The Problem With NSAIDs For Dogs

NSAIDs for dogs
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You’ve likely heard of names like Rimadyl, Metacam, Deramaxx, and Previcox. These non-steroidal anti-inflammatory drugs (NSAIDs) for dogs are often prescribed by veterinarians.

They help reduce inflammation and pain in a disease like arthritis. They’re also used for many other minor injuries and diseases involving inflammation. At some point during your dog’s life, your vet may recommend NSAIDs. 

But your vet may not tell you about the risks associated with these drugs … and that’s the information you need to make an educated decision about your dog’s care.

How Do NSAIDs Work?

NSAIDs inhibit the production of prostaglandins (1). Prostaglandins produced from fatty acids come from all cells in the body. The different types of prostaglandins in the body work to control inflammation. 

When tissue damage occurs, an enzyme system converts arachidonic acid to prostaglandins. This conversion is cyclooxygenase and there are two types: cox 1 and cox 2.2 NSAIDs can inhibit cox 1, cox 2 or both.

What Cox-1 does …

  • Promotes blood vessel constriction and platelet clotting when needed
  • Controls stomach acid production
  • Promotes gastrointestinal mucus secretion to protect the gut lining
  • Increases blood flow to the kidneys

What Cox-2 does …

  • activates an inflammatory response with pain and fever
  • Inhibits blood vessel constriction and platelet clotting when clotting is not needed

Manufacturers try to produce NSAIDs that inhibit cox 2 more than cox 1. Carprofen (the active ingredient in Rimadyl) demonstrated this in vitro (not in a live animal) (1)

Aspirin inhibits both. This is why aspirin can thin the blood and can cause stomach ulcers. This might be okay if you’re trying to prevent blood clots and stroke. But it isn’t okay if your dog needs to build a clot after a procedure. An example would be a dog’s inability to form a clot after a tooth extraction if taking aspirin. 

What The Experts Say About NSAIDs

Dr Colin Burrows is an internal medicine specialist at the University of Florida College of Veterinary Medicine.  He states …

Aspirin and other NSAIDs frequently cause gastritis or peptic ulcers and should be avoided unless absolutely necessary.

NSAIDs designated for human use, such as ibuprofen … are not safe for use in dogs or cats. These drugs cause severe, fatal gastric and intestinal ulceration.” (4)

Warnings From The Manufacturer

The manufacturers of Metacam report the following warnings on the package insert (5):

“As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity. […] Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID.

“[…] Death has been reported as an outcome of the adverse events listed above.”

Possible Organ Damage

Kidney specialist Dr Gregory F Grauer DVM, MS, DACVIM has a warning for dog owners. 

“Dogs of advanced age, those with subclinical kidney disease, or on concurrent medications such as furosemide … are at an increased risk for kidney damage when an NSAID is added to their treatment protocol.”

Idiosyncratic reactions (meaning the cause is unknown) can occur with any NSAID use. Some dogs may be more prone to reaction due to genetic predisposition. Reports of liver disease from carprofen (metabolized by the liver) use are only 0.05% of dogs treated. ….but not all reactions are reported. Regardless of the percentages, a reaction doesn’t feel so rare when it affects your pet! 

I’ve seen a distraught pet owner who learned her dog had irreversible dry eye. After a course of the NSAID etodolac (Etogesic) … and the anger of a pet owner whose pet suffers from kidney disease caused by deracoxib (Deramaxx).

And even worse,  most dog owners are not forewarned of these dire side effects.

Negative Side Effects of NSAIDs

If your dog is taking NSAIDs, you need to watch out for reactions. Common NSAID reactions include:

  • Vomiting with or without blood
  • Black stool or blood in the stool
  • Loss of appetite
  • Lethargy

Routine blood work is key for dogs on NSAIDs. A MAJOR side effect is anemia or low protein in the blood, due to blood loss in the gastrointestinal tract. 

What are the Benefits And Risks of NSAIDs

Drs Roach and  Johnson from the College of Veterinary Medicine at the University of Georgia agree that NSAIDs have a place in the management of osteoarthritis in dogs. They also recommend adding in joint support as added protection … things like polysulfated glycosaminoglycans, oral glucosamine, chondroitin sulphate, hyaluronan, and even acupuncture. They may also prescribe opioids … such as butorphanol or Tramadol for pain.

They emphasize nutrition and low-impact exercise (such as swimming) for weight control. Disease will progress despite these therapies, they say (6).

So why do they recommend all these other therapies? NSAIDs are not effective in improving the health of a joint and some may even add to joint damage (read about Dr Ross Hauser’s research below). By adding in alternative therapieswe can support the joint better.

Can NSAIDs Make Arthritis Worse?

According to Dr Ross Hauser MD in a paper published in the Journal of Prolotherapy (7) …

“One of the best documented but lesser known long-term side effects of NSAIDs is their negative impact on articular cartilage. […] It is clear from the scientific literature that NSAIDs from in vitro and in vivo studies in both animals and humans have a significantly negative effect on cartilage matrix which causes an acceleration of the deterioration of articular cartilage in osteoarthritic joints. The preponderance of evidence shows that NSAIDs have no beneficial effect on articular cartilage in OA and accelerate the very disease for which they are most often used and prescribed.

Even the authors of the esteemed Small Animal Surgery textbook (8) state caution. 

“Most NSAIDs interfere with chondrocyte (cartilage cells) glycosaminoglycan synthesis and therefore should be used continuously only for a short time.” They suggest adding in stomach protection to the list of added support when using NSAIDs. 

It’s hard not to conclude that the risks outweigh the benefits of NSAIDs for dogs.  Why reach for them when there are natural options that can be as effective?

The Body’s Natural Ability To Heal

The sensation of pain is a deeply ingrained trigger within the body to quickly protect it from harm. But sometimes we forget how good the body is at doing what it’s meant to do. The best approach to medicine is often not to interfere with the body’s natural processes. The concept of hormesis embraces this fact. It teaches us that a little stress is something that helps the body to repair and strengthen.

Inflammation is a natural, protective, physiologic mechanism. It is necessary to stimulate the body’s healing processes. Inflammation comes from the Latin word meaning “fire”. This is fitting if you have ever experience red and warm pain of inflammation. 

The initial acute pain of inflammation forces us to stop the insult to the tissue. This then allows the healing process to begin.  If you touch a hot stove, the burn will only begin to heal once you remove your hand from the stove. If you touched the stove and didn’t feel any pain, your hand would suffer considerable burning and damage. 

But chronic inflammation is difficult to manage. It’s more than removing your hand from the hot stove. Inflammation becomes chronic when it has been active for a period of time without relief. For example, an intestinal foreign body will stimulate inflammatory cells. Their mission is to attempt to expel the invader until it’s removed.

So, pain and inflammation would seem like a good thing for the body. Yet conventional medicine says we should suppress inflammation … I guess because it hurts? The good news is there are other options.

Natural Alternatives To NSAIDs for dogs

There are several natural treatment alternatives to NSAIDs. That relieve discomfort in dogs without the side effects of NSAIDs.

Zeel

A study looked at the use of the homeopathic blend Zeel® (made by Heel). Dogs with moderate to severe osteoarthritis used it for 8 weeks. This group had much less pain than their placebo peers. Although carprofen was more effective (9)

Homeopathy is often seen as elusive and controversial. But homeopathic remedies are effective and much safer than NSAIDs.  Another study of Zeel (10) showed its ingredients can inhibit leucocyte elastase, an inflammatory enzyme that can damage articular cartilage. Less cartilage damage means less pain for your dog.These findingshelp scientists understand and accept the validity of homeopathic medicines.

Traumeel

From the same parent company Heel, comes Traumeel®. Made popular among humans who find it to be effective. Many holistic veterinary practitioners and rehab specialists use this blend. Zeel is best for osteoarthritic conditions while Traumeel is great soft tissue injuries. Each comes in tablet or injectable form.

*Note: Heel has exited the US and Canadian markets and Heel Inc.  sold to MediNatura Inc. You can now look for T-Relief Arthritis and T-Relief*

 Protection And Pain relief With Corydalis

This Chinese herb is a natural anti-inflammatory and can replace many NSAID prescriptions. Corydalis is an analgesic that actually protects the GI tract.

Studies show corydalis relieves pain and also protects the GI tract (11) The species used is Corydalis yanhusuo.  It is a native to the northern Chinese province of Zhejiang.

Calming Pain Relief With California Poppy

If a painful pet also needs mild sedation, California poppy comes to the rescue!

Clients who skipped NSAID use after surgery found California poppy provided pain relief.  Studies show it contains small amounts of morphine and has analgesic effects (12). 

The Benefits of Boswellia

Boswellia is also an effective anti-inflammatory and is often used by migraine sufferers. Pet owners report stopping or lowering NSAID use for osteoarthritis when using boswellia. 

A clinical trial looked at the effectiveness of Boswellia serrata and found 71% of dogs with degenerative conditions showed improvement (13).  This is likely due to the presence of boswellic acids in the herb. These acids can reduce inflammatory cell infiltrates.

Arnica Liniment For Pain

My experience with Arnica is with the herbal liniment from Buck Mountain Botanicals. This provided amazing relief for a Labrador retriever with severe neurologic pain.

NSAIDs, Tramadol and Gabapentin did nothing…. but this old-fashioned topical brought immediate and long-lasting relief.

Some active components in Arnica are the sesquiterpene lactones, a chemical class of constituents present in many herbals and essential oils.

Caution: Homeopathic preparations of Arnica are safe, because they’re extremely diluted. But when you’re using a herbal preparation, it can be toxic. So you will need to watch out for licking!

Why are natural alternatives better than NSAIDs?

Natural products offer a safe and effective approach to controlling chronic inflammatory disorders. History has shown this. Most medical discoveries began with studying historical uses of plants as traditional remedies.

But when plant chemicals are isolated and used in drugs, they begin to get more dangerous.

Greg Tilford is a noted animal herbalist. He once told me, “Don’t ever forget, the whole herb is always greater than the sum of its parts.”

This is especially true when we’re discussing safety. Natural remedies help the body’s innate ability to change or balance itself.  Drugs tend to force the body into change.

Many natural approaches can be given together. They work well in conjunction with laser therapy, massage or acupuncture. Others are best alternated, especially energy medicines. Check with your holistic vet to be sure.

You have the right to know natural alternatives so you can make an educated health plan for your dog. 

References
  1. Donald C Plumb Pharm D, Plumb’s Veterinary Drug Handbook. 2008
  2. Fitzpatrick FA. Cyclooxygenase enzymes: regulation and function. Curr Pharm Des. 2004;10(6):577-88.
  3. Charles E Ophardt, Virtual Chembook, Elmhurst College, 2003
  4. M. Schaer. Clinical Medicine of the Dog and Cat. Iowa State Press 2003
  5. Metacam package insert, Boehringer Ingelheim Vetmedica, Inc. 8/2014
  6. Etienne Côté, DVM, DACVIM (Cardiology, SAIM). Clinical Veterinary Advisor, Second Edition, 2011
  7. Ross Hauser MD.  The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Non-Steroidal Anti-Inflammatory Drugs. Journal of ProlotherapyVol 2, issue 1, February 2010
  8. Theresa Welch Fossum, DVM, MS, PhD, Diplomate ACVS. Small Animal Surgery. Fifth edition, 2018
  9. A Hielm-Bjorkman. Evaluating Complementary Therapies for Canine Osteoarthritis—Part II: A Homeopathic Combination Preparation (Zeel®)Evidence Based Complementary and Alternative Medicine. Vol 6. 2009
  10. Heinz Birnesser, Pelle Stolt. The Homeopathic Antiarthitic Preparation Zeel comp. N: A Review of Molecular and Clinical DataEXPLORE, Volume 3, Issue 1. 2007
  11. Xu Y et al. Analgesic effect of the main components of Corydalis yanhusuo (yanhusuo in Chinese) is caused by inhibition of voltage gated sodium channels. J Ethnopharmacol. 2021 Nov 15;280:114457. 
  12. Fedurco M et al. Modulatory Effects of Eschscholzia californica Alkaloids on Recombinant GABAA Receptors. Biochem Res Int. 2015;2015:617620.
  13. J. Reichling et al. Dietary support with Boswellia resin in canine inflammatory joint and spinal disease. Schweizer Archiv für Tierheilkunde. Vol. 146, No. 2

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