Is Metacam Safe for Cats?

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Added March 25, 2011: New information on Long term use of oral Metacam in cats.

Metacam (also known as Meloxicam) is a pain medication that is used mostly for dogs, but also in cats. It is most commonly used for:

• Arthritis
• Muscle pain
• For animals that are painful after surgery

It can be given by your vet as a shot or it can be given in a liquid form that is put in your pet’s food or directly into your pet’s mouth.

The Metacam controversy...

Here are some of the things that I found while searching about whether Metacam is safe to use in cats:

• “DO NOT GIVE YOUR CAT METACAM – IT KILLS CATS“
• “Metacam causes cats to go into serious renal failure”
• “Why do vets prescribe Metacam to cats when they know it is fatal?”
• “sue the **** off your vet, close him down and prevent others from using the drug.”

Is Metacam meant to be given to cats?

The drug company that makes Metacam has done testing to show that it is safe to give a Metacam injection to cats. An example of using the drug like this is for pain relief after surgery.

But is it safe to give Metacam liquid orally to cats? In Europe, Australia and New Zealand, and now Canada the Metacam label says it is safe for use in cats. In the US and Canada, the only form of Metacam that is officially safe for use in cats is a one time dose of the injectable product. However, many vets will still prescribe Metacam for long term use in cats. This is called “off-label use” and is very common in veterinary medicine.

(It is interesting to note that the dose that is approved as safe in the US is 1.5 times higher than what is approved in Canada.)

Why would a vet prescribe a drug when there is no research done to show that it is safe? (Note...a new study does show that long term oral Metacam is safe...click here to read about this.) This is done when the benefits outweigh the risks. Metacam used to be considered to be a safe drug to use long term in cats when used in appropriate dosages to healthy cats. However, in September, 2010 an FDA Black Box Warning was printed on Metacam boxes sold in the US stating that it should not be used repeatedly in cats.

So why does one country say it is safe, and another does not? Personally, I think it is all about litigation. US citizens are more likely to sue Boehringer if an animal on Metacam has a problem. See below, about new information that states that Metacam really is safe for long term use in cats.

One of the problems that vets face is that there are very few pain relievers that can be safely and effectively given to cats long term. So, when we have a cat with a chronic problem like arthritis, we have to weigh the pros and cons of any drug that we give.

A surprising find in my research!

I have to admit that it was hard to write this article without having a bias. I do give Metacam injections and have given oral Metacam to cats many times and have yet to see a problem. I set out writing this article with the thought in my head that Metacam is safe and that Metacam bashing forums and sites such as this one were all inaccurate.

However, I was a little surprised by what I turned up in my research. I did a search in some veterinary archives using the keywords “Meloxicam renal failure” and found a very large number of posts.

These posts were talking about cats that had kidney problems because of receiving a Metacam injection. Sometimes these problems could be explained by improper use of the drug:

• The dose that was given was too high or owners were giving it more often than recommended.
• An animal under anesthetic did not have blood pressure monitored and then was given Metacam. (If an animal’s blood pressure drops under anesthetic then this can cause kidney damage.)
• Animals did not have blood or urine tests done before surgery. Some of these cats may have already had kidney problems.

However, what surprised me were the number of cases where the vets did everything right – preanesthetic blood and urine tests, intravenous fluids during surgery, blood pressure monitored, correct dosage given – and STILL had a cat go into renal failure after a single injection of Metacam injection was given!

I do think we have some cause for concern when it comes to INJECTABLE Metacam use.

It is important to know that any drug can have side effects. We still continue to give vaccines despite the fact that the odd animal will have a serious vaccine reaction. We prescribe antibiotics when some animals can have a serious allergic reaction. Almost any medication can cause a rare reaction that can be life threatening.

I do really believe that when Metacam is given appropriately, at the correct dosage, to a healthy cat the chances of developing kidney problems are extremely rare. But, it can happen.

I have also noticed that in the US, the dose for a Metacam injection for cats is 0.3 mg/kg. In Canada it is 0.2 mg/kg. It may be that there are more issues with Metacam for cats in the US because of the higher recommended dose.

Do I give Metacam injections to cats?

NEW INFO ADDED NOVEMBER 4, 2011

When I first wrote this article, I stopped giving Metacam injections completely to cats. Instead, after a surgical procedure such as a feline spay I would give an injection of Tolfedine and send a cat home with oral Tolfedine tablets. Tolfedine is an antiinflammatory drug that is not available in the US. I had said at the time that "...there seem to be fewer cases of Tolfedine-induced renal failure than Metacam. But, what we don't know is whether this is because Tolfedine is safer or because it is not used as often as Metacam."

This week, I received a letter at our office telling us that there have been an increased number of cases of adverse reactions with Tolfedine now. So, what is a vet to do!!!

You can read more in my blog about the latest concerns over Tolfedine use in Canada.

Despite what I have written above, I do now give Metacam injections to cats when I feel it is necessary. However, I use a dose of 0.1 mg/kg. The labelled dose in Canada is 0.2mg/kg and most of the cases where cats have reacted had the US recommended dose of 0.3 mg/kg. I also send some of my surgery patients home with a box of oral Metacam, that is now labelled for use in cats, for a maximum of three days. If an animal has an issue with their kidneys, or experienced low blood pressure during surgery then I will avoid any NSAIDS.

Alternatives to Metacam:

Depending on the reason for Metacam being used there may be alternative medications that can be used.

Cosequin is a good and safe supplement that helps cats with arthritis

For cats with arthritis, Metacam tends to be the best drug to give. However, some cats do well with shots of either Cartrophen or Adequan. You can ask your vet about the possibility of using a drug such as buprenorphine, amantadine, gabapentin or tramadol. Additionally, many cats do well with a joint supplement called Cosequin. Cosequin is really easy to give to cats and for some cats it works really well.

For pain relief after surgery, buprenorphine or tramadol are alternative medications that will sometimes help.

New FDA Black Box Warning

In September, 2010, the makers of Metacam were forced by the FDA to put the following "black box label" on boxes of Metacam:

This warning has caused concern amongst veterinarians. Many veterinarians (myself included) have prescribed metacam to many cats and have never seen a case of renal failure related to the drug. I am not sure why this warning was added because in March of 2011 the Canadian authorities decided the opposite and said that oral Metacam was safe.

I do prescribe oral metacam to some cats. I think the key is to treat this medication with respect and only prescribe it when the benefits outweigh the risks. (Added: New research shows that oral Metacam does not increase the risk of kidney problems in cats (see below).

New Information on use of ORAL Metacam

Added Mar 25, 2011

In Canada, Metacam is now labelled for oral use in cats. As of this week, there is a label on Canadian Metacam bottles that says it is safe to use it for two days after surgery.

Remember, the controversy that was discussed above is regarding the use of a Metacam Injection. I no longer give Metacam injections to cats, but I do prescribe it orally to some cats.

I have found a very interesting study that I will summarize for you:

Recent information on long term use of Metcam in cats

This information is from a study in the Journal of Feline Medicine and surgery and was published in July 2010. You can read the article abstract here: Long term use of Meloxicam in cats.

In this study they had two groups of cats: Cats with Stage 1-3 Chronic Renal Disease and Cats with no renal disease. They gave Metacam long term to all of these cats and looked at how long they lived and whether or not their kidney disease got worse. The study showed that there was no harm to the kidneys from long term use of oral Metacam.

Recommendations for using Metacam long term in cats.

For many cats, Metacam is really the best available drug for arthritis. When I put a cat on Metacam long term here are some things I do to make it as safe as possible:

• I do blood and urine tests first to get a baseline of what the kidney and liver status is.
• I dose the cat based on what their lean body weight is. So, if I have an overweight cat, I will lower the dose slightly.
• I tell the owner to call me if they are seeing any appetite loss. This can be a sign of issues related to Metacam. (But it can also be a sign of many other things!)
• I do blood and urine tests every 6 months (or more frequently if I am treating a cat that already has kidney disease).

If your vet has prescribed oral Metacam for your cat, there is no need to panic! Again, for many cats, Metacam is the best available drug to treat arthritis. We use it with caution when we think the benefits outweigh the risks.

Article Summary

I understand that this article may be confusing. In some places I have said that there could be risks with the administration. In others I've said that there is now a warning box telling us that oral Metacam is unsafe. And then, I've said that it is perfectly safe. So, how do we understand all of this? Here is my summary:

• There have been some tragic cases where healthy cats have died of renal failure after receiving a single injection of Metacam. My thought is that these cats received the US recommended dose of 0.3 mg/kg. I feel comfortable giving a Metacam injection to cats at a dose of 0.1 mg/kg where I feel it is necessary.
• In the US, there is now a label on oral Metacam boxes saying that it is not recommended for long term use in cats. However, in Canada, this label does not exist. The studies mentioned above show that giving oral Metacam does not cause harm to a cat's kidneys even if they have pre-existing kidney diseae. My personal opinion is that it is safe to give, but if I have a cat on long term oral Metacam I will regularly do blood tests to monitor their kidney enzymes.

Share your Metacam Experiences!

Do you have an experience with using Metacam in cats? Feel free to leave a comment on my blog post about Metacam use in cats. Or, you can leave a comment below:

Leave a comment below!

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