Paracetamol for Dogs in UK Practice | Veterinary Prescriber
Paracetamol is an established component of human analgesia and antipyretic protocols in the UK, but its role in veterinary practice is less clearly defined, there are only few veterinary formulations, and frequent off‑label use of human formulations under the cascade. This article is intended for veterinary surgeons and veterinary nurses. It reviews how, when and why paracetamol is used in dogs in UK practice.
Paracetamol use in humans
Paracetamol is probably the most familiar medicinal product for humans in the UK. It is used for the management of mild to moderate pain and for reducing pyrexia. It is widely available as generic and branded products in a variety of formulations and can be bought from general retail outlets as well as pharmacies. Paracetamol is also available in medicines in combination with other ingredients, including codeine. The latter combination, known as co-codamol, is only available to buy from pharmacies or on prescription. The mode of action of paracetamol as an analgesic is not fully understood. Adverse effects of paracetamol are rare when it is used at the correct dose.
Paracetamol use in dogs
There is much less formal advice and certainty around the use of paracetamol in dogs compared to humans and only one veterinary licensed product for dogs, Pardale-V tablets. Veterinary Prescriber found limited clinical trial evidence on the use paracetamol in the management of peri-operative pain in dogs, none on its use in chronic pain, and a need for high-quality clinical research. Clinical experience and a low incidence of reports of adverse effects support the use of paracetamol as an alternative or adjunct to NSAIDs and other analgesic medications.
The single paracetamol product licensed for use in dogs, the brand Pardale-V, also contains codeine. This was originally marketed as the veterinary version of a human medicine, Pardale, and was available to buy without a prescription (NFA-VPS) until 2019 when it was reclassified as a prescription-only (POM-V) medicine.
The combination of paracetamol with codeine does not now seem rational, given that the codeine is not thought to contribute any analgesic effect in dogs, and may affect paracetamol’s absorption and cause adverse effects. However, this combination is the only licensed form of paracetamol for dogs. Vets wanting to avoid prescribing concurrent codeine for a patient may decide to prescribe a paracetamol-only formulation under the cascade.
For more on paracetamol pharmacology and a review of the evidence on its use in dogs, see our review Paracetamol for the Management of Pain in Dogs. (subscription needed). For the authorised prescribing information for Pardale-V, see the summary of product characteristics/datasheet.
How vets use paracetamol
A 2023 survey of UK vets' perceptions of paracetamol use in dogs (Bello and Dye 2023) found that paracetamol is widely used although most veterinary practices have no policy on its use. The findings included:
UK vets mainly use paracetamol as an analgesic, sometimes they use it to treat pyrexia.
Paracetamol is used as an analgesic when an NSAID is contraindicated or as part of multi-modal therapy; and as an antipyretic when an NSAID is contraindicated or ineffective.
Few vets use paracetamol as first-line therapy for analgesia or pyrexia.
Low cost and accessibility during out-of-hours (because of the likely availability in the home) were also factors affecting choice.
Most vets perceive that paracetamol has a low risk of adverse effects, and believe that these are likely to be mild.
Many had changed their perception of paracetamol over the previous decade, and were now more likely to prescribe it, believing it to be more effective and to have fewer adverse effects than previously thought.
Generic forms of paracetamol (unlicensed/off-label use of human medicines) seem to be more commonly prescribed than the veterinary licensed form (Pardale‐V).
For a detailed review of the evidence and practical dosing considerations, see the member CPD module Paracetamol for the Management of Pain in Dogs (subscription needed).
When considering paracetamol as part of multimodal analgesia or as an NSAID alternative, it can be helpful to review NSAIDs and other analgesic options in dogs covered in our modules (for a list, see under further reading below).
Summary
Paracetamol is commonly prescribed for dogs, usually as an alternative to an NSAID (when contraindicated) or in multi-modal therapy, rather than as first line therapy.
Vets' confidence in using paracetamol appears to have grown over the past 10 years or so.
There is a need for high-quality research on its efficacy in dogs.
The only licensed product for dogs is a combination product containing codeine.
For broader discussion of evidence quality and rational medicines use in practice, see Everything you needed to know about veterinary medicines: Making sense of medicines. What is good quality evidence on veterinary medicines (subscription needed).
Further Reading for Veterinary Professionals
For more prescribing guidance and clinical decision support in dogs, you may find the following Veterinary Prescriber resources useful (subscription may be required):
Paracetamol for the management of pain in dogs
Galliprant (grapiprant): an update
Daxocox (enfliximab) - a new NSAID for dogs
Everything you needed to know about veterinary medicines: Making sense of medicines
Gabapentin and pregabalin in the management of chronic pain in cats and dogs
Amantadine in the management of chronic pain in dogs and cats
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