Paracetemol and steroids

Re: Paracetemol and steroids

Julian Earl — Mon, 03 Jan 2011 12:14:47 GMT

[quote user="Julian Earl"]

In fact, just where is the evidence that the NSAID/steroid combination is a problem in dogs? We all avoid it, but I have never seen published evidence stating the risks. I once asked about this at a BCVA meeting where downer cows were under discussion and Ketofen and massive dexamethasone doses were being recommended; everyone there looked at me with a puzzled expression and no-one either knew or was bothered about the risk - if indeed there is one.

So, apart from it being stated in case articles, is there any established risk? If so, how common are side-effects? How common are severe side-effects? Is it just spinal cases? Or are we living in fear of a myth?

[/quote]

Even PubMed papers only refer to the risk in people but no papers specifically detail the risk. Any ideas? Anyone?

Re: Paracetemol and steroids

Matt Gurney — Sun, 02 Jan 2011 21:13:25 GMT

I commonly use paracetamol at 10mg/kg BID-TID alongside steroids. Perioperatively I use an IV paracetamol preparation and for hospitalised cases or chronic cases use Pardale. The codeine in Pardale is only 4% bioavailable so not worth worrying about. No-one really knows where the 10mg/kg dose came from. I have not seen any side effects with paracetamol (which is generally not classed as an NSAID but there is plenty of speculation on its exact mode of action) and steroids but plenty from steroids and the common NSAIDs used together, especially in spinal cases where steroids are not indicated.

Re: Paracetemol and steroids

Andrew Mellor — Sun, 02 Jan 2011 08:14:39 GMT

I will commonly use paracetamol with Nsaids, steroids or plt ( bit of both), it is very much a stand alone drug which I find very useful. In my experience dogs seem to respond to paracetamol a little like children, within 20 mins of calpol my kids are bouncing around like normal rather than on death's door, it also seems to help restful sleep in the old arthritic dogs that pace because they cannot get comfortable at night. I tend to stick to 10mg/kg though and have to say IMHO I don't find the codeine of much benefit in pardale.

Re: Paracetemol and steroids

sarah mason — Sat, 01 Jan 2011 22:00:48 GMT

I have used paracetamol in dogs with gastric ulceration, dogs who get very sedated with opioids and in combination with NSAIDs for post-operative/chronic pain. The anaethetists I work with are very happy to use it and some of them prefer it to tramadol and would argue it is at least licenced. The data sheet for pardale is out of date and I don't think the company did the work but they are safe to use in combination, presume it should be fine to use in dogs on steroids as well.

Re: Paracetemol and steroids

Christopher Saul — Fri, 31 Dec 2010 20:55:48 GMT

[quote user="Laurence Webb"]

Interestingly the dose rate of Pardale is 400mg paracetamol/12kg which equates to 33mg/kg, 3 times higher than the dose rate in the small animal formulary.

[/quote]

Intersting yes, I'd not spotted that! though I would never use this higher dose. Whenever I use paracetamol in dogs (whether as pardale or as stand-alone) I keep to the formulary dose of 10mg/Kg .

Regards the question of steroids with paracetamol: The BSAVA formulary mentions no specific drug reaction of paracetamol with steroids, though if I want to use analgesia in a dog on steroids, I would more commonly use tramadol as my first choice; generally I don't reach for paracetamol very often

Re: Paracetemol and steroids

Laurence Webb — Fri, 31 Dec 2010 17:30:28 GMT

[quote user="Michael Woodhouse"]

Pardale V [the only vet licensed paracetamol & codeine AFAIK] mentions nothing about concurrent use with steroids, but states "do not administer other NSAIDs concurrently or within 24 hours of each other."[/quote]I spoke to Arnolds about this and they said that the data sheet was many years old and the contraindication was put in because they hadn't done the testing, not because there was a known interaction. Dan Holden was recommending it's use as a combination at a talk I went to last year

I've certainly used paracetemol and NSAIDs together quite often especially in chronic OAs where NSAIDs alone aren't cutting it and there have been undesirable side effects/lack of efficacy of opiates/tramadol. It is contravening the data sheet to use both but I'd argue that the clinical situation justifies it.

Interestingly the dose rate of Pardale is 400mg paracetamol/12kg which equates to 33mg/kg, 3 times higher than the dose rate in the small animal formulary.

Re: Paracetemol and steroids

Mark Hedberg — Fri, 31 Dec 2010 15:44:36 GMT

Melox and steroids are pretty bad together; inherited a dog case at a practice i used to work at. Dog had bern on preds for severe arthritis, owner decided that meloxicam as an nsaid had fewer side effects than steroids so decided to change over to meloxicam (without inquiring at the vet, of course. No, don't know where they got the meloxicam. ) which would be fine, but our precocious owner failed to stop the preds before starting the meloxicam.

Presented to me for inexplicable (to the owner) vomiting with traces of blood.

So yes, paracetamol isn't meloxicam but i don't even keep the bottles on the same shelf as reds, never mind prescribing them together! :p

Re: Paracetemol and steroids

Eamon McAllister — Fri, 31 Dec 2010 15:39:48 GMT

I give NSAIDS for a day or two to small animals on steroids and I never see any problems at all. I once saw a dog with gastric ulceration which had been on PLT (poorly leg tablets) for about 10 years! I changed the treatment and the dog quickly recovered and the stomach was ulcer free when scoped. After a few weeks the owner insisted that it go back on PLT as they seemed to work best. There was no recurrence.

Re: Paracetemol and steroids

Mark Holmes — Fri, 31 Dec 2010 15:11:25 GMT

I take paracetamol and ibuprofen together regularly. Cannot see why steroids and paracetamol would be worse.

Re: Paracetemol and steroids

Julian Earl — Fri, 31 Dec 2010 14:33:22 GMT

[quote user="Hannah Wynne Richards"]

I wouldn't risk it Paracetamol is alsoan NSAID

Wynne

[/quote]

It's not a worry in humans at all, that's for sure. For auto-immune arthritis they happily prescribe NSAIDs, paracetamol, sulphasalazine (containing NSAID), and give steroids all at the same time.

Re: Paracetemol and steroids

Michael Woodhouse — Fri, 31 Dec 2010 13:47:54 GMT

[quote user="Hannah Wynne Richards"]I wouldn't risk it Paracetamol is alsoan NSAID[/quote]

Not really. It's a pain killer and has anti-pyrexic properties. It has no anti-inflammatory effect. It is really in a class of it's own. On the BNF steroids and other NSAIDS are not listed as contraindications. In fact doctors often prescribe staggered aspirin/ibuprofen then 2 hours later paracetamol.

I think you'd be ok using them together, and I have done so in the past.

Re: Paracetemol and steroids

Hannah Wynne Richards — Fri, 31 Dec 2010 13:03:03 GMT

I wouldn't risk it Paracetamol is alsoan NSAID

Wynne