D

1)   DERACOXIB

a)      Classification

i)        A coxib class COX2 selective NSAID

b)      General Information

i)        Effective anti-inflammatory/analgesic generally free of significant GI side effects

c)      Advantages/Recommended use

i)        Short term use for acute pain

ii)       Long term use in chronic pain for tolerant patients

d)      Cautionary Information

i)        As with any NSAID, GI side-effects can be substantial

(1)   Discontinue use if GI signs develop

ii)       Avoid use in:

(1)    Combination with corticosteroids

(a)    Potentially increased ulcerogenic effect

(2)   Renal compromised patients, dehydrated or hypotensive patients, patients with hepatic disease, pregnancy, patients with pre-existing GI disease, coagulopathies

iii)     Monitor liver enzymes of canine patients on chronic therapy

e)      Dosage Information

i)        Dogs – 1 to 2 mg/kg PO SID for general pain management

(1)   3 to 4 mg/kg PO SID for up to 7 days for acute surgical pain

ii)       Cats – use of deracoxib is not recommended at this time

f)       Cost

i)        Moderately high

2)   DEXMEDETOMIDINE

a)      Classification

i)        Alpha-2 agonist

      (1) The more potent dextro enantiomer of the racemic medetomidine

b)      General Information

i)        Potent sedative/analgesic

ii)       Moderately short duration of effect (1 - 2 hours)

c)      Advantages/Recommended use

i)        Best reserved for healthy patients needing a reversible agent

ii)       Significant reduction in induction agent and lower MAC of inhalants

iii)     10 times more selective for alpha-2 vs. alpha-1 than xylazine

iv)     Can be used with ketamine and an opioid as an IM anesthetic protocol for short procedures

d)      Cautionary Information

i)        DO NOT USE AS SOLE AGENT AT BOX LABEL DOSES

      (1) Label doses are as high as 0.040 mg/kg at smaller patient size

ii)   Do not use in debilitated or cardiovascularly unstable patients

iii)     Extremely stressed patients may not respond as well

(1)   Isolate in quiet, darkened room if possible to facilitate effect

iv)     May cause dramatic bradycardia

(1)   This can rarely be a an unresponsive, fatal bradycardia

(2)   Anticholinergic use is a debatable issue (the author does not routinely an antocholinergic when using alpha-2 agonists)

(a)    If anticholinergics are used with an alpha-2 agonist they should be given with or prior to the alpha-2 agent

(b)    Anticholinergics may be used after an alpha-2 agonist IF at least one hour has transpired since alpha-2 agonist administration

v)      Alpha-2 agonists depress insulin production

(1)   Use with caution or avoid in non-insulin dependent diabetics

e)      Dosage Information

i)        Dog & Cats - general preanesthetic use

(1)   0.0005 to 0.015 mg/kg (0.00025 to 0.0075 mg/lb) IV, IM, SC

(2)   0.001 to 0.010 mg/kg (0.0005 to 0.005 mg/lb) is usually very adequate for dogs and cats when combined with an opioid

ii)       IM protocol (Anesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine, ketamine injection in dogs. Ueyama Y, Waselau AC, Wiese AJ, Muir WW. Vet Anaesth Analg. 2008 Nov;35(6):480-7. Epub 2008 Aug 15.) (Anaesthetic and cardiopulmonary effects of intramuscular morphine, medetomidine and ketamine administered to telemetered cats. Wiese AJ, Muir WW. J Feline Med Surg. 2007 Apr;9(2):150-6. Epub 2007 Jan 2.)

(1)   20 to 60 ug/kg DexMedetomidine, 5 mg/kg Ketamine, 0.2 mg/kg Morphine - combined and given IM

(a)    Use lower doses for dogs, higher doses for cat

(b)   Consider insulin syringes especially for smaller cats

(c)    Always use lean body weight when dosing

(2)   An IV catheter is highly recommended if not required

(3)   Intubation and Oxygen support is highly recommended if not required

(a)    Allows the easy addition of inhalant anesthetic agent should the patient be inadequately anesthetized for longer procedures

f)       Cost

i)        High (especially if atipamazole is used)

3)   DEXTROMETHORPHAN

a)      Classification

i)        An antitussive drug and an NMDA antagonist

b)      General Information

i)        Developed initially as a human cough suppressant

ii)       An oral prescription medication capable of NMDA antagonism useful in managing the central sensitization component of chronic pain management

c)      Advantages/Recommended use

i)        Chronic pain management

d)      Cautionary Information

i)        Reduce dose or discontinue in patients with hepatic dysfunction

e)      Dosage Information

i)        Dogs & Cats

(1)   0.5 to 2.0 mg/kg (0.25 to 1.0 mg/lb) TID to QID PO

ii)       Robitussin CoughGels_Ò are an OTC gelcap that contains 15 mg dextromethorphan per capsule and no other drugs. Vicks Formula 44 Cough Relief_Ò is a dextromethorphan only liquid OTC product that contains 2 mg/ml and comes in 118 ml bottles.

f)       Cost

i)        Moderate

4)   DIAZEPAM

a)      Classification

i)        A benzodiazepine hypnotic sedative agent

b)      General Information

i)        Usually combined with ketamine or an opioid

c)      Advantages/Recommended use

i)        Combined with ketamine for:

(1)   Older patients

(2)   Some cardiac patients

ii)       Combined with oxymorphone for:

(1)   Debilitated patients

(2)   Geriatric patients

iii)     Cats

(1)   Several hour duration makes it suitable for short term sedation in the cat

iv)     Spinal surgery cases

(1)   Give at extubation for muscle relaxation (decreases pain)

v)      Diazepam is reversible using flumazenil

d)      Cautionary Information

i)        Propylene glycol base makes diazepam somewhat painful and less predictably absorbed than midazolam when given IM

(1)   Propylene glycol has potential to cause hemolysis and vasodilation if given in sufficient quantity

ii)       Rapid IV administration may lead to short term arrhythmia

iii)     Dogs

(1)   Extremely short duration makes it unsuitable for sedation as sole agent in the dog

e)      Dosage Information

i)        Dogs & Cats

(1)   Generally dose – 0.2 mg/kg to 0.4 mg/kg (0.1 to 0.2 mg/lb) IV, IM

(2)   IV induction #1 - combined with equal volume of Ketamine

(a)    Draw up 1cc of total mixture per 10 kg (20lb)

(i)      Give ½ initially, then to effect

(ii)    Reduce dose by 30% - 50% if depressed or heavily sedated by pre-meds

(3)   IV induction #2 - combined with fentanyl, hydromorphone, or oxymorphone – most useful for dogs

(i)      See Diazepam & an Opioid section under Induction Protocols for details

(ii)    Cats would need low dose Ketamine (1 to 5 mg/lb) or Propofol (0.5 to 2 mg/lb) to facilitate intubation

(4)   IV maintenance – most useful for dogs

(a)    See Diazepam & an Opioid section under Maintenance Protocols for details

(i)      Main indication would be canine patient with difficult to manage hypotension while on inhalant agent

f)       Cost

i)        Low

5)   DOBUTAMINE

a)      Classification

i)        Positive inotropic agent related to dopamine

ii)       Primarily a direct beta₁-adrenergic agonist with mild beta₂- and alpha₁-adrenergic effects

b)      General Information

i)        Used to help increase blood pressure in hypotensive patients

ii)       Compatible with most of the commonly used IV fluids including D5W, saline, and LRS

(1)   The initial vial and the diluted drug is stable for 24 hours

c)      Advantages/Recommended use

i)        Used to increase blood pressure when an anesthetic reduction, IV fluids, and colloids are inadequate

d)      Cautionary Information

i)        This drug must be diluted before administration

(1)   Final drug concentration must be no greater than 5.0 mg/ml

ii)       Use open vial and diluted drug for no longer than 24 hours

iii)     Use caution when mixing with other drugs

(1)   Confirm compatibility before doing so

iv)     Discontinue if significant increase in heart rate or if any arrhythmia develops

(1)   Arrhythmias are much less likely at dose rates below 0.008 mg/kg/min (0.004 mg/lb/min)

e)      Dosage Information

i)        Dog – 0.001 to 0.010 mg/kg/min (0.0005 to 0.005 mg/lb/min)

ii)       Cats - use low end of dog dose range

iii)     Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose

(1)   4.8 ml @ 12.5 mg/ml = 60 mg

(2)   Add to 250 ml 0.9% saline for 0.24 mg/ml

(3)   Give 0.5 ml/kg/hour

f)       Cost

i)        Low 

6)   DOMITOR

a)      Pfizer’s brand name for medetomidine

i)        See medetomidine

7)   DOPAMINE

a)      Classification

i)        Positive inotropic agent

ii)       Precursor to norepinephrine and epinephrine

iii)     Primarily beta₁-adrenergic effects at therapeutic doses with alpha₁-adrenergic effect at higher dose rates

b)      General Information

i)        Used to help increase blood pressure in hypotensive patients

ii)       Compatible with many of the commonly used IV fluids including D5W, saline, and LRS

(1)   Diluted drug is stable for 24 hours

c)      Advantages/Recommended use

i)        Used to increase blood pressure when an anesthetic reduction, IV fluids, and colloids are inadequate

d)      Cautionary Information

i)        This drug should be diluted before administration

ii)       This drug is available in many different strengths – adjust recipes accordingly

iii)     Use open vial and diluted drug for no longer than 24 hours

iv)     Protect from light

v)      Use caution when mixing with other drugs

(1)   Confirm compatibility before doing so

vi)     Discontinue if significant increase in heart rate or if any arrhythmia develops

(1)   Arrhythmias are much less likely at dose rates below 0.020 mg/kg/min (0.010 mg/lb/min)

e)      Dosage Information

i)        Dog – 0.002 to 0.010 mg/kg/min (0.001 to 0.005 mg/lb/min)

ii)       Cats - use low end of dog dose range

iii)     Recipe for 0.002 mg/kg/min (0.001 mg/lb/min) dose

(1)   1.5 ml @ 40 mg/ml = 60 mg

(2)   Add to 250 ml 0.9% saline for 0.24 mg/ml

(3)   Give 0.5 ml/kg/hour

f)       Cost

i)        Low

8)   DURAMORPH

a)      Classification

i)        Preservative free morphine

ii)       Pure mu opioid agonist

b)      General Information

i)        A specific preparation for epidural use

c)      Advantages/Recommended use

i)        Epidural analgesia

d)      Cautionary Information

i)        Single use 10 mg (10 ml) vials and 2 mg (2ml) vials - do not save residual meds

e)      Dosage Information

i)        Epidural use

(1)   Dog & Cat - 0.1 mg/kg (0.045 mg/lb.)

(a)    1 cc per 10 kg

f)       Cost

i)        Moderately high – significant wastage

E

1)   EPINEPHRINE

a)      Classification

i)        Endogenous adrenergic agent with Alpha and Beta properties causing increased contractility and increased blood pressure

b)      General Information

i)        An emergency medication

c)      Advantages/Recommended use

i)        Anaphylactic allergic reactions

ii)       Cardiac resuscitation (asystole)

d)      Cautionary Information

i)        Store in refrigerator

e)      Dosage Information

i)        Dogs

(1)   Cardiac resuscitation - 1 ml per 10 kg (20 lb) IV (1:1000 dilution)

(2)   Anaphylaxis – 0.010 to 0.20 mg/kg (0.005 to 0.10 mg/lb) IV

ii)       Cats

(1)   Cardiac Resuscitation - 1 ml per 10 kg (20 lb) IV (1:1000 dilution)

(2)   Anaphylaxis – 0.010 to 0.20 mg/kg (0.005 to 0.10 mg/lb) IV

(3)   Feline asthma - 0.1 ml SQ or IV (1:1000 dilution)

f)       Cost

i)        Very low

2)   ETODOLAC

a)      Classification

i)        A COX2 selective NSAID

b)      General Information

i)        Effective anti-inflammatory/analgesic generally free of significant GI side effects

c)      Advantages/Recommended use

i)        Short term use for acute pain

ii)       Long term use in chronic pain for tolerant patients

d)      Cautionary Information

i)        As with any NSAID, GI side-effects can be substantial

(1)   Discontinue use if GI signs develop

ii)       Avoid use in:

(1)    Combination with corticosteroids

(a)    Potentially increased ulcerogenic effect

(2)   Renal compromised patients, dehydrated or hypotensive patients, patients with hepatic disease, pregnancy, patients with pre-existing GI disease, coagulopathies

iii)     Monitor liver enzymes of canine patients on chronic therapy

e)      Dosage Information

i)        Dogs – 10 to 15 mg/kg (4.8 TO 6.8 mg/lb) PO SID

ii)       Cats – use of etodolac is not recommended at this time

f)       Cost

i)        Moderately low

3)   ETOMIDATE

a)      Classification

i)        An imidazole

b)      General Information

i)        Considered the best induction agent for dilated cardiomyopathy

ii)       Comes in two forms

(1)   Standard USA product in propylene glycol vehicle

(2)   European lipuro form in hyperlipid emulsion similar to propofol

c)      Advantages/Recommended use

i)        For serious cardiac cases including cardiomyopathy cases

d)      Cautionary Information

i)        May cause myoclonus, retching, or excitement during induction or recovery – this is uncommon if patient is adequately sedate from the premeds or is clinically depressed

(1)   Premed with one of the following:

(a)    Oxymorphone 0.05 mg/kg (0.025 mg/lb) IM and midazolam 0.1 mg/kg (0.05 mg/lb) IM

(b)   Hydromorphone 0.1 mg/kg (0.05 mg/lb) IM and midazolam 0.1 mg/kg (0.05 mg/lb) IM

(c)    Butorphanol 0.2 mg/kg (0.1 mg/lb) IM and midazolam 0.1 mg/kg (0.05 mg/lb) IM

ii)       Does suppress adrenocortical function for 3 hours after administration

(1)   This effect can be overcome by corticosteroid administration if there is an existing adrenal concern

(a)    Some believe this lack of a “stress response” may actually reduce patient morbidity

iii)     The propylene glycol containing etomidate can trigger hemolysis that some consider a potential for renal stress

(1)   Effect of possible pigment overload

(2)   For renal or anemic patients use etomidate-lipuro

iv)     Unused etomidate-lipuro should be discarded if not used that day

e)      Dosage Information

i)        Routine induction

(1)   Dogs - 0.5 to 3.0 mg/kg (0.25 to 1.5 mg/lb) IV

(a)    If patient is not already depressed or is not reasonably sedate from premeds, precede etomidate with 0.2 to 0.4 mg/kg (0.1 to 0.2 mg/lb) diazepam IV

(2)   Cats – 0.5 to 2.0 mg/kg (0.25 to 1.0 mg/lb) IV

(a)    If patient is not already depressed or is not reasonably sedate from premeds, precede etomidate with 0.2 to 0.4 mg/kg (0.1 to 0.2 mg/lb) diazepam IV

ii)       Give the propylene glycol containing etomidate with IV fluids to minimize pain on injection and hemolysis

(1)   This concern is due to the propylene glycol content of this preparation

f)       Cost

i)        Very high

F

1)   FENTANYL

a)      Classification

i)        A pure mu agonist

b)      General Information

i)        Duration of effect is 30 to 45 minutes

c)      Advantages/Recommended use

i)        Short-term analgesia

(1)   Excellent as an intra-operative “top up” analgesic

ii)       Induction agent when combined with a benzodiazepine

iii)     CRI analgesic use

d)      Cautionary Information

i)        May see panting and muscle rigidity

e)      Dosage Information

i)        Induction

(1)   See Diazepam & an Opioid section under Induction protocols for details

ii)       Analgesia

(1)   Bolus – 0.002 mg/kg (0.001 mg/lb)

(2)   CRI – 0.001 to 0.004 mg/kg/hr (0.005 to 0.002 mg/lb/hr)

(3)   Duragesic patch – based upon weight

(a)    Small dogs and cats, use the 25 mcg/hr patch but only expose ½ of the patch

(b)    For even smaller cats consider exposing ¼ of the patch

(c)    Never cut the patch

(d)    Clip hair as closely as possible at planned patch site without irritating the skin. Gently wipe area once or twice with slightly dampened gauze to remove loose hair. Let area dry. Warm patch to body temperature. Remove backing and apply patch to skin. Hold firmly against skin with hand for 2 full minutes. White tape and Kling gauze are used to cover and support the patch when possible.

(e)   For dogs greater than 30 kg, two 50 mcg patches will likely provide better drug delivery than one 100 mcg patch.

f)       Cost

i)        Low per IV use

ii)       High per patch

2)   FLUMAZENIL (ROMAZICON_(R))

a)      Classification

i)        Benzodiazepine antagonist

b)      General Information

i)        Reversal agent for diazepam and midazolam

c)      Advantages/Recommended use

i)        To reverse any undesirable effects resulting from diazepam or midazolam use

d)      Cautionary Information

i)        None

e)      Dosage Information

i)        Dogs – 0.02 to 0.1 mg/kg (0.01 to 0.05 mg/lb) IV

ii)       Cats – 0.02 to 0.1 mg/kg (0.01 to 0.05 mg/lb) IV

f)       Cost

i)        Very high

Return to Drug Info Homepage