воскресенье, 29 апреля 2007 г.
In the gap between non-steroidal anti-inflammatory drugs (NSAIDs) like Rimadyl and Deramaxx, which some dogs cannot tolerate and some owners aren't willing to give, and can rarely be safely used in cats, and heavy-duty narcotics like Fentanyl and morphine, is a human pain drug getting recent increased attention in veterinary practice. This is the drug tramadol (Ultram).I first heard of tramadol when it was prescribed for post-surgical pain for a dog of mine at the specialty practice where he had his surgery. Being the kind of dog owner I am, I investigated it thoroughly before giving it to him, and when I did, I wondered how I'd managed to miss it before - and to wish I'd known about it when I had a senior dog who became intolerant of NSAID drugs, and ended up being put to sleep when I could no longer control her pain or maintain her quality of life.There are many ways to inhibit pain. NSAIDs do so by interfering with the production of an enzyme known as "cyclo-oxygenase," or "COX," which is involved in inflammation (as well as many beneficial and essential organ functions). The class of drugs known as opioids does so by stimulating opiate receptors in the brain. Some opiate receptors are responsible for beneficial effects such as pain relief, while others can produce hallucination, sedation, and heart and respiratory problems. Tramadol works by stimulating the "mu" receptor, which provides pain relief without sedation and without addiction.Some Side Effects and ContraindicationsLike all drugs, tramadol has side effects, although they are usually mild. There is a wide range of possible dosing with this drug, and sedation sometimes can occur at higher doses; if this happens, it is recommended that the dosage be reduced.Constipation can occur rarely in some dogs, and will resolve when the drug is discontinued.Although tramadol does not harm the gastrointestinal lining as NSAID drugs can, it can cause nausea. This is rare.Contraindications include dogs who are being treated with L-Deprenyl for Cushings or cognitive disorders, or dogs taking serotonin reuptake inhibitors, monoamine oxidase inhibitors, or certain antidepressant medications.Note: The human drug Ultracet is a combination of Ultram (tramadol) and Tylenol (acetaminophen). This drug must not be given to animals.FeaturesUnlike NSAIDs, tramadol can be taken with steroids. It can also be taken with NSAIDs to provide additional pain relief and allow a lower dose of both drugs to be used.Tramadol is a prescription human medication and will require a prescription from a veterinarian. It is not a controlled substance and no special paperwork is required to prescribe, stock, or dispense this medication in veterinary practice.Tramadol is not passed to nursing puppies through the dam's milk so can be used for pain control in lactating bitches.Dosing InformationThere is a wide range of dosing possible with this medication. Within the recommended safe dosing levels as given in the veterinary literature, it's possible to experiment with different intervals and amounts to achieve the desired level of pain relief and minimize unwanted effects or sedation. Some animals do very well on the minimum dosage given in two equal doses, 12 hours apart, while others might need the same dose, but given in six doses 4 hours apart, or four doses 6 hours apart, or three doses 8 hours apart. And still other animals might need a higher overall dose, given at any of those intervals.The lower doses are typically used for chronic pain relief, such as with arthritis pain, while the higher are for severe post-surgical pain. But this is extremely variable and each animal's and owner's needs should be taken into account on an individualized basis before a dosage schedule is finalized. For example, sometimes giving a slightly higher overall dosage at greater intervals will allow the animal to experience relief of pain without the owner having to adminster the medication repeatedly throughout the day (which is not always possible).Because tramadol is not in widespread use yet in veterinary practice, it's possible that a veterinarian you consult or work for is not familiar with it. For more information, including recommended dosages, veterinary professionals should consult Plumb's Veterinary Drug Handbook (the latest edition, the fifth, includes Tramadol; earlier editions do not)