Accidental Drug Toxicity-A cautionary tale

[Blackdawgs]

I have a 14 year old dog who is in stage 3 renal failure. Overall, she seemed to becoming slowly, but progressively weaker and ataxic, which I had assumed was due to aging and disease progression. This past week was particularly bad and stabbing at straws, I emailed her internist and asked if this could be due to the medication. The vet did not think so but told me to stop the anti-hypertensives anyway and then I emailed her a second time and asked if this could be due to the gabapentin. In the meantime, the dog was loosing her appetite and had vomited. So, I took her to the vet and we drew blood, gave her fluids, etc and I spent 24 hours fearing the worse that my dog's labs would be awful.

 

My dog improved greatly over the next 36 hours (missed drug doses due to vomiting) and it turned out that her labs were essentially unchanged since July and those were essentially unchanged since March.

 

My dog was having drug reactions.

 

Gabapentin is predominately eliminated thru the kidneys and in human medicine the dose needs to be adjusted based on something called the glomerular filtration rate. My dog has been on gabapentin for years and when she was diagnosed with kidney disease in March, I asked my vet about reducing the dose. She bounced the question to someone else and received bad information, so the dose was not decreased like it should have been. Hence the weakness and ataxia.

 

The loss of appetite, perhaps some of the weakness, and probably the extreme itchiness (which I thought was allergies) was probably from one of the anti-hypertensives. In this instance, the internist did everything correctly, slowly increasing the dose over many weeks and titering to blood pressure.

 

It was really a pharmacologic perfect storm.

 

Accidental drug toxicity is very very VERY common in human elderly. Old people just do not handle drugs as well as young people and they often take many drugs at once thus compounding the problem. Our dogs are probably the same.

 

If your dog's condition declines or it develops other symptoms, look at the drugs!!

 

Of course don't stop anything without speaking with your vet, but always consider the possibility of accidental drug toxicity.

[GentleLake]

Good for you for being observant, thoughtful and persistent. You may just have extended your dog's life, or at the very least made it much more comfortable for her.

[Cody & Duchess]

My border diagnosed with lung cancer in March..given two months to live. At the end of August he stopped eating, then vomited for about twelve hours. From March to mid August he took his drugs willingly...piroxicam,hydrocodone/homatropine, ciprofloxacin. The last two weeks in August he actually clutched his teeth closed.I took him off all meds because I did not want his last days to be me shoving pills down his throat. It took two days before he slowly started eating again. Now he eats two hearty meals a day. I want a good quality of life for him...especially since it is short. I assume he was just trying to tell me in August that his body just was not tolerating the drugs anymore. I think the above reference to drugs and the elderly is spot on. I am just glad that he is back to eating.