I have a 10 year old labrador who has arthritis. She first went onto Metacam in Nov 2016 and took it through the winter on a gradually reducing dosage. In April 2017 we were down to about a half dose and the vet I saw suggested stopping it altogether through the summer (as long as she seemed comfortable). All went well and I didn’t feel she needed to take it again until Dec 2017. She is now down to nearly a half dose again (i.e. she’s 25kg and she’s getting the dose of a 15kg dog). However, when I asked the vet (a different vet at the same practice) whether I should try stopping it he told me that there was evidence to suggest that continuing to give a maintenance dose and keeping on top of inflammation is better than stopping and starting. I should add that my dog is also on Yumove Advance and gets physio and hydrotherapy. I know that no-one on the internet can tell me if my dog needs to take the drug or not. My question is what is the evidence regarding the benefits of continuing on a maintenance dose of an NSAID as opposed to stopping it for a while to give the organs a break?
Thank you, Shona, for taking the time to answer and for your suggestion regarding lowering the dosage. I really appreciate this group and the advice available from experts. It’s a great resource.
I would second all that Kathryn has said. I can’t find specific evidence that continuing on a maintenance dose is better than stopping and starting, and this would make sense from what Kathryn mentions.
Pain medication is an important part of arthritis management, and we are lucky these days in that we have a fairly wide array of drugs and drug combinations to choose from. I will aim to get patients on the lowest dose of drugs that keeps them comfortable and/or the optimal combination to manage their pain with minimal risk of side effects.
With supervision from your vet and other therapists you could try dropping her dose a little more for a week at a time to find a level she stays comfortable at, with the provisio that she may have times when she needs a bit more for a few days if she flares. Adding in therapies such as myotherapy and acupuncture can help pain management and reduce the dose of pain medication required.
Great to hear how the hydrotherapy is helping 🙂
Thank you, Kathryn. That’s helpful information. I think there’s a tendency for a lot of us to worry about drugs and feel that we want to get our dogs off them if we can, particularly when there are so many scare stories on the internet. I need to remember that arthritis can’t be cured so drugs are likely to be a necessary and ongoing part of management. That’s why I want to know how the drugs work so that they can be used in the most efficient way.
On a more positive note, Tess saw a vet yesterday for blood tests. She hadn’t seen Tess for a year but immediately remarked on how the muscles in her hindquarters had developed. The underwater treadmill is working!
The datasheet for Metacam says that adverse reactions such as changes in liver enzyme levels will only happen in less than 1 in 10,000 patients so I wouldn’t worry too much about “giving the organs a rest”, especially if you are only giving a low dose of the drug anyway. Certainly there is a cumulative effect of the drug on the level of inflammation so it will work better used every day for a period of time than if only used on “bad days” or 2-3 times a week. With regards to using it for months at a time and then stopping and starting I can’t be so certain but it would definitely take a few days on treatment to get full effects again when you do restart it.
If you imagine the joints become stiff and painful, your dog will then change their gait to compensate, making all the surrounding tissues sore too and this is what can take some time to recover. Certainly that your dog has regular physio means that the muscle stiffness will hopefully be less and any deterioration should be picked up quickly..
Does anyone else have an input on this?