PHARMACOLOGY
Any dog or cat that becomes anorectic
or vomits while on combination NSAID
and corticosteroid therapy should be
promptly evaluated by a veterinarian.
Concurrent therapy with corticosteroid/NSAID combinations should only
be done when medically necessary and
with close and careful patient monitoring.
Prophylactic therapy may be warranted
in patients that are at risk for GI ulcers
and receiving both types of drugs.
Postmortem stomach specimen from a Great Dane that was administered 2 doses of naproxen shows multiple NSAID-induced mucosal
erosions. Courtesy Dr. Michael Schaer
•
•
SAIDs also trigger an increase in adhesion of leuN
kocytes to the vascular endothelium in the GI microcirculation, which is an early and critical event in the
pathogenesis of NSAID-induced mucousal ulceration.6
NSAID-induced GI bleeding is increased by NSAIDs
that have COX-1 activity, which reduces platelet aggregation.
Corticosteroids + NSAIDs
• Retrospective studies have associated the concurrent
use of corticosteroids and NSAIDs with GI ulceration
and perforation in dogs and cats.7,8 Concurrent administration of an immunosuppressive dose of prednisone and ultralow-dose aspirin in healthy dogs increased the frequency of mild, self-limiting diarrhoea
but did not increase the severity of GI lesions compared with prednisone alone or placebo.5
• In a study comparing concurrent administration of
ketoprofen (a COX-1 selective NSAID) and prednisolone with meloxicam (a COX-2 selective NSAID)
and prednisolone, the ketoprofen-treated dogs had
significantly more severe GI lesions compared with
the meloxicam-treated dogs or untreated controls.
All ketoprofen-treated dogs had positive fecal occult
blood tests, but only one meloxicam treated dog had
a positive test.9
• In a comparison of the effects of flunixin and flunixin
plus prednisone on the GI tract of dogs, dogs given
prednisone and flunixin developed GI lesions more
rapidly and lesions were more severe than those in
dogs given flunixin alone.10
fects of corticosteroid/NSAID combination therapy.
•
•
•
Prevention Of Complications
Currently there is insufficient evidence to recommend
prophylactic gastroprotective drugs in all dogs or cats receiving NSAIDs and/or corticosteroids, but prophylactic
therapy may be warranted in patients that are at risk for
GI ulcers and receiving both types of drugs.
•
•
Complications of GI ulceration include intraluminal haemorrhage, ulcer perforation, and stenosis of affected areas.
Perforation and septic peritonitis are the most common
life-threatening sequelae of GI ulcers in dogs and cats.7
Haemostatic & Renal Complications
Little is known about the adverse hemostatic or renal ef-
In dogs, the combination of ketoprofen and prednisolone caused significant decreases in GFR and
renal plasma flow, hyperalbuminuria, an increased
urine albumin:creatinine ratio, and enzymuria with
exfoliation of renal t X