Editor’s note: In light of a report issued Friday (April 17) by the U.S. Food and Drug Administration, we’re republishing this column from Dr. Barchas on the danger of topical pain-relief creams to cats. The FDA alert came in response to two cats who experienced kidney failure yet survived after veterinary care, as well as three cats who died. All were exposed to pain killers in topical creams that the owners applied to themselves, not directly to the cats.
Humans have been poorly engineered by nature. Virtually everyone experiences back pain at some point. Our joints are prone to arthritis as we get older. Aches and pains are a part of life for many people.
Naturally, therefore, an industry has developed to treat those aches and pains. Big Pharma has been all over this for many decades, focusing largely on oral medications that relieve pain. Such medications include oral non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, combination products like Norco (formerly known as Vicodin), and medications such as gabapentin that affect the way nerves transmit pain.
But a lot of people rightly feel that these oral medications are overkill. If you have an ache in one finger, why medicate your entire body? And many people don’t like the side effects of NSAIDs (especially gastrointestinal upset) or narcotics (such as sedation, disorientation, and compromised motor skills). Other people like the side effects of narcotics too much — these drugs have significant abuse and addiction potential.
Therefore, over the years another cottage pain control industry has developed. I’m talking about pain creams. These products come in several varieties. Commercially available products such as Aspercreme and Ben Gay have been around for ages. They contain derivatives of aspirin.
Recently, however, there has been an explosion of new pain creams. Many doctors and pharmacies are now working together to create proprietary products. These products are called compounded pain creams.
Patients like pain creams because they seem less drastic than oral medications. In fact, to many people the creams don’t seem like medicine at all. But make no mistake: Many of the creams contain very powerful medicine indeed.
According to a recent letter from the ASPCA Animal Poison Control Center to the Journal of the American Veterinary Association, “[T]hese products may contain a variety of pain medications and anti-inflammatory agents as well as muscle relaxants, antiviral, anti-scarring, and anti fungal agents; and local anesthetics.”
It is the anti-inflammatory agents that appear to be causing the most trouble for cats. In particular, a non-steroidal anti-inflammatory drug (NSAID) called flurbiprofen is common in compounded pain creams. And, you guessed it: Flurbiprofen is markedly toxic to cats.
Cats, in general, are especially susceptible to the adverse and toxic effects of NSAIDs. I only very rarely recommend or use drugs in this class in cats. And flurbiprofen is in no way safe for cats, even in minute quantities.
That is where compounded pain creams cause trouble for cats. The authors of the letter discussed seven cases of feline exposure to creams containing flurbiprofen. The routes of exposure varied — some cats licked their owners’ skin after the product had been applied. Others appeared to be exposed through prolonged skin-to-skin contact, or by having been pet by owners who had recently applied the cream to their hands. One cat was exposed after a small drop of the owner’s pain cream accidentally fell on its tail. The owner in the last case immediately cleaned the tail, to no avail.
All seven cats became ill, and three of them are known to have died. Symptoms in the affected cats included severe gastrointestinal distress, anemia, kidney failure, and lethargy. Only two of the cats are known to have survived (with aggressive treatment). The remaining two were lost to follow-up, and their outcomes are not known.
The letter to JAVMA pointed out that in most cases the owners of the cats did not realize the dangers that the pain creams posed to their pets. I would wager that most people who use these creams are similarly unaware of the risks.
Remember that pain creams are real medicines, and they can be very dangerous to pets. Although I don’t recommend that cats have access to owners who have used commercial products, remember that pain creams of the compounded variety are the most dangerous. If you own cats and have pain creams in your house, I recommend that you dispose of the creams. This is especially important if any of the creams contains flurbiprofen.
The letter referenced in this article is J Am Vet Med Assoc. 2015 Jan 15;246(2):182 by Charlotte Means, DVM and Irina Meadows, DVM
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