An overview of NSAIDs (non-steroidal anti-inflammatory drugs)
Arthritis is the most common cause of chronic pain in dogs. Managing that pain is the foundation of treating arthritis and preserving a high quality of life for your dog.
It can be hard to know when our dogs are in pain, as the signs can be subtle. If you haven’t already, take our pain quiz (linked at right) to better understand what pain looks like for dogs so you can help them stay comfortable and active.
In this article, we’ll answer the most common questions around a very commonly prescribed pain management option, non-steroidal anti-inflammatory drugs (NSAIDs).
What are NSAIDs and how do they work?
Non-steroidal anti-inflammatory drugs (NSAIDs) work by decreasing a key mediator of pain and inflammation called PGE2 (prostaglandin E2). NSAIDs are the most researched and proven method of controlling arthritis pain and are considered the first line treatment recommendation for most dogs with arthritis.
“Traditional” NSAIDs block an enzyme called COX which produces PGE2, thereby decreasing the production of PGE2 and reducing inflammation and pain. While PGE2 plays an important role in pain and inflammation, it is also necessary for normal functions in the stomach, kidney and other organs. So the goal is not to eliminate PGE2, just to reduce excessive production and its role in pain. A newer type of NSAID called grapiprant (brand name Galliprant) has a more targeted mechanism of action and only blocks one of the PGE2 receptors rather than reducing its overall production. It is possible that the targeted action of Galliprant might reduce some potential side effects of COX-inhibiting NSAIDs. However, there are currently no studies proving that grapiprant is safer than COX-inhibiting NSAIDs, and all drugs in this class have the potential to have side effects associated with the GI tract, kidneys and liver.
Examples of COX-inhibiting NSAIDs include: carprofen (brand names Rimadyl, Novox, Quellin, Rovera, Vetropfen and more), meloxicam (brand names Metacam, Loxicom, OroCAM), firocoxib (Previcox), robenicoxib (Onsior), deracoxib (Deramaxx).
Please note: humans can easily switch between or combine NSAIDs, but this is NOT recommended in dogs. Dogs are also very sensitive to human NSAIDs, so DO NOT give your dog a human brand of NSAID.
Which NSAID is the most effective? Safest?
There are numerous studies showing that NSAIDs decrease pain associated with arthritis. There are multiple NSAID products available for dogs, and none have been found to be superior in effectiveness or safety. Dogs, like people, respond differently to different NSAIDs, so one particular product may be more effective for your dog while another dog may respond better to a different brand. One day we will probably have a test to determine the best medication for your dog based on their genetics, but we aren’t there yet. For now, your veterinarian will recommend the NSAID they are most comfortable with to start with.
All NSAIDs have potential side effects, including vomiting, diarrhea, decreased appetite, elevated kidney values and elevated liver values. There are rare cases of severe side effects such as gastric ulceration or perforation and acute liver failure. Appropriate case selection and use of NSAIDs strongly minimizes the risks of side effects.
How soon after starting NSAIDs should I see a response?
You should see a response in your dog within 2 weeks of starting therapy (though there is often some relief after a single dose). Studies have shown that continued weekly improvement is likely for at least the first 4 weeks of daily treatment. Other studies have shown that dogs continue to improve month after month while taking daily NSAIDs.
If you don’t see any improvement after 4 weeks, you should ask your veterinarian about trying a different NSAID or trying Librela, and ensuring that the appropriate diagnosis has been made (for example, a dog with an ACL tear in their knee might not show improvement because there is instability in the knee that is best addressed with surgery).
Should I ask my veterinarian about using NSAIDs daily?
When you first start treating your dog’s arthritis, your veterinarian will likely recommend giving them NSAIDs daily for at least several months to see how your dog responds.
Studies have found a cumulative effect in effectiveness with doses given daily for up to 1 year. In other words, dogs often keep getting better (less pain, better mobility, etc.) the longer they are on daily doses of NSAIDs!
As with any medication, side effects can occur at any time. However, according to studies, the length of time a dog is on NSAIDs doesn’t appear to increase the risk of developing side effects. But it will be important to always remain diligent about giving the appropriate dose and monitoring for side effects.
Will my dog need to stay on NSAIDs for the rest of their life?
Arthritis is unfortunately a chronic, progressive disease. So just like other chronic diseases such as diabetes, life-long management is necessary. Managing arthritis pain is essential to preserve your dog’s quality of life. And some dogs with arthritis will need life-long pain management to ensure they are comfortable. But starting an NSAID does not necessarily mean that your dog will be on it forever. In some cases, weight loss alone can reduce pain sufficiently to allow for discontinuing daily NSAIDs. Studies have also shown that diets enriched with omega-3 fatty acids can reduce the need for daily NSAIDs. But it is important to note that arthritis “flares” are expected, and if your dog has achieved a level of pain control without daily NSAIDs, it is still a good idea to have some on hand for if/when a flare occurs.
NSAIDs scare me. Are they really safe to give to my dog?
In general, the benefits of NSAIDs vastly outweigh the risks. Side effects can happen with any medication, but they are generally very low with NSAIDs if they are used appropriately.
Remember, unmanaged pain is not benign. If pain goes untreated, it will get much worse and become much harder control. It is in the dog’s best interest to control pain as effectively as possible, as early as possible. When used appropriately, NSAIDs are an excellent first line treatment option for arthritis pain.
However, you should always be aware of potential side effects, such as vomiting, diarrhea, decreased appetite, or lethargy. Alert your veterinarian if your dog is showing any signs of side effects. Make sure they know all medications and supplements your dog takes.
Can I minimize the risk of side effects?
There are a few things you can do to reduce the risk of side effects:
- Do NOT combine NSAIDs and aspirin or corticosteroids (prednisone) or mix different brands of NSAIDs.
- Read nutritional supplement labels closely and avoid ones that contain aspirin or natural anti-inflammatories such as willow bark or meadowsweet.
- Make sure you follow the NSAID dose your veterinarian recommends exactly (for example, once or twice per day, half tablet vs a full tablet, etc). Doubling the dose in one day could increase the risk for side effects.
- Do not give an extra dose if you think your dog is extra painful. Speak to your veterinarian about additional pain relievers.
- If you are unsure if your dog’s reaction to NSAIDs is normal, contact your veterinarian!
- Decreased appetite is often the earliest sign of a problem- call your veterinarian if you see this!
- Blood work should be done prior to staring NSAIDs to ensure normal liver and kidney function. Bloodwork should be monitored regularly after starting NSAIDs.
Reviewed/updated 12/2024