Another Meds Question

[NeylasMom]

So...Neyla's pain is still not controlled the way I would like with increased Tramadol (100 mg x/day) and Gabapentin (200 mg 2x/day). It seems like the Deramaxx is the only thing that really takes care of Neyla's pain. She is currently on 25 mg 2x/day and I have boosted that an extra 25-50 mg on one or two bad days. However, my oncologist doesn't like the idea of increasing past what we're on (the max rec. long-term use dosage for her weight) b/c of the risk of side effects to the liver (Neyla's ALT is slightly elevated, not alarmingly so), kidneys, and of gastric ulcers.

 

So I'm thinking about this and I'm wondering, wouldn't giving pepcid 20-30 minutes before the Deramaxx help reduce the changes of an ulcer? And if so, why has my vet not mentioned it? I am also going to put Neyla on milk thistle to hopefully address the elevated liver enzymes.

 

Also, I read through all of the dosage studies and it seems like there are few side effects up to as much as 8-10 mg/kg, which would be over 200 mg/day for Neyla so maybe increasing to 75 mg/day wouldn't be all that risky with the pepcid and milk thistle added as precautions? The max surgery dose for Neyla would be 100 mg/day FYI.

 

Ultimately, addressing the pain from her cancer is more important than the possibility of long term usage side effects - I realize that - but at this point, I am deciding between increasing the Deramaxx and doing IV pamidronate, which carries it's own risks/side effects. So any thoughts? Has anyone used Deramaxx at the surgery doses for longer term and did you see any side effects?

[krissn333]

Sutra took Deramaxx at the post-surgical dosage (for him this was 50mg twice a day) for probably the last couple of months that he was with me. It was the ONLY thing that helped his discomfort. He weighed right around 60/65 lbs. We never made it to trying Gabapentin, but tramadol seemed to do very little for him, other than make him antsy and uncomfortable.

 

He didn't have any ill effects kidney or liver-wise, but, he did end up in the ER with some gastritis at one point. I can't say for sure if the Deramaxx caused it, but, my theory is that because he had not been eating very well for a couple of days (likely due to the beginning of a pancreatitis flare-up), giving the Deramaxx on an empty stomach is what tipped the scale toward a problem. After he was home from the ER, I made sure he always had something in his tummy before giving it to him and we never had another issue. If he wouldn't eat his kibble, he always got some canned food or something from the fridge (leftover meat, spaghettios, mashed potatoes, macaroni and cheese, slices of cheese, cottage cheese...) before I would give him the Deramaxx. No problems

 

I don't personally see a problem with giving Pepcid beforehand if you want to, but IMO just being sure she has something in her tummy is enough to prevent issues.

 

Using the milk thistle to offset any liver issues that might be caused by a higher Deramaxx dosage is a good idea

[Guest mbfilby]

Deramaxx is basically the K9 equivalent of Celebrex. These two drugs block only the Cox-2 enzymes and are much safer on the blood clotting, liver, and stomach lining functions. The problem with most NSaids is that they also block the COX-1 enzyme which keeps blood platelets (and stomach wall lining) healthy. NSaids do not cause gastric issues from added acidity, but from reducing the body's natural protection.

 

Instead of pepsid I would used prilosec or it's otc generic omeprasol. These are PPIs and actually reduce the stomach acid production.

[tbhounds]

Totally agree with the prilosec. You also might consider giving Carafate three times a day (one hour before meds and meals).

[Batmom]

Pepcid (famotidine) also blocks acid production -- it isn't a "soak it up" med like some of the older ones.

 

With longterm use of NSAIDs or steroids, I always give some type of stomach med as well as food before the drug. Short-term use, dog with iron stomach, I might just give food (meal or substantial snack).

 

 

Jen, I think it really depends on what stage you feel your girl is in. If you believe her cancer is very slow-growing, you might want to look at other meds. If there aren't any others, then I'd go for the increased dose. You know to watch for side effects, and you can run a liver/kidney panel a couple weeks in.

[joejoesmom]

OSU has me use 15 mg famotidine (Pepcid) 15 minutes before each meal. He continues on this due to chemo drugs. When he was taking Deramaxx, they had me give it at mealtime. This was while he still had pain from the surgery and mild LS pain. He only took 50 mg a day though. They took him off the Deramaxx as soon as he would tolerate it. They also had me use sucralfate (the generic for carafate) when he had some stomach upset with chemo. The timing on this was important but I forget now exactly what it was. The Sucralfate was available as a generic for little money at the human pharmacy. You need a vet's script though. They would have given Joe 20 mg famotidine at his pre-amp weight.

 

I don't know anything about the maximum Deramax dosage.

 

Jane

[NeylasMom]

Well it sounds like regardless, I should start giving the Pepcid again before her Deramaxx doses. I have a ton of Pepcid on hand and no Prilosec so I think I'll just go with that.

 

Jen, I think it really depends on what stage you feel your girl is in. If you believe her cancer is very slow-growing, you might want to look at other meds. If there aren't any others, then I'd go for the increased dose. You know to watch for side effects, and you can run a liver/kidney panel a couple weeks in.

I was going to answer this, but it was becoming a ridiculous rant of self-pity and frustration so I'm going to post that bit in the osteo thread. The short answer is I don't really know, hence I don't know what to do.

 

Thanks for the input all, as usual you guys rock!