Vet School 101 Why I love Adequan for cats and dogs

This is not a “testimonial” intended for the commercial betterment of any one brand. It juts so happens that the only version of polysulfated glycosaminoglycans (PSGAG) in the veterinary marketplace is Adequan®. And it works.

Poly what?? OK, so it doesn’t really matter to me that you can’t pronounce this alphabet-soupy injectable drug. It’s enough for me that you know what it does so you can ask your veterinarian about it the next time your cat or dog suffers conditions for which it might prove beneficial.

The conditions? Officially, the menu is a short one as it’s currently approved only for use in dogs and horses “for the treatment of noninfectious degenerative and/or traumatic arthritis and associated lameness of canine and equine synovial joints.” So says my Plumb’s Online Veterinary Drug Handbook (courtesy of VIN).

Unofficially, however, this drug is used safely in cats for the same indication––joint pain. Increasingly, veterinarians are turning to it for felines as a result of our extremely limited arsenal of pain-relieving drugs for this species. We’re not about to wait for approval when we all know our cats receive a pittance of the research funds dogs do. Might as well use it “off label”...if it’s safe. And we think it is.

Though Adequan is labeled as a drug, most veterinarians don’t tend to think of it in these terms. That’s because it’s derived from cow tracheas and only slightly modified in a laboratory to make it more stable. As such, it’s more like a nutraceutical (think glucosamine and chondroitin sulfate, which this drug more closely resembles than any NSAID we may use for pain relief).

Yet while it’s considered way safer than NSAIDs (Rimadyl, Metacam et. al.), make no mistake: it’s not a 100% safe product. Toxicology studies have found that when megadoses are administered, liver and kidney changes are observed. Even in moderately over-large doses, platelet numbers are reduced and blood clotting problems may result. Furthermore, a small percentage of these overdosed dogs showed pain at their injection sites (I've never noticed this in my patients so the discomfort may be related to the larger volumes administered to these test subjects)

Yes, Adequan’s delivered as an injection. It goes in the muscle. For horses, it’s also approved for injection inside the joint. (I don’t know anyone using it this way in dogs, but I’m sure someone out there does.) And it’s only available by prescription through your veterinarian. Luckily, most vets I know are willing to show you how to give it––that is, if you’re brave enough to want to learn.

OK, so enough about Adequan’s gruesome origins, side-effects and delivery options. How does this stuff work? Though the mechanism by which Adequan makes joints feel better isn’t well understood, its action is an anti-inflammatory, cartilage-protecting one. We believe it acts by inhibiting enzymes that break down the cartilage within joints and by increasing the thickness of joint fluid.

But that’s not enough to completely explain how it reduces inflammation. Given that Adequan also seems to work to reduce swelling in the bladder and help repair corneas, it’s clear there’s more going on with this drug than meets the eye (pardon the pun).

Though it’s not been approved for use in these conditions and research is pending to prove this efficacy is more than anecdotal, feline veterinarians have been using it for the dreaded kitty condition known as interstitial cystitis (AKA, feline idiopathic cystitis) while horse vets in Brazil tested it out on indolent corneal ulcers and found that their patients' eye lesions healed much faster than their control subject counterparts.

I’ve never tried it out on eyes and I’m waiting for more of a consensus on that front before mixing it into eye drops myself (though a quick search on VIN showed that vets out there are using it with some success). I do, however, use it in my feline patients to manage their arthritis and to reduce the symptoms associated with many urinary conditions. I’ve been using it for years in this way and always thought it made at least a slight difference. In fact, some cats experienced such a tremendous benefit I’ve taken to trying it out on all of my arthritic kitties and inflamed feline urinary tracts.

For dogs and cats alike, my basic approach has been the same as of a few months ago: eight shots over four weeks (I used to use a longer course with less frequent dosing). I use it less often at a slightly lower dose for those whose kidneys and liver are in some way compromised and I always lower (or eliminate) the NSAID or steroid dose for those who are also taking these or any other drugs that have the possibility of inhibiting platelet function or “thinning the blood.”

But don’t just take my word for it. Consider that veterinarians everywhere are starting to get in on the Adequan act. With our pets living longer, we recognize the need to more carefully manage our pain relievers. Using this less side-effect fraught, alternative approach to treating pain and inflammation may just be what your vet orders, too. So go ahead, ask.

August 6th, 2009

Add Comment79 Comments

My vet successfully used it to treat my dog's cystitis which resulted from chemo he was taking for lymphoma. I had researched a human cystitis drug, and Adequan was chemically very similar. So instead of hunting down the human drug for off-label use, we went with Adequan. His symptoms were alleviated with the first dose, and we continued the suggested regimen since he also was slightly arthritic. I now have him on once-monthly followup treatments. It's well worth the expense.

Debbie August 6th, 2009 10:21:27 AM

Is there a degree of risk for sulfa reactio, especially triggered immune issue with at risk reeds/individuals, with this?

I had great results with Adequen for mild ocd shoulder issues, but the last dog I gave it too (bilateral hd with pain adult) crashed within a matter of hours with what appears not to have be auto-immune hemolytic anemia. I say "appeared" because at the time that diagnosis was not a vet forefront, and a necropsy was not performed.

I've been reluctant to give it since - probably a shame considering it has helped many dogs for us before then.

Wendy August 6th, 2009 10:39:24 AM

oooh, I forgot, the vet opthamologist that treated my dog for an ulceracted cornnea used Adequen as an eye drop to reduce the inflammation.

I have no idea if that's label use or not, but my goodness did it work well!

(again, this was before the suspect AIHA - I have to get over that :( )

Wendy August 6th, 2009 10:41:55 AM

Wendy: It's always hard to get back on that horse after a bad experience. Even when you can't be sure it was the drug that caused it. No, I checked and there don't seem to be any cases of hemolytic anemia associated with it. However, it is an exogenous agent and whether it's a nutraceutical or drug it may have triggered an aberrant immune response. One in a million knd of thing, perhaps, but scary for you nonetheless.

FWIW, I'm glad you're not one of those people who sees a terrible reaction and wants the product banned for everyone. I see people head in that direction far too often after a suspected drug death. I can't say I blame them but it's refreshing to see you approaching this open-mindedly.

Dr. Patty Khuly August 6th, 2009 10:56:24 AM

Thanks for the informative post, Dr. K - safe (or even somewhat safe) and effective kitty drugs sure are hard to come by.

I'll be looking forward to future studies and expanded uses for Adequan - for all species!

Kim August 6th, 2009 11:32:03 AM

Although I am happy to see a non-NSAID available, I believe strongly in the responsibility of veterinarians to inform their clients (particularly those with cats) that . ..

It's not approved for use in cats

The safety is not yet known

This "trying it out" essentially amounts to enrolling their cats in a study, an experiment, if you will. Administration of the drug could have unknown, unforseen consequences, and that study of "off label use" should only be undertaken with full knowledge and consent of the owner. And with the client information sheet in hand, including the part that says: "not for use in cats"

That way, clients can make a fully informed decision. I don't believe that enrolling a clients pet in what is essentially an on-the-job experiment with off label use should ever be done without full discussion and knowledge of the client -- it's not the vets decision to make.

It's their job to make the recommendation, but leave the decision to the client, who is fully informed.

And as the metacam case taught us, it is really important to have the discussion with clients about how important it is that they not increase the dose on their own, and what the consequences could be if they do so. Although, sounds like this is only injected in-office, so that's probably not an issue for this particular drug.

Stefani August 6th, 2009 11:35:16 AM

Have you ever tried giving Adequan sub-q instead of IM? Cartrophen (Pentosan polysulfate sodium), the equivalent product that's used in Canada, Australia and Europe, is given sub-q. I've heard from people who have used Adequan that way and said it worked just as well as giving it IM.

Personally, I've been reluctant to give frequent IM injections to a dog, and would not be able to do that at home, whereas I can give sub-q. I would think it would be even more difficult with cats than with dogs. Offering sub-q as an option might widen the number of people willing to give it a try.

Interestingly, when I looked up Cartrophen, it says it was originally developed to treat interstitial cystitis in humans and is being used to treat and prevent FLUTD (http://www.veterinarypartner.com/Content.plx?A=1830).

How often do you give Adequan after the initial loading dose?

Mary Straus August 6th, 2009 01:59:43 PM

My 11 yr. old Shep-Rott mix has been getting the injections for degenerative bone loos/arthritis in his hips, and at first there was a distinct improvement. Now, for the past few weeks, he's been choosing to lay on the bare wood floor instead of his dog bed, which I can't imagine feels more comfortable. I just don't get it...?

KateH August 6th, 2009 02:04:36 PM

Stefani: The off-label issue is the case with the vast majority of drugs used in feline medicine––along with hundreds of dog versions, too.

So while I undersatnd the point you make, I think it only makes sense to offer an informed decision––not necessarily to point out which drugs have or have not been approved for use in that particular species for that particular indication. Not when we're talking about very low risk drugs with a long track record of common use. I'm not saying it shouldn't ideally be included in any discussion but I'm not a package insert, you know? There's only so much we can realistically discuss up front. Detailing the risks should be enough.

Dr. Patty Khuly August 6th, 2009 02:06:39 PM

HateH: Are you saying he's no longer improving?...or that you fear he's more uncomfortable than ever before? Either way, most pets do arrive at a sort of plateau with the product, which is why I administer it twice a week for four weeks (hope that answers your Q, Mary). Afterwards, we take a break for a month and start all over––during which time pets typically remain at peak comfort, though some will start to decline back to where they were before.

For bladder and ophthalmic issues, however, the dosing schedule may be different. Some veterinarians advocate its use twice a week for four weeks then a gradual slow-down in frequency. As long as it's still working we keep it up––usually at no less than once a month, though. So you know, some OA patients may do well with this method, better than with the one month on, one off approach. Lots of trial and error here.

Dr. Patty Khuly August 6th, 2009 02:14:51 PM

I think that he did improve for a bit, but the weakness when he walks up steps is back and the laying on the wood floors just doesn't make sense to me. The dog bed should be more comfortable, and he very rarely laid on the wood floors before the injections (he's gone through the 2x for 4 weeks and is now on 1 a week or so - we've missed 2 of them - we'll be out of the 4th bottle tomorrow). I just don't know if, at his advanced age, I should suck up the price of more, especially when I'm so underemployed. When he was getting Zubrin (last year), he seemed just as comfortable. It was only when I stopped that in March (a bit freaked by my other dog's CHF death) and tried Tramadol, while looking for other options, that I started the Adequan. I wonder if Tramadol would help with the pain enough, since I don't know how much benefit his old bones/joints received. Would the nerve pain reduction from Tramadol make him FEEL as good as the possible lessening of lameness (which seems to have come back)? Did that make sense?

KateH August 6th, 2009 02:40:00 PM

I forgot to mention -- my vet used a solution of Adequan eye drops in 2001 when my dog had an indolent corneal ulcer, and the ulcer did heal. At the time, I found at least two veterinary ophthalmology sites recommending this treatment, so it's been around for awhile and there does seem to be some concensus that it works.

Mary Straus August 6th, 2009 02:44:12 PM

Oops. I see I wrote Hate H––Hope you know I didn't mean nothin' by it. ;-)

Dr. Patty Khuly August 6th, 2009 03:00:53 PM

KateH: You can also try the gabapentin approach or just layer some tramadol on top of your Adequan--ask your vet about these options. When I'm using Adequan with an older patient and take them off the NSAIDs in the interim, I'll almost always make sure they're still getting the tramadol. It just works too darn well to pass on.

Dr. Patty Khuly August 6th, 2009 03:05:28 PM

Just wanted to say that my 11yo Lab has been getting Adequan injections since her first TPLO and is doing well. She has significant arthritis and can't take NSAID's, so the Adequan and Cosequin DS have so far kept her mobile. I do know people who give Adequan sub-q but it really isn't difficult to give IM. There's a helpful technique video here: http://pupvideotraining.com/news/Injection_Techniques/index.html

Alice August 6th, 2009 03:56:41 PM

I live in New Zealand.

I have a 16 year old cat on Pentosan (vets did inform me it was 'off label'), and a 10 month old puppy who's been on it since she was 7 months due to hock deformities. (The specialist who has seen her has advised me to keep her on monthly injections until she's about 18 months, she was on weekly injections for 4 weeks initially).

My cat followed my vets normal protocol; weekly injections for a month, and then 3 monthly, which sounds pretty light compared to yours Dr K ? To be honest, I haven't noticed any difference in my cat, would it be worth asking if they could 'up' her treatment ? The puppy is on it as a prophylatic measure, so hard to judge.

I found very little info on Pentosan when I tried to research it, and assumed it was just the New Zealand name for Adequan.

Alison August 6th, 2009 06:30:16 PM

KateH: For reasons I am not entirely sure of, a dog with spinal pain will lay on a hard surface. I saw this with my IVDD dog. Despite several types of bedding, she preferred to bunch it up away from her and lay on the bare crate bottom or the floor. Other people have noticed the same.

Sometimes with bad pain, the position taken is Sphinx-like.

A friend with a dog diagnosed as a pup with cervical pain , was given Adequan & pred intermittently for years to relieve her pain & increase mobility. All the shots were vet-administered and reduced to "as necessary frequency" She lived a good long time & died of non-related pneumonia because of a weak trachea (tacked , I think, twice)

Interesting that it was not mentioned for my Dottie's bilateral corneal ulcers, hers healed with conventional drops, anyways.

But I may want to investigate the cystitis treatment!

Barb A./NH August 6th, 2009 10:15:50 PM

OT but in response to KateH - FWIW, my mom has pretty significant vertebral disc disease and finds it more comfortable to sleep on the floor when she has a flare-up...strange, but maybe your kiddo feels the same way.

anna August 6th, 2009 10:58:58 PM

Concerning pain at injection site - I remember a long time ago when I used to check out the Vetinfo for dogs site, the vet there talked about this new drug "adequan". He personally hadn't used it yet, but there was a vet conference going on, and the vet next to him told him that it truly does hurt at the injection site. The vet was shocked. Had the guy injected HIMSELF with it?! And indeed he did. Apparently the guy was sore from skiing, and decided to "try" it on himself. He said it hurt like hell, but it was worth it, since his joint pain did go away. Crazy hunh?

lynn August 7th, 2009 02:41:33 AM

Thanks for the info, Dr. K., Barb, and Anna! I have a visit today for the last injection from the 4th bottle and will take the printout of all this to see what she thinks.

KateH August 7th, 2009 09:39:35 AM

We are using Adequan after Cosequin resulted in acute vomiting for my cat (think vomiting at least once an hour from about 1 a.m. - 2:30 p.m. last Christmas despite injections of famotidine and dolasetron, a stay at the ER the following night for x-ray, fluids and monitoring - only to end up constipated 4 days later and needing a manual extraction). Speaking of off label drugs - I think those are two more for cats (dolasetron, famotidine - plus ondansetron and Cerenia), but very important for cats with IBD and pancreatitis!!

So, glucosamine and chondroitin don't appear to be options for him. Going by x-rays his arthritis is in pretty early stages. Although he doesn't jump on counters much anymore, I judge how he is feeling by how smoothly he goes up and down stairs. He can get chair height fine, but doesn't go much higher very often anymore. We started him at weekly injections for two months at what our vet considered a low dose for his age - wanted to make sure nothing caused a GI flare up. We then increased to what the vet said was a moderate dose and were left to determine if we thought he needed the injections every other week or monthly. So, he has had that dose twice now. I noticed as he was nearing the end of the two weeks he seemed a little stiff going up the stairs, but one day later he was sitting on the desk in our kitchen (it used to be he would sit there for hours).

By the way, we give the injections SQ, not IM. I've run into a few people on the lists that are doing them that way for their cats. Certainly makes life easier at home!

Our vet is also OK with our using buprenex for him if he shows pain, but we have not yet used it very frequently. I was tempted one morning when he seemed really stiff, but that hard stool dropped a few hours later in our living room told me that it was time to increase his lactulose instead! Interesting thing with him - I've learned that GI symptoms can frequently "look like" arthritis symptoms! Anyway, that was off topic!!

Jenny August 7th, 2009 10:29:54 AM

Oops - meant to say low dose for his WEIGHT, not age!!

Jenny August 7th, 2009 10:35:48 AM

Jenny: I've had great success giving increasing amounts of the powdered (non-flavored) glucosamine when pets exhibit GI signs with these supplements. Start by using just glucosamine--no chondroitin--and just a few grains from the inside of a capsule. You might find you can work up to a full dose of glucosamine this way. You can then add in the chondroitin. Again, very slowly. If you're into the avocado extract (I am) then add this in, too. It might take some work to do this but if you're committed, it might just do the trick.

Dr. Patty Khuly August 7th, 2009 12:29:32 PM

Thanks Dr K. We were using the unflavored Cosequin as we wanted to make sure that there weren't any added ingredients in it that would bother him. It does have chondroitin in it, but none of the other stuff that is in the cat version. We did increasing doses hoping to avoid making him sick, but it actually backfired on us. If only I had recognized drooling as a warning sign, I would have avoided the problems on Christmas :( After the first increase in dose I found him hypersalivating twice. The first time I thought maybe he got into something, the second time he was sitting with me so I knew he did not. Then we increased the dose again, and on Christmas Eve he was sitting with me and was drooling again. His chin was just soaked. I should have given him his dolasetron and famotidine injections then, but had no clue what was about to happen. Anyway, I hear what you are saying about using just glucosamine, but at this point, I'm too afraid of oral supplements. Interstingly, another member on the yahoo feline IBD list found that her cat gets diarrhea from glucosamine. After stopping the Cosequin, she tried a product that was glucosamine only and still had problems. We've had another few people that have had problems too, not sure if they have tried just glucosamine by itself. I wonder how seafood allergies might come into play - I have a human friend that can't take glucosamine because of the seafood. Since IBD and allergies frequently come hand in hand, I wonder?

But it took us several weeks to get Bo stable again. We were finally able to slowly taperi off his nausea meds over about 3 weeks. There are a lot of things he just can't tolerate - sucrulfate (vomits). metoclopramide (cramps), Prozyme (vomits), any significant variation in food (have to blend old and new date batches of food to avoid GI symptoms). He hypersalivated the day after his last rabies injection - so will be watching that very closely. He's stable again, though! We have kind of a joke with our vet. If we are trying something new, we ask if the cats she sees have issues with it - the response is "well, most cats do very well with it - but we are talking about your cat!! He's always one of the exceptions".

But I am glad he seems to tolerate the Adequan quite well!

Jenny August 8th, 2009 09:34:28 AM

haw you do?

kaser August 8th, 2009 12:42:49 PM

Dasuquin, a similar product, worked like a charm on my 19 yo CRF cat with interstitial chronic sterile cystitis.

Erin August 10th, 2009 11:20:34 AM

Dasuquin is a pill, not an injection. And in regards to pilling some felines, Pill Pockets are lifesavers.

Erin August 10th, 2009 11:23:30 AM

Erin: I, too, love the Dasquin (a glucosamine and chondroitin-based nutraceutical). I'm a big believer in the added (synergistic?) beneifts of the avocado extract in Dasquin and other brands. Sounds hokey to some but I believe my patients experience a more rapid onset of relief with these glucosamine and chondroitin products. Still, it's not as rapid and immediately dramatic as I see with Adequan.

Dr. Patty Khuly August 11th, 2009 08:49:09 AM

My 14 year-old Persian's arthritis had worsened to the point that she could barely walk on her own when my vet suggested that we try Adequan. We started in late June, and the results have been nothing short of amazing! I won't say she can run like a kitten, but her mobility is 100 times better. And she seems so relaxed and pain free. When the arthritis was at its worst, she slept curled up in a tight ball. (Not that she was sleeping well.) Now, she is back to her old habit of sleeping on her side stretched out as far as she can. I have seen nary a side effect.

My question is what you think the best maintenance dosage is. We went through the initial 2 shots a week for 4 weeks regime, and I then waited a month to give her a "booster." Should I repeat the 2 shots a week regime or do something less?

Any advice would be greatly appreciated! Thanks!

Lori August 14th, 2009 10:14:57 AM

I'm interested in seeing a response to the queston asked by Mary Straus about giving Adequan sub-q, especially after reading another post here that said IM injections are very painful. I'm considering giving my almost 18 year old CRF cat adequan, but I'm trying to find out more about it first. I'd be much more inclined to do so if it could be given SQ and yet still have it work just as effectively as IM.

Deb August 17th, 2009 05:19:20 PM

I have just given my first IM shot of Adequan to my kitty, and there was nothing to it! I was quite nervous at first, but I "practiced" on my other cat with a needle-less syringe to get the feel of it. By the time I did the real thing, I was comfortable with the feel of it and it worked like a charm - she didn't even blink.

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