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Dr. Z.
Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 5684
Experience:  Over 25 years of experience in caring for dogs and cats.
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Hi! My cancer sick dog is currently on Tramadol (3 times per

Customer Question

Hi!
My cancer sick dog is currently on Tramadol (3 times per day) as well as Clavamox for urinary tract infection. He also has Denamarin to support his liver due to the cancer (Nerve sheath tumor grade 3) : 2 in the morning. I have started going down a little bit on dosage of Tramadol since he's not sleeping at night, panting, being restless. Still eats but drinks more. Question: interaction between Tramadol, Clavamox, Denamarin? Today he's running a very small fever, not so before. He started Clavamox 3 days ago (had very dark brown urine and licks himself after each pee, urine is clear now though). THANKS! Susanne
Submitted: 7 months ago.
Category: Dog
Expert:  Dr. Z. replied 7 months ago.
Hello and thanks for trusting me to help you and Melker today. I'm a veterinarian with over 25 years experience and would be happy to work with you but need a bit more information in order to assist you better if you don't mind.

How long has Melker been on the Tramadol? Did you start it with the Clavamox or were you using it before?

When did the panting and restlessness start in relation to the urinary tract infection and the addition of the meds? Meaning, was he fine before the meds or was he restless before?

How high was the fever?

How have his stools been? Formed? Loose?

Thanks and I will respond further after you reply. There may be a slight delay while I formulate and type a thorough response.

Customer: replied 7 months ago.

Hello,


Melker has been on trmadol since August 10. We started with one tablet in the morning and went up to two tablets after a few days. Since 5-6 days he gets three tablets per day. The Clavamox was started this weekend after we discovered dark brown urine, ie August 25 (one tablet in the morning and one in the evening). WE think that the panting and anxiety started on teh noght of the 23rd or 24th of August, just before we started him on Clavamox. His temperature is at 102,5 today August 28, was 101,8 yesterday August 27 and normal the day before that, August 26. His stools are formed and seem normal in color and consistency. Melker also has severe arthritis in the same should he has the cancer tumor so h'es limping badly. Tumor was removed July 5th and has come back to same size two weeks ago. I hope this helps! THANKS!

Expert:  Dr. Z. replied 7 months ago.
Thank you for the prompt reply.

I would not be so worried about an interaction between any of the three drugs (clavamox, tramadol and denmarin) as all can safely be used together. However, the clavamox or the tramadol can have adverse effects at times on any given dog and certainly with the tramadol, it can be dose dependent. Tramadol can also cause a sense of dysphoria in some pets which is usually manifest is restlessness and seeming somewhat disoriented, but this is a bigger problem in cats than dogs. Clavamox can lead to GI upset in some pets which can cause panting and restlessness, but if he is eating and has normal stools, I doubt that is happening.

So the question is why is he panting and restless, especially at night. I would most highly consider discomfort as the cause and it could possibly be from the UTI (but should be better now) or the cancer plus/minus his arthritis. It sounds like a fast growing tumor and these can be painful so coupled with the pain of his arthritis, it may not be very well controlled with just the tramadol. The same holds true for his temperature. Even though 102.5 is still in the normal range, his increase may have been related to pain and inflammation.

Tramadol by itself is not the most effective pain control medication and you may need to get another medication on board as well. The concept of multi modal therapy (combining drugs) is very effective and if the Tramadol alone is not enough, adding another drug to the regime may be beneficial. This not only incorporates attacking the pain by a different mechanism of action, but the sometimes synergistic effect of the two drugs together allows you the keep the doses of both down, avoiding potential side effects. Two of the oral drugs I keep in mind to add for pain are a non-steroidal anti-inflammatory (like Rimadyl) and Gabapentin. Your vet will know if either is an appropriate choice for your dog if you need to provide extra pain relief now or on a more chronic level in the future. I would start there and see if the restlessness improves.

I hope this is helpful. My goal is to provide you with excellent service – if you feel you have received anything less, please reply back as I am happy to address follow-up questions. Kindly rate me when you are done. Thank you for allowing me to assist you.

Dr Z

Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 5684
Experience: Over 25 years of experience in caring for dogs and cats.
Dr. Z. and 3 other Dog Specialists are ready to help you
Expert:  Dr. Z. replied 7 months ago.
Thank you kindly for the positive rating. It is truly appreciated.

Good luck with Melker and please let me know if any other questions or concerns come up.

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