Gastroduodenal ulceration from NSAIDs and steroids in dogs
10-year-old Labrador with osteoarthritis on meloxicam; five days ago another clinic added prednisone for pruritus. It now has vomiting with digested blood, melaena and pale mucous membranes, without signs of perforation.
Besides stopping both drugs and stabilising the dog, which antacid treatment is most appropriate?
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A. Famotidine once daily, because it is the most potent
H2 antagonists are less effective than proton pump inhibitors, and once-daily dosing does not keep pH raised.
B. Misoprostol alone, which replaces the prostaglandins inhibited by the NSAID
It may have a preventive role against NSAID injury, but it causes diarrhoea and is not the treatment of choice for an established bleeding ulcer.
C. Omeprazole once daily in the evening
The drug is right, but once-daily dosing does not achieve the pH control that healing needs. In dogs it is given every 12 hours.
D. Proton pump inhibitor (omeprazole, or IV pantoprazole) every 12 hours, with or without sucralfate
Correct. PPIs twice daily are the most effective antacids in dogs and cats, superior to famotidine. Sucralfate may be added as a local ulcer protectant.
lightbulb Key takeaway
Never combine NSAIDs with steroids or two NSAIDs together, and allow a washout period when switching. PPIs are given before food and every 12 hours; when stopping after more than 3–4 weeks, taper gradually because of rebound.
References: ACVIM consensus statement: rational use of gastrointestinal protectants in dogs and cats (2018)
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.