Toxciology Brief: Ibuprofen toxicosis in dogs, cats, and ferrets - Veterinary Medicine
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Toxciology Brief: Ibuprofen toxicosis in dogs, cats, and ferrets


VETERINARY MEDICINE


Treatment

After an acute ibuprofen overdose, rapid and aggressive decontamination, as with most toxicants, is important.2 In clinically normal animals (i.e. those not vomiting or showing neurologic signs), attempt emesis, especially within two hours of the ingestion. In animals exhibiting neurologic signs and not, therefore, candidates for emesis, gastric lavage or enterogastric lavage may be useful. Administer multiple doses of activated charcoal (every six to eight hours for 24 hours) in all affected animals because ibuprofen undergoes enterohepatic recirculation.10,11


Table 2 Drugs Used to Protect the Gastrointestinal Tract in Ibuprofen Toxicosis*
Other treatments should be directed at preventing or treating possible complications of either acute or chronic exposure. For possible gastrointestinal upset and ulceration, use gastrointestinal protectants. For ingestion of low doses of ibuprofen (< 100 mg/kg), over-the-counter liquid antacids containing aluminum or magnesium hydroxide can be used.11 Do not use agents that contain bismuth subsalicylate (such as Pepto-Bismol [Procter & Gamble] and newer formulations of Kaopectate [Pfizer]) because of the possible interaction of salicylates with the ibuprofen. For ingestion of higher doses or when gastrointestinal signs have occurred, a combination therapy of acid reducers (H2-blockers or proton-pump inhibitors), sucralfate (liquid or a slurry of tablets), and misoprostol may be used (Table 2). Continue treatment for seven to 14 days or more, depending on the dose and clinical signs. Control vomiting with an appropriate antiemetic. If gastrointestinal bleeding is severe, transfusions may be necessary. Treat gastrointestinal perforation surgically.10,11

At doses that may cause renal failure, diuresis with intravenous fluids given at twice the daily maintenance rate (120 ml/kg/day) for at least 48 hours is recommended. Obtain baseline blood urea nitrogen, creatinine, and phosphorus concentrations, and recheck them daily. Serial urinalysis can be used to monitor for tubular casts, which may be seen in as little as 18 hours. If renal function test results are normal at 48 hours, reduce fluid therapy to maintenance rates, and then discontinue it in 24 hours if renal values remain normal. If the test results are elevated, continue diuresis until the values normalize or stabilize.10,11

Treat neurologic signs symptomatically. Control seizures with diazepam or barbiturates as needed. Comatose animals need supportive care such as monitoring and maintenance of body temperature and respiratory support if needed.10,11

Conclusion

Ibuprofen ingestion is a common and potentially life-threatening problem in animals. The prognosis depends on the amount ingested, severity of signs, and treatment. Prompt and aggressive decontamination and supportive care are essential to improve the chances of recovery.

"Toxicology Brief" was contributed by Eric Dunayer, MS, VMD, ASPCA Animal Poison Control Center, 1717 S. Philo Road, Suite 36, Urbana, IL 61802. The department editor is Petra A. Volmer, DVM, MS, DABVT, DABT, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802.

REFERENCES

1. Ibuprofen. AHFS Drug Information 2001. American Society of Health-System Pharmacists, Bethesda, Md., 2001; pp 1917-1923.

2. Poortinga, E.W.; Hungerford, L.L.: A case-control study of acute ibuprofen toxicity in dogs. Prev. Vet. Med. 35:115–124; 1998.

3. Kore, A.M.: Toxicology of nonsteroidal antiinflammatory drugs. Vet. Clin. North Am. (Small Anim. Pract.) 20 (2):419–429; 1990.

4. Scherkl, R.; Frey H.H.: Pharmacokinetics of ibuprofen in the dog. J. Vet. Pharmacol. Ther. 10:261–265; 1987.

5. POISINDEX Editorial Staff: Ibuprofen. POISINDEX System, Vol. 119, MICROMEDEX, Englewood, Colo., expires 3/04.

6. Adams, S.S. et al.: Absorption, distribution and toxicity of ibuprofen. Toxicol. Appl. Pharmacol. 15:310–330; 1969.

7. Smith, K.J.; Taylor D.H.: Letter: Another case of gastric perforation associated with administration of ibuprofen in a dog. JAVMA 202 (5):706; 1993.

8. Plumb, D.C.: Glucocorticoid agents, general information. Veterinary Drug Handbook, 4th Ed. Iowa State University Press, Ames, 2002; pp 387-389.

9. Rainsford, K.D.: Gastrointestinal damage from nonsteroidal anti-inflammatory drugs. Toxicol. Pathol. 16 (2):251–259; 1988.

10. Richardson, J.A.: Management of acetaminophen and ibuprofen toxicosis in dogs and cats. J. Vet. Emerg. Crit. Care 10 (4):285–291; 2000.

11. Villar, D. et al.: Ibuprofen, aspirin and acetaminophen toxicosis and treatment in dogs and cats. Vet. Hum. Toxicol. 40 (3):156–161; 1998.

12. Brown, S.A.: Ferrets: Basic anatomy, physiology and husbandry. Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery (E.V. Hillyer; K.E. Quesenberry, eds.). W.B. Saunders, Philadelphia, Pa., 1997; pp 3-13.

13. Richardson, J.A.; Balabuszko, R.A.: Ibuprofen ingestion in ferrets: 43 cases (January 1996–March 2000). J. Vet. Emerg. Crit. Care 11 (1):53–59; 2001.


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