It is presumed, as in other species, that using drugs with a greater COX-2 selectivity in cats will help avoid some of the potential adverse effects associated with COX-1 suppression, such as gastrointestinal irritation/ulceration and platelet inhibition. However, selective COX-2 inhibition will not completely eliminate the possibility of adverse effects. To avoid potential side effects, owners should be encouraged to titrate to the “lowest effective dose.” When attempting to reduce the dosage of an NSAID, reduce the label dose but maintain the label frequency. Liquid formulations will provide for the most accurate dosing. For overweight or obese cats, begin treatment based on patients’ lean or ideal bodyweight. Use a dedicated and clearly marked syringe for administration. Concurrent use of NSAIDs and glucocorticoids should be avoided whenever possible. A thorough history and physical examination is mandatory in all cats prior to NSAID therapy. Laboratory evaluation should focus on the renal and hepatic systems, plasma proteins, and hematocrit. Particular care should be taken with unstable disease, such as congestive heart failure or thromboembolic disease. Use of NSAIDs in patients at higher risk for adverse drug events (ADEs), such as older cats or those with existing cardiovascular, renal, hepatic, or gastrointestinal disease, requires greater effort to use the lowest effective dose, along with increased monitoring. Owners need to be made aware of signs that should prompt cessation of therapy and/or the need to seek veterinary advice. To reduce the potential for ADEs, NSAID therapy should always be given with or after food. If the cat does not eat, therapy should be withheld. An initial reassessment of all cats is recommended after the first 5 to 7 days of therapy. A routine reevaluation is recommended after the first 2 to 4 weeks. Thereafter, the frequency of reevaluation should be based on perceived risks and patient characteristics. All ADEs should be reported to the relevant pharmaceutical company and regulatory board.

Commentary: Cats are notorious in their ability to hide their pain, especially the slowly progressing, chronic pain of osteoarthritis. As veterinarians have become sensitized to the presence of chronic pain in older cats, we want to do the right thing and relieve that pain. Unfortunately, until now, when we have reached for NSAIDs we have been left wondering if we are truly doing the right thing or, in fact, have we been placing our feline patients in harm’s way. Now, finally, we have consensus guidelines for the long-term use of NSAIDs in cats. This puts a map in our hands to craft a reasonable dosing, monitoring, and client education plan for painful cats that need and deserve our help. Felines everywhere will be grateful.

IFSM and AAFP consensus guidelines: Long-term use of NSAIDs in cats. Sparkes AH, Heiene R, Lascelles BDX, et al. J Fel Med Surg 12:521-538, 2010.