(for veterinary information only)
BRAND NAME: DERAMAXX
Deracoxib is a member of the class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), the same class as such common over-the-counter remedies as Advil (Ibuprofen), Aleve (Naproxen), and aspirin. This class of drug is used for pain relief successfully in humans but the development of safe NSAIDs for pets has only been achieved relatively recently.
The problem with the pet use of NSAID's made for humans has been unacceptable (even life-threatening) side effects:
The veterinary profession had been in need of an NSAID that could effectively relieve pain without the above risks. In 1997, Pfizer Animal Health released the first NSAID for dogs in the U.S. as the answer to this need. This product was carprofen which had been available in the U.K. since 1994 and has earned a reputation for effectiveness and safety. Since then, numerous other NSAIDs for dogs have gained FDA approval and been marketed. Long gone are the days when aspirin was the only option.
This new plane of safety was made possible by new biochemical knowledge. Inflammatory biochemicals responsible for the pain and inflammation we want to allieviate are produced by an enzyme called “cyclo-oxygenase 2” or simply "COX-2." The goal is to inhibit this enzyme without inhibiting its counterpart “cyclo-oxygenase 1.” Cyclo-oxygenase 1, abbreviated COX-1, is what is called a “constituitive” enzyme. This means it is involved in producing regulatory biochemicals (called “prostaglandins”) which are important in maintaining the normal health and function of our bodies. We want to leave this enzyme alone. Cyclo-oxygenase 2, abbreviated COX-2, produces inflammation but also is important in regulating kidney blood flow and in some reproductive and central nervous system function. We want to inhibit COX-2 in such a way that we do not disrupt its healthful functions.
In the past, NSAIDs could not distinguish the COX enzymes and inhibited them both. With the development of “COX preferential," we can inhibit mostly COX-2 and largely leave COX-1 alone. The introduction of COX-2 preferential NSAIDs has reduced stomach and intestinal side effects by 50% in humans and has made FDA approval of certain NSAIDs possible for pets. The "coxib" class of NSAID's takes things a step further. The coxib class is actually "COX selective," not merely "COX preferential," which means it completely inhibits COX-2 and completely leaves COX-1 alone, potentially making a safer drug. Deracoxib is a member of the coxib class.
HOW THIS MEDICATION IS USED
Deracoxib is used in the treatment of pain either for short term or long term use with different dosing schedules depending on how the drug is to be used. In addition to pain relief, deracoxib has been found to show efficacy in suppressing bladder cancer (Transitional Cell Carcinoma). This effect appears to be separate from its pain relieving properties.
All NSAIDs, even the COX-2 selective ones, have some potential for reactions. Deracoxib would not be appropriate for a dog with kidney or liver disease so screening tests are needed and monitoring tests are recommended. A dog that is potentially a candidate for long term use of deracoxib should have a complete examination by the veterinarian, a screening blood panel to establish baseline biochemical values, and ideally some kind of recheck testing two weeks after starting deracoxib. This is because most adverse reactions, unusual as they may be, occur within this initial time frame and it is important that they be recognized before they get out of hand. After this initial period, complete blood panels should be screened every six months, an important step with any medication for long term use, not just the NSAIDs.
The side effects of concern are the same with all NSAIDs regardless of their COX selectivity: stomach ulceration, loss of kidney function, and inappropriate bleeding. These are dependent on the dose of medication used and on risk factors of the host (for example: an aged pet may not efficiently clear a dose of medication from its body leading to stronger and longer activity of the drug). There is also a particular idiosyncratic reaction for NSAIDs which has received a great deal of press. An idiosyncratic reaction is one that is not dose-dependent nor predictable by any apparent host factor; it simply happens out of the blue. This particular idiosyncratic reaction is a liver toxicity which is rare enough that it did not show up in any of the initial 400 test subjects with carprofen, nor in the U.K. use of the carprofen and was not recognized until carprofen was used in over a million dogs in the U.S. after its release as the first NSAID. At first this reaction was considered to be only a carprofen problem but as time has passed and more dogs have been on NSAIDs it has been found that this reaction can occur with any NSAID. We will review this reaction below along with the other potential NSAID side effects.
The hepatopathy reaction usually occurs in the first 3 weeks
It is important to realize that COX-selectivity is not the sole factor in safety. In humans, the incidence of kidney function-related side effects was unchanged by the development of COX-2 preferential NSAIDs and we expect the same is true with dogs. Still, these drugs have an excellent track record for safety. The important issue is to recognize risk factors for adverse reactions and take preventive steps (see the Concerns and Cautions section below). Many exaggerated reports and rumors have surfaced on the internet and it is important to consider only confirmed and properly investigated information.
INTERACTIONS WITH OTHER DRUGS
Drugs of the NSAID class should not be used concurrently as the potential for the aforementioned side effects increases. For similar reasons, NSAIDS should not be used in conjunction with corticosteroid hormones such as prednisone, dexamethasone, etc. Pfizer recommends a 5-7 day rest period when changing over to carprofen from one NSAID to another. Aspirin poses an exception due to its strong platelet inactivating abilities so 10-14 days is recommended when switching to carprofen from aspirin. Allow at least one week between prednisone and deracoxib.
If deracoxib is used concurrently with phenobarbital, it is especially important that appropriate liver monitoring be performed. (Our hospital recommends bile acids testing every 6 months for dogs on phenobarbital.) These two drugs interact such that neither may work well if they are used together.
ACE inhibitors such as enalapril or benazapril may not be as effective in the presence of NSAIDs. (ACE inhibitors are used in the treatment of hypertension or heart failure.) This is because ACE inhibitors depend on the dilation of blood vessels in the kidneys and such dilation can be interfered with by NSAIDs).
Deracoxib is a member of a class of drugs called “sulfonamides” which means it contains a chemical group containing sulfur. Often these medications are called “sulfa drugs.” Antibiotics of the sulfa class (deracoxib is not an antibiotic) have been associated with some specific drug reactions (for more information see the section on trimethoprim sulfa). If a patient is known to have reactions against another sulfa drug, it is best to choose an NSAID other than deracoxib.
CONCERNS AND CAUTIONS
Deracoxib is available as a chewable tablet which is highly palatable to animals. This increases the potential for accidental overdose should a pet gain access to a large amount of chewable tablets.
Keep chewable deracoxib out of the reach of children and pets.
Deracoxib has not been tested in pregnant or nursing females and thus is not recommended for use in such individuals, particularly since COX-2 is important in reproductive function. This also means that pregnant women might do well not handling this medication.
NSAIDs should not be used in dogs with pre-existing liver or kidney disease. In order to screen for pre-existing liver or kidney disease it is a good idea to run a blood chemistry panel prior to starting long term therapy with an NSAID.
ANY DOG ON LONG TERM MEDICATION OF ANY KIND SHOULD
The blood pressure related side effects that have made COX-2 selective NSAIDs
Deracoxib should not be used in patients with pre-existing GI ulcerations.
Deracoxib has been tested for safety in puppies as young as 4 months of age but not younger. Safety has not been evaluated in younger puppies.
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Page last updated: 6/25/2017