Selected Analgesics for Use in Dogs
Selected Analgesics for Use in Dogs
Drug | Class | Pain category | Intermittent dosage regimen | Epidural dosage | CRIa dosage regimen | Comments |
|---|---|---|---|---|---|---|
Alfentanil | Opioid | Acute | NA—very short acting | NA—very short acting | 0.5–1 mcg/kg IV followed by 0.5–1 mcg/kg/minute IV CRI | DEA Schedule II. Short acting opioid given by CRI to achieve effect. |
Bupivacaine | Local anesthetic | Acute | Injectable solution: 1–2 mg/kg locally (not IV); liposomal injectable product: 5.3 mg/kg infiltrated into the surgical site at closure | Preservative-free injectable 0.5% solution: 1–2 mg/kg | Not for IV use | Not for IV use. Systemic administration has resulted in severe cardiac and CNS toxicity including death. Products combined with epinephrine will prolong the duration of local effect and reduce the likelihood of systemic toxicity. |
Buprenorphine | Opioid partial antagonist/agonist | Acute | Injectable 0.03% solution: 0.005–0.03 mg/kg) IV or IM q 4–6 h; 0.12 mg/kg transmucosal q 4–8 h | 0.004 mg/kg | Injectable 0.03% solution: 0.005–0.01 mg/kg), followed by 0.002–0.004 mg/kg/h IV CRI | DEA Schedule III. Long-acting concentrated 1.8 mg/ml injection is not typically used in dogs. |
Butorphanol | Opioid partial antagonist/agonist | Acute | 0.2–0.4 mg/kg IV, IM, SC q 1–2 h | 0.25 mg/kg | 0.2 mg/kg IV as a loading dose followed by 0.1–0.24 mg/kg/h IV CRI | DEA Schedule IV. Dosages are reduced in dogs with the ABCB1-1Delta genetic mutation. |
Carprofen | NSAID | Acute/chronic | 4.4 mg/kg/day (may be divided q 12 h) PO, SC, IV | Not for epidural use | Not for CRI | Monitor hepatic enzymes to detect idiosyncratic hepatotoxicity |
Deracoxib | NSAID | Acute/chronic | Postoperative analgesia: 3–4 mg/kg PO once daily as needed, not to exceed 7 days; chronic pain: 1–2 mg/kg PO once daily as needed | Not for epidural use | Not for CRI | Do not confuse higher short-term postoperative dosage with lower chronic dosage. |
Dexmedetomidine | Alpha-2 adrenergic receptor agonist | Acute | 0.005–0.02 mg/kg IV, IM, SC for short, painful procedures | 0.003–0.006 mg/kg | 0.001–0.002 mg/kg followed by 0.0007–0.001 mg/kg/h IV CRI | Transmucosal dexmedetomidine is not typically used for analgesia in dogs. |
Fentanyl | Opioid | Acute | Transdermal patch: 0.001–0.005 mg/kg/h rounded to the nearest 12.5 mcg, 25 mcg, 50 mcg, 75 mcg, or 100 mcg patch | 0.004 mg/kg, diluted with 0.2 mL preservative-free normal saline | 0.01 mg/kg IV loading dose, followed by 0.01 mg/kg/h IV CRI | DEA Schedule II. Note delayed onset of analgesia (12–24 h) limits utility as an initial monotherapy for acute pain. |
Firocoxib | NSAID | Acute/chronic | 5 mg/kg PO q 24 h | Not for epidural use | Not for IV use | Firocoxib injection is approved for horses and typically not used in dogs. |
Gabapentin | GABAb receptor agonist | Chronic | 10–15 mg/kg PO q 8 h | Not for epidural use | Not for IV use | Gabapentin is a reportable controlled substance in some states in the US. |
Hydromorphone | Opioid | Acute | 0.05–0.2 mg/kg IV, IM, or SC every 2–4 hours | 0.03–0.04 mg/kg | 0.025–0.05 mg/kg IV followed by 0.03 mg/kg/h IV CRI | DEA Schedule II. |
Ketamine | NMDAc receptor antagonist | Acute | 3–5 mg/kg IV as a perioperative analgesic adjunctive therapy | Not recommended | 0.5–1 mg/kg IV followed by 0.12–0.6 mg/kg/h IV CRI | DEA Schedule III. Ketamine may be neurotoxic when administered by the epidural or intrathecal route. |
Lidocaine | Local anesthetic | Acute | 4–6 mg/kg local infiltration | Preservative free: 4.4 mg/kg | 1–2 mg/kg IV followed by 20–50 mcg/kg/minute IV CRI | |
Maropitant | NK-1d receptor antagonist | Acute | 1 mg/kg SC, IV | Not for epidural use | 1 mg/kg IV over 1–2 minutes followed by 0.03 mg/kg/h IV CRI | Rapid injection of maropitant by the intravenous route may cause severe hypotension. Refrigerating the injection may reduce the pain associated with SC injection. |
Meloxicam | NSAID | Acute/chronic | 0.2 mg/kg PO, IV, or SC followed by 0.1 mg/kg PO q 24 h | Not for epidural use | Not for CRI | |
Meperidine | Opioid | Acute | 3–5 mg/kg IM, SC q 1–2 h | Not for epidural use | Not for IV use | DEA Schedule II. Also known as pethidine. Do not administer IV due to histamine release. May be painful on IM or SC injection. |
Mepivacaine | Local anesthetic | Acute | 1–5 mg/kg local infiltration | 3–4.5 mg/kg | Not for IV use | Not for IV use. Systemic administration has resulted in severe cardiac and CNS toxicity including death. |
Methadone | Opioid | Acute | 0.1–1 mg/kg IM, SC, IV q 4–8 h | 0.1 mg/kg | 0.1–0.2 mg/kg IV followed by 0.12 mg/kg/h IV CRI | DEA Schedule II. Oral bioavailability is limited in dogs. |
Morphine | Opioid | Acute | 0.5–1 mg/kg IM, SC, or IV (slowly) | Preservative free: 0.1 mg/kg | 0.3–0.5 mg/kg IV (slowly) followed by 0.1–1 mg/kg/h IV CRI. | DEA Schedule II. Rapid IV administration causes CNS excitation. |
Oxymorphone | Opioid | Acute | 0.05–0.2 mg/kg IV, IM, SC q 1–6 h | Preservative free: 0.05–0.1 mg/kg | 0.02–0.1 mg/kg followed by 0.01–0.02 mg/kg/h IV CRI e,f | No longer commercially available in the US. |
Prednisone/Prednisolone | Corticosteroid | Chronic | 0.5–1 mg/kg PO q 24 h | Not for epidural use | Not for IV use | Do not use concurrently with NSAIDs. |
Pregabalin | GABA receptor agonist | Chronic | 2–5 mg/kg PO q 8–12 h | Not for epidural use | Not for IV use | DEA Schedule IV. |
Remifentanil | Opioid | Acute | NA due to extremely short duration of action. | NA due to extremely short duration of action. | 1 mcg/kg IV followed by 0.1–0.3 mcg/kg/minute IV CRI. | DEA Schedule II. |
Robenacoxib | NSAID | Acute/chronic | 2 mg/kg SC for up to 3 days; 1 mg/kg PO q 24 h | Not for epidural use | Not for IV use | |
Ropivacaine | Local anesthetic | Acute | 2 mg/kg as a local infiltration | 0.2–1.65 mg/kg | Not for IV use | Not for IV use. Systemic administration has resulted in severe cardiac and CNS toxicity including death. |
Sufentanil | Opioid | Acute | 0.5–1 mcg/kg | 0.5–1 mcg/kg slow IV followed by 0.5–1 mcg/kg/h IV CRI | DEA Schedule II. | |
Tramadol | Synthetic opioid | Acute/chronic | 4–10 mg/kg PO q 6–8 | Not for epidural use | Not for IV use | DEA Schedule IV. |
Xylazineg | Alpha-2 adrenergic receptor agonist | Acute | 0.05–0.5 mg/kg IV, IM, or SC as an adjunctive therapy. | Not for epidural monotherapy | Not for use as CRI | Not suitable for analgesic monotherapy. |
a CRI=constant-rate infusion. b GABA=gamma-aminobutyric acid. c NMDA=N-methyl-D-aspartate. d NK-1=neurokinin-1 eMathews KA. Small animal practice update on management of pain. Vet Clin North Am. 2008;38(6):1435. fSmith LJ, Yu JK, Bjorling DE, Waller K. Effects of hydromorphone or oxymorphone, with or without acepromazine, on preanesthetic sedation, physiologic values, and histamine release in dogs. J Am Vet Med Assoc. 2001;218(7):1101-1105. gHerrera Becerra JR, Monteiro ER , Martins LGB, Baier ME, Santos EA, Bianchi SP. Epidural administration of combinations of ropivacaine, morphine and xylazine in bitches undergoing total unilateral mastectomy: a randomized clinical trial. Vet Anesth Analg. 2022;49(1):126-134. | ||||||