PHARM limitations and uses

meloxicam use

drug of choice NSAID in cats (low dose), OA pain, post-op analgesia

meloxicam limitations

GI ulceration, renal injury, avoid dehydration or concurrent NSAIDs/steroids

firocoxib use

OA pain in dogs, musculoskeletal pain in horses

Firocoxib limitation 

NOT for cats (poor hepatic metabolism = longer DOA = increased AE risk), expensive

Carprofen use

OA and perioperative pain dogs (most common)

carprofen limitations

ideosyncrantic hepatopathy in dogs

phenylbutazone use

drug of choice for equine colic pain, cattle mastitis, respiratory

phenylbutazone limitation

NEVER IM (tissue necrosis), right dorsal colitis in horses

piroxicam use

Adjunct treatment of transitional cell carcinoma, OA pain

piroxicam limitation

High GI ulcer risk, renal toxicity

aspirin use 

Antithrombotic (saddle thrombus cats - very low doses to avoid toxicity, heart disease dogs), mild analgesia

aspirin limitation

LONG half-life in cats = toxicity, GI bleeding, irreversible platelet functioning

tolfenamic acid use

pain/fever cat/cattle/dog

tolfenamic acid limitation

renal injury in cats, limited to short-term use

grapiprant use

directly blocks prostaglandin receptor (mainly for pain/inflammation in OA, used for OA when NSAIDs contraindicated (safer renal/GI))

grapiprant limitation

less effective than NSAIDs, mild GI upset

pentosan polysulfate ‘Cartrophen’ use

OA dogs/horses, disease-modifying/joint protective

pentosan polysulfate ‘Cartrophen’

ONLY effective for OA, avoid in coagulopathies

midazolam use

drug of choice for emergency seizure control (more potent but shorter DOA than diazepam), can be used CRI (water soluble)

midazolam limitation

sedative effect = respiratory depression Caution with concurrent opioids (↑ depression)

diazepam use

can be used for emergency seizure control (midazolam preferred), pre-med, muscle relaxant, appetite stimulant for cats (caution)

diazepam limitation 

NOT for chronic epilepsy (tolerance), fatal hepatotoxicity cats esp. long-term use, avoid in liver disease

phenobarbitone use

Drug of choice for long-term epilepsy control (dog/cat)

phenobarbitone limitation

Hepatotoxicity, sedation, other drug AEs (enzyme inducer), requires blood monitoring

pentobarbitone use 

Refractory status epilepticus, euthanasia agent

pentobarbitone limitation

Profound respiratory depression, essentially induces coma, NOT routine anticonvulsant (used when other drugs fail)

potassium bromide use

Adjunct or monotherapy for epilepsy (dogs)

potassium bromide limitation 

CANNOT use in cats (fatal lung disease), very long half-life BUT slow onset/adjustment

propofol use

status epilepticus CRI, induction anaesthetic

propofol limitation

MUST be IV, dose-dependent apnoea/hypotension, impractical for long-term GA use

imepitoin use 

Idiopathic epilepsy in dogs, noise phobia (labelled), less hepatotoxic

imepitoin limitation

NOT for cats, less potent than phenobarbitone, sedation/ataxia possible

furosemide use

Drug of choice for pulmonary oedema / CHF, hypercalcemia, hyperkalemia (blocks Na reabsorption therefore water retained (Ca/P too)

furosemide limitation

causes dehydration, hypokalemia, NOT monotherapy

inodilator use 

Drug of choice for canine CHF (valvular disease, DCM), preclinical mitral disease

inodilator limitation

Avoid in obstructive cardiomyopathy (HCM cats), rare arrhythmias

benazepril use

CHF maintenance (drug of choice vasodilator), lowers glomerular pressure = decrease GFR = decrease protein loss = kidney protection
(can slow progression of chronic kidney disease)

benazepril limitation 

contraindicated in dehydration / acute renal failure, avoid in pregnancy

propanolol use 

Hypertrophic cardiomyopathy in cats (decreased HR = longer diastolic filling = decreased contractility = less hypertrophy due to decreased contractility stress)

propanolol limitation

DO NOT use in acute CHF (-ve inotrope), contraindicated in asthma (beta2 blocker = bronchoconstriction)

fentynal use

severe pain (CRI, patch, perioperative)

fentanyl limitation  

profound respiratory depression, unreliable patch absorption

morphine use

severe pain (horse, dog), perioperative analgesia

morphine limitation

Emesis, histamine release (DO NOT rapid IV), dysphoria cats/horses

methadone use 

strong analgesia (drug of choice if morphine poorly tolerated), perioperative, neuropathic pain

methadone limitation

sedation, respiratory depression, serotonin syndrome risk (adjunct SSRIs)

codeine use

antitussive (dogs), weak analgesia

codeine limitation 

poor analgesia in dogs, NEVER paracetamol/codeine in cats (hepatotoxic)

butorphanol use

sedation/premed in dogs, cats, horses. Analgesia in birds

butorphanol limitation

weak analgesia in mammals, short DOA, NOT for severe pain

buprenorphine use 

#1 opioid, moderate pain (drug of choice opioid in cats), long DOA, multimodal analgesia

buprenorphine limitation

ceiling effect, expensive, mild dysphoria possible

tramadol use

adjunct analgesia, chronic pain, neuropathic pain

tramadol limitation 

poor efficacy in dogs (low M1 metabolite), serotonin syndrome risk, dysphoria cats

naloxone use

opioid reversal for overdose

naloxone limitation

short DOA (60 mins), repeated treatments required, use can elicit severe pain reaction

naltrexone use 

opioid reversal (Naloxone preferred), can treat OCD disorders

naltrexone limitation

can elicit severe pain reaction

prednisolone use

drug of choice for anti-inflammatory therapy, autoimmune disease, Addison’s disease

prednisolone limitation 

PU/PD/PP, immunosuppression, NEVER with NSAIDs

dexamethasone use 

emergency anti-inflammatory (shock, CNS, oedema, induction of parturition)

dexamathasone limitation

DO NOT use in pregnancy (except induction), laminitis

methylprednisolone acetate use

long-acting depot for chronic pruritus, feline asthma

methylprednisolone acetate limitation

NEVER IV (suspension), long DOA = AE irreversible, diabetes in cats

hydrocortisone acetate use 

topical ear/skin/eye inflammation

hydrocortisone acetate limitation

weakest potency, avoid on infected/deep wounds

hydrocortisone aceptonate use

topical spray for canine atopic dermatitis

hydrocortisone aceptonate limitation 

local irritation/alopecia, DO NOT use in pregnancy or eyes

triamcinolone use

IA for equine OA, systemic when pred inadequate

triamcinolone limitation

risk of laminitis, joint cartilage degeneration, avoid in ponies

acepromazine use

premed, sedation, antiemetic (motion sickness)

acepromazine limitation

NO analgesia, hypotension, contraindicated in boxers / stallions, shock

azaperone use

pig tranquilizer (aggression, transport, farrowing)

azaperone limitation 

ONLY pigs, IM only, penile prolapse, hypotension

medetomidine use

sedation / analgesia dog/cat (minor procedures)

medetomidine limitation

CVS depression, vomiting, avoid in heart disease / shock

xylazine use 

sedation / analgesia (esp. large animals), emesis in cats

xylazine limitation

profound CVS depression, cattle 10× more sensitive, abortion risk

detomidine use

primarily for equine colic pain, longer DOA than xylazine – better analgesia

detomidine limitation 

Horse SE = ataxia, swaying, sweating, bradycardia

romifidine use

strong, lasting sedation with minimal ataxia – ideal for standing equine procedures

romifidine limitation

bradycardia, hypotension

dexmedetomidine use 

sedation / analgesia dogs / cats (minor procedures)

dexmedetomidine limitation

CVS depression, vomiting, avoid in heart disease / shock

antipamezole use

specific reversal of a2 sedation / analgesia

antipamezole limitation

DO NOT give IV (rapid arousal, tachycardia)

Tricyclic Antidepressants (TCAs) e.g. Clomipramine use 

separational anxiety (dogs, drug of choice TCA),  Feline lower Urinary tract disease/innapropriate spraying

Tricyclic Antidepressants (TCAs) e.g. Clomipramine limitation 

Contraindicated in cardiac disease / seizures, anticholinergic effects

Selective serotonin re-uptake inhibitors (SSRIs) e.g. Fluoxetine use 

separation anxiety, compulsive behaviours, spraying in cats 

Selective serotonin re-uptake inhibitors (SSRIs) e.g. Fluoxetine limitation

Takes 4–6 wks for effect, risk of serotonin syndrome, avoid in liver disease

Diazepam (behaviour) use

situational anxiety, appetite stimulant

diazepam (behaviour) limitation

Hepatotoxic in cats long-term, paradoxical aggression possible

Progestagens e.g. Medroxyprogesterone use 

suppress oestrus, last-line for behaviour suppression

Progestagens e.g. Medroxyprogesterone limitation

risk of pyometra, diabetes, mammary tumours, avoid in entire females & cats

Haloperidol use 

stereotypic behaviour horses, birds (rare)

haloperidol limitation

ONLY used in horses & birds, extrapyramidal signs, NOT for epilepsy

propentofylline use

cognitive dysfunction in dogs

propentofylline limitation 

Mild effect only, GI upset

trazodone use

situational anxiety (vet visits), adjunct to SSRIs & TCAs

trazodone limitation

Sedation, avoid in severe cardiac disease, risk of serotonin syndrome