QUARTERLY BEAT / APRIL 2022 ///
WEBINAR HIGHLIGHTS
Top 10 Human Medications Poisonous to Dogs and Cats
JUSTINE LEE , DVM, DACVECC, DABT VETgirl Co-Founder
output becomes reduced, and secondary severe hypoperfusion and acute kidney injury (AKI) can potentially develop. 3-5 With ACE-inhibitors, severe overdoses can cause hypotension, dizziness, and weakness.. In general, there is a wider margin of safety with ACE-inhibitors, which are typically considered much safer. Pets ingesting small amounts of ACE-inhibitors can potentially be monitored at home, unless they have underlying disease (e.g., kidney failure, cardiac disease, etc.). With ACE- inhibitors, ingestions > 10-20X a therapeutic dose are generally considered toxic, and can result in severe clinical symptoms (e.g., hypotension). 5 Treatment for any cardiac medication includes decontamination (e.g., emesis induction, gastric lavage, activated charcoal (AC) administration), blood pressure monitoring, aggressive IV fluid therapy if hypotension is detected, and blood work monitoring. With severe toxicosis, the use of high-dose insulin therapy or intravenous lipid emulsion may be warranted as a potential antidote for calcium channel blocker toxicosis. 3 SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRI) Selective serotonin re-uptake inhibitors (SSRIs) are a class of medications that are commonly used in human medicine for depression. Common examples include the following drugs fluoxetine (Prozac® in human beings; Reconcile™ in veterinary medicine), citalopram (Celexa®), paroxetine (Paxil®) and sertraline (Zoloft®). Other similar drugs include selective norepinephrine re-uptake inhibitors (SNRIs), which include common drugs like duloxetine (Cymbalta®), nefazodone (Serzone®), and venlafaxine (Effexor®). SNRI and SSRI drugs result in similar clinical signs of toxicosis, and therefore are treated the same. In veterinary medicine, SSRIs are used for a wide array of behavioral problems, including feline urine spraying, canine separation anxiety, lick granulomas, etc. These SSRI drugs work by blocking the reuptake of serotonin in the pre-synapse, thereby increasing the levels of serotonin in the pre-synaptic membrane. In small animal patients, common clinical signs from SSRIs include the following:
Need a review of poisoning cases in dogs and cats? Missed the last toxicology webinar by Dr. Justine Lee, DACVECC? Get the highlights here on “Top 10 human medications poisonous to dogs and cats,” Dr. Justine Lee, DACVECC, DABT reviews the importance common human medications that dogs - and even cats - ingest! Each year, the ASPCA Animal Poison Control Center (APCC) manages hundreds of thousands of poisoning calls. At the ASPCA APCC, an estimated 50% of pet poisonings comprise human over the counter (OTC) and prescription medications. In the veterinary poisoned patient, the goal of decontamination is to “inhibit or minimize further toxicant absorption and to promote excretion or elimination of the toxicant from the body.” 1,2 When treating the poisoned patient, the clinician should have an understanding of the toxic dose (if available), the pharmacokinetics (including absorption, distribution, metabolism, and excretion), the underlying mechanism of action, and the potential clinical signs that can be observed with the toxicant. 2 This will help determine appropriate decontamination and therapy for the patient. While some of these human medications are VERY common (e.g., antidepressants, amphetamines, acetaminophen), a few are less common but more deadly (e.g., 5-FU, isoniazid). CALCIUM CHANNEL BLOCKERS, BETA- BLOCKERS, ACE-INHIBITORS, STATINS AND DIURETICS Certain cardiac medications include broad categories such as calcium channel blockers (CCB), beta-blockers (BB), and angiotensin-converting enzyme (or “ACE”) inhibitors. These medications are commonly used in both human and veterinary medicine to treat underlying cardiac disease or hypertension. Each category of cardiac medication has different margins of safety. CCB and BB toxicosis should be treated aggressively, as these two categories of medications have a narrow margin of safety. Toxicosis of these agents can result in myocardial failure, severe bradycardia, and hypotension; untreated, cardiac
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