NSAIDs in Older Dogs: Benefits, Risks, and the Monitoring Question
Anti-inflammatories help many arthritic dogs, and carry real risks. What the FDA and the evidence say, the warning signs, and what to ask about blood tests.
Written by thecanineledger
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If your dog is on an anti-inflammatory and has vomiting, diarrhoea, black or bloody stools, stops eating, becomes lethargic, or has yellow gums or eyes, stop the medicine and call your vet. That is the US Food and Drug Administration’s advice (FDA, Get the Facts about Pain Relievers for Pets).
“FDA-approved nonsteroidal anti-inflammatory drugs offer pain relief for many dogs with osteoarthritis.” The FDA says so in the same breath as a warning: “Yet, there are risks.”
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common medicines for arthritis pain in dogs. While the risks are real, the evidence suggests serious problems are uncommon, and there are practical steps that reduce them. This page sets out both sides, and the questions to ask your vet.
1. What NSAIDs do
NSAIDs reduce pain and inflammation by blocking substances called prostaglandins. But prostaglandins also do useful work. The FDA explains that they help protect the lining of the stomach and gut, and keep blood flowing to the kidneys when blood flow is low.
That’s why the side effects, in the FDA’s words, “are mainly seen in the digestive tract, kidneys, and liver.”
2. The risks
The FDA lists the most common side effects reported in dogs and cats: vomiting, eating less or not at all, lower activity, and diarrhoea. More serious ones include “ulcers in the stomach and intestines, perforations (holes) in the stomach and intestines, kidney failure, liver failure, and even death in some cases.”
Older dogs need extra care. The FDA notes that dogs with arthritis “are usually older and may have another disease in addition to osteoarthritis, such as kidney or liver disease.”
3. How common are problems?
That’s harder to answer than it sounds.
The American Animal Hospital Association’s 2022 pain guidelines say that while kidney, liver and gut problems can occur, “the true incidence is likely low (and unknown).” They add that “Studies of long-term use of NSAIDs in dogs do not show increased organ-based toxicity with longer treatment but do show a positive trend toward increased efficacy” (AAHA, Pharmacological Agents in the Treatment of Chronic Pain).
A 2013 systematic review of 64 studies found that in randomised, placebo-controlled, blinded studies, “the incidence of adverse effects was not statistically different between treated and control dogs” (Monteiro-Steagall et al., J Vet Intern Med 2013). But it warned that most studies “involved a healthy nongeriatric population of research dogs.” In other words, the studies mostly weren’t of the older, sicker dogs who take these drugs for years.
Our note: The 2013 review is old. We didn’t find a newer systematic review of NSAID safety in older dogs.
4. Lowering the risk
The FDA’s advice to owners, in short:
- Tell your vet about your dog’s history, especially any past stomach or gut problems. The FDA notes dogs can have ulcers “without showing signs.”
- Tell your vet about every other medicine. “Two different NSAIDs, or an NSAID and a steroid, should not be given at the same time.”
- Never give a human painkiller. → Ibuprofen, Paracetamol and Other Human Painkillers
- Ask for the Client Information Sheet. Every oral NSAID approved for dogs in the US comes with one. The FDA says “You should ask for this sheet if you aren’t given one.”
- Watch for side effects, during treatment and “for a little while after” it stops.
5. The monitoring question
Before long-term treatment, the FDA says to “ask your veterinarian about performing baseline blood tests.” It also says to “Talk to your veterinarian about how often to recheck your dog’s blood tests.”
The FDA doesn’t say how often. We found no single agreed schedule in the sources we read. Your vet will weigh your dog’s age, other illnesses and other medicines.
Questions to ask:
- Does my dog need blood tests before starting?
- How often should we recheck them, and what are we looking for?
- What should make me stop the medicine and call you?
- If my dog has kidney or liver disease, is an NSAID still an option?
- What are the alternatives? → Arthritis Treatment: What Works, From Weight to Medication
Our note: Many practices recheck blood every few months on long-term NSAIDs. We haven’t found a guideline that sets a schedule.
Our note: What owners receive with an NSAID, and which NSAIDs are approved for long-term use, differ by country.
6. What we could not verify
| Commonly said | What we found |
|---|---|
| “NSAIDs always damage the kidneys over time” | Not shown in long-term studies, AAHA says; problems can still occur. |
| “NSAIDs are completely safe for older dogs” | No. The FDA lists serious risks, and older dogs may have more risk factors. |
| “Blood tests every three months are required” | We found no source setting a schedule. Ask your vet. |
Sources
- US Food and Drug Administration: Get the Facts about Pain Relievers for Pets (government regulator; content current as of 29 September 2022; read)
- American Animal Hospital Association: 2022 Pain Management Guidelines: Pharmacological Agents in the Treatment of Chronic Pain (professional body guidelines; industry-funded; read)
- Monteiro-Steagall BP, Steagall PV, Lascelles BD. Systematic review of nonsteroidal anti-inflammatory drug-induced adverse effects in dogs (J Vet Intern Med 2013; systematic review; abstract read)
Always confirm with your vet before acting on anything on this page.