Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog

Abstract

In comparison with other over‐the‐counter anti‐inflammatory drugs, naproxen has a longer half‐life in dogs and can lead to severe morbidity and mortality. This report describes the successful use of membrane‐based therapeutic plasma exchange after a massive ingestion of naproxen by a dog resulting in 86% reduction in plasma concentration.

Outcomes of 434 dogs with non‐steroidal anti‐inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange

“…Ibuprofen has greater potential for morbidity in dogs compared with other NSAIDs, 1 , 12 , 16 , 21 , 29 , 30 while the nonselective nature of naproxen and its long half‐life of 74 hours has been highlighted throughout the literature as a cause for concern. 1 , 14 , 16 , 31 Our study found that ibuprofen toxicosis was associated with the development of more severe clinical signs compared carprofen but not naproxen. Similarly, others have not identified a significant difference between ibuprofen and naproxen toxicosis with regards to the development of AKI or signs of GI disease in dogs undergoing TPE.…”

“…Ibuprofen has greater potential for morbidity in dogs compared with other NSAIDs, 1,12,16,21,29,30 while the nonselective nature of naproxen and its long half-life of 74 hours has been highlighted throughout the literature as a cause for concern. 1,14,16,31 Our study found that ibuprofen toxicosis was associated with the development of more severe clinical signs compared carprofen but not naproxen.…”

“…Over the past 10 years, intravenous administration of lipid emulsion (ILE) has gained popularity as a readily accessible and cost‐effective management strategy for several lipophilic drug intoxications in animals, including NSAIDs 10‐13 . Therapeutic plasma exchange (TPE) has also become more commonly used in the management of NSAID intoxications in dogs 14‐19 . This technique involves the separation of the cellular components of blood from plasma by either centrifugal or membrane‐based TPE, facilitated by either the rotation of a blood chamber or a nonselective membrane filter, respectively 20 .…”

“… 10 , 11 , 12 , 13 Therapeutic plasma exchange (TPE) has also become more commonly used in the management of NSAID intoxications in dogs. 14 , 15 , 16 , 17 , 18 , 19 This technique involves the separation of the cellular components of blood from plasma by either centrifugal or membrane‐based TPE, facilitated by either the rotation of a blood chamber or a nonselective membrane filter, respectively. 20 This technique allows for high amounts of protein‐bound toxins to be removed from the circulation and replaced with donor plasma, preventing potentially life‐threatening consequences associated with NSAID intoxication.…”

Supporting the intoxicated patient: toxicants affecting the gastrointestinal and hepatobiliary systems

“…In severe recent (<12 hours) NSAID intoxications in which renal and central nervous system (CNS)impairment is expected or observed, therapeutic plasma exchange (available at some referral centres) should be considered as early as possible. This has been shown to be effective at reducing the levels of circulating ibuprofen (Walton and others 2017a), meloxicam (Walton and others 2017b), carprofen (Kjaergaard and others 2018) and naproxen (Kicera‐Temple and others 2019), and there is growing support for its use in severe NSAID intoxications (Rosenthal and Labato 2019).…”