Cartrophen - Pentosan Polysulfate - How often?

RE: Cartrophen - Pentosan Polysulfate - How often?

Mark Hedberg — Sun, 24 May 2020 09:17:33 GMT

[quote userid="4181" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222862"]Are you confusing it with Adequan?[/quote]

No, we didn't have adequan, I think we have to go for the simpler explanation that my memory is crap.

RE: Cartrophen - Pentosan Polysulfate - How often?

James Dunne — Sat, 23 May 2020 18:36:29 GMT

I stopped using Cartrophen routinely. It may do something in analgesic terms, but it's too variable and given that it needs 4 weeks to work in some cases, who's to say that the improvement is not just the arthritis pain waxing and waning? As for 'cartilage improvement' - maybe in rabbits where damaged hyaline cartilage can be replaced with [abnormal] hyaline cartilage; this does not seem to be the case in dogs. They're [reps] now saying that because it's a heparin analogue it 'declots' the venous drainage of the joint and this relieves pain??? I find a lot of the theories on how it works very nebulous. I think it does something in terms of pain relief for some patients; I don't know what or how and to be honest, there are that many other therapies with pretty good evidence behind them, that I think it should be consigned to the secondary or tertiary treatment armoury and not used as a first line arthritis treatment. That's just my personal opinion and more learned individuals may have differing or better arguments to make.

RE: Cartrophen - Pentosan Polysulfate - How often?

Busybee — Sat, 23 May 2020 18:01:43 GMT

We also use it regularly as a 'monthly top up' after the initial course of 4 weekly injections. Practice legend is that this regime came from a rep around 15 years ago but not sure how true that is! Does it work? Maybe. Maybe not. Owners seem to perceive a difference if they lapse from the monthly routine. I tend to say to owners that over time, this 'effect' from the monthly injections will wane so at some point they'll need to repeat the course of 4.

RE: Cartrophen - Pentosan Polysulfate - How often?

Beats — Sat, 23 May 2020 07:35:18 GMT

[quote userid="17690" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222874"]I thought dog rocks worked by being a diaretic and diluting the urine?[/quote]

I have neither seen anything to suggest that they are a diuretic, nor that they work.

I however have a lovely lawn. I have finally found the secret to this and will share it with you for only £10 a month!

After years of research, I have pinned it down to the naturally ion-filtered water that falls on my lawn - this is capable of neutralising the toxins in the dog's urine by a process of microfiltration, rendering it completely neutralised.

I have begun the process of collecting this water as it falls from the sky and gains its neutralising properties as it filters through the canopy of leaves of the trees bordering my lawn. It is important to realise that simply planting identical trees to me would not achieve the same effect as the water has already had some alteration in the clouds due to the local air concentration of free radicals and ionising particles before it reaches the trees - this part is essential, I believe, to prime the water for the ultrafiltration that occurs in the canopy of leaves. Unfortunately, it will not be possible for you to replicate this process precisely in your own clouds - I am simply a fortunate recipient of the amazing local air quality in this exotic and unique area.

I have begun collecting this water in a metal bath that belonged to my great-grandfather and the properties of this ancient bath appears to have amplified the properties of this amazing product as when I bottle it and spray it in its concentrated form on areas my dog has urinated, the effect is amazing.

There are, as you might imagine, some important aspects of use that you must adhere to, otherwise it may not work. For maximal benefit, the spray should be applied to the areas the dog urinates in immediately on urination - this prevents the harmful aspects of the urine from penetrating deep into the soil and trying to elude the neutralizing properties of the "lawn burn 100% proven spray solution". The amount required will vary on the size of your dog, and you may need to use quite large amounts in larger dogs - if this is the case, then you can dilute the solution with water from your tap (don't worry, the neutralizing properties are retained on dilution with tap water even at quite large volumes, and it doesn't matter if the tap water in your area is hard or soft).

If you are not local, and cannot collect the solution yourself from my garden (while leaving £10 in the honesty box beside it), then you might be interested in the super-concentrated version I have recently created. Through a series of repetitive agitations and passages, it is so concentrated, that I can post you just 5ml a month and you simply re-dilute it at your end with tap water to create a larger volume for application (just one drop contains enough to power a whole bucket of tap water!). As with all great products, this comes with a 100% money-back guarantee - if it doesn't work (don't worry, it will) then on receipt of photos of your lawn I will refund the cost of the product (minus postage and packaging) once you have returned any unused product (so it can be tested for impurities that may have affected its performance). Please be aware that to-date no customer has had to return any product!

RE: Cartrophen - Pentosan Polysulfate - How often?

Freya . — Fri, 22 May 2020 21:08:58 GMT

I thought dog rocks worked by being a diaretic and diluting the urine? Never sold any but am sure I've heard them mentioned as a thing to chk for in pups animals.

Also in the past used cartrophen off license on a as and when bases if responded to initial course did appear to work quite well but the evidence base always made me feel slightly uncomfortable.

RE: Cartrophen - Pentosan Polysulfate - How often?

Beats — Fri, 22 May 2020 20:28:07 GMT

I was presented with a fun circular argument by a rep once.

1) Here's all the research showing how it works.

2) It doesn't look convincing.

3) Look again, this is really convicing.

4) Not to me.

5) Have another look at this glossy brochure and vague bar chart..

6) It doesn't look any more convincing than the first time.

7) Then how do you explain it working.

8) I'm not sure I've been shown anything to suggest it does?

9) Oh, everyone knows it works. Loads of vets use it.

10) Loads of vets sell "Dog Rocks".

11) Owners see it working in their dogs. It worked for my dog.

12) Doing nothing worked for my dog.

13) But we know this works, we have all this research showing it works.

and repeat.

RE: Cartrophen - Pentosan Polysulfate - How often?

Rob Loxley — Fri, 22 May 2020 17:02:37 GMT

[quote userid="15742" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222865"]I had a conversation with the rep years ago regarding the best usage of it[/quote]

I'm not sure the rep is able to make any comment beyond the indication/dosage on the SPC?
We have a few animals that are on regular single top-up injections; also a number on concurrent nsaids (again with off-label consent obtained)

RE: Cartrophen - Pentosan Polysulfate - How often?

Anne Walton — Fri, 22 May 2020 15:58:28 GMT

I had a conversation with the rep years ago regarding the best usage of it and she advised that a dog needs to have 4 consecutive injections to gain the maximum benefits. Each injection builds on the previous one which is why you often don't see much improvement until they have had 3 or 4 doses. Giving a monthly top-up dose is not advised since there is no cumulative effect. Better to give the 12 injections in blocks of 4.

RE: Cartrophen - Pentosan Polysulfate - How often?

Rob Loxley — Fri, 22 May 2020 15:19:17 GMT

[quote userid="7638" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222857"]

Beats said:
That is not my reading of the current UK datasheet:

How strange. I'm not arguing, perhaps my memory is at fault. I somehow remember monthly injections for up to 6 months. (Been a few years, i cheerfully concede.)

[/quote]

Are you confusing it with Adequan?

RE: Cartrophen - Pentosan Polysulfate - How often?

Mark Hedberg — Fri, 22 May 2020 14:24:24 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222856"]That is not my reading of the current UK datasheet:[/quote]

How strange. I'm not arguing, perhaps my memory is at fault. I somehow remember monthly injections for up to 6 months. (Been a few years, i cheerfully concede.)

RE: Cartrophen - Pentosan Polysulfate - How often?

Beats — Fri, 22 May 2020 13:58:33 GMT

[quote userid="7638" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222847"]I found it helpful with mild to moderate arthritis in dogs, weekly for 4 weeks, then monthly (as per datasheet). [/quote]

That is not my reading of the current UK datasheet:

Dosage: 3mg pentosan polysulfate sodium/kg bodyweight (equivalent to 0.3ml/10kg bodyweight) on four occasions, with an interval of 5-7 days between each administration.

...

Do not exceed the standard dose. Increasing the recommended dose may result in exacerbation of stiffness and discomfort.

No more than 3 courses of 4 injections should be administered in a 12 month period."

Perhaps semantics, but I think the laballed dose in UK is a maximum of 12 injections per year, but as 3 courses of 4 (weekly) injections, rather than 12 x monthly injections per se.

RE: Cartrophen - Pentosan Polysulfate - How often?

Mark Hedberg — Fri, 22 May 2020 11:11:19 GMT

I found it helpful with mild to moderate arthritis in dogs, weekly for 4 weeks, then monthly (as per datasheet). Severe arthritis, not particularly helpful. I had a pet theory (no pun intended) that in severe arthritis there wasn't much cartilage left to improve, hence the little effect there.

Anecdote alert, etc.

RE: Cartrophen - Pentosan Polysulfate - How often?

jane alexander — Fri, 22 May 2020 10:19:06 GMT

We have 3 or 4 dogs on Cartophen injections, and have always used it as 4 injection initial course, then top-ups (of 2 to 4) as&when, often finding that the gaps are 6-18mths. A client who had transferred to us, has a dog on monthly injections, cost gets a bit extreme unless bottle used over longer period...., so, as there has been a gap in these, she is happy to try the 'burst' approach.

RE: Cartrophen - Pentosan Polysulfate - How often?

Neil Wheadon — Fri, 22 May 2020 07:52:31 GMT

The dog from yesterday was one I saw last year and referred for CT

XX was sedated and a CT scan was performed of both tarsi. This confirmed that she had an osteochondrosis lesion affecting the medial trochlear ridge of the talus in both tarsi. There were also significant changes associated with osteoarthritis in the right tarsus and to a much lesser extent the left tarsus. Radiographs of her hip were unremarkable.

NSAID's were tried

However the client was adamant that cartrophen had a great effect and I will recommend a 3 monthly injection

Over the years, the patterns have been far too similar

1) Seem to improve after the 3rd injection

2) About 85% report an improvement

I like it simply because its a drug of 'do little harm' and if you believe the hype, I describe as oiling the engine.

Maybe its less use in something as disruptive to a joint as a cruciate injury?

Neil

RE: Cartrophen - Pentosan Polysulfate - How often?

Evelyn Barbour-Hill — Fri, 22 May 2020 00:28:22 GMT

I have a couple of patients that have it once a month. One owner sticks to regular monthly appointments and notices a deterioration if for some reason they miss. The other owner comes when they notice a slight deterioration – that's about once a month.

RE: Cartrophen - Pentosan Polysulfate - How often?

Beats — Thu, 21 May 2020 20:53:43 GMT

I think there are 2 dosing regimens commonly done:

1) once a week for 4 weeks then every 3 months

2) 4 injections 5 to 7 days apart, repeat this when needed up to ?3 times a year?

Other fun games are is it in the fridge or on the shelf?

It is rarely used where I am, but last year I saw the first patient I've known of to fall foul of the contra-inidcation listed "haemagiosarcoma". Elderly labrador, that was pretty NSAID intolerant, 3 years post-splenectomy and a vet unfamiliar with it hadn't scrolled back that far ... I had the tough call on whether to give the 4th injection in the course or not when it presented!

RE: Cartrophen - Pentosan Polysulfate - How often?

Beats — Thu, 21 May 2020 20:47:26 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/orthopaedics/f/discussions/29122/cartrophen---pentosan-polysulfate---how-often/222825"]

I can't see past the evidence on this, last time I looked it was one paper funded by the manufacturer claiming success on owner reported outcomes such as reduced "stiffness". Haven't used it in years, sorry.

(I'm aware this answer is almost completely useless to you)

[/quote]

there's also the german cruciate paper form memory.

EDIT - no, it was USA and part-funded by manufacturer - that'll be the same paper then! But it wasn't owner reported outcomes I don't think.

Evaluation of Pentosan Polysulfate Sodium in the Postoperative Recovery from Cranial Cruciate Injury in Dogs: A Randomized, Placebo‐Controlled Clinical Trial

VetSurg 07

RE: Cartrophen - Pentosan Polysulfate - How often?

Neil Wheadon — Thu, 21 May 2020 20:18:06 GMT

It's why I put marmite in the title

Neil

RE: Cartrophen - Pentosan Polysulfate - How often?

David Mills — Thu, 21 May 2020 18:49:46 GMT

(I'm aware this answer is almost completely useless to you)