: PLT tablets

Beats — Fri, 18 Aug 2017 20:30:50 GMT

RE: PLT tablets

Martin Atkinson — Fri, 18 Aug 2017 15:30:26 GMT

The biggest problem with Tramadol in dogs is that in most cases it doesn't work. Many dogs don't have the receptors and in those that do it only lasts for a short time even just an hour or two. It is therefore not worth taking any risk with side effects, anecdotal or not.

Do I use it, yes occasionally, like James says - possibly just following the herd or more likely out of desperation to try something. It didn't even work in me as an analgesic just made me feel like a zombie, I'd rather put up with the pain.

RE: PLT tablets

George Cooper — Fri, 18 Aug 2017 14:26:12 GMT

Someone, somewhere in this thread mentioned in a whisper, the word Cartrophen, something that I've been using increasingly over the past few years, with, largely, satisfactory results.

Because nothing appears to have been written about where to go with these cases that benefit from its use, I've developed a system that is almost to effect. Most of the dogs that end up on it as a treatment of last resort are of the larger variety, though not necessarily obese, and we now follow a regime of four weekly injections, followed by two fortnightly and eventually either every month or every three weeks to demand. Owners stop giving NSAID, or the steroid the day before and after, always assuming that it is aving some.

Years ago, when it first appeared, we saw a couple of coagulation issues after cartrophen at data sheet guidelines, in the form of aural haematology development in labs and goldies. One advantage of this being by injection is that the vet in charge of the case is able to monitor progress.

RE: PLT tablets

James Dunne — Fri, 18 Aug 2017 13:52:39 GMT

Hi David

RE: PLT tablets

James Dunne — Fri, 18 Aug 2017 13:43:15 GMT

I won't be buying a new beamer any time soon , drove two of them second hand for many years. Whatever about having to turn the steering wheel to negotiate a corner, at least you don't have to use pesky indicators....

RE: PLT tablets

James Dunne — Fri, 18 Aug 2017 13:41:35 GMT

Hi Bob

We did use it an awful lot for a few years - following the herd a bit I'm afraid - but did notice an increased number of dogs developing haematemesis 3-4 days following discharge for surgery when we gave NSAID + tramadol. We hadn't changed our NSAID at all and I reckoned that for us to notice it, it must have been significant. We often combine gabapentin + NSAID now and do not see this as much. I know we could be adding 2+2 and getting 5, of course, but...

RE: PLT tablets

Bob Russell — Fri, 18 Aug 2017 09:37:30 GMT

Perhaps I am particularly risk averse but I cannot recall a single patient showing any major effects (other than sedation) following tramadol.

I did go through a stage of using it a lot but as with many vets, has dropped as confidence has dropped. Referral centres were prescribing it pretty much routinely after major orthopaedic surgery.

I have no doubt that these cases do happen but probably quite rarely.

I would always discuss possible side effects and risks with any long term medication but the vast majority just sail through without issue.

RE: PLT tablets

peter chalkley — Fri, 18 Aug 2017 08:43:35 GMT

have you tried something simple like nutramed alongside cartrophen injections?

how old is the dog?

RE: PLT tablets

Anthony Todd — Fri, 18 Aug 2017 01:51:50 GMT

[quote user="James Dunne"]there are almost always clear warnings on the data sheets[/quote]

Geez, wait until you drive a new BMW; it's a wonder you don't get a warning to " turn the steering-wheel when negotiating a corner"!!

RE: PLT tablets

David Mills — Fri, 18 Aug 2017 00:18:38 GMT

[quote user="James Dunne"]

Just remember that, despite what we all 'know' about the lack of problems in using these drugs in combination, there are almost always clear warnings on the data sheets of NSAIDs contra-indicating simultaneous use of corticosteroids. I have seen a large number of dogs over the years, not so much with prednisolone, but definitely with dexamethasone + NSAID - induced gastric ulceration, some of which have perforated and died. It is a crisis we see 3-4 times per year for dogs referred particularly for spinal problems. With regard to tramadol - be very careful. It does 'seem' to work in 30% of dogs but has a very short duration of analgesia in many of those it works in and also increases your risk of gastric ulceration when given alongside a NSAID, and it is addictive, often ineffectual, unlicensed, etc etc. If his arthritic joints are end-stage and it is just limited to one set of joints, then you could try intra-articular triamcinolone or depomed while awaiting the return of PLT...

[/quote]

Hmmm. It would be interesting to have these 3-4 a year as a published case series. And we're not talking about spinal cases with high dose dex (more ulcrerogenic than pred) on board but more like homeopathic doses of preds. There must be 1000s of dogs who've had plt and no issues. Scare stories are headliners but don't reveal the experiences of the general populus.

Equally 100s of dogs here on nsaids and tramadol (even short action can get over a hump) and never seen an ulcer. What is this claim based on? Capsules or tablets?

See other thread - whose evidence? And evidence of what?

RE: PLT tablets

James Dunne — Thu, 17 Aug 2017 21:31:57 GMT

RE: PLT tablets

Anthony Todd — Thu, 17 Aug 2017 11:13:28 GMT

[quote user="Bob Russell"]

Going back a million years, ordinary dogs were prescribed phenylbutazone (red) tablets and the posh ones got PLT (poorly leg tablets)!

One was a penny each the other about 10p.

[/quote]

Yep used bute and steroids for spinal pain in dogs and it worked a treat. you could buy generic bute in vast quantities and very cheaply.

I think all the dinovets did.

RE: PLT tablets

Bob Russell — Thu, 17 Aug 2017 10:56:56 GMT

Going back a million years, ordinary dogs were prescribed phenylbutazone (red) tablets and the posh ones got PLT (poorly leg tablets)!

One was a penny each the other about 10p.

RE: PLT tablets

Virginia Campbell — Thu, 17 Aug 2017 01:48:33 GMT

I had an arthritic insulinoma Westie do very well on normal dose meloxicam and low dose pred (1mg I think) as he was quite stiff without the NSAIDS and frequent feeding alone didn't control the hypo episodes. Never tried pred at higher doses with NSAIDS for skin/arthritis dogs but I do think GIT side effects of both pred and NSAIDs are a little hard to predict...I think there is huge variation between dogs. If alternatives fail and the dog is suffering, warn the owner well, cross your fingers and go for it.

RE: PLT tablets

Anthony Todd — Wed, 16 Aug 2017 12:04:00 GMT

PLT used to beat all the latest analgesics in my hands back in the day dramatically, and the amount of pred in PLT was well below therapeutic.

The steroidophobes today may find that just a very low dose of pred, in association with their favourite analgesic, may make a big difference?

RE: PLT tablets

Bob Russell — Wed, 16 Aug 2017 12:01:21 GMT

I have also used a combination of preds and NSAI's but only over relatively short periods. I would be concerned that the owner may go to Dr Google and be led to believe this is the crime of the century so make sure you have discussed the risks fully.

Not quite sure where Cinchophen fits into the analgesic groupings but I believe it is a bit like aspirin. Was used for gout in humans.

We have a tub of PLTs that I guard jealously for the very few patients that find it a wonder drug!

Have they tried on-line drug shops?

RE: PLT tablets

David Mills — Wed, 16 Aug 2017 11:40:37 GMT

You can combine NSAIDs and preds, have done it many times without an issue. It's widely practised in human medicine, but it is one of the pervading myths of veterinary medicine that its the devil's work.

Generally you can have a lower dose of both, so my usual combination is 1-2mg/kg SID of carprofen and 0.2-0.3mg/kg SID preds. Some people use ketamine IM 0.1ml/10kg q4w but I've not noticed a significant effect with it despite using it in a fair few cases. Tramadol can be used, it seems to work in around 30% of dogs, but wouldn't rely on as a sole agent.

RE: PLT tablets

Clive Ansell — Wed, 16 Aug 2017 11:38:17 GMT

Tramadol or paracetamol in combination with corticosteroids?

RE: PLT tablets

Martin Atkinson — Wed, 16 Aug 2017 11:15:05 GMT

Corticosteroids are already excellent analgesic, the only reason we have non-steroidals is to reduce the side effects. The clue is in the word 'non'! Sarcasm apart, have you actually tried just the preds on their own?