Is Metacam Safe? Will it Really Kill Your Cat?
We used to think cats weren't too affected by pain. Well of course they are and now that our cats are living longer, many are suffering from the effects of chronic pain due to arthritis as well as following surgery or suffering injuries. Pain killers are so important but are they safe? More specifically is metacam safe or will it kill your cat?
This drug is one of the most commonly used medications in cats. Meloxicam is the active ingredient, with Metacam being the most common trade name product used. It is a member of the non-steroidal anti-inflammatory drug group which has been discussed in the article all you ever wanted to know about NSAIDs. Today though I want to talk about safety in cats specifically.
Metacam's use in cats is highly controversial in some parts of the world, notably the US, while being completely accepted by the majority of vets in other parts, notably Europe and Australasia. This has led to different licensing of the product. In other words the same drug has different dosing regimes depending on where it is being used.
In Europe and Australasia meloxicam can be used as a one off injection, it can be given orally for several days after a lower dosed injection or it can be used for the long term management of pain such as that caused by arthritis.
In the US however it can only be used as a single injection to comply with its licensing. There is also a so called black box warning from the FDA which states that: "Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats." Pretty scary stuff but surely both opinions and approaches can't be right?
Are there risks?
Well, in a way they can but that doesn't mean both are in a cats best interest. No-one will deny that there are risks with giving any non-steroidal and cats do appear to be more sensitive to these drugs. It's been shown clearly that giving the highest licensed dose for just 3 days can cause mild changes in the intestines and kidney with 9 days of this treatment dose causing intestinal ulceration and peritonitis.
The fact of the matter is though that for long term treatment, the licenced dose is 6 times less than this single treatment dose. The additional benefit of meloxicam being available as a liquid is that it gives us the ability to gradually reduce the dose give to the lowest effective dose. But how do we know that this is safe?
How safe is meloxicam?
Well there have been several studies looking at this with a couple of studies in Australia that looked at safety in both otherwise healthy older cats as well as older cats with existing kidney disease In these patient histories of cats over 7 years of age were collected and those cats taking metacam for arthritis were compared with those not taking metacam. When cats were free of renal disease before starting treatment there was no difference in kidney function as they aged regardless of whether they were receiving metacam or not.
When the cats already had kidney damage before starting meloxicam, there was actually less deterioration in kidney function in those cats taking metacam compared to similar cats not taking the drug.
This means that rather than be dangerous, long term meloxicam may actually delay the worsening of disease in cats with otherwise stable chronic kidney failure.
As with most studies there are some points worth noting. This study was funded by the manufacturers of Metacam so there may be some bias. Also the dose of metacam given was very low, less than half of the dose licenced for long term use or 12 times less than the licenced single use dose.
This doesn't mean that it wasn't working just that the dose may well have been much lower than that given to cats who did experience side-effects. Finally, a study looking back at record like this is less valuable than ones where the animals are looked at and followed during treatment.
Despite all these facts, the study clearly shows that the European and Australasian approach is perfectly sensible and unlikely to be as reckless as suggested by the US black box warning. I really hope that there will soon be more studies into this to either back up or refute these findings.
The flip side is that NSAIDs offer our cats one of the best chances of a pain free life. Be that during the recovery from surgery, getting over a ligament or muscular injury or living with arthritis long term. Yes, there are alternative pain killers but none of them are proven to work as well in cats, especially long term and in most instances they themselves are actually not licensed for this use. Pain has many detrimental effects, it has a massive impact on a cats quality of life and should not be ignored.
Minimizing side effects
Of course we don't want to use any drug irresponsibly and there are a number of actions we can take to minimize the risk of any side-effects:
In older patients or any patient that is likely to be taking the drug on a long term basis a pre-treatment blood sample should be taken with follow up monitoring bloods run as advised by your vet. This will help pick up those individuals where there are concerns regarding liver or kidney function. If this is the case then it may be that an alternative treatment plan is made or that your pet is monitored more closely to be sure they don't deteriorate.
Stop if vomiting or diarrhea develops
Any cat that experiences vomiting or diarrhea should not continue to take the drug or risk the development of stomach ulcers. A few days off treatment will most likely result in recovery although your vet may want to give them some treatment to aid this recovery. It may be that your cat will be fine if they start the drug again, after all vomiting and diarrhea is fairly common in otherwise healthy cats who are not on any other treatment. For other cats, those seriously affected or known to have very sensitive intestines it may be that alternative treatments are then explored.
Stop if your pet appears depressed, becomes unwell or stops eating or drinking
If your cat is unwell for any other reason, if they stop eating or drinking then do not continue to give meloxicam. The reason for this is that if a cat becomes dehydrated, their organs may be under strain. An anti-inflammatory is then more likely to cause damage, especially to their kidneys.
Do not give a higher dose than your vet has prescribed
Do not give at the same time as steroids or any other NSAID
Don't use human pain killers unless specifically advised to by your vet (and never ever give your cat paracetamol).
Do contact your vet promptly if you have any concerns
If your cat is fat then give a dose approriate to their ideal weight rather than their actual weight.
Use other management and treatment strategies for arthritis and other chronic pain conditions to reduce the dose of NSAIDs needed to keep your pet pain free. This includes the use of different types of additional pain killers.
Do follow post-operative instructions fully to minimise pain and inflammation to allow a shorter course or a lower dose of medication to be used.
If we follow these recommendations we can ensure our cats are highly unlikely to experience any significant side effects WHILE AT THE SAME TIME BEING AS PAIN FREE AS POSSIBLE.
Pain is real
Don't be the owner who condemns their pet to suffer in silence when there is another way. Be sensible, yes. Don't use any drugs inappropriately, of course. But at the same time don't believe everything you read online is the whole story. You owe that to your cat.
While I expect anyone who's cat may have had side-effects to comment (and no, this article has not been sponsored by anyone), please let my know below how pain killers have helped your cat live a healthier, happier life. I would love to hear from you. Also, if it's your first time here sign up to our newsletter to make sure you don't miss out on future content and allow me to continue to help you and your cat.
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