Ibuprofen poisoning in dogs

Overview

A human painkiller in a dog's body

Ibuprofen is a non-steroidal anti-inflammatory drug, or NSAID. Human preparations include tablets, capsules and liquids. Combination products can also contain paracetamol or an antihistamine, for example. Even small amounts can harm dogs.

Canine plasma concentrations usually peak between 30 minutes and three hours after ingestion. Food can slow absorption. The liver converts ibuprofen into several metabolites.

Digestive tract irritation and bleeding are the most common toxic effects in dogs. Progressing poisoning can damage several organ systems.

Causes

Stomach protection and kidney circulation

Ibuprofen inhibits cyclo-oxygenase enzymes, reducing prostaglandin production. Prostaglandins help maintain the protective lining of the stomach and small intestine. Reduced protective mucus can allow stomach ulcers to form. Ibuprofen can reduce kidney blood flow.

Poisoning can follow a single ingestion. Repeated administration can also cause poisoning. The average canine half-life is around 4.6 hours. Metabolites are mainly excreted in urine within 24 hours.

Prostaglandins also contribute to normal kidney function. NSAID effects on platelets can impair clotting. Ulcers can develop in the duodenum as well as the stomach.

Risk factors

Exposure often occurs when dogs gain access to their owner's medicines. Another possible cause is giving human painkillers at home without veterinary advice. The same tablet provides more medicine relative to body weight in a small dog than a large one. Existing kidney disease increases acute kidney injury risk.

A Canadian veterinary hospital recorded 223 suspected or confirmed canine pharmaceutical exposures during 2018–2023. NSAIDs were involved in 86 cases. Ibuprofen was suspected or confirmed in 47, or 55% of NSAID exposures.

Of the 223 exposures reaching emergency care, 19 involved more than one medicine. Ibuprofen cases accounted for 21% of all canine pharmaceutical exposures at that hospital.

Typical symptoms

Signs vary with the amount swallowed.

• Vomiting can start within two to six hours.
• Appetite can fall as the digestive tract becomes irritated.
• Diarrhoea can occur.
• The abdomen may be painful.
• Drinking or urination can increase or decrease.
• Severe poisoning can cause trembling or an unsteady gait.

Stomach ulcers may not develop until around 12 hours or later. Signs of kidney failure may appear only after three to five days.

Dogs may become tired and subdued. Increased thirst can be a later kidney-related sign. Severe kidney injury can stop urine production completely.

Complications and consequences

Bleeding and organ damage

An ibuprofen-induced ulcer can perforate the stomach wall. Digestive tract ulcers can bleed. Severe poisoning can lower blood pressure. It can cause unconsciousness or coma. Some dogs sustain permanent kidney damage. Heavy ulcer bleeding can cause anaemia. Persistent vomiting or diarrhoea can worsen kidney injury through dehydration.

During 2015–2020, North American veterinary hospitals treated 434 dogs following ibuprofen, carprofen or naproxen exposure. Of these, 225 had ibuprofen exposure. In the ibuprofen group, 104 dogs, or 46%, had digestive signs at presentation. Acute kidney injury was present on arrival in 41, or 18%. Twelve, or 5%, had neurological signs at presentation.

Prognosis in treated dogs

Of all 434 dogs with NSAID exposure, 429, or 99%, survived to discharge. One ibuprofen-exposed dog died or was euthanased before discharge. During hospitalisation, kidney injury was recorded in 75 of the 217 ibuprofen-exposed dogs with available data, or 35%. Across all NSAIDs studied, longer delay before presentation was associated with more severe signs.

Kidney injury recovery can take days to months.

Diagnosis at the vet

Identifying the medicine and exposure time

The vet establishes which product may have been swallowed. Packaging helps estimate the amount. Risk assessment considers time since ingestion. Other active ingredients in combination products are identified from the same packaging.

Existing medication and kidney disease influence monitoring investigations. Blood tests assess organ function and blood cell numbers. A low red cell proportion can raise suspicion of ulcer bleeding.

Witnessed ingestion helps distinguish confirmed exposure from suspicion. A tablet in vomit can also confirm ingestion.

Kidney assessment and repeat tests

Urinalysis helps assess kidney function. Urinary protein can support suspected acute kidney injury. Rising blood creatinine can indicate injury even within the laboratory reference interval. A rise of at least 26.5 µmol/l from a known baseline within 48 hours can indicate deterioration. Urine output changes are assessed alongside creatinine.

Glucose entering urine because of kidney dysfunction can suggest tubular injury. Urinalysis measures concentration and includes microscopic sediment examination. Ultrasound can help distinguish acute injury from chronic kidney disease. The vet assesses whether dehydration explains raised kidney values or kidney injury is present. Hospital monitoring of kidney function occurs at least daily because injury risk is increased.

Treatment

Reducing absorption

Treatment aims to begin before the swallowed medicine is absorbed. Soon after ingestion, the vet may consider medically induced vomiting if the dog's condition allows. This can be dangerous with impaired swallowing reflexes or risk of inhaling vomit. Activated charcoal may reduce intestinal ibuprofen absorption. It can raise blood sodium.

For severe exposure, colestyramine may be considered to reduce reabsorption of medicine secreted into the intestine in bile.

Exceptionally, gastric lavage may be considered if vomiting cannot safely be induced. The airway is protected during lavage to prevent stomach contents entering the lungs. High aspiration risk can also preclude activated charcoal.

Symptom management and hospital monitoring

The vet prescribes gastrointestinal protectants when needed. Intravenous fluids correct dehydration and support kidney circulation. After dehydration is corrected, fluids are adjusted to urine output and other losses. If kidneys produce no urine, fluid can accumulate and cause pulmonary oedema. A specialist hospital may consider plasma exchange after very large exposure. Intravenous lipid emulsion is sometimes used for dogs with neurological signs.

Severe kidney injury can acidify blood, so acid–base balance is also monitored. Antiemetics can relieve kidney failure-associated nausea. Severe injury may require around a week in hospital, sometimes longer. Discharge may be considered once creatinine stabilises and signs are controlled without intravenous treatment.

A proton pump inhibitor can reduce stomach acid when treating gastric or duodenal ulcers. With severe kidney injury, blood electrolytes are checked at least twice daily early in hospitalisation. Dialysis may be considered if potassium remains at least 6.5 mmol/l despite other treatment. Fluid balance is assessed at least twice daily by weighing, clinical examination and urine output measurement. A kidney injury patient may need nutritional support if inappetence persists beyond 48 hours. Once drinking is adequate and creatinine falls, intravenous fluids can be reduced gradually.

Kidney follow-up after discharge

Following acute kidney injury, kidney values may initially be monitored at least every three months during the first year. Previous acute injury warrants long-term monitoring even after recovery.

Prevention

Keep human medicines where dogs cannot investigate them. Medicines in an open backpack on the floor can also be swallowed. Packaging that is difficult to open reduces access during travel. The vet chooses pain medication for your dog. Report previous kidney injury before a new painkiller is selected because it affects medication safety. Over-the-counter ibuprofen can still poison dogs. Check liquid medicines' active ingredients too, as ibuprofen is sold in liquid form.

During travel, an up-to-date medicine list helps identify products if packaging is damaged.

Important for dog owners

On the way to treatment

Move your dog away from medicines and collect remaining tablets. Bring the packaging or leaflet if readily available. Tell the emergency clinic when exposure may have occurred and what the package contains. Estimate missing tablet numbers if this can be done quickly. Check whether other household animals could also have accessed them. Report any tablet fragments noticed in vomit. Do not induce vomiting yourself. Salt is unsuitable for making dogs vomit.

Check whether a substance is poisonous.

Frequently asked questions

Can I monitor a well-looking dog at home?

Call a vet immediately if your dog may have swallowed ibuprofen. Digestive signs such as vomiting can appear within two to six hours. The vet assesses treatment needs from exposure details even if the dog still appears healthy.

What if I do not know how many tablets were eaten?

Contact a vet immediately even when the amount is uncertain. Packaging and remaining tablets help estimate ingestion. Packaging can also identify other active ingredients in a combination product.

What if my dog vomited up medicine?

Tablets in vomit can help confirm what was swallowed. Tell the vet, as some ibuprofen can be absorbed rapidly before vomiting. Gastrointestinal protection may still be needed afterwards.

Are tests needed after discharge?

After large or repeated exposure, blood tests can monitor kidneys and other organs after discharge. Following acute kidney injury, the first review is usually within a few days of discharge.

Can I give ibuprofen for lameness?

The vet decides medication for pain associated with lameness. Ibuprofen can cause ulcers, gastrointestinal bleeding and kidney injury in dogs. Separate NSAIDs have been developed for veterinary use. Ibuprofen can cause harm in small amounts, and repeated exposure can also cause poisoning.