Page 82 - BSAVA Guide to Pain Management in Small Animal Practice

5 | Pharmacological treatment of pain

VetBooks.ir Renal disease Liver disease

Opioids
Norpethidine is renally excreted, accumulation Prolonged duration of action or accumulation possible
could cause seizures in animals with severe Patients with hepatic encephalopathy more sensitive to sedation
renal disease orphine may be less e ective due to decreased production of
active metabolites (dogs)
NSAIDs
Consider individual licences, use in case of Most are contraindicated in animals with liver disease, some can
chronic nephropathy is controversial, and be used with caution in animals with liver disease
should be udged according to risk bene t
analysis. Do not use in acute renal disease or in
animals at risk of acute renal disease
Paracetamol (dogs only!)
Contraindicated, but it is commonly used with Contraindicated
caution as it is probably safer than non-
steroidal anti in ammatory drugs
Local anaesthetics
Can be used, provided hypotension is avoided Can be used
Tramadol
Active metabolites excreted in urine, possible Longer duration of action possible
prolonged duration of action (cats) Decreased production of active metabolite may lead to reduced
e cacy cats
Antidepressants
No data in dogs and cats, use with caution No data in dogs and cats, use with extreme caution
Gabapentin
No data in dogs and cats. Duration of action No data in dogs and cats. Duration of action may be prolonged
may be prolonged and side e ects more evident
Ketamine
Renally excreted in cats, possible prolonged Metabolized by the liver in dogs, possible prolonged duration of
duration of action or accumulation action or accumulation
Amantadine
Renally excreted, prolonged duration of action No data
possible
Alpha-2 agonists
ay reduce renal blood ow ay reduce liver blood ow
Reversible Prolonged duration of action or accumulation possible
E ects of low dose infusion not known, Reversible
unlikely to be harmful E ects of low dose infusion not known, unlikely to be harmful
Analgesic considerations for patients with renal and hepatic disease.

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