I'm surprised so many of you are against Tylenol. I've heard that baby/children's Tylenol is safe, but you have to be careful about not giving too much. Also make sure there are no other ingrediants, do not give Children''s Cold medicine with Tylenol, that can be deadly, but it's not the tylenol, its the other things. I hope the vet returns your call.
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Based on reactions in our canine patients, this is the ranking I would give these medications: safest = acetaminophen (Tylenol tm), also safe = aspirin, less safe = ibuprofen (Advil tm, Motrin Rx). However, this is the ranking that I would give them based on the reports in the literature and factoring in the likelihood of a bad reaction causing death: safest = aspirin, also safe but less so = acetaminophen and less safe = ibuprofen.
The reason for these rankings include these things. Aspirin is reasonably likely to cause gastric ulcers, which can be life threatening if ignored but which respond to withdrawal of the medication. Acetaminophen doesn't seem to cause ulcers but there are uncommon reactions to it in which liver failure occurs and this may not respond to therapy, so death is a possibility. Ibuprofen is very likely to cause ulcers, with 100% of dogs developing ulcers with the use of ibuprofen in at least one study. On the other hand, lots of my clients come in and tell me "I gave my dog an ibuprofen last night" and I have only had to treat one or two cases of ulcers and I can't recall a dog dying from this medication, yet.
My personal preference for pain and fever in dogs is aspirin but we do warn our clients to discontinue the medication if the dog stops eating and to call us or come in for a recheck if that happens.
In cats the situation is different. Acetaminophen is very toxic to cats and this medication should simply never be used to treat a cat. Aspirin has a long half life in cats, at least 24 to 48 hours, so it will reach toxic levels pretty quickly if it is given more frequently than once every 48 hours and the dosage is 10mg/lb so a baby aspirin (81mg) is a much more appropriate dosage for a cat than an adult aspirin. I have not seen much information on ibuprofen and cats but it is a good idea to avoid all non-steroidal anti-inflammatory medications in cats, at least until one of them does prove to be safe in someone's clinical trials.
Mike Richards, DVM
P.S. to the previous note. My guess is that the AVMA figures that it is safer not to confuse people with the difference between the effects of acetaminophen in dogs and in cats. I have several pain control references which state that acetaminophen is generally safe in dogs and it is used frequently because hydrocodone/codeine + acetaminophen combinations are pretty effective for post-surgical pain and for chronic pain from arthritis in dogs. The general feeling is the the narcotic provides the pain relief in this combination, though.
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