The FDA has prepared a brochure for veterinarians to give to their clients who are prescribed NSAIDs for their dogs. Approved NSAIDs in the United States include:

• ETOGESIC (etodolac)
• RIMADYL (carprofen)
• METACAM (meloxicam)
• DERAMAXX (deracoxib)
• PREVICOX (firocoxib)
• ZUBRIN (tepoxalin)
• NOVOX (carprofen)

(Although available without a prescription, it’s important to note that aspirin is also in this class of drugs.)

The brochure is actually very accurate and stresses both the benefits of these  drugs, primarily in relieving the pain of osteoarthritis in dogs as well as post-surgical pain, and the risks, which can be substantial and include death.

I’m all about the pain relief and have given several different NSAIDS to my dogs. I’m not one of the people you’ll meet on the Internets who thinks they’re evil and shouldn’t ever be used.

I do feel NSAIDs, like all medications, should be used only when necessary, properly, and with a full understanding of what signs to watch out for in case there is a problem. This brochure does an excellent job of pinpointing the warnings signs of what can be life-threatening side effects, including:

• Behavior Changes
• Eating Less
• Skin Redness, Scabs
• Tarry Stool/Diarrhea/Vomiting

Those symptoms, they say, mean you should stop giving the drug immediately, and contact your vet — advice that can be lifesaving. The brochure also clarifies that more than one NSAID cannot be given at a time, and specifically warns against aspirin, something most pet owners do not realize is dangerous to give with other NSAIDs. It also mentions that corticosteroids cannot be given with NSAIDs, but I wish they’d mentioned that includes prednisone and prednisolone.

The brochure also gives information on what to discuss with your vet before giving the drug to your dog, including one on pre-drug testing that could save your dog’s life. The FDA tells you to ask your vet:

• what the NSAID is being prescribed for
• how much to give
• how long to give it
• possible side effects
• what to avoid while your dog is taking an NSAID
• what tests are needed before giving an NSAID to your dog
• how often should your dog be re-examined
• your dog’s previous medical history and any previous drug reactions
• all medications and products your dog currently receives

If more clients understood how to properly use NSAIDs, a lot of the genuine bad outcomes and not-so-genuine urban legends that get passed around might be cut in half. More importantly, many dogs who were harmed and even killed by avoidable side effects and adverse reactions would have been saved.

Unfortunately, almost no clients I know have ever been given even the most basic of warnings about these drugs by their vets, let alone the client information sheet that the FDA requires be handed out with each prescription. (I should mention that many vets do follow this requirement; my dogs’ surgeon, Dr. Gary Brown of Fremont, CA, handed it out to me every time he filled my dog Raven’s NSAID prescription when she had bone cancer, and went over it with me carefully.)

Nor are most clients offered safer alternatives to try first, such as acupuncture, supplements, chiropractic, physical therapy, the human drug Tramadol, or even the prescription veterinary drug Adequan Canine, an injectable joint treatment that selectively targets inflamed joints and actually helps rebuild cartilage — unlike NSAIDs, which tend to mask pain and degrade cartilage in the joints. While it doesn’t help every dog, I’ve had several get great benefit from it, and never progress to needing NSAIDs even in old age.

In addition, few vets routinely recommend the use of stomach-protecting drugs such as misoprostol and sucralfate when they prescribe NSAIDs. They instead often wait until the dog has problems to suggest gastrointestinal protection, and even then, it’s frequently some kind of antacid, which is the least effective therapy for the damage caused by NSAIDs. In fact, while antacids sometimes makes dogs feel better, they actually have no protective or therapeutic benefit at all, unlike the other two drugs.

NSAIDs have a place, a big place, in veterinary medicine. I’ve used them for my dogs, and I’ll use them again. I take them myself from time to time, and I wouldn’t have gotten through a back injury without them. But they’re often used when there are safer alternatives, albeit ones without a big marketing budget from the drug companies behind them. If drug sales reps aren’t calling at your vet’s office reminding them about human drugs like Tramadol, Misoprostol, and sucralfate, nor even veterinary drugs like Adequan Canine, it’s all too easy for a veterinarian to reach for an NSAID every time a dog needs some pain relief.

If nothing else, it would be nice to see them reach for this brochure, too, and make sure their clients know everything they need to know to use these drugs safely and correctly.

Gina and I have had some hard words in the past for the FDA’s handling of the pet food recall, but if pet owners are still unaware of the potential problems with NSAIDs and how to avoid them, it’s not because the FDA isn’t trying to get the word out to your dog’s veterinarian. Make sure your vet passes that information on to you.

Your dog’s life could depend on it.