(for veterinary information only)

BRAND NAME: DERAMAXX

AVAILABLE IN
25 mg and 100 mg
CHEWABLES   

BACKGROUND

Deracoxib is a member of the class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), the same class as such common over-the-counter remedies as Advil (Ibuprofen), Aleve (Naproxen), Orudis (ketoprofen), and Aspirin.  The chief use for such drugs in the dog has been pain relief, usually joint pain or post-surgical pain relief.

The problem with this class of drugs has been unacceptable (even life-threatening) side effects. Problems have in the past been related to:

• Stomach ulceration - even perforation and rupture of the stomach can occur. This is not only painful but life-threatening.
   
• Platelet deactivation - platelets are the cells controlling the ability to clot blood and, as a general rule, it is preferable not to promote bleeding. We would prefer platelets to remain active and able to function should we need them.
   
• Decreased blood supply to the kidney - this could tip a borderline patient in to kidney failure.

The veterinary profession has been in need of an NSAID that could effectively relieve pain without the above risks.  The key appears to lie with the enzyme responsible for many inflammatory mediators, cyclo-oxygenase-2 (or COX–2). A different but related enzyme, cyclo-oxygenase-1 (COX-1), is responsible for producing important biochemicals needed to maintain normal blood supply to the kidneys and GI tract. It had been previously impossible to inhibit cyclo-oxygenase-2 without also inhibiting cyclo-oxygenase-1, hence the side effects of previous NSAIDS.

In 1997, Pfizer Animal Health released carprofen for dogs in the U.S. as the answer to this need. Carprofen is what is called a selective cyclo-oxygenase-2 inhibitor. Carprofen does inhibit cyclo-oxygenase-1 slightly but, for the first time, it became possible to exert a different effect on each of these two enzymes.

Deracoxib represents the latest generation in the search for a pain reliever with minimal side effects. The Coxib class of NSAIDs inhibits COX-2 with no inhibition at all of COX-1. Deracoxib, produced by Novartis Animal Health, is the first coxib class NSAID for animals, hoping to follow the wide success of Celecoxib (Celebrex®) and rofecoxib (Vioxx®). The human drugs are not very useful for dogs as metabolism is not predictable among individuals. Deracoxib has a predictable duration of action and dose response in dogs.

HOW THIS MEDICATION IS USED

At first deracoxib was approved only for post-operative pain relief but won a chronic use approval in early 2003. For best pain relief after a surgical procedure, it is best to begin deracoxib at least 2 hours prior to surgery (as a general rule it is always easier to prevent pain than to relieve existing pain). A slightly lower dose is used when the drug is intended for long term use (as in gthe treatment of arthritis).

Since deracoxib is not recommended for patients with pre-existing kidney disease or liver disease, a screening blood panel is recommended before long term use of this medication is attempted.

INTERACTIONS WITH OTHER DRUGS

NSAID drugs are best not combined with one another and it is also best to avoid using NSAIDs in combination with corticosteroids such as prednisone, dexamethasone etc.

SIDE EFFECTS

In a study of 207 dogs, half received deracoxib and half received placebo. The incidence of vomiting after orthopedic surgery was approximately 10% in the deracoxib group and 6% in the placebo group. Similar results were obtained for incisional oozing.

Deracoxib is a member of a class of drugs called “sulfonamides” which means it contains a chemical group containing sulfur.  Often these medications are called “sulfa drugs.” Antibiotics of the sulfa class (deracoxib is not an antibiotic) have been associated with some specific drug reactions (for more information see the section on trimethoprim sulfa). If a patient is known to have reactions against another sulfa drug, it is best to choose an NSAID other than deracoxib.

CONCERNS AND CAUTIONS

• The COX-2 enzyme has beneficial circulatory effects in the kidney. When COX-2 is inhibited, these effects are suppressed. This is not a problem in a normal kidney; however, if the kidney function is abnormal to start with, further kidney damage might results.
   
• Deracoxib should not be used in patients sensitive to sulfa-containing drugs.
   
• For this same concern over kidney function, NSAIDs are best avoided in conditions that involve significant circulatory disruptions (after a surgery where there has been more bleeding than expected or an anesthesia that has been longer than expected.)
   
• It is best not to use NSAIDs in the face of known liver disease as animals with liver disease do not remove drugs from their bodies normally. Deracoxib is normally removed by the liver and, in the event of liver disease, deracoxib removal would not occur at a normal rate.
   
• Deracoxib cannot be safely used in the cat.
   
• Deracoxib is currently approved by the FDA for use in dogs weighing greater than 4 lbs only.
   

Page last updated: 4/2/03