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| FOCUS ON PHARMACOLOGY Feline ChroniC Pain ManageMent: reCoMMended drug doses Drug Formulation/Class Dose OPIOIDS Buprenorphine Injectable solution (0.3 mg/mL) ��� Transmucosal: Using the injectable formulation (0.3 mg/mL), administer 0.01���0.03 mg/kg, which equates to 0.033���0.1 mL/kg, Q 6���8 H Tramadol Tablets, oral compounded liquid ��� Startingdose:2mg/kgPOQ12Hcommonlyused ��� Doserange:1���4mg/kgPOQ8���12H Meloxicam* Oral suspension (0.5 mg/mL) ��� ISFM/AAFPGuidelines:Initialdose,0.1mg/kgPO;then0.05mg/ kgPOQ24H ��� Alternativelong-termdosing:0.05mg/kgEODor0.025mg/kgQ24H Robenacoxib��� Tablets ���1mg/kgPOQ24Hforupto3days�� NSAIDS ADjuNcT MeDIcATIONS Amantadine Antiviral drug ���3���5mg/kgPOQ24H Amitriptyline Tricyclic antidepressant ���0.5���2mg/kgPOQ24H Gabapentin Anticonvulsant ���5���10mg/kgPOQ8���12H Prednisolone Glucocorticoid ���0.5���1mg/kgPOQ24H *Use of meloxicam oral suspension in cats is extra-label; ���Approved for short-term use in cats ��� 5.5 lb (2.5 kg) and ��� 6 months of age; ��ISFM/AAFP Guidelines recommend administration up to 6 days Althoughoverdosesmayproducesedationand/orvomiting, life-threatening acute overdose is rare. If respiratory depression occurs, higher than normal doses of naloxone may be required for reversal (based on human studies), due to buprenorphine���s high affinity for mureceptors.5,6 Duetotramadol���sserotonin���norepinephrinereuptake inhibitormechanism,itmaytakeupto14daystoreach maximumanalgesiceffect.9 Compounding tramadol in a flavoredoralsuspension(1)improvestramadol���spalatability,therebyincreasingcomplianceand(2)provides more accurate dosing. Cautions. Cats should be monitored for efficacy and Tramadol adverse effects during tramadol therapy. Tramadol hydrochloride, a synthetic opioid, is approved ���Euphoria, dysphoria, and mydriasis, typical signs for use in humans and is being used more frequently in associated with opioid use in cats, have been reportveterinarymedicine.Althoughnotcurrentlyclassifiedas ed following tramadol administration in cats. acontrolledsubstancebytheDEA,tramadolisclassified ���Signs of overdose include mydriasis, hypersalivaas a Schedule IV substance in some states and is reporttion,tachycardia,agitation,lethargyandataxia.3 able under state prescription drug monitoring programs. It is not approved for use in companion animals. Mechanism of Action. This centrally acting medication Tramadol: Further Studies Needed isbelievedto(1)bindmu-opioidreceptorsand(2)weakly Although pharmacokinetics of tramadol have inhibitserotoninandnorepinephrinereuptake.Boththe been studied in cats,10 clinical studies determining efficacy and appropriate long-term dosing parent compound and its primary metabolite, O-desmethare lacking. yl-tramadol(M1)areactive,andM1is200��moreeffective ��� Oneacutepainstudyincatsevaluatedtramaat mu-opioid binding.7 Cats have a lower M1 formation rate dol (2 mg/kg SC 1 H prior to surgery; then Q than dogs, but the lower metabolic clearance of tramadol 8 H for 72 H post surgery) alone and in comin cats results in higher M1 concentrations.8 bination with vedaprofen for the treatment of Administration. For treating feline chronic pain: ovariohysterectomy pain. ���Dose recommendations range from 1 to 4 mg/kg ��� Tramadolalonereducedpainwhencompared PO Q 8 to 12 H. to placebo, but tramadol and vedaprofen com��� 2 mg/kg PO Q 12 H is commonly used as a starting bined produced better analgesia than either dose.3 drug alone.8 ���Based on cat���s response to initial dose, dose/frequency will need to be evaluated. 78 Today���s Veterinary Practice November/December 2012