Trocoxil being discontinued - best alternative?

RE: Trocoxil being discontinued - best alternative?

Olivia Cook — Tue, 04 Feb 2025 22:56:51 GMT

I stopped using Tramadol as part of a pain relief protocol for injured greyhounds in conjunction with NSAIDs as I seemed to be getting wildly varying results with it - and I was always aware of the possibility of human misuse (especially in these days where people seem to have so much trouble getting a GP appointment. Some dogs seemed to respond well to it, others it seemed to have no effect at all.

RE: Trocoxil being discontinued - best alternative?

Mark Holmes — Tue, 04 Feb 2025 13:54:55 GMT

[quote userid="3607" url="~/f/clinical-questions/31113/trocoxil-being-discontinued---best-alternative/246379#246379"]Not sure what plans Zoetis has for Trocoxil but it is possible that the noise currently surrounding Liberal might lead them to leaving/restoring Trocoxil's availability.[/quote]

I have been looking at the noise around librela

The numbers are relatively small. I believe in the US it’s reported as around 20/10’000

It occurred to me that very early neurological cases could present in a way that was assumed to be OA. Slow rising difficulty with stairs. Slow on walks etc.

20/10000 seems well within what could be a reasonable level of error in the opinion - particularly in busy clinics.

Given that these are unlikely to progress to a full post mortem at the necessary level of detail. Wouldn’t that be a reasonable explanation?

RE: Trocoxil being discontinued - best alternative?

David Mills — Fri, 24 Jan 2025 10:23:53 GMT

[quote userid="3607" url="~/f/clinical-questions/31113/trocoxil-being-discontinued---best-alternative/246380#246380"]Anything is possible, but just because you can doesn't mean you should!![/quote]

Ah come on lad, I thought you liked a challenge?!

[quote userid="3607" url="~/f/clinical-questions/31113/trocoxil-being-discontinued---best-alternative/246380#246380"]The extent of fibrous scarring and anatomical alteration led me to think that THR in such cases was not something I would consider - more especially because such surgery would only be indicated if the FHNE had failed in which circumstance, the scarring and anatomic alteration would likely be more extreme than the dog I dissected.[/quote]

Interesting - also that the fibrosis occurs so rapidly and somewhat extensively. I suppose it makes sense given the movement in the area. Wonder how much is related to the competency of the procedure and how much is the minimum expected.

In my more indolent moments I often wonder why we don't transpose a muscle between the the femur and acetabulum following an FHNE - both to fill dead space, improve blood supply, and possibly reduce excessive fibrosis.

RE: Trocoxil being discontinued - best alternative?

Malcolm Ness — Thu, 16 Jan 2025 16:50:30 GMT

[quote userid="8991" url="~/f/clinical-questions/31113/trocoxil-being-discontinued---best-alternative/246372#246372"]Can you not do a THR following a competent FHNE?[/quote]

Anything is possible, but just because you can doesn't mean you should!!

I have done two THR cases after FHNE but both were very similar and unusual cases in that the THR was done only 2-3 weeks after the FHNE. The first case was an odd femoral capital physeal fracture in a young (?? 11-12mths) Labrador intended for work. Referring vet attempted repair, failed and revised the plan intra-operatively to FHNE. O was really keen to get the dog working and after lengthy discussion, we went for THR. Even 3 weeks after initial surgery, the THR was challenging due to fibrosis and the consequences of the earlier surgical approach having been somewhat 'approximate'.

The other case was also a young Labrador with a unilateral HD related to an asymmetric transitional L-S vertebra. Ref vet had done FHNE (without really discussing other possibilities) and dog had been 10/10 lame since. O had discussed things far and wide and asked for THR. After lengthy discussion, that's what we did. Surgery was similarly challenging first because of the fibrosis and second because of the extensive acetabular remodelling related to the joint dysplasia. Both dogs went on to do well.

I have also dissected a chronic FHNE case (that had done very well for several years) post-mortem. I did that with a view to converting FHNE cases to THR, if the need ever arose. The extent of fibrous scarring and anatomical alteration led me to think that THR in such cases was not something I would consider - more especially because such surgery would only be indicated if the FHNE had failed in which circumstance, the scarring and anatomic alteration would likely be more extreme than the dog I dissected.

RE: Trocoxil being discontinued - best alternative?

Malcolm Ness — Thu, 16 Jan 2025 16:33:18 GMT

THR will set the owner back c£7k all in. In good hands that will see the operated hip completely pain free and fully athletically functional within a couple of months of surgery in better than 80% of cases - about half of the others will reach that level of outcome after further surgery/medication/time. Ideally, the cost of such revisions will be borne by the practice and not the client. Cost of early salvage surgery is broadly similar to the cost of ten-years of medical management (including monitoring) though problems in many dogs get ahead of effective medical control. Not sure who you refer to for hips, but best to be looking for a residency-trained surgeon with experience of THR surgery numbered in the hundreds and with a current caseload of AT LEAST 25 hips a year who uses one of the well-established implant systems.

Not sure what plans Zoetis has for Trocoxil but it is possible that the noise currently surrounding Liberal might lead them to leaving/restoring Trocoxil's availability.

RE: Trocoxil being discontinued - best alternative?

David Mills — Thu, 16 Jan 2025 02:38:42 GMT

Can you not do a THR following a competent FHNE?

FHNE in good hands is still a very good option for these dogs.

RE: Trocoxil being discontinued - best alternative?

Beats — Wed, 15 Jan 2025 20:14:21 GMT

Got estimates for THR in February for completeness and unfortunately was beyond what could be paid at time. The owner did start saving, but the cost of the THR has increased faster than the owner can save.

Shame, because It would be a really good candidate I think for a unilateral THR (in competent hands).

I've only seen 3 dogs get a THR in my career and all have been successful. One dog got the second hip done a few years later.

I did see a cost-comparison (going back quite a few years now) showing lifetime cost of a hip replacement to be less than the equivalent time-period cost of an NSAID. The price on the Rimadyl tablets was pretty steep to make the comparison work, and it did remind me of those cost-calculators for farmers where they can see how much they are losing from not vaccinating for this or eradicating that etc, even though the sum total of their supposed losses would be significantly beyond the potential value of the animals they could conceivably hope to farm. Still, did make me think and was a very valid point.

I did consider an FHNE (I've done them in big dogs before), but I think there is a chance that the owner may find means for a THR in the coming years and didn't want to make the prospect of that less likely. Also it is managing reasonably well on the trocoxil, it is just without it that shows clear signs of pain.

I'm looking into if supply will continue in a market other than the UK in which case could likely continue with it longer term through imports. Letter from Zoetis said being discontinued in UK, but I'm presenlty unsure if that is (or is oging to be) a global thing. I'm sure having an NSAID that agreed with the dog would be helpful for the post-op period if ever did go for a THR in future. Can still get some online in UK pharmacies this week, is more planning where go to when that runs out (Michael's point about stock-piling for this dog is a fair one to consider, though 10 years sounds a little ambitious to me). I tihnk trocoxil's failure in UK stems from having had an unreliable supply chain with outages in the past (I kept a 6 month supply ahead as could not rely on Zoetis's supply through my wholesaler in an, albeit remote, part of the UK). You don't want to start a dog on a monthly NSAID if it might not be there in a few months and then you'll have to switch etc. I think I might try the Daxocox anyway as supply chain for that longer term probably more promising, so if it works for this dog then won't need to fuss chasing the trocoxil train.

RE: Trocoxil being discontinued - best alternative?

Malcolm Ness — Wed, 15 Jan 2025 09:12:23 GMT

Competently performed THRs will render the dog pain free and fully active and are worth considering, especially in a 3 yo dog.

RE: Trocoxil being discontinued - best alternative?

Michael Woodhouse — Tue, 14 Jan 2025 22:42:57 GMT

[quote userid="5464" url="~/f/clinical-questions/31113/trocoxil-being-discontinued---best-alternative/246364#246364"]gabapentin, amantadine, tramadol, [/quote]

I'm not even convinced those 3 really count as analgesics........

Pardale V & Pred worth a try

Can you not stock up? Probably good for 10 years if stored correctly......

RE: Trocoxil being discontinued - best alternative?

Chris Geddes — Tue, 14 Jan 2025 18:28:33 GMT

gabapentin, amantadine, tramadol, monthly SQ ketamine...

RE: Trocoxil being discontinued - best alternative?

KMurphy — Tue, 14 Jan 2025 05:47:24 GMT

I found Daxocox to be pretty good for those patients that couldn’t tolerate daily NSAIDs. No need for a month off either, which makes it easy to manage. I think it worked out a bit pricier for bigger dogs but I’ve moved practice and haven’t used it for a while so that may no longer be the case.
Pardale long term plus a good mobility diet can make a difference as well.