OVERVIEW
Steroids and NSAIDs used in treatment of Intervertebral disc disease (IVDD) updated 1/2008
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Dexamethasone

steroid side effects

NSAIDs

Prednisone

NSAID side effects

crate rest

Medrol (MPP)

stomach protectors

wash out time

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Medicine is constantly evolving. Your

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Both steroids and NSAIDs are commonly used as part of the treatment of IVDD, particularly if the dog does not have surgery. There is a lot of controversy regarding these drugs: When to use which? Which is better? Side effects vs. Benefits.
It is important for owners to be informed of the documented uses, effects and recommendations of each of these drugs that may be administered to your dog.

 

STEROIDS:
Dexamethasone (injected in the muscle) has been a steroid very commonly used for the treatment of IVDD to reduce swelling. In 1985 it was qualified as " the drug of choice". However, recent studies (2000 onwards) have reviewed this and it is no longer recommended to for IVDD, as the side effects are too high since it is a very aggressive steroid (7-10 times stronger than prednisone and longer acting) and it can only be used a few times before either tapering it off, or switching to a milder steroid.  It also takes too long for it to act, so it offers no neuro protective properties.
Prednisone (oral, pills) is also a commonly given steroid to reduce swelling, which acts rather fast and for shorter periods of time than Dexamethasone. It commonly causes several gastric side effects, but is fast reducing swelling and easy to administer while the dog is at home. Usually it is given after the dog received Dexamethasone or MPSS shots. Prednisone is followed up for 10-15 days and must be tapered off.
Solumedrol (Medrol, MPSS, Methyl Prednisolone Sodium Succinate). It's a fast acting IV steroid that must be given immediately, within 8 hours, after the dog shows the first signs of a disc herniation. It is the ONLY steroid that has neuro protective properties and not only reduces the swelling. 
This means that MPSS will actually help the nerve cord not suffer as much damage, aside from helping reduce the swelling caused by the herniation. The bad side is that the dog's body goes through a lot of chemical changes after 8 hours of the herniation. So giving it after 8 hours is actually dangerous.
ALL steroids must be tapered off gradually to allow the dog's body to start producing it's own steroids again. Not doing so, will make the dog very sick. Also, ALL steroids must be accompanied by gastric protectors and NEVER mixed either with NSAIDs or with another steroid (unless the veterinarian has a strong reason to do so) due to possible organ damage and metabolic disorders.
Caution with: diabetic, pregnant, liver, kidney, cardiac, infections or other health problems. Do not use when dog has been vaccinated or to be vaccinated. Recommend check up before use to verify dog is free from a silent disease or of symptoms not fully displaying. Recommend stomach protector such as Pepcid, Carafate, Misoprostol

 

NSAIDs
ETOGESIC (etodolac), RIMADYL (carprofen), METACAM (meloxicam), DERAMAXX (deracoxib), PREVICOX (firocoxib), ZUBRIN (tepoxalin), NOVOX (carprofen), ASPIRIN
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. NSAID companies have not done studies on use in IVDD. (http://www.fda.gov/cvm/currentlabels.html
Caution with: kidney, liver, heart and intestinal problems Do not combine different NSAIDs, aspirin or steroids. Recommend stomach protector such as Pepcid, Carafate, Misoprostol
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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. 

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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