I don’t get headaches often, and I avoid taking nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen because they can cause liver, kidney, and (especially) gastrointestinal problems. But a few mornings ago after an especially stressful night at work, I had a headache that needed something. I took two Advil, each containing 200 milligrams of ibuprofen.
I will say to the medicine’s credit that it worked — my headache was gone in half an hour. But as I was taking the pills, I noticed something that reminded me of many patient disasters in my professional life: The medicine tasted good.
Advil tablets are coated in a sweet shell. Like the overwhelming majority of medicines, ibuprofen is highly unpalatable to most people. A sweet coating makes the tablets easier to take. It also makes them attractive to dogs.
Unfortunately, child-resistant bottles are generally no match for a set of canine jaws, and canine noses can sniff out the sweet shell from halfway across the house. I regularly treat dogs that have consumed entire bottles of Advil. These dogs are at risk of kidney failure and severe gastrointestinal damage. These issues are dramatically compounded if the dog takes any medications (such as prednisone or a canine nonsteroidal anti-inflammatory drug) that are not safe to mix with drugs such as ibuprofen.
The problem, sadly, does not stop with sweet-tasting human medications. A number of veterinary drugs come in “flavor tablets,” which are designed to make giving the drug as easy as giving a treat. Some flavored medications, such as Heartgard Plus, are safe enough that most dogs won’t come to harm even if they eat a six-month supply. Others, however, are not.
In my experience, the most dangerous canine flavor tablet is another type of nonsteroidal anti-inflammatory drug called Rimadyl (carprofen). Unlike Advil, Rimadyl is labeled for use in dogs. But overdoses of Rimadyl are just as dangerous as those on Advil. This is true for other veterinary-approved nonsteroidal anti-inflammatory drugs such as Deramaxx or Previcox.
Although nonsteroidal anti-inflammatory drug overdoses have the potential to be life threatening, treatments are available (and usually successful). If the overdose was recent, the dog is made to vomit. Most dogs then receive repeated doses of activated charcoal. This absorbs residual toxins from the intestines, but it carries its own set of risks, such as aspiration (inhalation) and life-threatening blood electrolyte imbalances.
The kicker, for most owners, is that in many cases dogs must be hospitalized for 48 hours of IV fluids and gastrointestinal protecting medications. Animal toxicologists often recommend daily blood work to monitor liver and kidney function. The expenses can be enormous.
I believe medications like nonsteroidal anti-inflammatory drugs with low safety margins have little business tasting good to dogs or to anyone. I say make the pills small and not palatable, and let owners put them in Pill Pockets or cheese.
Owners should be aware that some dogs will consume even unflavored, highly unpalatable medications (dogs are known for eating crazy things, after all). I recommend that all medications — flavored and unflavored, human or canine — be kept in a locked cabinet or pantry.
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