Piroxicam, an NSAID, is a non-selective Cox-1 and Cox-2 inhibitor and has anti-cancer effects in dogs, which is well supported by the veterinary literature. Since those papers, veterinarians have prescribed other NSAIDS such as Deramaxx or Meloxicam, in lieu of Piroxicam, because these newer selective Cox-2 inhibitors are associated with lower rates of side-effects, such as GI ulceration and upset. It is assumed (but not known) that the anti-tumor effects are due to the Cox-2 inhibition, so it is also assumed that cox-2 selective NSAIDs should work as well as piroxicam.
However, this remains to be supported in the veterinary literature. (Not enough studies), but Piroxicam (and possibly other NSAIDS) remains a reasonable palliative option with careful monitoring.
Famotidine (Pepcid AC)
Available in 10 and 20 mg tablets OTC
Background
Stomach
ulceration in humans is a prominent medical condition and there has
long been pressure to develop effective and convenient ways to control
it. Until relatively recently, we relied on simply neutralizing stomach
acid by pouring alkaline solutions (i.e., Alka Seltzer, Tums, Rolaids,
etc.) into the stomach. In fact, ulceration is a complicated process and
there are many ways to address it.
Control of stomach acidity is
an important factor in the treatment of stomach ulcers. Acid secretion
is controlled by a hormone called gastrin (secreted in the presence of
food and leading to secretion of stomach acid), acetylcholine (a
neurotransmitter), and histamine (that same substance responsible for
the unpleasant allergic effects of hay fever).
Famotidine is a special antihistamine, as are its cousins cimetidine (Tagamet HB) and ranitidine
(Zantac). This class of antihistamine is not useful in combating
familiar allergic symptoms (itching, sneezing, stuffy nose etc.) In
allergy, histamine causes unpleasant effects by binding so-called H1
receptors. Famotidine, ranitidine, and cimetidine instead bind to
histamine receptors in the stomach called H2 receptors.
Cimetidine
was the first such H2 blocker available and each generation has brought
about improvements in terms of fewer drug interactions and stronger
effect. Famotidine is the longest lasting of the H2 blockers (usually
one dose lasts 24 hours). Famotidine is 32 times stronger in its ability
to inhibit stomach acid than is cimetidine and is 9 times stronger than
ranitidine. A newer H2 blocker called nizatidine is now available that
offers the additional advantages of especially rapid onset of action and
some effect on normalizing stomach contractions as well.
Famotidine
is currently available in an over-the-counter formulation making it
highly convenient for pet owners to obtain (though obviously one should
not consider using medications licensed for human consumption without
specific instructions from one's veterinarian). Famotidine is especially
useful for pets with chronic vomiting.
How This Medication Is Used
Famotidine
is useful in any situation where stomach irritation is an issue and
ulceration is a concern. It is often used in the treatment of Helicobacter infection, inflammatory bowel disease, canine parvovirus, ingestion of a toxin or medication that could be ulcerating (NSAIDs, like Metacam Meloxicam Peroxicam Duramaxx aspirin and others,
for example), any disease involving protracted vomiting, or chronically
in combination with medications which may have stomach irritating
properties.
In diseases involving frequent vomiting or
regurgitation, the esophagus (tube connecting the mouth and stomach) can
be ulcerated by continuing exposure to vomit/stomach acid. Antacids are
also helpful in this type of situation to reduce damage to the
esophagus. Megaesophagus would be a condition where a long-acting antacid such as famotidine could be helpful in mitigating injury to the esophagus.
Side Effects
The H2 blockers as a group have a limited potential for side effects, hence their recent release to over-the-counter status.
There
have been some reports of exacerbating heart rhythm problems in
patients who already have heart rhythm problems, so it may be prudent to
choose another means of stomach acid control in heart patients.
Interactions With Other Drugs
There
are some drugs that are absorbed better in the presence of stomach acid
(example: itraconazole). The dose of such drugs may require adjustment
in the presence of famotidine.
Concerns and Cautions
The
dose of famotidine may require reduction in patients with liver or
kidney disease as these diseases tend to prolong drug activities.
It appears that famotidine is safe for use in pregnancy but should probably be avoided during lactation.
However, this remains to be supported in the veterinary literature. (Not enough studies), but Piroxicam (and possibly other NSAIDS) remains a reasonable palliative option with careful monitoring.
Available in 10 and 20 mg tablets OTC
Background
Stomach
ulceration in humans is a prominent medical condition and there has
long been pressure to develop effective and convenient ways to control
it. Until relatively recently, we relied on simply neutralizing stomach
acid by pouring alkaline solutions (i.e., Alka Seltzer, Tums, Rolaids,
etc.) into the stomach. In fact, ulceration is a complicated process and
there are many ways to address it.
Control of stomach acidity is
an important factor in the treatment of stomach ulcers. Acid secretion
is controlled by a hormone called gastrin (secreted in the presence of
food and leading to secretion of stomach acid), acetylcholine (a
neurotransmitter), and histamine (that same substance responsible for
the unpleasant allergic effects of hay fever).
Famotidine is a special antihistamine, as are its cousins cimetidine (Tagamet HB) and ranitidine
(Zantac). This class of antihistamine is not useful in combating
familiar allergic symptoms (itching, sneezing, stuffy nose etc.) In
allergy, histamine causes unpleasant effects by binding so-called H1
receptors. Famotidine, ranitidine, and cimetidine instead bind to
histamine receptors in the stomach called H2 receptors.
Cimetidine
was the first such H2 blocker available and each generation has brought
about improvements in terms of fewer drug interactions and stronger
effect. Famotidine is the longest lasting of the H2 blockers (usually
one dose lasts 24 hours). Famotidine is 32 times stronger in its ability
to inhibit stomach acid than is cimetidine and is 9 times stronger than
ranitidine. A newer H2 blocker called nizatidine is now available that
offers the additional advantages of especially rapid onset of action and
some effect on normalizing stomach contractions as well.
Famotidine is currently available in an over-the-counter formulation making it highly convenient for pet owners to obtain (though obviously one should not consider using medications licensed for human consumption without specific instructions from one's veterinarian). Famotidine is especially useful for pets with chronic vomiting.
Famotidine is currently available in an over-the-counter formulation making it highly convenient for pet owners to obtain (though obviously one should not consider using medications licensed for human consumption without specific instructions from one's veterinarian). Famotidine is especially useful for pets with chronic vomiting.
Famotidine is useful in any situation where stomach irritation is an issue and ulceration is a concern. It is often used in the treatment of Helicobacter infection, inflammatory bowel disease, canine parvovirus, ingestion of a toxin or medication that could be ulcerating (NSAIDs, like Metacam Meloxicam Peroxicam Duramaxx aspirin and others, for example), any disease involving protracted vomiting, or chronically in combination with medications which may have stomach irritating properties.
In diseases involving frequent vomiting or
regurgitation, the esophagus (tube connecting the mouth and stomach) can
be ulcerated by continuing exposure to vomit/stomach acid. Antacids are
also helpful in this type of situation to reduce damage to the
esophagus. Megaesophagus would be a condition where a long-acting antacid such as famotidine could be helpful in mitigating injury to the esophagus.
Side Effects
The H2 blockers as a group have a limited potential for side effects, hence their recent release to over-the-counter status.
The H2 blockers as a group have a limited potential for side effects, hence their recent release to over-the-counter status.
There
have been some reports of exacerbating heart rhythm problems in
patients who already have heart rhythm problems, so it may be prudent to
choose another means of stomach acid control in heart patients.
Interactions With Other Drugs
There
are some drugs that are absorbed better in the presence of stomach acid
(example: itraconazole). The dose of such drugs may require adjustment
in the presence of famotidine.
Concerns and Cautions
The
dose of famotidine may require reduction in patients with liver or
kidney disease as these diseases tend to prolong drug activities.
It appears that famotidine is safe for use in pregnancy but should probably be avoided during lactation.
