NOT ONE MORE...

So it happened this week, another dog, a 6 year old, 5 pound miniature poodle who was administered the cocktail of gabapentin + methadone ....

The small dog, with no previous medical problems, collapsed on the floor, hitting his head, going limp with his tongue turning blue. The pet parents were able to blow air into his nose and do chest compressions and get him to a nearby ER. He began regaining consciousness on the way to the emergency vet clinic. Once at the clinic, he was administered gabapentin + methadone BEFORE any diagnosis or cause of the collapse was determined.

The questions I have as a doctor of veterinary medicine are:

• why would 2 drugs that are known central nervous system depressants, and known to cause bradycardia and respiratory depression, be administered to a dog shortly after it collapsed with a possible cardiovascular event?

• What amount of pain justifies the administration of a high-potency, long-acting opioid like methadone to a small dog?

• Are the staff members at hospitals using these medications trained to monitor for potential opioid overdose and synergistic effects of multi-drug administration?

• Do they have the reversal agent Narcan on hand and do they know it must be regularly re-administered, especially with a drug like methadone?

Who is coming up with these protocols and to what end?

Who is telling veterinarians to use these meds?

I have already had two patients die from overdoses and now multiple patients coming to me having received this cocktail.

The other disturbing issue is that once they are on these drugs they have altered mental status, many are ataxic, and it becomes difficult to tell what symptoms are from the medications and what are from the animals underlying medical condition.

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Please, if you are a veterinarian or technician or in a regulatory position, let’s open up this discussion and examine it. I personally do not want to see one more animal die from the medication administered under the care of a veterinarian.

References:

Adverse outcomes associated with concurrent gabapentin, opioid, and benzodiazepine utilization: A nested case-control study

FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR)