Deracoxib (Deramaxx)

Nonsteroidal Anti-inflammatory Drug (NSAID) Coxib (selective COX-2 inhibitor)

Dosage & Administration Guidelines

Species Route Dose Frequency Duration & Clinical Notes
Dog PO Postoperative pain: 3-4 mg/kg once daily; Osteoarthritis: 1-2 mg/kg once daily (maintenance); may be initiated at 2 mg/kg and reduced to 1 mg/kg after 7 days Once daily (q24h) Duration: Postoperative: 7-14 days; Osteoarthritis: chronic, as needed (evaluate periodically)
Notes: Administer with food to reduce GI upset. Use the lowest effective dose for the shortest duration. For postoperative pain, administer approximately 1-2 hours before surgery or at the time of anesthesia induction.
Horse PO 0.5-1 mg/kg once daily (off-label, based on limited studies) Once daily (q24h) Duration: Short-term (up to 5-7 days) due to lack of long-term safety data
Notes: Use with caution; monitor for GI and renal adverse effects. Not approved for equine use.
Cat PO Not recommended; no established dose N/A Duration: N/A
Notes: Avoid use in cats due to potential for severe renal and GI toxicity.

Clinical Indications & Species Uses

General Indications
  • Pain and inflammation management in dogs (primary species)
Dog (Canine)
  • Postoperative pain and inflammation associated with orthopedic surgery
  • Postoperative pain and inflammation associated with soft tissue surgery
  • Chronic pain and inflammation associated with osteoarthritis
  • Acute musculoskeletal pain (off-label in some regions)
Horse (Equine)
  • Not approved; may be used off-label for musculoskeletal pain and inflammation (limited studies; use with caution)

Pharmacology & Mechanism of Action

Drug Class: Nonsteroidal Anti-inflammatory Drug (NSAID) | Pharmacological Group: Coxib (selective COX-2 inhibitor)

Mechanism of Action: Deracoxib is a nonsteroidal anti-inflammatory drug (NSAID) of the coxib class that selectively inhibits cyclooxygenase-2 (COX-2) over cyclooxygenase-1 (COX-1). COX-2 is the enzyme primarily responsible for the synthesis of prostanoids (prostaglandins, prostacyclin, and thromboxane) involved in inflammation, pain, and fever. By selectively inhibiting COX-2, deracoxib reduces the production of these inflammatory mediators while sparing COX-1-derived prostaglandins that are important for gastrointestinal mucosal protection, renal blood flow, and platelet function. This selectivity is dose-dependent; at higher doses, selectivity may decrease, increasing the risk of COX-1-related adverse effects.

Pharmacodynamics: Deracoxib produces dose-dependent anti-inflammatory, analgesic, and antipyretic effects. In dogs, it has been shown to provide effective pain relief for postoperative pain and chronic osteoarthritis. Its anti-inflammatory activity is comparable to other NSAIDs but with a reduced potential for gastrointestinal ulceration and platelet dysfunction at therapeutic doses. The onset of analgesia occurs within 2-3 hours after oral administration, with peak effects observed at 4-8 hours. The duration of action supports once-daily dosing. In horses, deracoxib has been studied for its anti-inflammatory effects, but its use is not approved; it may have a longer half-life and different pharmacodynamic profile compared to dogs.

⚡ Pharmacokinetics Summary

Absorption: Deracoxib is well absorbed after oral administration in dogs. The presence of food can delay absorption but may increase overall bioavailability. Peak plasma concentrations are reached approximately 1-3 hours after dosing in fasted dogs. In horses, oral absorption is rapid but bioavailability may be lower and variable.
Distribution: Deracoxib is highly protein-bound (>95%) in plasma, primarily to albumin. It distributes widely into tissues, with high concentrations in the liver, kidneys, and inflamed tissues. It crosses the placenta and is distributed into milk in lactating animals, though the clinical significance is unknown.
Metabolism: Deracoxib is extensively metabolized in the liver, primarily by oxidation and conjugation. Multiple metabolites are formed, some of which may have pharmacological activity. The cytochrome P450 enzymes involved have not been fully characterized, but species differences in metabolism are significant.
Excretion: Deracoxib and its metabolites are excreted primarily in the feces (approximately 70-80%) and to a lesser extent in urine (20-30%). Biliary excretion is a major route. In dogs, the elimination half-life is approximately 3 hours, but the pharmacodynamic effect lasts longer due to tissue distribution. In horses, the half-life is longer (approximately 8-10 hours).
Half-Life: Dog: ~3 hours; Horse: ~8-10 hours (extrapolated from studies); Cat: not established (use not recommended)
Bioavailability: Dog: ~90% (oral); Horse: ~60-70% (oral, variable)
Protein Binding: >95% (primarily to albumin)

Available Formulations & Strengths

Oral Tablet 25 mg, 50 mg, 100 mg, 200 mg (PO)
Chewable Tablet 25 mg, 50 mg, 100 mg, 200 mg (some formulations) (PO)

Contraindications & Clinical Warnings

Contraindications:
  • Known hypersensitivity to deracoxib or other NSAIDs
  • Concurrent use with other NSAIDs or corticosteroids (including topical)
  • Pre-existing gastrointestinal ulceration, bleeding, or perforation
  • Renal or hepatic impairment (severe)
  • Pregnancy, lactation, or breeding animals (safety not established)
  • Cats (due to high risk of toxicity)
  • Food-producing animals (due to lack of withdrawal data)
Warnings & Clinical Precautions:
  • Use with caution in dogs with pre-existing renal, hepatic, or cardiac disease.
  • Monitor for signs of gastrointestinal toxicity (vomiting, diarrhea, melena, anorexia) during therapy.
  • Use the lowest effective dose for the shortest duration to minimize adverse effects.
  • In geriatric or debilitated animals, consider baseline blood work and monitor renal and hepatic parameters.
  • Avoid use in dehydrated, hypovolemic, or hypotensive animals, as NSAIDs can compromise renal perfusion.
  • Do not use in animals with bleeding disorders or those undergoing surgery where hemostasis is critical.
  • In horses, monitor for GI ulceration and renal function; use only when alternative therapies are not available.
  • Not approved for use in cats; if used off-label, extreme caution and close monitoring are required, but generally not recommended.

Adverse Effects & Reactions

Common:

  • Vomiting
  • Diarrhea
  • Decreased appetite
  • Lethargy
  • Increased thirst or urination

Serious / Severe:

  • Gastrointestinal ulceration, perforation, or bleeding
  • Renal toxicity (acute kidney injury, papillary necrosis)
  • Hepatic toxicity (elevated liver enzymes, jaundice)
  • Bone marrow suppression (rare)
  • Seizures (rare)

Rare:

  • Allergic reactions (skin rash, facial swelling)
  • Blood dyscrasias (thrombocytopenia, leukopenia)
  • Neurologic signs (ataxia, tremors)

Key Drug Interactions

Interacting Drug / Class Clinical Effect & Mechanism Severity
Other NSAIDs (e.g., carprofen, meloxicam) Additive risk of gastrointestinal ulceration and renal toxicity; concurrent use is contraindicated. High
Corticosteroids (e.g., prednisone, dexamethasone) Increased risk of GI ulceration and perforation; concurrent use is contraindicated. High
Anticoagulants (e.g., warfarin, heparin) Increased risk of bleeding due to platelet inhibition and GI ulceration. High
Diuretics (e.g., furosemide) Reduced efficacy of diuretics and increased risk of renal toxicity due to decreased renal blood flow. Moderate
ACE inhibitors (e.g., enalapril) Reduced antihypertensive effect and increased risk of renal impairment. Moderate
Aminoglycoside antibiotics Increased risk of nephrotoxicity. Moderate
Methotrexate Increased methotrexate toxicity (e.g., bone marrow suppression, renal toxicity). Moderate

Overdose & Toxicity Management

Signs of Toxicity:

  • Vomiting
  • Diarrhea (possibly bloody)
  • Lethargy
  • Anorexia
  • Abdominal pain
  • Melena
  • Renal failure (oliguria, azotemia)
  • Seizures (in severe cases)
  • Coma

Emergency Treatment Protocol: Treatment is symptomatic and supportive. Induce emesis if ingestion is recent (within 2 hours) and the animal is conscious. Administer activated charcoal to reduce absorption. Provide intravenous fluid therapy to maintain renal perfusion and correct dehydration. Monitor renal and hepatic function, blood gases, and electrolytes. Administer gastroprotective agents (e.g., misoprostol, omeprazole, sucralfate) to prevent or treat GI ulceration. In severe cases, consider blood transfusion if GI bleeding is significant. There is no specific antidote for deracoxib overdose.

Food Animal Withdrawal Times

Deracoxib is not approved for use in food-producing animals. Extra-label use in food animals is prohibited in the United States under AMDUCA because no withdrawal times have been established. Do not use in animals intended for human consumption.

Storage, Handling & Regulatory Information

Storage Temperature: Store at controlled room temperature 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F).

Handling & Special Conditions: Keep in a tightly closed container. Protect from moisture. Keep out of reach of children and animals.

Dispensing Status: Prescription Required (Rx Only)

Approval Status: Approved by the FDA for use in dogs (Deramaxx, NADA 141-203).

Extra-Label (Off-Label) Use: In the United States, deracoxib is approved for use in dogs only. Extra-label use in other species (e.g., horses) is permitted under AMDUCA only with a valid veterinarian-client-patient relationship, and requires a withdrawal time estimate based on scientific evidence. However, for food-producing animals, extra-label use of deracoxib is prohibited because it is not approved for such species and no withdrawal data exist.

Clinical Pearls & Practice Notes

💡 Clinical Insights: Deracoxib is a selective COX-2 inhibitor primarily used in dogs for the management of postoperative pain and chronic osteoarthritis. Its selectivity for COX-2 provides effective analgesia with a potentially lower risk of GI ulceration compared to non-selective NSAIDs, but the risk is not eliminated. It is important to use the lowest effective dose for the shortest duration, especially in geriatric or debilitated patients. Baseline and periodic monitoring of renal and hepatic function is recommended for chronic therapy. Deracoxib should not be used in cats due to a high risk of toxicity. In horses, limited studies suggest it may be effective, but it is not approved and should be used with caution. Always consider the animal's hydration status, concurrent medications, and underlying diseases before prescribing. Client education should include signs of adverse effects and the importance of not administering other NSAIDs or corticosteroids concurrently.

References & Literature

  • 📚 Plumb's Veterinary Drug Handbook
  • 📚 Papich Veterinary Pharmacology and Therapeutics
  • 📚 Compendium of Veterinary Products (CVP)