Using Deramaxx Safely

This discussion is about a drug called Deramaxx,  a non-steroidal anti-inflammatory (NSAID) sold by Novartis Animal Health Products. If you haven't already, please read Side Effects of Deramaxx and The Problems with Deramaxx.

There are many reasons dogs need pain relief. This makes finding a safe, effective analgesic critical. An NSAID used wisely can be beneficial. But it needs to be used wisely.

A general rule in using an NSAID is to use no more than the absolute minimum necessary to manage the pain. The key word is MANAGE. This does not mean obliterating the pain. It means reducing it so that the quality of life is not significantly diminished.

Your pet cannot tell you when he has enough medicine to get by and enjoy life. It is up to you to make that decision. Give your dog enough analgesic to make him comfortable, not oblivious. Strong, long-term pain medication can mask underlying disorders or disorders that develop during the course of analgesic therapy. Of course, these disorders are not necessarily caused by the analgesic. Such disorders may be serious enough to require the attention of a veterinarian. If a pet is asymptomatic because of strong analgesic therapy administered for an unrelated clinical condition, then even the most attentive owner may miss the disorder early on. Try not to overdo the analgesia. Your pet’s life may depend on it. Play it safe.

The manufacturers of Deramaxx^® and other NSAIDs need to develop a screening procedure that identifies Slow Metabolizers, the dogs who are most likely to experience adverse reactions. The science of characterizing dogs as Fast or Slow metabolizers is well established, the trick is getting this technology into the clinic.

Until a screening test becomes available, there are three things an owner and veterinarian need to do when prescribing an NSAID such as Deramaxx^®.

1. Screening

The dog should be screened for kidney and liver problems. It won't matter whether your dog is a Fast or Slow Metabolizer if he or she has pre-existing kidney or liver problems.

Dogs with impaired kidney or liver function are not good candidates for NSAIDs —period.

Dogs with heart problems are in danger of heart failure because of the effects of COX-2 inhibitors’ on the kidneys. These dogs should not be given Deramaxx^®.

The stool should be checked for blood. If gastrointestinal bleeding is present, Deramaxx^® administration is contraindicated: toxic levels in a Slow Metabolizer could produce life-threatening hemorrhage. We will never know whether Rudy had an asymptomatic stomach ulcer before receiving Deramaxx^® or whether he was a Slow Metabolizer. If a stool test had been performed and had been positive for blood, then Deramaxx^® should never have been administered.

2. Concomitants

Adverse reactions have been linked with insufficient time between administration of one drug and beginning Deramaxx^®. The time that needs to elapse between administering Deramaxx^® after having received another NSAID has not been established. It is hoped that either Novartis or the FDA will research this further and provide guidelines.

3. Careful Observation

This one is tough. There are a large number of cases in the adverse event reports and reports from owners who have not formally reported the reaction in which the dog has  died or almost died after receiving a single dose of Deramaxx^®.

In general, with Deramaxx^® or any other NSAID, the drug should be stopped at the first sign of an adverse reaction. In most cases, stopping the drug is enough to prevent permanent damage and the symptoms quickly resolve.

Veterinarians and owners should be alert for signs and symptoms of gastrointestinal problems such as vomiting, diarrhea, dark or bloody stools or changes in appetite or drinking.

Liver and kidney problems are more difficult to spot. Look for changes in the frequency or amount of urination and drinking (fluid and electrolyte imbalance), yellowing of the whites of the eyes (jaundice) or any behavioral change such as aggression or lethargy (hepatic psychosis).

Reports have suggested that Deramaxx^® can affect a dog’s central nervous system. In many cases, symptoms have occurred post-operatively and can be attributed to the anesthetic or post-operative pain. Aggression, disorientation, staring off into space, circling, lack of coordination when walking, lethargy or hyperactivity have been documented.

No scientific study has investigated whether Deramaxx^® is tumorigenic (can cause tumors, benign or malignant). Any long-term intervention in the inflammatory response can affect tumor growth, pro or con. This topic is currently under research with respect to Celebrex^®, a widely prescribed human COX-2 inhibitor. Different tumors respond differently to COX-2 inhibitors. Does Deramaxx^® accelerate the growth of preexisting tumors or cause them to shrink?

If your pet is exhibiting negative side effects, please see Negative Reactions to Deramaxx.

I've also posted other articles about Deramaxx, including:

Deramaxx Side Effects

The Problem with Deramaxx

Some of the information on this page has been freely provided by Vetnsaids.com.

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