What is Deramaxx?
Deramaxx is Novartis’ brand name for the drug deracoxib. Deracoxib is a non-narcotic, non-steroidal anti-inflammatory drug (NSAID) that is prescribed to relieve pain, fever, and inflammation in dogs. It is commonly used in dogs with arthritis, hip dysplasia, or to control pain.
The main reasons veterinarians prescribe Deramaxx is to manage chronic pain in dogs with osteoarthritis (chronic joint inflammation) or as a postoperative medication to treat pain and inflammation in dogs following a surgery or dental procedure.
Deramaxx is like an Ibuprofen for dogs, it works to relieve inflammation, reduce fever, and decrease pain.
How is Deramaxx Administered?
Deramaxx for dogs must be prescribed by veterinarians. It is available in 12 mg, 25 mg, 75 mg and 100 mg beef-flavored tablets that are orally administered, preferably with food. The suggested dose of Deramaxx is 0.45 mg/lb – 0.91 mg/lb as a single dose once a day, as needed. Therefore, if your dog is 30 lbs, the lowest dose prescribed should be 13.5 mg and the maximum dose prescribed should be 27.3 mg. When using Deramaxx to provide relief in a long-term treatment, it is best to use the lowest effective dose.
Tips for Using Deramaxx for Dogs
Deramaxx should be stored at room temperature, between 59℉ and 86℉. Prior to taking Deramaxx, it is recommended that dogs undergo a kidney and liver screening. Blood and gastrointestinal tests may be helpful in determining whether your dog currently has a problem that could be made worse by using Deramaxx.
Dogs that are currently using another NSAID should not use Deramaxx. It is not intended for dogs that are pregnant or nursing. It is not suggested for dogs with a history of liver, kidney, or heart disorders; have stomach ulcers; are prone to appetite loss or dehydration; or are allergic/have hypersensitivity to other NSAIDs.
Deramaxx should not be prescribed to dogs that are younger than 4 months old or to dogs that are under 4 lbs. If you observe any adverse or potentially harmful reactions consult your veterinarian immediately whom may advise you to discontinue Deramaxx.
Adverse reactions may be increased if taken with the following types of drugs:
- Other NSAIDs
- Steroids (including Corticosteroids)
- Nephrotoxic medications (including ACE inhibitors)
While your dog is receiving Deramaxx as a treatment the following patient monitoring should occur regularly:
- Blood chemistry
- Complete blood count (CBC)
- Physical exam
How Does Deramaxx Work?
The mechanism of action of Deramaxx is not completely understood, it is suspected to be associated with the inhibition of cyclooxygenase activity, similar to other NSAIDs. The therapeutic effectiveness of NSAIDs rely on the inhibition of cyclooxygenase (COX) activity, particularly COX-2. COX enzymes catalyze the conversion of arachidonate to prostaglandin H2 (, which is the precursor of many important biological molecules. One of these precursors is prostaglandin, which plays a large role in modulating the inflammatory response. All drugs that act as inhibitors of COX activity are said to be NSAIDs.
Deracoxib has been shown to selectively inhibit COX-2 mediated prostaglandin E2 (PGE2) production in lipopolysaccharide (LPS)-stimulated human whole blood. Although, an in vitro study (tested outside of the organism ie: in a dish or test tube) has shown that Deramaxx has specificity for COX-2 in canines. It should be noted that they also found that the specificity may vary from species to species. There have been no clinical or in vivo studies (tested within an organism) done that support this study.
In laymen terms, Deramaxx works by obstructing the process that causes inflammation.
Side Effects of Deramaxx for Dogs
During the studies conducted prior to approval, the researchers found that the most common side effects were digestive tract disorders (including diarrhea and vomiting in dogs) and systemic disorders (abnormal clinical chemistry results, including increased AST and Increased ALT). The rest of the adverse reactions were reported after Deramaxx received FDA approval.
General Side Effects of Deramaxx
- Anorexia— refusal to eat
- Lethargy— lack of energy and enthusiasm
- Weight loss
Gastrointestinal Effects of Deramaxx
The following symptoms are signs of issues involving the stomach and small intestine. Gastrointestinal effects of Deramaxx can occur when the slightly acidic drug gets stuck in the stomach – causing irritation of the stomach lining.
- Vomiting (affects 10% of dogs treated with Deracoxib)
- Diarrhea— loose or watery bowel movements
- Hypoalbuminemia— abnormally low levels of albumin in blood serum, physical symptoms include
- Melena—stools appear black and tarry due to the presence of digested blood in stool
- Hematochezia— passage of fresh blood in stool, bright red blood in stool
- Elevated amylase levels— enzyme that helps digest carbohydrates
- Elevated lipase levels— enzyme that helps break down lipids
- Vomiting blood
- Abdominal pain
- Peritonitis— inflammation of abdominal cavity
- Decreased or increased total protein and globulin
- Gastrointestinal perforation— formation of a hole through the stomach, large bowel, or small intestine
- Gastrointestinal ulceration— formation of ulcers due to the thinning of mucosal lining of the stomach
- Hypersalivation— overactive saliva production
Hepatic Effects of Deramaxx for Dogs
These side effects occur from issues related to the liver and its function. Adverse reactions from Deramaxx that are not caused by an overdose are rare and are often due to having a sensitivity to the drug.
- Elevated liver enzymes
- Hyperbilirubinemia— high concentration of bilirubin causing jaundice
- Jaundice – yellow discoloration of mucous membranes (gums, nostrils, genitals, and other areas
- Ascites— accumulation of fluid (25ml or more) in the peritoneal cavity
- Decreased Blood Urea Nitrogen (BUN)
Hematologic Effects of Deramaxx
Disorders and diseases that affect the blood. These symptoms can only be properly determined by administering blood tests. This is why it is important to get regular blood tests to monitor adverse reactions on the blood.
- Anemia— very low red blood cell count or improperly functioning red blood cells
- Leukocytosis— elevated levels of circulating white blood cells
- Leukocytopenia— decreased levels of white blood cells
- Thrombocytopenia— very low levels of blood platelets
Neurologic Effects of Deramaxx for Dogs
These are symptoms of issues involving the nervous system, including the spine and brain.
- Ataxia— loss of balance and coordination of limbs, head, and/or trunk
- Recumbency— state of leaning, resting, or reclining likely due to pain
- Hind limb paresis— muscular weakness in hind limbs caused by nerve damage or disease
- Nystagmus— involuntary eye movement
- Proprioceptive disorder— inability to use paws properly
- Vestibular signs— loss of ability to balance, symptoms include walking in circles, head tilting, stumbling, falling, etc
Behavioral Effects of Deramaxx
Urologic Effects of Deramaxx
The following symptoms are concerned with the function and disorders of the urinary system, which include kidneys. In the event that blood flow to kidney is decreased, prostaglandins assist in opening arteries that go up to the kidneys. Deramaxx can further reduce the blood flow since it decreases the production of prostaglandins, thus causing kidney damage in dogs.
- Elevated Blood Urea Nitrogen (BUN)
- Elevated creatinine— symptom of impaired kidney function
- Polydipsia— excessive thirst
- Polyuria— increased frequency of urination
- Hyperphosphatemia— elevated levels of phosphate in blood
- Hematuria— presence of blood in urine (affects 2% of dogs treated with deracoxib)
- Low urine specific gravity— chemical imbalance of urine
- Urinary incontinence— inability to urinate
- Kidney failure— loss of kidney’s ability to remove waste and balance fluids
- Urinary tract infection
Dermatologic Effects of Deramaxx
These symptoms affect the skin, nails, and hair.
- Pruritus— desire to itch, scratch, and chew on skin causing inflamed skin
- Erythema— reddening of skin
- Urticaria— skin rash often caused by an allergic reaction
- Moist dermatitis— raw, painful, and irritated skin lesions
- Facial/muzzle edema— inflammation of the head
- Dermal ulceration/necrosis
Respiratory Effects of Deramaxx
- Dyspnea— difficulty breathing
- Epistaxis— bleeding of the nose
Cardiovascular Effects of Deramaxx
The following symptoms deal with issues regarding the heart and its function.
- Tachycardia— rapid heart rate
- Heart murmur
- Bradycardia— slow heart rate
- Arrest— abrupt loss of heart function
Sensory Effects of Deramaxx
- Vestibular signs— loss of ability to balance
- Glazed eyes
- Uveitis— inflammation of the middle layer of the eye called the uvea
Ophthalmic Effects of Deramaxx
These symptoms pertain to the eye.
- Mydriasis— dilation of pupils
- Conjunctivitis— also known as pink eye
- Dry eye
- Uveitis— inflammation of the middle layer of the eye called the uvea
In some cases, death is associated with the adverse reactions listed above
Signs of Deramaxx Overdose in Dogs
- Bloody vomit
- Black-tarry stool
- Inappropriate urination or thirst
- General malaise
- Abdominal pain
- Elevated blood urea nitrogen (BUN)
- Renal changes
Deramaxx Overdose Treatment
If you suspect your dog is suffering from Deramaxx overdose, act immediately and seek help from your local veterinarian.
- Induce vomiting (if ingestion was within 4 hours)
- Stomach pumping
- Administer activated charcoal slurry
- Supportive care
- Perform baseline blood values, including CBC and chemistry
Reported Issues and Lawsuits Against Deramaxx
On November 10th, 2010 Holly, a border-collie mix, was prescribed Deramaxx after hurting her leg while playing fetch. The week after beginning the Deramaxx treatment, Holly’s limp turned into wobbling and her breath became rancid. She still behaved normally besides being less motivated to run far when playing catch. By the second week the owner reported that Holly wasn’t eating to their vet, but they recently changed her diet so the veterinarian assumed the new diet was the cause of inappetance. Over the next couple of days Holly’s lack of coordination worsened and was accompanied with weakness, excessive sleepiness, inappetence, and diarrhea.
Holly was brought back to the veterinarian on November 29th to have blood tests done. The vet insisted that Deramaxx was not the causing these problems and to continue the treatment. The following day the vet called with the blood test results indicating kidney failure, hypothyroidism, and high cholesterol. Holly was rushed to the clinic as soon as possible to be treated, but she didn’t end up responding well to the treatment and ended up having to put her down the following day.
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