- Corticosteroids—Glucocorticoid Effects (Veterinary—Systemic)
- The United States Pharmacopeial Convention, © 2004
- http://www.usp.org/pdf/EN/veterinary/corticosteroids.pdf last accessed 12/17/2007)
Accepted Use
Disk disease, intervertebral (treatment)—Dogs: Dexamethasone injection{R-4} and flumethasone injection{R-18} are indicated as supportive therapy in the treatment of intervertebral disk disease (disk syndrome). But it should be noted that high dosages of dexamethasone carry a risk of severe adverse effects.{R-166} Therapy should be tailored to the type of disk dysfunction and clinical signs. [Methylprednisolone]1, [prednisolone]1, or [prednisone]1, administered at an anti-inflammatory dosage, may be a more appropriate choice of therapy in many cases. However, acute paralysis due to intervertebral disk disease is an emergency usually requiring surgery and/or anti-inflammatory dosages much higher than those typically used for inflammation. For this form of the disease, see [Spinal cord trauma, acute] listed in this section.
[Spinal cord trauma, acute (treatment)]1—Cats and dogs: Methylprednisolone sodium succinate has been shown to improve clinical outcome in cats when administered within 1 hour of acute experimental spinal cord trauma.{R-25; 44; 45; 91; 173; 182} The strength of evidence of efficacy of methylprednisolone sodium succinate in cats leads clinicians to recommend use for this indication in dogs, also.
Pharmacology/Pharmacokinetics Note: Unless otherwise noted, the pharmacokinetics included in this section are based on intravenous administration of a single dose.
- Spinal cord trauma, acute—Glucocorticoids may limit neural damage by preserving microcirculation by vasodilation, scavenging for free radicals, acting to control edema and inflammation, and blocking lipid peroxidation.{R-43}
Veterinary Dosing Information Tapering dose: In order to decrease adrenocortical suppression, tapering the dose to the minimum required to control signs is an important strategy while treatment is ongoing. Tapering the dose is also important when discontinuing treatment.
Note: Because of a lack of research data on an effective dose of glucocorticoids in the treatment of disk disease in dogs, anti-inflammatory doses are listed below, based on clinical judgment. This is not the dose or dosage form recommended for neurologic dysfunction or paralysis due to disk disease (see acute spinal trauma under Methylprednisolone Sodium Succinate For Injection):
Dexamethasone Tablets Usual dose: [Dermatoses]; Inflammation, general; or [Inflammation, musculoskeletal]—Cats and dogs: Oral, 0.07 to 0.15 mg per kg of body weight a day for five to ten days or as appropriate for the disease condition.{R-212}
Dexamethasone Injection [Disk disease, intervertebral]—Dogs: Intravenous, 0.07 to 0.15 mg per kg of body weight a day.{R-212}
Methylprednisolone Sodium Succinate for Injection Note: Human products have been listed for this dosage form based on relevance to veterinary practice. The dosing and strengths of the dosage forms available are expressed in terms of methylprednisolone base (not the sodium succinate salt).
Usual dose: [Spinal cord trauma, acute]1—Cats and dogs: Intravenous, 15 to 30 mg (base) per kg of body weight, administered in a solution of 5% dextrose in water over one to several minutes. This dose has been effective when administered as an initial dose immediately after injury followed by a dose of 15 mg (base) per kg every eight hours and a tapered dose every eight hours over the week following the injury.{R-44}
Note: The above dosing regimens are based on efficacy studies in cats with induced spinal trauma. Some suggest that administering glucocorticoids for longer than six to eight hours after the spinal trauma occurs is nonproductive or even counterproductive.{R-223}
Methylprednisolone Tablets [Disk disease, intervertebral]1—Dogs: Oral, 0.05 to 0.45 mg per kg of body weight every twelve hours.
Prednisolone Tablets [Disk disease, intervertebral]1—Dogs: Oral, 0.5 to 1 mg per kg of body weight every twenty-four hours as an initial dose. Once clinical effect is achieved, the dose should be reduced gradually to reach the lowest dose that is effective. Additionally, alternate- day therapy should be employed to reduce side effects.
Prednisone Tablets [Disk disease, intervertebral]1—Dogs: Oral, 0.5 to 1 mg per kg of body weight every twelve to twenty-four hours as an initial dose.{R-31; 189} Once clinical effect is achieved, the dose should be tapered to reach an effective alternate-day dose administered every forty-eight hours.
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NSAIDs
Generally NSAIDs are used in the control of postoperative pain and inflammation associated with orthopedic surgery and for the control of pain and inflammation associated with osteoarthritis in dogs. Current labels for NSAIDs are available from the FDA.
Package inserts for NSAIDs:
(http://www.fda.gov/cvm/currentlabels.html last accessed 12/19/2007
No non-steroidal anti-inflammatory drug (NSAID) has been designed specifically for IVDD nor are NSAIDs listed for use in spinal cord trauma of IVDD on drug manufacturer package inserts.
- Accepted Use
- Inflammation, musculoskeletal (treatment); or Pain, musculoskeletal (treatment)—Dogs:injection and tablets are indicated in the control of inflammation and pain associated with osteoarthritis.{R-1; 2; 9; 40; 41; 61}
- Pain, postoperative (treatment)1—Dogs: injection and tablets are indicated in the control of postoperative pain associated with soft tissue or orthopedic surgery.{R-1; 2; 61}
http://www.usp.org/pdf/EN/veterinary/carprofen.pdf
http://www.usp.org/pdf/EN/veterinary/meloxicam.pdf
http://www.usp.org/pdf/EN/veterinary/deracoxib.pdf
- "A dog with chronic pain due to cervical nerve root irritation associated with disc disease may continue to be painful, even after the disc material has been removed. Treatment with a constant rate infusion of fentanyl, ketamine, diazepam, and lidocaine for several days may be needed to reduce the muscle spasms, pain and irritation. The dog may then be transitioned to oral drugs such as gabapentin, morphine, amantidine, and NSAIDS." (Managing Intractable Pain NAVC Proceedings 2006, North American Veterinary Conference (Eds). Publisher: NAVC Internet Publisher: International Veterinary Information Service, Ithaca NY Last updated: 11-Jan-2006. http://www.ivis.org/proceedings/navc/2006/SAE/348.asp?LA=1
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