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How much is my cat at risk from Meloxicam?
March 7, 2011 3:47 PM   Subscribe

My vet has given my cat two doses of Metacam (Meloxicam) in the last seven days. The drug is black-labeled for usage in cats by the FDA ("Repeated Use In Cats Has Been Associated With Acute Renal Failure And Death"). What should I do now?

Cat was injured and lamed by a bite. Cat is approx eight months old, about 2 to 3 kg in weight.

Initial dose of Metacam given last week, I don't know the amount or whether orally or by injection.

Second dose was given today, probably oral, 0.1 ml oral suspension (but I don't know what dosage level). (I was also given several more doses to administer.)

Do I immediately take her to another vet, or do I monitor for signs of renal failure? If so, what am I looking for?

The warning label for Meloxicam reads, in part, "Do Not Administer A Second Dose Of Meloxicam" and "Repeated Use In Cats Has Been Associated With Acute Renal Failure And Death."

Is a second dose in a week a "second dose" or two "first doses"? (That is, how quickly is Meloxicam metabolized in cats?)

Thanks.
posted by orthogonality to Pets & Animals (10 answers total)
 
Don't know but I suggest you change vets now and go to one that specializes in cats. It does not sound like this vet knows what they are doing.
posted by mermayd at 4:01 PM on March 7, 2011 [1 favorite]


My boss is one of the leading veterinary pharmacists in the country, and I'll get her input on this in the morning, but if my memory serves, we permit cats to be on meloxicam for up to 5 consecutive days, at which point they then have to be off of it for 2 consecutive days. I may have those numbers slightly off, though. Bottom line, meloxicam is safe in cats if given carefully and thoughtfully.
posted by Rock Steady at 4:13 PM on March 7, 2011 [3 favorites]


I would go to another vet. Cats are weird and metabolize meds differently, don't tolerate anti-inflammatories well, and Metacam should be used with extreme caution in cats.
posted by bolognius maximus at 4:19 PM on March 7, 2011


Rock Steady's comment matches my personal experience: our cats were on meloxicam for several days after their spay and neuter, and neither had any issues related to it.
posted by Lentrohamsanin at 4:20 PM on March 7, 2011


Pain management in cats is difficult because they really don't metabolize many medications well; there are limited options for pain meds and each one of them can be risky, but I'd take the risk if administering it meant my cat wasn't in agony. Was your cat's renal function tested beforehand? Even if so, you may want to have it tested again, and your vet (old or a new one) may have suggestions for kidney support.

You asked about the symptoms of renal failure in cats, and here is the list from Vetinfo:
•Decreased urination
•Increased Thirst
•Loss of appetite
•Lethargy
•Vomiting
•Weakness
•Disorientation

I feel for you, and your cat is fortunate to have someone caring for her so well, but please keep in mind that the labeling on many medicines are catastrophically worded. The FDA studies on Metacam that led to its labeling were done at higher levels than the clinical norm, and most of the cats in the study were older, which increases risk.

Here is a blog post with some information, fwiw.

There really isn't any clear good option for pain management in cats, and I hope someone is seriously working on that. Sending wishes to your cat for a quick and complete recover.
posted by vers at 4:30 PM on March 7, 2011 [1 favorite]


I'd take the risk if administering it meant my cat wasn't in agony.

Oh, she's not in agony. As I told the vet, she's been putting weight on the injured leg since Friday, and when walking "pushing off" with that leg as well, thus articulating the knee, ankle and toes, and running after the laser pointer. I'm sure she has residual pain and stiffness, but she's been clearly improving.

We had a long wait for the vet today, and in that time she jumped off the exam table a couple of times, so she was favoring the leg slightly more once the vet got there. (She was also about to jump back up to the exam table, until I grabbed her.) Today's visit was purely to reassess, and to get some vaccinations.

Whatever pain she might be in, she's not putting full weight on the leg, but it's not stopping her from playing and exploring (and even trying to climb the windows like a furry lumberjack.)
posted by orthogonality at 4:57 PM on March 7, 2011


Just got this via email from my boss:

The International Society for Feline Medicine and the NC State Comparative Pain Management Laboratory recommend the following meloxicam dose for cats:

0.1mg/kg orally ONCE,
followed by: 0.05mg/kg orally once daily for no more than 3-4 days,
followed by: 0.025mg orally once daily or once every other day with the goal being to keep the cat pain free on the lowest possible dose of meloxicam.

The cat should also have normal renal function and not be particularly geriatric and should also be very well hydrated.  If the cat received the dog dose, (0.2mg/kg) the drug should be stopped and the cat evaluated immediately for renal damage.

Obviously, this is not specific medical advice, and you should really call your vet (or their emergency service) if you have any questions about your pet's medication.
posted by Rock Steady at 4:58 PM on March 7, 2011 [5 favorites]


Yeah, Rock Steady is exactly right. It's very effective for short-term use in cats, and is generally quite safe as long as it's dosed appropriately. Your vet is not wrong for doing this at all.
posted by biscotti at 4:58 PM on March 7, 2011 [2 favorites]


This is not medical advice, I'm not your vet.

Rock steady is spot on. Metacalm is widely used in feline pain management.

I would add that it is unwise to post formulary dose instructions without the drug concentration. If a veterinary hospital has it compounded with flavor or the injectable concentration is referenced, the patient would be in danger.

Here is the quote from Plumbs:
Uses/Indications
Meloxicam is principally used for the symptomatic treatment of osteoarthritis in dogs. Short-term (single dose injectable) use is also approved (in the USA) for cats for the control of postoperative pain and inflammation associated with orthopedic surgery, ovariohysterectomy and castration when administered prior to surgery.

In the future if you don't trust your vet, find one that does. Random people on the internet and Google don't know your cat's history, and as this tread has evidenced, the feedback signal to noise ratio can be all over the place.
posted by Nickel Pickle at 5:28 PM on March 7, 2011 [2 favorites]


Um, Metacam is used long term in many cats both here in NZ and in Australia. It's a very effective arthritis treatment. You have to test the cat's kidney function regularly (urine tests every three months in our case) and make sure there are no contraindications in that particular cat (e.g. previous renal insufficiency) but it's not some kind of death sentance. It's also commonly used short term for post op care or other acute issues. My cat was on a maintenance dose for two years until she had to stop because of unrelated health issues, and my sister's cat took it for five years without issue. I see a cat-only vet with extra postgrad level feline medicine training, plus a registered vet specialist (which involves all kinds of extra training and experience above what a vet gets), so they really do know what they're doing.

It's all in the dosing (0.1 mL means nothing, mg/kg is what you need to be looking at), the follow up care (including other testing if necessary), and also in understanding the rest of that cat's medical history. None of which we can help you with. If you don't trust your vet then sure, get a second opinion. But make sure to discuss the whole issue with them and understand what actually they are doing and why rather than listen to random stuff from the internet.
posted by shelleycat at 7:34 PM on March 7, 2011 [1 favorite]


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