NSAID Toxicity in Cats

Ingestion of over-the-counter human medications is the top reason for pet poison calls for the fourth year in a row, according to the ASPCA Animal Poison Control Center (APCC). In 2021, these calls made up 17% of the APCC’s call volume with ingestion of ibuprofen, an NSAID, among the most common toxins.

Here’s some useful information on NSAID toxicity in cats and what to do if you suspect that your cat may have eaten your NSAID medications.

Why Are NSAIDs Toxic to Cats?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are common over-the-counter and prescription medications used to relieve pain and reduce inflammation (swelling) in humans as well as dogs and cats.

NSAIDs work by blocking an enzyme called cyclooxygenase (COX), which is used by the body to make prostaglandins. Prostaglandins are compounds that play a key role in inflammation and pain. Therefore, by blocking COX, NSAIDs decrease prostaglandins and the inflammation and pain that they would cause. This can be very useful when treating conditions such as arthritis in people.

However, some prostaglandins are also crucial to maintaining blood supply to the stomach and kidneys. In humans, the effects of NSAIDs decreasing prostaglandins to the stomach and kidney are typically minor, but cats are much more sensitive to NSAIDs.

Giving human NSAID medication to cats can quickly lead to overdoses, resulting in life-threatening issues such as stomach ulcers (which can become severe and result in significant bleeding into the gastrointestinal tract), kidney damage (progressing rapidly to failure), and even brain damage at high enough doses.

NSAID toxicity in cats can occur when a cat accidentally gains access to the product (medication bottle, pills, or creams) or when the pet parent intentionally gives an over-the-counter human NSAID product to their cat to alleviate pain without realizing the danger these drugs pose.

There are no safe over-the-counter human pain medications for cats, and you should NEVER give your pet a medication without your veterinarian’s specific instruction to do so. If you think your cat is in pain, please call your veterinarian to discuss the best treatment options.

NSAIDs are highly toxic to cats and given the relatively large milligram size of human products compared to the relatively small size of cats, an ingestion of any amount (partial or full tablet, any exposure to topicals or creams) should be considered an emergency. You should take the cat immediately to a local veterinary hospital for evaluation and treatment.

Types of NSAIDs

There are only two FDA-approved NSAIDs for cats: meloxicam (coming in several brand names) and robenacoxib (brand name Onsior). Both are for short-term use only. There are no NSAIDs approved for long-term use in cats. Compared to dogs and humans, cats are more sensitive to the side effects of NSAIDs because of the way the drugs are processed in their liver.

The most commonly ingested NSAIDs in pets are over-the-counter human medications, specifically ibuprofen (Advil, Motrin), aspirin (Bayer), and naproxen (Aleve). This may be in part because people tend to have these products readily available at home, but it may also be due to the candy coating on some tablets, which are enticing to pets.

However, there are prescription NSAIDs that can come as tablets, liquids, topicals (creams, lotions, gels, patches, etc.), and/or injectables. There are many different human NSAID medications on the market as well as many different brand names of those drugs, but some common ones include celecoxib (Celebrex), diclofenac, flurbiprofen, and ketorolac. If you believe your cat may have ingested any type of human medication, contact your veterinarian or a local emergency veterinarian immediately.

Be sure to ask your human healthcare provider and pharmacist if any medications you are prescribed are NSAIDs. They should be able to advise you on any precautions needed to prevent exposure of your pet to the medication. Topical medications, in particular, should be watched, to ensure your cat does not come into contact with the medication.

Symptoms of NSAID Toxicity in Cats

Initial symptoms of NSAID toxicity in cats usually develop within 2-6 hours after ingestion, but they can be delayed by a few days. The main areas of concern are stomach upset or ulceration, kidney failure, and, in high doses, neurologic signs. Signs to watch for include:

• Vomiting (with or without blood)

• Nausea/drooling (hypersalivating)

• Diarrhea (with or without blood)

• Black, tarry stool (melena)

• Loss of appetite (anorexia)

• Abdominal pain

• Pale gums

• Lethargy or increased hiding behavior

• Increased drinking (polydipsia)

• Increased urination (polyuria)

• Stumbling or loss of balance/incoordination

• Seizures/coma

What Should I Do if My Cat Ingests an NSAID?

If your cat has ingested an NSAID, you should take him immediately to your veterinarian or local emergency veterinary hospital.

It is very important to bring the product, including label information with specific drug name and milligram of medication, an estimation of amount ingested (number of tablets), and when the ingestion occurred. If you are unsure how much medication your cat may have consumed, always round up so that the vet can calculate the worst-case scenario for exposure.

If you accidentally applied NSAID cream or ointment to your cat or they gained access to a tube, your vet may instruct you to bathe your cat in diluted dishwashing liquid (such as Dawn) right away, before going to their office, to prevent further absorption of the product.

Your vet may also instruct you to call the Pet Poison Helpline at 855-764-7661 or the ASPCA Animal Poison Control Center at 888-426-4435 for more information regarding the toxicity and treatment options. However, since cats are very small and human NSAIDs are very potent, any ingestion (no matter how small) is likely to require an emergency trip to the vet.

Should I Induce Vomiting if My Cat Ingested NSAIDs?

Do not induce vomiting at home unless you have been specifically instructed to by a veterinarian. If you think your pet ate an NSAID or NSAID-containing product, or you saw them do so, the best thing to do is to call your veterinarian or a local emergency veterinarian immediately.

Once at the vet, if your cat ingested the NSAID or NSAID-containing product within the past 2 hours, your veterinarian may inducing vomiting at the hospital as a means of decontamination. However, medications used to induce vomiting in cats are not always reliable, and cats can have complications associated with inducing vomiting, such as aspiration pneumonia. Induction of vomiting should always be done with direct veterinary supervision, especially in cats.

Treatment of NSAID Toxicity in Cats

If you see your pet ingest any type of NSAID or suspect they may have been exposed or gained access to an NSAID, it is very important to head immediately to the local veterinary emergency hospital. It’s helpful to bring the product with label information to help the vet determine which NSAID was ingested and at what dosage/milligram. Given the wide variety of human NSAID products, your vet may wish to call the pet poison hotlines to gain additional information about the toxicity.

The veterinarian will start with a good physical examination to assess your cat’s neurological status as well as check for any signs of bloody vomiting/diarrhea, pale gums, or abdominal pain. A complete blood count, serum blood chemistry with electrolytes, and urinalysis will likely be recommended for a baseline evaluation. Other tests such as an abdominal x-ray or ultrasound may be recommended to further assess the digestive tract and kidneys.

Cats should be treated as soon as possible for NSAID toxicity for the best possible outcome. In addition to inducing vomiting, they may also be given active charcoal to bind any additional toxin. Most cats will need to be hospitalized and placed on IV fluids for hydration and kidney support. Medications may be given to protect the digestive tract and help heal any stomach ulcers.

In severe cases where a large dose of NSAIDs has been ingested, cats may even need blood transfusions or medications to treat any neurological symptoms, such as seizures. In cases not responding to traditional supportive care, your vet may consider a newer treatment called intralipid therapy to help pull the NSAID out of the tissues faster and shorten the duration of symptoms. 

Early diagnosis and aggressive treatment are crucial in treating NSAID toxicity in cats. Even a single Advil could be enough to cause a cat to have kidney failure and die. Cats have their best chances of survival if seen quickly by a veterinarian.

Most cats will remain hospitalized for observation and treatment for 3-5 days depending on how much of the NSAID was ingested. Typically, recheck bloodwork will be performed and may include screening for blood loss (anemia) if there are significant gastric ulcers and to recheck kidney values.

Prognosis of NSAID Toxicity in Cats

The prognosis depends on the amount of NSAID ingested and how quickly the pet receives medical care. Cats can fully recover and go on to lead normal, happy lives. However, some cats may have lifelong kidney disease that may require long-term management or, in severe cases, NSAID toxicity can be fatal in cats. Again, if you think your cat has ingested an NSAID, do not delay in seeking veterinary care.

Prevention of NSAID Toxicity in Cats

As with most toxicities, prevention is key! Always keep medications in a safe and secure place away from pets. Cats are notorious for being on counters and can knock down medications for themselves and their canine friends to get into. It is best to store medications in a closed cabinet or drawer and not on countertops or tables. Remember to never leave medications or tablets in a plastic baggie within your pet’s reach, such as in a purse or luggage. If you drop a medication, ensure every single tablet is picked up: Remember that even one NSAID tablet can be dangerous for a cat.

Special consideration should also be given to topical human NSAID products to avoid leaving medication residues on couches, chairs, bedding, or other clothing. It is best to consult your human healthcare provider to discuss if covering your treated body area to prevent pet exposure is the best course of action or if there is a specific time frame between application and handling your cat (often it is at least a few hours and only after thorough washing).

It is important to remember that there are no safe human over-the-counter pain medications for cats. Do not give your cat any human pain medication. If you think your cat is in pain, consult with your primary care veterinarian. They will be able to decide how to proceed and what medications are right for your pet.