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Ask Drhollowayvet Your Own Question
Category: Dog Veterinary
Satisfied Customers: 882
Experience:  Relief Veterinarian at Aloha Animal Hospital
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My dog has Spindle cell sarcoma, stage 3. She's an

Customer Question

My dog has Spindle cell sarcoma, stage 3. She's an Australian Shepherd weighs 42.4 oz, and is 13 years, one week old. She takes gabapentin 400mg 3 x a day, amitryptiline 50 mg, 2 x a day and hydrocodone w/APAP 10-325. she is having surgery to remove the tumour again (amputation at the shoulder was not an option due to her age) on Tuesday and needs to be taken off the Hydrocoone due to the aspirin. But without the combination of pain meds she'll be in too much pain, can you readily suggest an alternative pain med that works with the amitryptilie and Gabopentin?
JA: I'm sorry to hear that. Some lumps are serious and some aren't. Let's see what the Veterinarian has to say. What is the dog's name?
Customer: Patti
JA: Is there anything else the Veterinarian should be aware of about Patti?
Customer: She's in good weight, and healthy except for the cancer
Submitted: 8 months ago.
Category: Dog Veterinary
Expert:  Drhollowayvet replied 8 months ago.

Hello my name is Dr. Holloway but you can call me Dr. H, and I am a licensed veterinarian.

I am sorry to hear that your pet is battling cancer and needs to come off the pain medication that is making her comfortable. I do have some alternative pain management suggestions that are compatible with Gabapentin. The Amitryptilline will not be compatible with any of the other available pain management medication unfortunately, so either its dosage will have to be decreased (to avoid exacerbation of the effects) or it will have to be discontinued.

1) Fentanyl patch- this is a pure opiate and is usually applied to the pets skin several hours before surgery. It's effectiveness is only good for up to 3 days however.

2) Methadone- This is also an opiate used for pain management in dogs. Again Methdone also may exacerbate the effects of Amitryptilline when used in conjunction, so decreasing the dose of Amitrytilline or completely stopping the medication is advised.

This medication is available mostly as an injectable and the oral use has to be strictly monitored due to possible side effects. So if it is to be used Patti would have to be monitored in the hospital leading up to her surgery date.

3) Tramadol- this is also an opiate, it doesn't have nearly as much pain control as the other drugs mentioned. It should not be used along with Amitryptilline due to an increased risk of seizures, so it does appear to be quite a risk when used along with that medication when compared to the others.

So it does seem there are not a great deal of good options for Patti out there. They all come with their own limitations for use.

- Dr. H

Expert:  Drhollowayvet replied 8 months ago.

It is a tough decision. However I did a quick look and found that even Gabapentin and Hydrocodone have precautions for using them conjunctively. So it appears that Patti is already on two medications that don't particularly work well together.

Also you have to keep into consideration that the affects that Amitryptilline has are shared with her pain medications. So the need for Amitryptilline won't be there because she will experience sedative effects of the opiate medication.

Do you have any other questions or concerns for me to address at this time?

- Dr. H