GI Perforation Following NSAID Administration in Dogs

NSAIDs inhibit the COX enzyme in the arachidonic acid pathway, and those used in dogs are generally selective for COX-2, the isoenzyme induced during inflammation. These drugs can be beneficial, but adverse effects (eg, gastric and duodenal perforation [GDP]; rare]) may limit their use. Although several studies have linked GDP to various individual NSAIDs,^1-4 none have examined the relationship between GDP and the frequency at which different NSAIDs are prescribed.

This study retrospectively evaluated GDP cases at a university teaching hospital over a 13-year period. Data were collected on the specific NSAID prescribed, dosage, and concurrent medications, including glucocorticoids and other NSAIDs. Local referral clinics were also surveyed to determine which NSAIDs were most frequently prescribed to dogs during the same period.

Thirty cases met inclusion criteria; 18 dogs were administered  a single NSAID at the recommended dose. Of those, 8 received meloxicam, 5 received firocoxib, 3 received deracoxib, and 2 received piroxicam. Eight dogs received a combination of NSAIDs (including carprofen) and/or NSAIDs plus glucocorticoids. Only 4 dogs were administered an NSAID overdose (ie, ≥10% above the high end of the labeled dose). Survival rate of dogs with GDP was 66.7%.

Although carprofen was the most frequently prescribed NSAID during the corresponding time period (70.6% of reported prescriptions), no cases of GDP were associated with carprofen administered as a single agent. Other NSAIDs prescribed by survey respondents, in decreasing order of frequency, were meloxicam, deracoxib, firocoxib, aspirin, and other. 

Results indicate need for awareness of potential GDP in dogs given NSAIDs. Meloxicam, firocoxib, and deracoxib are selective for the COX-2 isoenzyme but were associated with development of GDP. Carprofen was not associated with GDP when given alone but may lead to GDP when combined with glucocorticoids or other NSAIDs.

Key pearls to put into practice:

NSAID administration can lead to GDP in dogs, even at the labeled dose. NSAIDs more commonly associated with GDP (in descending order of frequency) are meloxicam, firocoxib, deracoxib, and piroxicam.

COX-2−selective drugs are considered safer than nonselective alternatives and were administered to most patients in this study. Appropriate caution and monitoring for adverse effects should be used when administering any NSAID to dogs.

Single-agent carprofen was not associated with GDP despite being the most commonly prescribed drug but was associated with GDP when coadministered with glucocorticoids or other NSAIDs. Concurrent administration of these drugs is thus not recommended due to increased risk for GDP and other adverse effects.