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Any vets in the house - advice about pain meds in a dog

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 kipper12 15 Sep 2021

Hi

this is a bit of a long shot:

ive a 9 year old lurcher, who I adopted 16 months back.  He has had a lower front leg break sometime in the past, which was not treated properly, and the poor lad has an odd gait/stance with some arthritis.  So recently he has been having physio and massage, and the physio recommended pain relief to help get the best from the physio.  He’s been on meticam for 6-7 weeks,  it a blood test came back showing sub clinical signs of kidney damage, and recommended stopping, which I have.  The vet mentioned opioids, which I don’t really want to try, there are also some non Cox-2 NSAIDs, but would those pose a kidney risk.  I’d appreciate advice which didn’t come with a hefty bill attached, so any vets/vet nurses on here, I’d appreciate some help please.

cheers

 girlymonkey 15 Sep 2021
In reply to kipper12:

No direct help from me, but our pet insurance comes with a free vet nurse helpline which you can call for advice. Might be worth looking if you have that too as they should be a bit more impartial I would think.

 BedRock 15 Sep 2021
In reply to kipper12:

https://www2.zoetis.co.uk/products-solutions/dogs/oa-pain/librela

A new drug (not usre of cost) but worth considering.

 upordown 15 Sep 2021
In reply to kipper12:

I'm not a vet but am involved in a group called Canine Arthritis Management. They have a website (https://caninearthritis.co.uk/) and an owner support group called Holly's Army on Facebook. The drug librela which is mentioned above is a monthly injection of a monoclonal antibody which is thought to have minimal effect on liver and kidneys. However, there are currently supply issues and vets are not supposed to be starting any new patients on it. There is a new type of NSAID, a piprant called galliprant, which is more specifically targeted and should have less impact on kidneys and liver so that might be an option. To keep costs down get a prescription and buy online. Some dogs remain on NSAIDs with kidney disease but you'd want the advice of a specialist to go down that route. There's lots of info on things you can do on the website and FB page mentioned above and there isn't any cost involved.

In reply to upordown:

CAM is an excellent resource.

In reply to kipper12:

Hi Kipper - sorry to hear about your dog. Its not really kosher for me to give you direct advice about how to manage your dog, but if you are in the liverpool area then it would be worth asking if your vet can get some advice from the anaesthesia team at the vet school, or alternatively one of the other places in the area that have veterinary anaesthetists - so North West Surgeons  Chestergates or Manchester Veterinary Specialists, whichever they have a realtionship with - in general we are all really happy to give advice to vets FOC.

 Yanis Nayu 15 Sep 2021
In reply to kipper12:

Half a paracetamol? Pretty sure that’s what our vet’s advised for our lurcher in the past. 

 kipper12 15 Sep 2021
In reply to Dr.S at work:

Brilliant, thanks

 mik82 15 Sep 2021

Sorry, no direct help but fascinating that there seems to be more options for relief of osteoarthritis pain in dogs than in humans.

In reply to mik82:

Exciting time - galliprant (EP4 receptor antagonist) is cool enough but the species specific NGF antibodies are really exciting and it will be interesting to see how they do for conditions beyond OA. 
 

 kipper12 15 Sep 2021
In reply to Dr.S at work:

How do the monoclonal antibody therapies compare to the more traditional small molecules, in terms of cost/benifit

 im off 15 Sep 2021
In reply to kipper12:

I'm a vet. Deal with alot of lame dogs.

There's many drugs and treatments for osteoarthritis these days. 

There are several nsaids similar to metacam. Some claim to have a better safety profile.

Galliprant is a newer drug that isn't a Cox inhibitor and is safe for dogs with renal problems. I find it not as effective but maybe worth trying.

A more recent drug.....Librela.....is worth checking out. Its a monoclonal antibody against nerve growth factor. Has good safety profile and ideal if has iffy kidneys.

Other meds.....paracetamol at the correct dose can help but ask your vet as not licenced. Tramadol has been used but now thought not very effective for oa pain. Gabapentin. Amantadine.

I'd check and try Librela. I think there may be some supply problems with this at the moment though.

Good hydrotherapy. 

It may be There's a surgical solution too depending on the problem.

Hope that helps abit.

In reply to kipper12:

We don’t really know yet I’m afraid - they are pretty new to market.

 im off 15 Sep 2021
In reply to kipper12:

We're getting good reports back from owners about librela. It costs abit more but will depend on the practice. Its a monthly injection. If there was a marketed human equivalent I'd be trying it.

Maybe the other thing to chase up is how bad you're dogs kidneys are. It may cope OK with metacam. Metacam is a really effective oa drug but as with all drugs needs to be carefully used. 

 kipper12 15 Sep 2021
In reply to im off:

One of his kidney tox markers was elevated, difficult to hear from behind a mask in accented English, which markers.  Upshot is that the changes are sub clinical,  but advice was to discontinue.  What we don’t know is what his baseline was.   I think I’m going to need to move him to something else, ive a few suggestions now.  Does anyone know what the rough cost might be for monoclonal therapy.  It would be good to know what ball park, as nothing comes cheep for our animals.

 im off 15 Sep 2021

It works out more than metacam really. It's a monthly injection. You'll probably get charged an injection consult fee. I can't remember but maybe 30% more than metacam per month?

You may find no one can start you on it at the moment as supply issues but this should change.

Good luck with the old lad.

 kipper12 15 Sep 2021
In reply to im off:

Thanks, so maybe 100 or so.  The positive is the plan is not for him to be on pain relief in the short term, according to the physio.  

 Andypeak 16 Sep 2021
In reply to kipper12:

Meticam didn't suit my Labrador, had him vomiting every night. We were recommended paracetamol instead which seems to do the trick and suits me fine as it 29p a packet instead of £50. Obviously check with vet first before giving it to your dog. We use that combined with glucosomine

In reply to kipper12:

If it is lower leg also very much worth considering surgical options, not straightforward so worth getting sent to a specialist surgeon but it is possible might negate the need for meds. 


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