Concerns over long term use of metacam and paracetamol

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My 2 year old bitch has just been diagnosed with hip dysplasia on both sides and early stages of arthritis in one of her stifles. Both hips are showing signs of OA. She was on metacam for 2 weeks  with no improvement and my vet has added half a 500g tablet of paracetamol twice a day(she weighs 32.8kg). They have also suggested she takes gabapentin and amantadine as well, this seems an awful lot of meds and I am unsure about the last 2 having read about them and the vet didn’t offer any advice when I asked about them. I advised the vet that I wanted to see how she did on just the metacam and paracetamol before adding anything more are these also ok to take long term?  Is ok for her to be on these additional meds long term – should I be asking for tests to be done to check they are not doing her any damage. There isn’t a lot of choice up here in the scottish highlands and the vets do not advocate any supplements – so looking for some guidance please. I have had her on Joint Aid since she was 7 months and have just started her on golden paste, bone both , 1 x green   lipped muscle capsules a day , 1/8th tsp of magnesium, calcium and boron powder, 3tsp omega 3 oil , there anywhere I can check if these are ok to take with her meds and if these doses are ok for her weight as I’ve drawn a blank on the net. Any info/advice would be great.

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Hi Lorraine,

Lynsey as done a pretty good job of answering your question so I’ll just add some vet advice. 2 weeks of NSAIDs is not very long to see a significant change in a long-standing condition such as your dog has and it is likely things will start to improve. It is appropriate for your vet to have added paracetamol at this point. I generally try to start new medications one at a time in order to judge their effectiveness but many patients do end up on 2 or 3 and occasionally more long term as their disease progresses. Your vet is welcome to contact me for free advice – via info@caninearthritis.co.uk or another pain clinic that perhaps he/she has referred to in the past.

As Lynsey says – it is very important to consider external factors and not just rely on medicines and supplements. I’ve seen plenty of patients appear not to improve on a new medicine and then I’ve discovered the dog is still being allowed to run at full pelt, jump in and out of the car, and tumble up and down stairs, not to mention slipping around on laminate floors. It is easy to throw money away on medicines and supplements if you haven’t addressed these other factors.

Finally, there is often a great deal of tension and discomfort in the muscles/tendons/fascia associated with a joint problem and this doesn’t necessarily respond as well to NSAIDs (Metacam – type drugs) and may benefit from an assessment by a physiotherapist. I practice pain medicine through all of my clinics – but I still defer to my physiotherapist for a really good soft-tissue assessment

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Hi Lorraine, thanks for your post. One of our vets may be along to comment here but I am a vet nurse and here are my thoughts 🙂

We can’t really comment on individual cases as we don’t have access to full case history which is important. However my main concern would be starting all of those things, supplements and meds and then not knowing which are helping and making a difference and which are not. The combination of prescribed medications sound like those usually used as the disease progresses, however I obviously cannot judge how painful she is from here. You and your vet together are the best people to do that.

With regards to the supplements, they should be used as just that rather than total pain control, so I would suggest taking it back to the dasuquin, finding the prescription meds that give her pain relief (use our chronic pain indicator chart to help you assess this) and once that is under control add in the supplements one by one and again use chronic pain/improvement indicators to help you decide what is working. We would usually suggest a 12 week period of use before making a decision. Generally speaking Omega 3 fatty acids from a cold marine based source are the one thing that have been shown to have to most effect on joint health.

 

If the metacam isn’t working for her, talk to your vet about trying another NSAID which works in a slightly different way. Previcox or onsior for example, as they may suit her better.  Usually 6 month blood and urine tests are indicated to ensure the liver and kidneys are functioning properly. There can be issues using things like NSAIDs long term, but mostly only if there are kidney/liver issues already present, or other underlying disease that develops which may contra-indicate prescribed meds.

 

Also consider home and lifestyle management if not already. Although basic, addressing this can mean meds can be reduced in some cases.

 

See CAM conversations and FAQs on our website from the drop down for more detailed information about supplements, tumeric, NSAIDs etc.

 

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Lynsey AVNDIPMEDRVN

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