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Medication and Your Dog
Deramax (Rx) is Deracoxib
Faxing and regulations regarding prescriptions
Cosequin effects and pain management for hip dysplasia
Cyclosporin
Tums for calcium carbonate requirements
Aluminum hydroxide and phosphorus binders
Acetaminophen (Tylenol) safety in dogs
Stanozolol (Winstrol-V tm)
Medication interference - aluminum hydroxide and ursodiol (Actigall Rx)
On-line PDR, chronic infection and long term antibiotics
Doxycycline for urinary infection
Anxiety medication for phobias - Valium and Buspar
Ketoconazole (Nizoral Rx)
Metamucil
Heart disease drugs, Cushing's and medications
Celebrex
Kaopectate
Tioconazole
Clomicalm Rx (clomipramine)
Tylan and false test results
Dramamine for motion sickness
Alprazolam (Xanax Rx)
Leflunomide
Acyclovir (Zovirax Rx)
Ivermectin - for Demodex
Misoprosil (Cytotec)
Trazadone
Methioform (d,L methionine)
Levothyroxine
also see Immumoregulin
also see Phenylpropanolamine
also see Metronidazole- Flagyl
also see Pain control
also see Heartworm prevention and monthly flea control medication
also see Adaquan
also see Lysodren and Anipryl for Cushing's
also see Etogestic
also see Acepromazine
also see Amitriptylline (Elavil Rx)
also see Aspirin
also see Herbs, Supplements and Nutriceuticals
also see Ovaban
also see Prednisone and other Corticosteroids
also see Rimadyl
also see Side Effects and Reactions
also see Phenobarbital and other seizure control medication
also see Prozac
also see Non-steroidal anti-inflammatory drugs (NSAID)
Warning: Rimadyl will cause liver damage in some dogs. There have been some deaths in dogs with this reaction. This effects 0.02% of dogs and 70% of those are geriatric. More information can be found by consulting the Small Animal Clinics of Pharmacology's latest edition.. This is a remarkable drug for many dogs. Blood work however should be done prior to beginning treatment and one or two weeks into treatment to monitor liver values.
Deramax (Rx) is Deracoxib
Question: Dear Dr. Mike,
Do you know anything about a new pain reliever called Duramax for
animals? Is there a website that has a write up on it or other
information? Thanks and still a great newletter!
Sincerely,
Debbie
Answer: Debbie-
Deramax (Rx) is deracoxib. This is a medication in the same category as Celebrex (Rx) and Vioxx (Rx) for humans. It was originally approved for post-surgical pain but has recently been approved for chronic use for arthritis, although I have not received dosing information from the company for this use, yet. It is manufactured by Novartis and there probably is a web site for it, but I have not seen it.
We have used this medication for post-surgical pain and for pain associated with pelvic fractures in a number of patients. It appears to work very well and based on our initial impressions, I think it is the most potent of the non-steroidal anti-inflammatory medications that we have used. While I have no experience with long term use, at this point, I suspect it will be a good choice based on the use of Celebrex and Vioxx in people.
At this time, there are no alerts for problems such as liver injury or kidney damage but it is still early in the use of this medication and it would be prudent to keep in mind that new medications do sometimes have effects that won't show up until they are used in large numbers of patients.
Mike Richards, DVM
3/27/2003
Faxing and regulations regarding prescriptions
Question: I recently tied to order heartgard med. for my dogs. The pharmacy faxed my vet a form to be faxed back. The vet then gave me a written prescription for me to mail in. My dogs are all up to date on tests vaccines etc. My vet sells interceptor which I do not like. Two of my dogs are also on elavil for aggression. Now I'm afraid he won't give me a renewal form for that either. I just don't know what to do and I don't know what my rights are. I just want to be able to get what I need for my dogs without having to feel uncomfortable asking for it. Do you have any suggestions?
Thank you, Irene (a subscriber)
Answer: Irene-
In many states (probably most and perhaps all) it is illegal for a veterinarian to refuse to write a prescription for a product that they would dispense. It is not illegal for your vet to refuse to write a prescription if there is a legitimate reason for not doing so, such as not seeing the patient within a year, no heartworm examination on file, heartworm examination that is beyond the term that the vet hospital routinely uses -- for many vets still a yearly procedure but may be longer if there is reasonable evidence that you have been giving the medication.
At the present time, in Virginia, the Board of Veterinary Medicine is suggesting that veterinarians do not fax prescriptions to pharmacies that call and request them, because there has been some abuse of this. Their suggestion is that the client be given a written prescription that they can take, or send, to the pharmacy of their choice. I am not sure how or when this issue will be resolved to everyone's satisfaction so I suspect that for a while, at least, you will have to pick up written prescriptions if the Board in your state has made a similar suggestion to veterinarians. We do sometimes call in prescriptions to pharmacies and the Boards suggestion on this was to be sure we were talking to a pharmacist when we call in a prescription for the first time and to renew prescriptions from the same pharmacy only.
In Virginia, veterinarians are required to post their license, which has the Board of Veterinary Medicine phone number printed on it. If some question about the prescriptions arises in the future you can get the phone number for the Board in this manner or from the state government web site or other information source.
It is a little more trouble to have to pick up the prescription but the fraudulent practices of some Internet and mail order pharmacies have troubled the veterinary boards and pharmacy boards in many states and resorting to requiring a written prescription, which is hopefully harder to alter, is the current stop gap measure they are suggesting to combat fraudulent practices.
Mike Richards, DVM
4/16/2003
Cosequin effects and pain management for hip dysplasia
Question: Dr. Mike,
My 8 yo GSD has been diagnosed with mild hip dysplasia. She has been
given Rimadyl in the past for a flare but suffered from bloody diarrhea
and vomiting after 4 days of treatment. At the same time she was also
started on Cosequin DS. Obviously she should not be given Rimadyl
again but I'm have a couple questions regarding treatment:1. Could the Cosequin DS have also contributed to her adverse
reaction? I'm not sure about the side effect profile of this product.2. What are her future options for treatment for acute pain? I'm not
sure I'd be comfortable with even a short course of steroids given her
reaction to the NSAID.3. If she truly needs steroids do you have any information about the
addition of a drug like ranitidine or omeprazole to prevent GI
problems?Thanks. Pat
Answer: Pat-
I have not heard of bloody diarrhea associated with the use of Cosequin
(tm) or other glucosamine/chondroitin products. However, we have had at
least one dog in our practice who developed diarrhea without blood when
given glucosamine/chondroitin products that was a repeatable
circumstance and I have talked with other vets who have had similar experiences. So I
suspect that there are a few dogs who develop diarrhea as the result of
the use of glucosamine and/or chondroitin use. In general these are pretty
safe products, though. We have had some clients who reported vomiting
associated with the administration of glucosamine and chondroitin and there are
anecdotal reports of disturbances in glucose levels in diabetic patients
when using glucosamines. There is some concern about exacerbation of
pre-existing bleeding disorders due to the similarity in chemical
structure between glucosamines and heparin. Since shepherds are somewhat prone to
bleeding disorders this may be something to think about due to the
bleeding that occurred in association with the diarrhea when Rimadyl (tm) was
administered, even though it isn't highly likely to be a problem.I would not rule out the use of all non-steroidal anti-inflammatory
(NSAID) medications based on a reaction to one of them. Individual patients seem
to react differently to the various NSAIDs and it is often possible to use
a different one without problems. Among the NSAIDs it seems reasonably
safe to use aspirin, carprofen (Rimadyl Rx), etodolac (Etogesic Rx),
ketoprofen (Orudis tm - 1mg/kg/day, may be best to use intermittently) and
meloxicam (not yet available in the U.S., in in Canada). All of the NSAIDs do
have some potential to cause problems, usually gastrointestinal, liver or
kidney related. This risk has to be weighed against the potential for pain
relief and improvement in the quality of life. Based on our practice experience
the quality of life improvement can be dramatic and justifies taking
small risks, however your experience with carprofen does give rise to higher
worries than exists in most cases. I wouldn't totally rule out the
possibility of trying a different NSAID in the future if the arthritic
pain associated with hip dysplasia becomes more severe.It is acceptable to use cimetidine (Tagamet tm), famotidine ( Pepcid AC
tm), ranitidine ( Zantac tm) and misoprostol ( Cytotec Rx) to lessen the
gastrointestinal effects of NSAIDs in cases in which they are irritating
but it still seems necessary to consider their use.For pain relief associated with hip dysplasia there are several
additional options. Narcotics can be used with good success in some dogs. We use
hydrocodone/acetaminophen (Vicodin Rx) combination medications in our
practice for chronic pain fairly frequently and it seems to be
beneficial to many patients. This combination can't be used in cats due to the
acetaminophen and rarely acetaminophen causes liver damage in dogs, as
well. Hydrocodone is available without acetaminophen and it is
acceptable to use codeine (0.5 to 2mg/kg every 8 to 12 hours). Amitriptyline
(Elavil Rx), seems to help in chronic pain when used alone or in conjunction
with narcotics. While I think it works better when used with narcotics, we do
have one patient on amitriptyline alone for chronic hip dysplasia
because it seems to do well with amitriptyline as the sole drug. Morphine (
0.5mg/kg every 4 to 6 hours) works well for chronic pain relief as well
but we usually try to reserve this use to really difficult cases when all
other medications fail. Fentanyl patches (Duragesic Rx) are an effective
short term solution for moderate to severe pain in dogs and some veterinarians
use these more chronically but we have not tried this approach, yet.Corticosteroids are very effective anti-inflammatory medications. They
have wider ranging systemic side effects than most of the other medications
used in veterinary medicine, though. For this reason, most veterinarians
prefer to avoid the chronic use of corticosteroids for conditions that can be
treated with other medications. However, there is a time in the course
of hip dysplasia when the risk/benefit balance begins to favor the use of
corticosteroids, as well. While corticosteroids can cause
gastrointestinal problems, including ulcers, this effect is less common with cortisones
than with non-steroidal anti-inflammatory medications. Misoprotol doesn't
seem to help much with cortisone induced ulcers but the H2 blockers
(famotidine, ranitidine, cimetidine) might be helpful. In general, though, I don't
think that it is really necessary to use these medications in conjunction with
steroids unless the dosage is high or daily use (as opposed to every
other day use) has to be continued for long periods of time.Using anti-oxidants, such as Vitamin E (up to 2000U/day) and marine fish
oils (3V Capsules tm) may be beneficial to some patients with chronic
inflammatory disorders. Glucosamine (500mg/25lbs body weight/day) and
chondroitin (400mg/25 lbs body weight/day) are widely used for chronic
anti-inflammatory effects and there are now some better studies that do
support their use.I wouldn't rule out hip replacement surgery, either. This works really
well in 90% of the patients who have surgery and the relief post surgically
is sometimes really dramatic. It is more costly initially but I suspect
that many of our clients spend more money in the long run treating the
chronic pain and the dog gets the benefit of not having the pain that has to be
treated. While it is probably overkill for most dogs with mild pain I
don't see any reason not to consider it for a patient who has reactions to
pain medications.I hope that this is helpful. I think that there will be additional
choices in non-steroidal medications for dogs, including one or more of the
newer C0X-2 inhibitors (a human example would be celecoxib (Celebrex Rx))
being approved for use in dogs. That may be helpful for dogs like yours who
have stronger gastrointestinal reactions to the medications that have more of
a COX-1 or mixed COX-1/COX-2 effect.Mike Richards, DVM
12/7/2001
Question: Dr. Mike,
I have a nine year old female Pekinese who recently has had some eye problems. Somehow she damaged
her right eye and scratched it causing an indentation on her eye. I noticed that her eye didn't look right
and immediately took her to my vet. My vet placed dye in her eye so that she could evaluate the damage
and started her on antibiotics. My vet also prescribed atripine and gentocin ointment for her eye. My vet
continued to check her eye every two to three weeks and changed the dosage of the medicine
accordingly. Three weeks ago I added artificial tears as well as continuing to put the ointment in her
eyes. Now the eye looks better, but there is some scar tissue. My vet is ordering cyclosporin and
explained that it would take at least a week before she got it. I'm to use it four times a day to start and
then the dose will taper off. My vet wants me to keep the dog on this medication for her eyes for the rest
of her life. It was explained to me that the scar tissue in the eye would go away and the cyclosporin
would help to lubricate the eye since my dog never fully closes her eyes even when asleep. Have you
had any experience with this drug called cyclosporin? Thanks again for the great service that you
provide.Vicky
Answer: Vicky-
Cyclosporin is the medication that is used in humans to prevent rejection of organ transplants. It
stimulates tear production in dogs for some reason. It doesn't seem to have this effect in cats. It
is far and away the best medication for the problem of tear deficiency in dogs. Since tear
deficiency is the most common cause of excessive mucous formation in the eyes of older dogs
and since tear deficiency leads to keratoconjunctivitis sicca, in which eye ulceration can occur, it
is likely that this is why your vet is using this medication.We use cyclosporin on a twice daily basis most of the time. It is available in an ointment with the
brand name Optimmune (Rx). If the ointment doesn't work, it can also be formulated in a eye
drop, although this is not an approved formulation.I do not know how well cyclosporin might work if the problem is that the lids do not close
sufficiently. Usually, when this problem is present we refer our patients to an ophthalmologist for
a procedure referred to as nasal reconstructive blepharoplasty, in which part of the eyelid
margin is closed surgically in order to allow the rest of the eyelid margin to successfully close
over the eye. This seems to work well for most of the dogs with problems closing their eyelids
completely.Once in a while we see reactions to cyclosporin, usually when we are using the formulated eye
drops and this is usually due to the oil that the medication is mixed with. I can't remember a
reaction to the Optimmune ointment. Cyclosporin probably helps about 80% of the dogs with
tear deficiency. It is OK to supplement the cyclosporin with artificial tears or other medications
to stimulate tear production, if necessary.It is really important to do something that is effective when tear deficiency is present, so keep
working with your vet until you find a solution to this problem.Mike Richards, DVM
8/7/2001
Tums for calcium carbonate requirements
Question: I need to include calcium carbonate in my dogs home cooked diet, but have yet to find it
except in the form of Tums. I have read that Tums can be detrimental to pets.
Is this true?Answer: To the best of my knowledge, there is no
problem with using unflavored Tums (tm) in dogs for calcium carbonate
requirements. One Tums tablet contains 0.5gm of calcium carbonate. It is also
possible to find calcium carbonate as the calcium ingredient in some human calcium
supplements. I don't know the names but you could probably pick them
out by reading the ingredients.Mike Richards, DVM
8/3/2001
Aluminum hydroxide and phosphorus binders
Question: Dr. Richards,
Princess is suppose to take 2-3 times a day Alternagel as a phosphorus
binder because she is now on Calcitriol I just finished reading the
information about aluminym hydroxide on www.petseducation.com. From what I
have read, it seems that prolonged use of aluminum (hydroxide) has a number
of very undesireable side effects. Princess also does not like the taste
of the stuff and vigorously opposes having to take it. The problem with
this situation is that she has laryngeal paralysis. I think you get the
idea. I guess my questions are these:1. Can this product be compounded so that it goes down better?
2. If the product can be compounded, can it just contain the
aluminum hydroxide only or would there be other ingredients other than calcium?
3. She also has to take ursodiol (Actigall). The problem is
that Aluminum hydroxide negates the effectiveness of the Actigall
4. Are there better phosphate binder alternatives? It seems
prolonged use of the aluminum hydroixde has very bad effects.Tony
Answer: Tony-
The information on side effects of aluminum hydroxide is gathered mostly
from human medicine. The specialists who work with kidney failure patients
in veterinary medicine do not report these effects. It is likely that the
shorter durations of therapy with aluminum hydroxide ( perhaps 2 to 3 years
for pets and 10 to 15 years for humans due to the use of dialysis) makes
this compound safer for pets. I read the information on the Foster and
Smith web site and these warnings do match those listed in some veterinary
formularies but these usually mention that the reports are from the human
literature, making it reasonable to be cautious. Despite this, there are
no reports that I can find of these effects occurring in animals.Our compounding pharmacy makes aluminum hydroxide products for us because
we were having a hard time finding the medications for a while.Phosphate binders containing aluminum do bind with ursodiol (Actigall Rx),
so it is possible that they would interfere with its action. It may be
reasonable to increase the dosage of the ursodiol to compensate for the loss.An alternative phosphate binder containing neither aluminum or calcium
would be sevelamer hydrochloride (Renalgel Rx). It supposedly has worked
well for some pets but I have not seen published data with dosages and an
evaluation of how well it works.Mike Richards, DVM
3/13/201
Acetaminophen (Tylenol™) safety in dogs and cats
Question: Hi Dr Mike:
I have a question about Acetaminophen (Tylenol™). The
Receptionist at our local veterinarian told us that in case of fever, it was ok to give our dogs
a Tylenol™ and NOT to give them ASPIRIN, or IBUPROFEN.http://www.avma.org/pubhlth/poisgde.asp#yew
According to the AVMA Pet Poison Guide ratings scale, it appears
to me that the Acetaminophen (Tylenol™) is more dangerous then the ASPIRIN, or
IBUPROFEN. Is this true or am I misunderstanding what I am reading or was
this by chance a misprint?What would you recommend be given to a dog in case of a fever
ASPIRIN, IBUPROFEN, Acetaminophen (Tylenol™) or something else?Thank you for your time. I hope to hear from you soon, David
Answer: David-
Based on reactions in our canine patients, this is the ranking I would give
these medications: safest = acetaminophen (Tylenol tm), also safe =
aspirin, less safe = ibuprofen (Advil tm, Motrin Rx). However, this is
the ranking that I would give them based on the reports in the literature
and factoring in the likelihood of a bad reaction causing death: safest =
aspirin, also safe but less so = acetaminophen and less safe = ibuprofen.The reason for these rankings include these things. Aspirin is reasonably
likely to cause gastric ulcers, which can be life threatening if ignored
but which respond to withdrawal of the medication. Acetaminophen doesn't
seem to cause ulcers but there are uncommon reactions to it in which liver
failure occurs and this may not respond to therapy, so death is a
possibility. Ibuprofen is very likely to cause ulcers, with 100% of dogs
developing ulcers with the use of ibuprofen in at least one study. On the
other hand, lots of my clients come in and tell me "I gave my dog an
ibuprofen last night" and I have only had to treat one or two cases of
ulcers and I can't recall a dog dying from this medication, yet.My personal preference for pain and fever in dogs is aspirin but we do warn
our clients to discontinue the medication if the dog stops eating and to
call us or come in for a recheck if that happens.In cats the situation is different. Acetaminophen is very toxic to cats and
this medication should simply never be used to treat a cat. Aspirin has a
long half life in cats, at least 24 to 48 hours, so it will reach toxic
levels pretty quickly if it is given more frequently than once every 48
hours and the dosage is 10mg/lb so a baby aspirin (81mg) is a much more
appropriate dosage for a cat than an adult aspirin. I have not seen much
information on ibuprofen and cats but it is a good idea to avoid all
non-steroidal anti-inflammatory medications in cats, at least until one of
them does prove to be safe in someone's clinical trials.Mike Richards, DVM
3/10/2001Answer: David-
This is sort of a p.s. to the previous note. My guess is that the AVMA
figures that it is safer not to confuse people with the difference between
the effects of acetaminophen in dogs and in cats. I have several pain
control references which state that acetaminophen is generally safe in dogs
and it is used frequently because hydrocodone/codeine + acetaminophen
combinations are pretty effective for post-surgical pain and for chronic
pain from arthritis in dogs. The general feeling is the the narcotic
provides the pain relief in this combination, though.Mike Richards, DVM
3/10/2001
Stanozolol (Winstrol-V tm) and poor appetite with renal failure
Question: Dr. Richards,
Princess is a 16-year old Pom weighing in at 11 lbs. She is somewhere in
the end stage of kidney failure.Question 1: She is given a weekly injection of 25 mg. of winstrol. At
what level is this dosage? And is one of the side effects heightened activity?
Princess kept me awake for a goodly portion of last night when her constant
rearranging of her blankets and pillows. What are some of the potentially
serious side effects of this drug?Question 2: Princess currently receives 250 ml. daily of LRS. Would
upping the volume help to improve her appetite? Inappetance continues to be a
major problem.Tony
Answer: Tony-
The recommended dosage of stanozolol (Winstrol-V tm) for small dogs by
injection is 25mg once a week. No dose range is suggested. For large dogs
it is recommended that Winstrol-V be given at a dose rate of 50mg once a
week by injection. It is available in an oral form, as well. When using
the oral tablets the dose for small dogs is 1 to 2mg per dog per day and
for large dogs it is 2 to 4mg per dog, per day. There is surprisingly
little information on the effects and side effects of stanozolol in the
veterinary literature considering that it has been around a long time. In
cats there are reported cases of liver damage that appear to be related to
use of the medication. In dogs the only side effects that are reported are
"androgenic effects", which might include increased aggression, increased
activity, weight gain and mood alterations. We do not use this medication
in our practice so I do not have much personal familiarity with it.Increasing the fluid dosage will only increase Princess' appetite if she is
dehydrated or uremic (has toxins in the blood stream that should be removed
by the kidneys but that is not happening). A poor appetite may very well
be due to the presence of either of these conditions, though. If so,
increasing the fluid dosage might help with the situation.Mike Richards, DVM
2/27/2001
Medication interference - aluminum hydroxide and ursodiol (Actigall Rx)
Question: Dr. Richards,
Alternajel contains aluminum hydroxide which Princess needs to take in
order to control the phosphorus level. She is also on actigall at least
for now. Does not aluminum hydroxide negate the effectiveness of the
actigall?Tony
Answer: Tony-
It is possible that aluminum hydroxide, or any aluminum containing compound
could reduce the effectiveness of ursodiol (Actigall Rx). Magnesium based
phosphate binding compounds should not be used in patients with kidney
failure so there is not a safe alternative.Since both medications work best if given at mealtimes it may be necessary
to consider increasing the dosage of ursodiol in order to compensate for
the binding of the medication by the aluminum hydroxide, or to choose which
one is more necessary right at the present time. You should ask your vet
about this, too.Mike Richards, DVM
2/27/2001
On-line PDR, chronic infection and long term antibiotics
Question: Dr. Richards,
Thank you for this service, the web site and this service are an
invaluable resource.
I have several questions.
1: Chow 12yrs. of age. Male not neutered. normal wgt. 65-70lbs.
(a): Has had a chronic thermal cycle problem (2-3yrs. extant),
seemingly an Enteric condition of unknown cause. Perhaps E. coli based.
Symptoms are: elevated temperature, increased water ingestion, minor to
moderate bloat, general lethargy.
Usually runs 5-6 days followed by a period of 3-6 days absence of all
the listed symptoms, one would use the word "normal"! Aspirin is the
agent that best helps and near the end of the cycle using electrolyte
replacement supplementation in the water.
I mention E. coli because of a fiendishly difficult bout of anal
infection fought 3-4 years ago. There was only one antibiotic that
culture sensitivity tests found to work, unfortunately our Vet. forgot
to record the name, which will I think become important later.
(b): Currently. We are fighting a systemic infection that first (we
think) started as a external testicle infection. This was most likely
caused from dried fecal material caught in underbelly hair. We were
unaware that an infection was present I am supposing for several weeks.
At the time the situation was found the application of Bactine followed
with application of Neosporin ointment twice daily. This course was
continued for 7-12 days, during which a marked increase in body weight
and abdominal bloat accompanied by dry cough and attendant heavy
respiration. At this juncture we went to our Vet. His orders were to
administer 1@ Amoxicillin (500 mg.) twice per day for 10 days continue
with an antibiotic creme and cleaning as before. --10 days later--
continued bloat and respiratory distress this time administer Primor 600
3@ tabs the first day continuing with 1.5@tabs daily for 7 days, and 2@
Medrol (4 mg.) twice daily for 5 days then gradually reduce to nothing
by day 10. This worked the bloat came down.
However by the 4th day off the Primor 600 the dry cough was returning
and the bloat was coming back. Vet. again: An injection of a diuretic,
and a synthetic Penicillin, instructions to administer 1@ Amoxi. (500
mg.) 2 times daily, discontinue use of antibiotic creme situation is one
of moist eczema use Gold Bond medicated powder and continued cleaning
multiple times daily. ---10 days late-- Marked turn for the worse, dog unable
to walk, massive bloat, raging fever, testicles very inflamed, diarrhea,
breathing very labored, very little willingness to eat or drink. I insisted
on a change of medication, back to the Primor 600 this time dosage to reflect
the total weight of now 97.5lbs- 3@tabs first day then 2@tabs once daily
for 10 days. The result is markedly positive, but we lost a lot of valuable
time and the series will run out before the infection has been completely
defeated. The external infection is very slowly easing, but the internal
mucus/stuff will take a long time to be reabsorbed through the intestines
as defecant to completely reduce the bloat. The Vet. has basically
written us off, as he is convinced that there is a "growth" substance causing
the edema. His dictum is that an ultra-sonic scan is need before further
consideration is given. My 'take' on it is that the ultra-sound procedure
will show important things, and I am not unwilling to have it performed,
BUT, if there is a growth of any sort this symmetrically arrayed there
is nothing that is possible to be done. Additionally, the infection if
untreated will make moot the whole debate, therefore, I espouse eradicating
the infection first, then look at ultra-sonigrams. Now the question: Given
that the Primor 600 is working, also given that this class of pharmaceutical
is not safe at high dose levels for extended periods, what suggestions
do you have?As with several of the bladder infection queries posted on the web
site this will be a protracted recovery.2: Is there a Veterinary P. D. R. on the web that one may peruse?
Thank You in advance, Matthew
Answer: Matthew-
The disease that popped into my mind with the symptoms that you are seeing is brucellosis. This is
usually caused by Brucella canis in dogs but can occur due to Brucella abortus or other species of
Brucella. The periodic fever problem is more common in humans infected with Brucella abortus than
with dogs infected with Brucella canis but it is a possible problem and testicular
inflammation/infection is very common with this infection. It seems like it would be worth checking
into this, if it has not already been ruled out. There are serum tests available and the organism can be
cultured from blood samples in some patients. It is treated with streptomycin (an aminoglycoside
injectable antibiotic not available in the United States at the current time), doxycycline and
enrofloxacin (Baytril Rx). The other aminoglycosides might work (amikacin, gentamicin) but these
are injectables and pretty toxic for long term use and antibiotics usually have to be used for some
time. A compromise is to use streptomycin, amikacin, gentamicin for a week and then change to one
of the oral medications.The second thing that came to mind, which is probably more likely in a twelve year old chow, was
metastatic cancer. This is the most common cause of fever of unknown origin in older patients,
probably. It can lead to enough immune suppression that secondary infections occur easily, which
confuses the issue.The Compendium of Veterinary Products is available on the Network of Animal Health (NOAH),
run by the AVMA but I am not sure what the policy is on non-member use of the site (I don't know
if there is any public access allowed at all). You can purchase Dr. Plumb's "Veterinary Drug
Handbook" for the PalmOS from http://www.anmldr.com/. This is a very good reference but does
not contain all of the commonly used drugs in veterinary medicine, just a big percentage of them.I do think that I would switch away from sulfadimethoxine/ormetoprim (Primor Rx) after three
weeks of use and that is in the package insert direction as well. This medication does seem safer
than the trimethoprim-sulfa combinations and if it is the only antibiotic that is helpful, you might have
to consider using it longer and monitoring for problems, such as low platelet counts, anemia and liver
problems.It does sound like it might be a good idea to consult an internal medicine specialist. If your vet refers
patients for ultrasound examination to an internal medicine specialist it would be possible to get a
second opinion as well as the ultrasound results.Mike Richards, DVM
2/1/2001
Doxycycline for Urinary tract infection in Irish setter
Question: Dear Dr. Richards:
Recently my other Irish Setter of 10 yrs died (who had several problems of
her own) and Rubi was not eating like she usually does. I attributed it
to the loss of my other dog for a few days, but it did not get better and
we found upon bringing her to the vet she has a urinary tract infection.She is now taking 400mg doxycycline.
1) I could not find much info on this tetracycline and I wondered if you
thought it would be effective in treating a uti.Sorry to take up so much time.Thanks, Tina
Answer: Tina-
1) Doxycycline is used for urinary tract infections but not as commonly as
other antibiotics. Doxycycline is usually dosed at 5mg/kg of body weight
every 12 hours. If this antibiotic doesn't work, choosing the next
antibiotic based on culture of the urine and sensitivity testing may be a
good idea.
Hope this helps some.
Mike Richards, DVM
6/16/2000
Anxiety medication for phobias- buspirone (Buspar Rx) and diazepam (Valium Rx)
Question: If an 11 month old (Rough) Collie has been successfully
obedience trained, and showed eagerness and a desire to
please during the training process, but developed phobias of
certain objects (that a dog needs to be able to encounter
daily without displaying objectional behavior), would you
entertain the thought of medicating the dog (perhaps
with a drug like Buspar), to help it overcome it's fears?
The dog was alpha in it's litter, unusually strong willed
(for a Collie), typically highly intelligent, and learned rapidly.
However, the same dog has a few phobias that no
trainer, including myself, has been able to help the
dog completely overcome -- not even in time or with
persistence, praise or patience.
Answer: I think that there are times when the anti-anxiety medications like buspirone (Buspar Rx) and
diazepam (Valium Rx) are helpful with fearfulness or anxiety. If these are not helpful, some dogs do
respond to the SSRIs mentioned earlier for anxiety related behaviors, as well. It is worth trying these
after behavioral modification techniques have failed when used alone.
Mike Richards, DVM
1/3/2001
Ketoconazole (Nizoral Rx) for Malassezia (yeast) dermatitis in Pug
Question: Hi there.. I have an older rescue (8 yo)
with a severe yeast overgrowth. He is on antibiotic therapy (cephlaxin,
ketoconazole, and hydroxizine) with topical Dermapet spray, and when we
remove the antibiotic his skin begins to "weep" again. This was an extremely
severe case, and I am concerned about long term side effects of the
ketoconazole and cannot seem to find drug information. He is starting to
cough...and I am concerned about effects on the lungs. He is HW-. Also...is
there any diet that possibly could help retard the growth of this horrid
yeast? His worst spots have been neck/stomach/nose folds and naturally ears.If you can point me in the right direction..I am an avid amateur researcher...
Thank you!!!!! Pam
Answer: Pam-
Ketoconazole (Nizoral Rx) is considered to be a fairly safe medication. It
has a couple of known serious side effects but they affect only a small
number of patients. It can definitely cause birth defects if given to a
pregnant female, which obviously is not going to be a problem in this case.
It will decrease the fertility of male dogs while on the medication by
lowering testosterone levels but this is a reversible effect. A small
number of patients will develop liver problems. This appears to be an
idiosyncratic reaction, rather than a toxicity due to the dose or duration
of treatment. These reactions are the serious ones that are seen with
ketaconazole that affect small groups of patients (since the testosterone
effect is really only important in dogs used for breeding). I can not find
any mention of ketoconazole causing coughing.More commonly, some dogs and cats will have gastrointestinal irritation
leading to lack of appetite, vomiting or diarrhea. Ketoconazole lowers the
serum cortisol levels in most patients during administration, which may
make it necessary to give corticosteroids if highly stressful situations
occur while the medication is being administered. This can be a serious
side effect if the client or veterinarian are unaware of it and surgery is
necessary or a severely stressful event does occur.For Malassezia (yeast) dermatitis in dogs, ketaconazole usually has to be
given for at least 30 days. If it doesn't work, itraconazole (Sporonax Rx)
may be helpful, given for the same length of time. It is also important to
use topical therapy. Using a shampoo that can help remove the greasiness,
such as a tar and sulfur shampoo or other anti-seborrheic shampoo can be
helpful. Using white vinegar mixed 1:1 with water as the rinse to get the
last of the shampoo off can be very helpful, as well. Dogs should be bathed
at least twice a week during the time they are being treated for
Malassezia. Many dogs have both yeast infections and bacterial infections,
so it is often necessary to treat for the Malassezia and bacterial
infection at the same time.Unless there is an underlying food allergy, I do not know of a diet that is
helpful in the treatment of yeast skin infections.Mike Richards, DVM
11/29/2000
MetamucilQuestion: Dear Dr Mike,
I have a 40 pound 12 year old lab mix who has a number of food and
inhalant allergies. She is on a food that works well for her allergies
but her stools are very soft. At her last checkup, the vet had to
express her anal glands. I want to add more fiber to her diet and she
does not like pumpkin. When she did eat the pumpkin, her stools were
normal. My questions are:1. If I use Metamucil, what would be the dosage? Do most dogs like
it just sprinkled over their dry food? The package states that a human
should drink 8 ounces of water with it. How does that work for a dog?
2. Another product for fiber comes in a tablet and contains calcium
polycarbophil (625 mg). This might be easier to administer. Do you
know if that would be safe for a dog? If so, what would be the dosage?
Has anyone in your practice used it?
3. Are there any other products that I could use to increase fiber
that are safe for dogs?
4. She is also on Atarax (2x day), Cosequin (2x day), 3V caps (1x
day), and etogesic (1x day) long term. She is on Cephalexin (2x day)
short term (bacterial skin infection). Would giving her the fiber
supplement cause any problems with absorption of these other
additives/medicines?Thanks for your help. I really look forward to your newsletter. Please
do not use my name if you use these questions on your website.Answer: D-
We usually recommend using 1/4th teaspoonful of Metamucil per 20 lbs of
body weight twice a day but there is a wide variation in recommended
dosages and it is probably safe to use slightly more than this. It probably
doesn't work as well when water isn't added but this doesn't seem to be
enough to affect the use.I don't know what the dosage would be for other products but for a 40 lb
dog it is probably reasonable to give about one-third to one-half of the
recommended dosage for humans.Green beans are a good source of fiber and many dogs like them. There are
lots of psyllium containing products on the market and all would be
acceptable substitutes.None of the other medications are listed among the medications that can be
affected by fiber in the diet.Mike Richards, DVM
11/6/2000
Heart disease drugs, Cushing's and Medication
Q: Dear Dr. Mike:
I have a few questions:
1. Would 500mg per day of Lysodren (for Cushing's) cause heart disease or
heart failure in a 30 pound Lhasa Apso?2. If he already has heart disease, would that dosage of Lysodren make
his heart disease worse?3. Does Rimadyl reduce the ability of Vasotec (aka Enalapril) to treat
heart disease or heart failure?4. Are there any circumstances under which diuretic furosemide should not
be used with Vasotec to treat heart disease or heart failure?5. Under which circumstances should any of the following drugs be used,
either alone or with any other drug or drugs, to treat either heart disease
or heart failure:
Amrinone
Captopril
Digitalis Glycosides
Digoxin
Dobutamine
Hydralazine
Intravenous Furosemide
Milrinone
Morphine
Nitroglycerine
Nitroprusside
Procainamide
Propranolol
Quinidine
TheophyllineWhat ever advice you can offer will be much appreciated, because, as a
layman, I cannot understand the veterinary articles on this subject.Gregory
A: Gregory-
Lysodren is the brand name for a mitotane. This is a medication chemically
related to DDT (the insecticide). It is useful in the treatment of
hyperadrenocorticism (Cushing's disease) because it selectively kills
adrenal tissue. Most of the adverse effects of mitotane are related to its
effect on the adrenal gland because it can cause signs of
hypoadrenocorticism (Addison's disease) if it is overdosed. It is very easy
for small dogs to be overdosed with mitotane because it is only available
in 300mg tablets. Initially dogs are given about 25mg/lb of bodyweight
twice a day. (so about 1 tablet per 12 lbs). This dosage is continued until
the symptoms of Cushings disease subside or for 10 days to 2 weeks. At that
time the medication is usually used on a once per week or twice per week
schedule, using somewhere between 10 and 30mg/lb of body weight, based on
the clinician's evaluation of the initial response to treatment.When Lysodren is overdosed most of the problems seen are due to the
medication causing hypoadrenocorticism. The signs of this are vomiting,
diarrhea, weakness, depression, shock and even death. Once in a while these
symptoms will appear really rapidly with Lysodren use but usually they are
seen after a week to 10 days. Since the object of using Lysodren is to kill
adrenal cells and decrease production of adrenal hormones the effects of
the medication must be closely monitored, especially during the period when
it is being used everyday. Lysodren can cause liver damage that is
unrelated to its effect on the adrenal gland and hypersensitivity (allergy)
reactions have been reported to it, as well. I am not aware of any reported
effects on the heart function. Addison's disease can lead to heart failure
due to high potassium levels that occur as a result of the disease and
inhibit cardiac function but this effect is supposed to be uncommon with
the use of mitotane because it isn't as effective at killing the adrenal
cells that control potassium levels as it is at killing adrenal cells that
are involved in corticosteroid production. So there would be a small
chance of heart effects due to overdosage of Lysodren but they would be an
indirect effect.I have written the word "overdosage" in relation to the use of Lysodren
several times in this note and I think that it needs to be explained a
little. Many medications are used according to specific guidelines, such as
5mg/lb of bodyweight. Lysodren is used "to effect", which means that it is
dosed daily until it has done its job and then a guess is made as to how
much is needed on a maintenance basis. There are no easy guidelines for
Lysodren use and it is very very easy to overdose the medication despite
doing a good job of monitoring its use.Question 2: A lot of dogs with Cushing's disease have some degree of heart
failure, because Cushing's disease causes muscular weakness and the heart
is basically a specialized muscle group and because most dogs with
Cushing's disease are older animals likely to have heart failure
independently of the Cushing's disease. Lysodren should help this situation
in most cases. As far as I know heart failure as a specific reaction to
Lysodren is not reported to be a problem.Question 3: It is very likely that carprofen (Rimadyl Rx) will decrease the
effectiveness of enalapril (Enacard Rx, Vasotec Rx) because other
non-steroidal anti-inflammatory medications are reported to have this
effect. I do not have a package insert from Rimadyl with me (I'm on the
road this weekend) but I will try to check and see if this effect was
studied during the drug approval process for carprofen.Question 4: Furosemide is a diuretic which has some effect on blood
pressure (lowering it). Enalapril also lowers blood pressure. Using both
medications at the same time may cause the blood pressure to get too low
(hypotension). If this happens it is probably better to reduce the amount
of furosemide being given than to reduce the amount of enalapril. It is a
good idea to be very cautious when using either furosemide or enalapril in
patients with low sodium levels. Enalapril and potassium sparing diuretics,
such as spironolactone, can be a bad combination, leading to excessively
high potassium levels.Question 5: There are a lot of different causes of heart failure and
different medications are used based on they type of problem present. I
will try to give you an idea of the circumstances medications are used in
but not in great detail. If you need more information on any of these, let
me know.Amrinone: This medication is used in low output heart failure. I have not
ever used it and have no personal experience with it but low output heart
failures are situations in which the heart is too weak or too damaged to
pump blood effectively or when blood volume is too low for the heart to
work properly.Captopril: Captopril is closely related to enalapril and it is used in the
same circumstances. Both are in the "ACE inhibitor" class of medications
which are used to treat chronic heart failure. Prior to the availability of
enalapril (Enacard Rx) as an approved medication for use in dogs captopril
was commonly prescribed.Digitalis Glycosides: this is a group of medications which include digoxin
and digitoxin. In humans digoxin is the digitalis glycoside of choice. In
dogs digitoxin may be safer and more effective. These medications increase
the strength of the heart beat and help to control arrythmias. There has
always been a lot of controversy over the effectiveness of digitalis
glycosides but currently they seem to be in favor again.Digoxin: see above
Dobutamine: Dobutamine is supposed to be a heart strengthening medication
(positive ionotrope) but I haven't seen much written on its use in
veterinary medicine.Hydralazine: Hydralazine is a rapidly acting venous dilator. It can be used
in an emergency situation to reduce the workload on the heart prior to
initiating therapy with enalapril or other ACE inhibitors since they are
slower to exert their beneficial effects.Intravenous Furosemide: Intravenous furosemide is used when it seems
unlikely that a pet would be able to properly absorb oral furosemide
(severe heart failure symptoms) or when oral administration is not
advisable (gastro-intestinal disease).Milrinone: I have not used milrinone but it is supposed to be helpful in
low output heart failure, which is when the heart is too weak or the valve
function too poor for the heart to pump enough blood.Morphine: Low dose morphine usage is supposed to be helpful in controlling
anxiety associated with severe heart failure. It may also be useful if pain
is the cause of an arrythmia, such as might occur with trauma or difficulty
delivering puppies.Nitroglycerine: Nitroglycerine is used in situations in which rapid
lowering of pulmonary venous pressure may be beneficial. This situation
doesn't arise as often in the dog as it does in cats. It also has the
advantage of being absorbed across intact skin which means that it can be
applied to cats in severe respiratory or cardiac distress without hassling
the cat too much.Nitroprusside: I think that nitroprusside is also probably used more in the
cat than in the dog but am not certain of this. It is also a potent
vasodilator, affecting both arterial and venous blood pressure. It is
possible to lower the blood pressure beyond what is good for the patient
using this medication so it is best to monitor its use carefully. In cats
this medication is sometimes credited with real life-saving ability in
severely ill cats and it is possible that it may be similarly effective in
dogs.Procainamide: This medication is used to control ventricular (large heart
chamber) arrhythmias. It is sometimes associated with sudden death, which
may be an effect of the medication or might just be due to the situations
it is used in, since these dysrhythmias seem to occur in stressful situations.Propranolol: Propranolol is used to treat ventricular arrhythmias and
atrial tachycardia (too rapid beating of the atrium). It is a "beta
blocker" and has a rapid but short-lived effect. Despite this it may be
recommended for long term use in atrial tachycardia in some casesQuinidine: Quinidine is an antiarrhythmia medication that is similar in
effect to procainamide. It enhances the effect of digitalis glycosides and
must be used with caution when also using those medications.Theophylline: Theophylline is used in dogs with heart failure because it is
has a slightly positive effect on heart strength and because it is a
bronchodilator, which may make it easier for a pet to breathe if it has
pulmonary congestion secondary to the heart failure. Personally, I don't
think this medication works well enough to make much use of it. It can be
hard to distinguish lung problems from heart problems early in either
disease and theophylline may benefit either one, so I think it is used
sometimes in an effort to cover all possibilities.In chronic heart failure in dogs, there are three commonly used groups of
medications: "ACE Inhibitors" which decrease blood pressure and make it
easier for the heart to work; diuretics which also lower blood pressure and
make it easier for the heart to work; digoxin or digitoxin, which increase
the strength of the heart muscle and control arrythmias. Cough suppressants
can be beneficial in dogs in which cough persists despite medications for
the heart problems.Mike Richards, DVM
Question: My 9 year old golden retriever has very stiff back legs. He
has trouble getting up and down. He does not tolerate the Rimadyl , loose stools. My
vet here in N.C. said he could take Celebrex the human drug 100mg. twice a
day.
Just wanted a second opinion. The vet. clinic here is very busy and
sometimes they get their information confused. Do you remember I am the
one who has the little corgi girl with the excessive bleeding after bladder
stone surgey. Your advice at that time was correct, there was something
else wrong. She had a major kidney infection. So I would like to know if
Charlie can take the celebrex. I love him very much, and I want him to be pain
free and move a little better. He eats good and seems happy. He is just very
stiff in the back legs. Like me , getting up and down is very hard for
him. I have Ankylosing Spondylitis and I take methotrexate. I wonder have
they ever used that medication in dogs?
Answer: C-
Unfortunately the best answer I can give is "I don't know". There is
not a published dosage for this medication, yet, that I can find for dogs or
cats. Your vet might know of a validated dosage, that I don't, though.Anecdotally, I know that some vets are using Celebrex, but I don't know
how they are calculating the dosage to use. I have not heard of any
problems but there were no reports of problems with carprofen in Europe
and then when it was approved in the US for dogs (a much larger market) a
few dogs did develop liver problems as a result of the medication.I use hydrocodone with acetaminophen (Vicodin Rx) for my patients who
don't tolerate carprofen (Rimadyl Rx) or etodolac (Etogesic Rx) well. There
is a small risk of liver problems due to acetaminophen, too --- but so far wehave not had a problem with this. I can't say this is a better option
but it is another option -- and for chronic arthritis problems in older dogs
it is nice to have options.Methotrexate is used in dogs but not commonly for arthritis, since
rheumatoid arthritis is not a common problem in dogs and the
immunosuppressive effect of methotrexate isn't as beneficial in other
forms of arthritis.Another option is glucosamine, chodroitin or glucosamine/chondroitin
combination products. These are very safe and seem to help a fair number
of dogs with chronic arthritis problems.Hope this helps some.
Mike Richards, DVM
9/29/2000
Question: Dear Dr. Mike,
I read that Kaopectate can be used to treat digestive upset in dogs. When
is it appropriate and how would I determine dosage? Can it be used to treat
diarrhea?
Thanks again,
Answer: T-
The recommended dosage for kaopectate is 1 to 2 ml/kg of body weight, every
2 to 6 hours (recommendations vary a lot on this product). This works out
to about about a teaspoonful per 10 lbs of body weight for the low end of
the dosage and about a teaspoonful per 5 lbs of bodyweight for the high end
of the dosage. Our personal experience has been that it is hard to get
this much kaopectate into a patient and that the protective action of the
kaopectate is pretty minimal, so we don't use it. It is usually used for
the treatment of diarrhea or suspected toxin ingestion, where its purpose
is the absorption of the toxic agent. We use activated charcoal when we
think absorption of a toxin might be helpful and we usually use loperamide
( Immodium AD tm) for symptomatic control of diarrhea when that seems
appropriate.If you have heard of another use and want me to check into it, I will be
glad to do that.Mike Richards, DVM
5/4/2000
Question:1. I have a slight fungal infection in a toe nail which I sometimes
treat with a tioconazole solution (28% w/w) which is painted on the nail
like nail polish and allowed to dry. Blue likes to apply his tongue to
everything. If I see he is about to go for my toes I usually stop him,
but occasionally his tongue has touched this nail.Any idea of risks? Would there be long term risks of cancer from ingesting
fungi? I believe tioconazole can affect the liver.
Answer: I could not find any information on the use of tioconazole in dogs or cats,
except one study on the PubMed web site that discussed susceptibility of
ringworm cultures to the medication but I couldn't tell if any of it was
actually administered to cats based on the abstract of the
study. Tioconazole is considered safe for treating diaper rash in babies,
though. Presumably, babies are likely to ingest it, too. So I think that
minor exposure such as Blue is getting, would present no problems.
Tioconazole can induce increases in some liver enzymes but it is not clear
that this is actually a problem, since there isn't an association with
decreases in liver function or other problems and the induction (increased
activity) of the liver enzyme. Contact allergy appears to be the most
common serious problem associated with tioconazole in humans.Mike Richards, DVM
4/23/2000
Question: My dog is a female Lab X who is spayed and about 13 years old. In
September, she had a seizure which lasted about 2 minutes. The emergency vet kept her
overnight and ran tests on her. Her regular vet ran additional tests on
her.All tests came back in the normal range and/or negative. She has not had a
MRI as it is cost prohibitive at this time so we do not know if my dog may
have a brain tumor or something similar. My dog had a second seizure in
October about 5 weeks after the first seizure. This second seizure lasted
less than a minute. My dog seemed more cognizant than the first time around.
As the seizures are more than one month apart at this time, our vet does not
want to put my dog on anti-seizure medication.At the time of her first seizure, she had been on Clomicalm for about 6
months. She was on Clomicalm due to lick granuloma. At this time, she is tapering
off the Clomicalm per our regular vet's instructions. Our regular vet has
not found much evidence for or against giving Clomicalm to dogs with history
of seizures nor if Clomicalm could have caused the seizures.I am writing to you to see if you read or heard anything new or different
about this matter. Or perhaps where I or my vet could do further research
on this matter.Thank you for your help.V.
Answer: V.-
In humans clomipramine (the generic name of Clomicalm Rx) is thought to
lower the seizure threshold. There has not been any research on this effect
in pets that I know of but it is reasonable to assume that it may have the
same effect in dogs and cats. That information is from Dr. Plumb's book
"Veterinary Drug Handbook" and a search of the PubMed database."Lowering the seizure threshold" means this: dogs seizure when the brain
activity that leads to the symptoms of seizures reaches a certain level. It
is possible for a dog to have electrical activity in the brain that is just
below the level necessary to lead to a seizure. This means that if a
medication is given that lowers the brain's resistance to seizures a
seizure will occur that wouldn't have without the medication's help. So the
medication has "lowered the seizure threshold".So hopefully, tapering her off of the Clomicalm will make future seizure
activity less common. It probably won't eliminate them, because all the
Clomicalm does is make it easier for a seizure to occur -- there is still a
reason that it occurs in the first place.If the lick granuloma returns there is a new medication, which I think is
called Facilitator (TM) that is a liquid adhesive material that bonds to
lick granulomas and is reported to help a great deal in the product's
literature. Of course, they are trying to sell the product, it is new, and
time will tell how well it really works -- but it is an additional option
that we didn't have before.Mike Richards, DVM
11/16/99
Question: Dear Dr. Richards,
While researching inflammatory bowel disease on the Internet I came
across your VetInfo q&a, "Chronic Diarrhea", that mentioned a side effect of
Tylan: false elevations of SAP in tests that rely on colorimetry. This
caught my attention since my 12-year-old Weimaraner has been on Tylan for
three years, and though his IBD symptoms are mostly controlled with that
plus a diet of w/d, his alkaline phosphatase levels have been a concern. The
readings have ranged from 500s to 900s even when his IBD has been in a good
spell. He's been tested for Cushing's disease and had a liver sonogram,
neither of which indicated a problem.
My vet had never heard of this effect of Tylan when I recently mentioned
it. We did find out that the equipment at the lab he uses does indeed rely
on a color change method for SAP analysis. I contacted the manufacturer of
Tylan and they had no knowledge of such an effect. Can you point me to the
source of your information?And what kind of lab equipment should I look for to see if we get a
different reading?Also, my research turned up a consensus for trying the limited, novel
ingredient diets in managing IBD. I gave a venison-and-potato food a try,
and my dog's symptoms returned within a week. I was supplementing with oat
bran for fiber (being leery of the gluten in wheat bran), but this didn't
amount to as much insoluble fiber as the w/d. I suspect that either the
fiber deficit or the food's higher fat content caused the problem. Any
thoughts?
Thank you. C.M.
Answer: C.M.
I am going to have to check back on our site (too late tonight to do that)
because Dr. Plumb's "Veterinary Drug Handbook" says that false elevations
of AST (SGOT) and ALT (SGPT) may occur when colorimetric assays are used
while using macrolid antibiotics (the class that includes tylosin). If I
put alkaline phosphatase in an answer, instead of one of the above tests, I
may have been misleading. I have a another handbook I use that also lists
test problems but it is at my clinic and I am at home so I wasn't able to
check that one tonight.I will also try to think about the question regarding diet and get back
with you on that.Mike Richards, DVM
11/5/99
Dramamine for motion sickness in dogs
Q: Is it possible to give dramamine to my dog. She gets
carsick ; it starts off as slobering terribly, and sometimes
she throws up.
She wasn't like that when I got her back in Feb (from
the local HS). I could drive all over with her. Even a four
hour drive!
She's about 14 months and the size of a
German Shepherd.
Thanks.
A: It is OK to give dimenhydrinate (Dramamine TM) for motion sickness in dogs.
There have been several doses for this published. The easiest one to
remember is 25 mg three times a day for dogs weighing less than 10 pounds
and 50mg three times a day for dogs weighing more than that. Dramamine is
an antihistamine and can cause drowsiness in dogs, in addition to the
anti-vomiting effect.It also helps to take dogs for really really short rides pretty frequently.
Sometimes it is necessary to take rides as short as one or two minutes to
start with. Gradually, over time, increase the amount of time of the rides
until they are normal length for routine chores. Make sure you go to some
fun places. Bank drive throughs that give biscuits are good -- stuff like
that.Mike Richards, DVM
8/10/99
Q: Dr.Mike,
We have a springier spaniel named Muffy. She is 13 1/2 yrs. old.
She has several problems, Blindness, Arthritis ect.
Recently past 3 months) she has developed very severe anxiety in that
she howls constantly, shakes and is very nervous in general.Would it be OK for our vet to try Zanax instead of Valium to help
Muffy??Thanks so much,
Rick
A: Rick-
Alprazolam (Xanax Rx) is a relative of diazepam (Valium Rx). There are
published dosages for dogs (usually around 0.02 to 0.1mg/kg) and many vets
feel that this medication works better for some forms of anxiety than
diazepam. So I see no problem with using it.I think that it might be worth considering a couple of alternatives, if the
Xanax is not effective enough or if sedation from it is bothersome. Older
dogs sometimes become more anxious due to a senility syndrome (Canine
cognitive dysfunction syndrome) that is responsive in many cases to
administration of l-deprenyl (Anipryl Rx). The major drawback of this
medication is expense. We have used it a couple of times and feel that it
has been successful, so far. Another possible solution for anxiety disorders
appears to be on the horizon. I wish that I could tell you more about it but
there have have been a series of ads in veterinary journals suggesting that
a new medication for separation anxiety would be released soon and not
giving any other details. I think that pharmaceutical companies are not
allowed to advertise brand names until they get FDA approval. When that
happens I hope to know more -- but it may be worth keeping in contact with
your vet if the problem doesn't respond well to Xanax.Good luck with this.
Mike Richards, DVM
Q: Dr. Mike:
This is a follow-up on Dudley, the Wire Fox Terrier, who has been
diagnosed with "inflammatory chord disease". He has gotten weaker in the hind legs,
and is having increased difficulty walking. He is totally normal in every
other way. In my last letter I asked if you had heard of the new
medication that the F.D.A. was going to approve for treatment of this condition. At the time
of your response you asked if I knew the name. After much searching, I have received the information
from our Vet.
The name of this drug is Leflunomide, also known under brand name of Araba, or Arraba?
He said the drug is available now, but the cost is prohibitive--$1000 to $2000 per month. The
drug originates in Germany, and they are trying to find sources to get it at a
cheaper rate. Do you have any knowledge of this drug? If so, can you get
any improvement after a few weeks, or is it one of those that takes months for
results? Are there any side-effects if removed from the drug suddenly,
such as with Prednesone? Any information you may have or can get would be
greatly appreciated...would anyone be doing any trials that would bring the
cost down?
Doesn't seem plausible that there might be a helpful drug out there, but
whoever manufactures it charges so much no one can use it. Hope to hear
from you soon, and once again, thanks for your time.Respectfully, Chris
A: Chris-
I can not find information on this medication in the veterinary databases
that I subscribe to. Unfortunately, there can be a lag time between the
recognition of a medication's value by researchers and its debut in the
veterinary literature. I will keep trying to find information on this and
get back with you if I do find something.There is a lot of information on leflunomide (Arava Rx) at the PubMed site
(http://www.ncbi.nlm.nih.gov) but a lot of it is theoretical. Use as an
anti-graft rejection medication and indications for use in rheumatoid
arthritis are mentioned. There is a good chance that it would be helpful in
spinal cord problems as these may have similar underlying pathology.One article mentioned the use of this medication for myasthenia gravis.
(Leflunomide prevents the development of experimentally induced
myasthenia gravis. Vidic-Dankovic B, Kosec D, Damjanovic M, Apostolski S,
Isakovic K, Bartlett RR). You might want to read it. I searched using the
term "leflunomide + nerve" to find this article but you could search on
Vidic-Dankovic and probably get it, too.Unfortunately, lots of human pharmaceuticals (and even some veterinary
ones) have price tags that seem exorbitant, especially when the patents
still apply.Mike Richards, DVM
Q: You mentioned in one response that acyclovir may be useful in the
treatment of herpes, but you didn't suggest any dosage. I seem to have
become a rescuer of wild, sick cats & kittens -- and the latest little
guy (FIV positive) has a serious case of herpes. My vet (who has donated
her services to these little causes) and I are concerned that he will
lose one eye. I have passed along the info on l-lysine (thank-you!), but
would like to know more about dosing with acyclovir -- I know it is
effective for herpes in humans. Any info would be greatly appreciated.
Answer: Mark-
Acyclovir (Zovirax Rx) comes in 200mg capsules which can be given 2 to 4
times a day. The dosage and even the use of acyclovir seems to be a little
controversial. I am not sure if we posted it yet but we received a letter
recently from someone who reported that their ophthalmologist felt that
acyclovir was too toxic for use in cats and that it would cause death in
some patients. In spite of that it is listed in veterinary textbooks for
systemic use for herpes infections in cats and there are veterinary
ophthalmologist who still recommend its use when nothing else seems to be
working. I can't be sure but I imagine their logic is that the eye is
painful and that an attempt to cure chronic pain is worth some risk. I do
not have much personal experience to help with understanding the risks.Mike Richards, DVM
Ivermectin - for Demodex
Q: Thank you Dr. Mike for answering my questions. I talked to Chiquito's Vet about skipping the Ivermectin treatment and putting him back on Milbemycin Oxime
preventative, but he thinks it is important to give him the Ivermectin. He is planning to use a 200 mcg/kg of body weight injectable dose, Is this a safe dose?
Have you heard of giving such a big dose?, What are the outcomes?, What
are the risks?I also asked about the microfilariae test result ( it is negative),the Vet explained that small amounts of microfilariae are hard to see during the test,but that doesn't mean
they're not present,and that is the reason why it is important to give the Ivermectin.
Thank you Dr. Mike for your help!
A: Angelica-
We use 200mcg/kg of ivermectin, or more, fairly frequently in the treatment
of demodectic mange. While this is dosage is in the range that some dogs
will react to we have had pretty good luck using it (we haven't lost a
patient but we have had a few noticeable adverse reactions).I don't agree with your vet about the microfilaria situation, though.
Ten years ago I would have agreed wholeheartedly with your vet. My patients
were mostly on diethylcarbamazine for heartworm prevention and it would
sometimes cause really nasty reactions, including death, if it was given to
patients who were harboring microfilaria. I would treat with a
microfilaricide after treating for adult heartworms even if I couldn't find
microfilaria in the bloodstream in order to avoid any risk of causing a
diethylcarbamazine reaction. The situation has changed, though. The new
heartworm prevention medications do not cause reactions at all in most
cases when microfilaria are present and when reactions do occur it is
usually in dogs with a lot of microfilaria and the reactions are usually
not fatal. Plus, the new heartworm preventatives ARE the drugs used for
killing microfilaria so any reaction that does occur is going to occur
however you give them the medication. So now we just give the patients
heartworm medications and wait for the microfilaria to die. We feel most
comfortable when the pet stays with us for a few hours after administration
of the first monthly preventative pill. Once in a while killing the adult
female heartworms will cause microfilaria to be released into the
bloodstream that were not there prior to treatment, so we feel like it is a
good idea to be cautious even when microfilaria were not present on our
initial exam. While there are much higher published dosages for the
microfilaricide effect of ivermectin than the dose used for the
preventative tablets it is also pretty clear that the preventative dose of
ivermectin and milbemycin will kill microfilaria over the course of two or
three months. I am comfortable taking this slower approach.There are often disagreements over the details of treatment for conditions
like heartworms among vets. Your vet may have personal experiences that are
different than mine. Perhaps he has seen patients in which the lower doses
didn't seem to clear up the microfilaria or a reaction on a second or third
dose of heartworm preventative, which we have never seen. It is also
possible that he was around when there was a severe risk of reaction to the
daily heartworm preventatives and he just can't quite get comfortable with
the idea that the new medications do not have the same risks. Vets, like
other people, can be slow to let go of long held fears.Mike Richards, DVM
Misoprosil (Cytotec)Q: Do you have any info on the use of Misoprosil (Cytotec) in dogs for GI protection from NSAIDS?
Dr. Z
A: Dear Dr. Z
Misoprostol (Cytotec Rx) is often prescribed to decrease the potential for gastric ulcers when non-steroidal anti-inflammatory medications with a medium to high potential for causing gastric ulceration must be administered. This is probably most commonly done when piroxicam (Feldene Rx) is used in dogs, but use is not limited to this medication.
Misoprostol decreases gastric acid secretion and has other protective properties that help prevent ulcers. There are several published dose ranges, which do not totally agree, but the overlap point seems to be at about 3mcg/kg two or three times a day. Your vet may need to tailor this dosage for your particular dog's needs. It is important to remember to follow other directions intended to reduce gastric irritation, such as
giving the NSAID with or shortly after meals and at the dosage schedule
recommended by your veterinarian.
Mike Richards, DVM
Q: Do you have any experience with Trazadone in dogs. My "ADD" dog has not responded to Elavil or Prozac. A pharmacist suggested Trazadone, a dog trainer suggested Melatonin. Abe is a yellow lab, 6 years old, around 90 lbs. Any help is appreciated. Thanks. Jeanie and her vet
A: Jeanie- I could not find any reference to the use of Trazadone in dogs. Melatonin is used in seasonal flank alopecia (a skin disease) of dogs, primarily boxers, and that is the only reference I can find to its use in dogs. It is reported to have a number of effects in people but not all of them have been scientifically validated as far as I can tell.
Most of the behaviorists recommend hard workouts for dogs with hyperactivity -- playing an intense game of Frisbee for half an hour twice a day or something like that. This may not be practical advice for most people, though.
I hope you can find an answer somewhere.
Mike Richards, DVM
Q: Dr. Mike- I have a four year-old female springer spaniel who has had a problem with chronic UTIs all her life. There are generally signs of phos. crystals and irritation when these occur, so the vet suggested a regular regimen of Methioform tabs to acidify the urine. While the dose is fairly low compared to manufacturer suggested doses, I've heard that continued use of this compound may result in bone loss through calcium leaching. Is this correct? What other acidifiers might be better suited to the situation? Thanks- Judy
A: Judy- Methioform (d,l methionine) is an amino acid that is used to acidify urine. I am under the impression that administration of medications to acidify the urine may interfere with calcium deposition in growing bones but does not affect calcium already in bones to a significant degree.
Mike Richards, DVM
Q: Can you please tell me the normal dosage range of levothyroxine for dogs?
A: Al and Judy- At present, there does not appear to be a complete consensus on how to dose levothyroxine. This is the best explanation I can put together. I hope it helps.
The "standard" dose for levothyroxine is 0.1mg per 10 lbs. of body weight twice a day. For some time this has been the way that most vets dosed levothyroxine. It appears to be reasonable safe to dose at this level but more recent studies seem to indicate that this level of dosing is not always necessary.
Dogs with clinically apparent hypothyroidism have greatly depleted stores of thyroid hormone. Dogs are apparently able to store a great deal of thyroxine in the body, so there is a great need for thyroxine when signs of deficiency are apparent. So now, twice a day dosing is recommended for a month or two. Once the stores are replaced it is not necessary to dose twice a day, probably.
There does appear to be a limit to the weight at which it is necessary to give 0.1mg/lb as well. It is likely that dogs do not need to get more than 1.0mg per day even if they are very large.
Of course it is a really good idea to be as certain as possible that a dog actually has hypothyroidism prior to putting it on replacement therapy.
Mike Richards, DVM
Last edited 08/24/05