Updated NSAID Protocols for 2026: What's Changed

The landscape of veterinary NSAID therapy continues to evolve. Recent pharmacovigilance data and new research have led to updated recommendations for NSAID use in companion animals.

Key Changes for 2026

1. Shorter Duration Protocols
New evidence supports shorter treatment courses for post-operative pain. Studies show that 3-5 days of NSAID therapy provides equivalent analgesia to 7-14 day courses for most orthopedic procedures.

### 2. Renal Monitoring Updates
The International Renal Interest Society (IRIS) has updated recommendations:

Baseline SDMA and creatinine before initiating NSAID therapy
- Recheck renal values at 2 weeks, then every 3 months for chronic therapy
- SDMA >15 μg/dL warrants caution; >25 μg/dL is a relative contraindication

### 3. Hepatopathy Awareness
New data on idiosyncratic hepatotoxicity:
- Terrier breeds may be at increased risk
- LFT monitoring recommended at 2, 4, and 8 weeks after initiation
- Any elevation >3x baseline warrants discontinuation

## Practical Recommendations

### For Acute Pain (Post-Operative)
- First choice: Meloxicam 0.2 mg/kg SC day 1, then 0.1 mg/kg PO SID × 3-5 days
- Alternative: Carprofen 4 mg/kg PO SID × 3-5 days

### For Chronic Pain (Osteoarthritis)
- First choice: Grapiprant 2 mg/kg PO SID (non-COX inhibitor, safer GI profile)
- Alternative: Meloxicam 0.05 mg/kg PO SID (lowest effective dose)
- Consider: Monthly frunevetmab injection for cats

## Bottom Line

NSAIDs remain the cornerstone of veterinary analgesia, but shorter courses, careful monitoring, and newer agents like grapiprant offer improved safety profiles.