INTERNAL MEDICINE
NSAIDs are highly protein bound and most package
inserts will indicate caution when using with other
highly protein bound substances and that drug dis-
placement from the proteins can occur. The clinical
significance of these interactions is likely to be low,
and the protein binding displacement interactions
involving NSAIDs used for chronic management of
osteoarthritis are unlikely to cause adverse effects in
patients. 2
•
3. Give the Client Verbal and Written Instructions
Give the client verbal and written instructions to avoid
contraindicated medications as mentioned above
and to discontinue and alert the hospital at the first
sign of an adverse event. 1
COX-1 and COX-2 are involved in renal tubular function
and renal blood flow regulation; therefore we cannot
just assume that COX-1-sparing NSAIDs are safer for
the kidneys. 2 NSAIDs cause renal injury through inhibi-
tion of prostaglandins important in maintaining renal
haemodynamics, although the exact mechanism is
not yet understood. 2 Important to note that healthy
dogs administered approved doses of NSAIDs are at a
low risk for developing renal adverse events. 2
Osteoarthritis is a life-long disease and the client buy
in and understanding is the most important aspect
to having a successful treatment program for the pa-
tient.
The client needs to understand the medication pre-
scribed and extra time needs to be spent with these
clients. This will ultimately lead to improved compli-
ance and hopefully the owner will be able to pick up
early signs of adverse events.
Ensure appropriate hydration and haemodynam-
ic status when animals receiving NSAIDs undergo
anaesthesia and/or surgical procedures or develop
conditions which may result in dehydration or com-
promised haemodynamic status. 2 The key aim of in-
tervention is to maintain adequate renal perfusion.
4. Recognise Early Signs of Adverse Effects (AEs)
and Immediately Withdraw NSAID Treatment
It is critical that veterinarians provide the client infor-
mation that describes the potential side effects. Signs
of gastrointestinal toxicity usually emerge within the
first 2 – 4 weeks; however they can occur at any point
during administration. 1
What to be aware of is concurrent use of NSAIDs with
other potentially nephrotoxic drugs (e.g. aminoglyco-
sides) is not recommended as it increases the risk of
renal injury. 1 Practitioners should also observe addi-
tional precautions with renal function due to possible
drug interactions with furosemide and use caution
with angiotensin-converting enzyme inhibitors. 1,2
Recognition of early signs of adverse events, such as
inappetence allows early intervention and a better
prognosis.
2. Not all Patients are Candidates for NSAIDs
Be discriminating in your patient selection and be cau-
tious or avoid NSAIDs in patients with the following
existing/anticipated conditions:
•
•
•
C
•
Renal dysfunction: the effects of NSAIDs on the
renal function of dogs with underlying renal dis-
ease have not yet been reported, therefore use
cautiously in these patients. 1,2
Hepatic dysfunction: there is very limited data of
use of NSAIDs in animals with underlying hepatic
disease, and no data indicating increased risk of
NSAID hepatic toxicity in these animals
If the NSAID dose needs to be reduced due to
slower elimination of the drug, (cats or hepatic
disease) the drug should be used with caution in
these animals. 1,2
Trocoxil
Strip adverts
3 x different.pdf
1
Cardiac
dysfunction.
Low-flow states such as dehydration, hypo-
volemia, congestive heart failure, and hypoten-
sion. In such cases, IV fluid support and blood
pressure monitoring should be available for
anaesthetised animals. 1
5. Perform Laboratory Monitoring
Frequency of laboratory monitoring depends on the
risk factors of the patient. Ideally laboratory monitor-
ing should be done within the first month of initiating
treatment and then every 6 months thereafter in low-
risk patients.
For at-risk patients monitoring can be done more fre-
quently, such as every 2-4 months depending on the
risk-factor assessment. 1
2
Other literature advises to do an initial baseline hepat-
ic and renal panels by clinical chemistries before initi-
ating chronic NSAID therapy, then testing again in the
first two weeks and thereafter periodically. This allows
the clinician to assess trends and absolute values and
to investigate any increases in hepatic enzymes that
2017/01/18
may occur. 2 07:15:27 AM
M
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CM
MY
New in canine osteoarthritis
VETERINARY MEDICINE
The continuous path of pain relief
with a monthly dose.
S4 Trocoxil 20 mg (chewable tablet). Reg. No.: 11/3.1.2.2/02. Each tablet contains 20 mg mavacoxib. S4 Trocoxil 30 mg (chewable tablet).
Reg. No.: 11/3.1.2.2/03. Each tablet contains 30 mg mavacoxib. S4 Trocoxil 75 mg (chewable tablet). Reg. No.: 11/3.1.2.2/04. Each tablet contains 75 mg mavacoxib.
S4 Trocoxil 95 mg (chewable tablet). Reg. No.: 11/3.1.2.2/05. Each tablet contains 95 mg mavacoxib. Also contains sucrose.
For full prescribing information refer to the package ins