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 insert approved by the medicines regulatory authority . Full product information available from Zoetis South Africa ( Pty ) Ltd ., Co . Reg . No .: 2012 / 001825 / 07 . 6th Floor , North Wing , 90 Rivonia Road , Sandton ,
2196 . PO Box 783720 , Sandton , 2146 , South Africa . Tel .: + 27 11 245 3300 or 0860 ZOETIS ( 0860 963847 ). www . zoetis . co . za TR / TD / SA1
INTERNAL MEDICINE
6 . Utilise a Balanced , Integrated Analgesic Approach as Part of NSAID-Sparing Strategies A pre-examination questionnaire for the owner , of behavioral changes or abnormalities would be the first step in recognising and assessing pain , however thereafter there should be measures put in place for not only veterinary assessment at regular intervals , but rather to also have primarily pet owner observation and input . 1 This will allow the veterinarian to monitor how the patient is doing and if the pain is under control .
NSAIDs form the cornerstone of oral osteoarthritis therapy and controls the chronic inflammation and pain . If the chronic pain is not controlled it will lead to peripheral and central sensitisation and lead to progression of the disease . 2
Current evidence shows that using NSAIDs at the labeled dose for long term treatment is beneficial and does not increase the NSAID-induced adverse events as the duration of treatment continues . 1 , 2
If a patient responds well to a NSAID during chronic pain management but then experiences an increase in pain due to progression of the underlying disease , then rather than switching NSAIDs it may be more appropriate to add another analgesic from a different class of drugs . 2
A holistic approach to osteoarthritis pain management is encouraged , paying attention to weight control , hydrotherapy , physiotherapy , and potentially acupuncture can all assist with pain management . 2
Once again discussing the treatment plan , goals and expectation to the owner is vital to the success of treatment .
7 . Consider Washout Periods In the event that a patient after initiating therapy has an adverse reaction or an inadequate response to a NSAID , switching to a different NSAID may be indicated . 2 Most experts recommend a washout period between switching oral NSAIDs for chronic pain management to avoid the potential for adverse effects , however clinically relevant washout periods remain controversial and largely undefined . 1 , 2
Conservative washout periods for NSAIDs , apart from aspirin and mavacoxib , have been 5 – 7 days , assuming the switch is not due to adverse effects . 2
Aspirin should not be administered because there are safer alternatives , however if a course of treatment with aspirin has been started in a dog , the recommended washout period before starting an approved veterinary NSAID is up to 10 days . 1
When switching from a corticosteroid to a NSAID , if it is a short-acting corticosteroid 7 days washout period applies , however if longer acting corticosteroids , a longer washout period should be considered . 1
If the reason for switching is due to adverse effects from a NSAID , additional precautions should be considered before starting another NSAID . If the adverse event is gastrointestinal , ideally you should wait until all clinical signs have resolved before beginning the new treatment . The addition of prostraglandin E analogues ( misoprostil ) and gastroprotectants can also be considered . 2
8 . Use Gastroprotectants Use gastroprotectants to either treat suspected gastropathy or prevent its occurrence , especially if no washout period is implemented . Proton pump inhibitors , H2 antagonists , misoprostol , and sucralfate can be helpful . 1 The afferent renal artery and the gastric mucousal arteries use PG E to vasodilate in conditions of hypovolaemia to ensure bloodflow . NSAIDs block the ability of the body to compensate in this manner and causes local ischaemia . This is where misoprostol has a role to play .
9 . Dose Optimization Work out dosage on lean body weight . Some clinicians recommend titrating to the lowest effective dose , however there is no definitive evidence that the dose reduction of NSAID lowers the risk of adverse events . 1 In the case of Trocoxil ®, the dosage of 2 mg / kg body weight is already the lowest effective dose , therefore decreasing the dose is not advised .
References : 1 . Epstein M ., et al . 2015 AAHA / AAFP Pain Management Guidelines for
Dogs and Cats . J Am Anim Hosp Assoc . 2015 ; 51 : 67 – 84 .
2 . KuKanich B ., Bidgood T ., Knesl O . Clinical pharmacology of nonsteroidal anti-inflammatory drugs in dogs . Veterinary Anaesthesia and Analgesia . 2012 ; 39 : 69 – 90 .
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 insert approved by the medicines regulatory authority . Full product information available from Zoetis South Africa ( Pty ) Ltd ., Co . Reg . No .: 2012 / 001825 / 07 , 6th Floor , North Wing , 90 Rivonia Road , Sandton , 2196 . PO Box 783720 , Sandton , 2146 , South Africa . Tel .: + 27 11 245 3300 or 0860 ZOETIS ( 0860 963847 ). www . zoetis . co . za TD / TRA / 2017
VETERINARY MEDICINE
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Issue 06 | DECEMBER 2017 | 32