NSAIDs post caesarian

Re: NSAIDs post caesarian

mariette asselbergs — Sat, 03 Sep 2011 12:47:39 GMT

"How many puppy deaths are post analgesia, we just don't know?"

I once treated a guide dog bitch with metacam when her puppies were about 5 weeks old (I hadn't tghought of it being contraindicated in lactating bitches) and next day all the pups were vomiting and off food. Scary. but recovered quickly. Now I wouldn't dare to use it again! But maybe this was because of course at 5 weeks the pups drink quite a lot and new borns don't.

Re: NSAIDs post caesarian

Claire Fisher — Sat, 03 Sep 2011 12:24:59 GMT

[quote user="Neil Wheadon"]

Metacam gets in the milk into the puppy and can cause renal failure, that's the reason.

[/quote]

Has the work been done to show this or is it just an assumption?

We currently use metacam peri op but may consider using Rimadyl based on Bob's post earlier.

Re: NSAIDs post caesarian

Neil Wheadon — Fri, 02 Sep 2011 23:26:25 GMT

Metacam gets in the milk into the puppy and can cause renal failure, that's the reason. How many puppy deaths are post analgesia, we just don't know? I used to dispense it, but a client read the data sheet and complained and there seems no decent alternative.

Re: NSAIDs post caesarian

James Laidlaw — Thu, 01 Sep 2011 23:39:22 GMT

[quote user="bob lehner"]

Clearly animals post-caesar should have analgesia - it would be nice to have some advice from an expert in the field !

[/quote]

Anyone...?

Re: NSAIDs post caesarian

james hunt — Thu, 01 Sep 2011 22:42:16 GMT

I generally give NSAIDs and continue for a short course after caesar.

This NHS page seems to suggest that ion trapping and protein binding limit the amount of NSAID excreted in (human) milk

http://www.ukmicentral.nhs.uk/drugpreg/nonsteroidalantiinflammatories.asp

Re: NSAIDs post caesarian

Mark Holmes — Thu, 25 Aug 2011 12:05:00 GMT

Necessary pragmatism is required, where is the biggest threat to bitch and pups? Being squashed or not fed successfully by painful mother or small risk of NSAID. I know where my judgement falls

Re: NSAIDs post caesarian

bob lehner — Thu, 25 Aug 2011 11:10:43 GMT

[quote user="Claire Fisher"]As I understand it they aren't licensed for lactating bitches and there was a recent DC case where someone was reprimaded for giving Metacam. (Not sure if the issue was giving it or not telling the owner it was off licence)[/quote]]

This is actually quite an interesting and rather confusing topic.

Metacam data sheet has a specific contra-indication for use during pregnancy and lactation. Ditto Previcox and Onsior.

Rimadyl has a contra-indication during pregnancy and in very young animals - but the data sheet doesn't specifically say don't use in lactating animals. However if you look at the various other brands of carprofen on the market most of them do specifically say don't use in lactation - some say this is because there are no specific safety data in lactating dogs.

Buprenorphine data sheets say don't use for caesarean pre-op. One brand says don't use in lactation - another says use with care in lactation.

Butorphanol injection doesn't seem to mention problems in pregnancy or lactation - but butorphanol tabs say don't use in lactation.

Tramadol use in humans says don't use in pregnancy - and not recommended in lactation (tho' amount excreted in milk is small). I doubt if there is any data on Tramadol excretion in canine milk ?

The only veterinary licensed analgesic I can find which doesn't seem to have have any contra-indications for pregnancy or lactation is Pardale (codeine and paracetemol).

Overall I think the problem is down to lack of specific data - and obviously drug firms then cover their backs. The difficulty as usual for those at the coal face is that if you use a product off-label and there is a problem then you may face the consequences. Also I think it is a bit difficult to get the owner to sign an off-label consent form for a product where there is a specific contraindication for that particular use.

Clearly animals post-caesar should have analgesia - it would be nice to have some advice from an expert in the field !

Re: NSAIDs post caesarian

Joyce Whitehead — Wed, 24 Aug 2011 21:40:28 GMT

I always use rimadyl/carprofen post op in caesers, as I found there was no specific contraindication for lactation (unlike Metacam). I haven't looked recently I must admit, but I am sure the only contraindication was for pregnancy not lactation. I certainly haven't had problems with it.

I too was given diclofenac post caeser, but didn't read the data sheet so didn't realise it was contraindicated!

Re: NSAIDs post caesarian

Mark Holmes — Wed, 24 Aug 2011 17:55:25 GMT

Following my sons birth the doctors dispensed diclofenac to my wife post op whilst lactating.... off licence use. There was no advice on the off licence use. They also supplied sufficient that we were still using it up when my second child was born 3 years later!

Re: NSAIDs post caesarian

Claire Fisher — Wed, 24 Aug 2011 17:40:18 GMT

[quote user="Clive Ansell"]

I always use nsaid's post c-section, never had any problems as far as I know and they are effective.

When the likes of Metacam and Rimadyl are licensed for peri/post op analgesia should we really being using Tramadol first line under cascade regs?

[/quote]

As I understand it they aren't licensed for lactating bitches and there was a recent DC case where someone was reprimaded for giving Metacam. (Not sure if the issue was giving it or not telling the owner it was off licence)

Re: NSAIDs post caesarian

Clive Ansell — Wed, 24 Aug 2011 12:40:48 GMT

I always use nsaid's post c-section, never had any problems as far as I know and they are effective.

When the likes of Metacam and Rimadyl are licensed for peri/post op analgesia should we really being using Tramadol first line under cascade regs?

Re: NSAIDs post caesarian

Anonymous — Wed, 24 Aug 2011 07:07:58 GMT

[quote user="Mark Rowland"]Whats wrong with tramadol[/quote]

Again, nothing wrong with it, but if we're talking about dogs, then I do think people may overestimate its analgesic properties. The fairly limited pharmacological studies available don't necessarily suggest that a drug company is going to rush to license it:

"oral immediate release administration bioavailability was 30 % and was 10 % following oral sustained release and rectal administration. T [tramadol] showed a rapid absorption, good distribution and fast biotransformation to M5 and M2 metabolites after oral and rectal. In these two latter administration routes, the amounts of the metabolites (M2 and M5) in plasma were always higher than the plasma parental drug level. Contrarily, the M1 concentrations were quite low, very close to the LOQ of the method and extremely variable; for these reasons it was not possible to calculate the pharmacokinetic parameters for this metabolite for some dogs."

That would be the M1 metabolite which is formed in some other species and estimated to have a 200-times greater affinity for the mu-receptors, being the main source of the opioid properties (with some analgesia also via re-uptake inhibition of noradrenaline and serotonin).

When you consider the poor bioavailablitity of available oral formulations, and rapid metabolism:

"In conclusion, in the dog, T seems to be effective after injective administrations (formulations indicated for attack therapies), whereas it may be ineffective following oral and rectal administrations (formulations suggested for long-term therapies)."

I'm not saying I don't sometimes use it, but I just don't expect much analgesia as a result, and would consider it a poor substitute for a suitable NSAID until someone proves otherwise.

REF: M. Giorgi & S. Del Carlo & G. Saccomanni & B. Łebkowska-Wieruszewska & V. Turini & C. Kowalski. Biopharmaceutical profile of tramadol in the dog. Vet Res Commun (2009) 33 (Suppl 1):S189–S192

Re: NSAIDs post caesarian

Michael Woodhouse — Tue, 23 Aug 2011 23:55:21 GMT

[quote user="Mark Rowland"]Whats wrong with tramadol, its cheap and doesnt cross the blood milk barrier that effectively so its relatively safe.[/quote]

Nothing wrong with it! I would use opioid and NSAID for that sort of Sx.

I've had it make a couple of dogs sort of restless, unsettled and pacing.

I do like Tramadol

Re: NSAIDs post caesarian

Mark Rowland — Tue, 23 Aug 2011 23:32:33 GMT

[quote user="Michael Woodhouse"]

Yes we know it's maybe contraindicated on the data sheet, but what can you do. I wouldn't not give them.

Guessing that's your question?

[/quote]

Whats wrong with tramadol, its cheap and doesnt cross the blood milk barrier that effectively so its relatively safe.

Re: NSAIDs post caesarian

Michael Woodhouse — Tue, 23 Aug 2011 23:13:16 GMT

Yes we know it's maybe contraindicated on the data sheet, but what can you do. I wouldn't not give them.

Guessing that's your question?