Cats are not dogs, especially in pain control

November 1, 2010

If you know much at all about cats, you probably know that they have a unique physiology that calls for veterinarians to look at them differently when it comes to the use of drugs. Medicines commonly used in dogs cannot always be used in cats. Some medicines used for dogs can be safely used in cats. And there’s an interesting subset of drugs used in dogs that, if used in cats, must be used differently.

One of those drugs is meloxicam (Metacam), a nonsteroidal anti-inflammatory drug made primarily for use in dogs, with one exception for cats: The use of a single injection post-operatively.

Last week, the U.S. Food and Drug Administration asked Boehringer Ingelheim to change the label on meloxicam to include the following warning: “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.”

The FDA asked BI to make the label change after identifying many cases of kidney failure and death in cats who received multiple doses of the drug. When I heard about the label change, I knew I wanted to ask PetConnection’s  Dr. Robin Downing, a noted expert in the management of pain in animals, what she thought about the modification in recommended usage. I interviewed her in 2006 about anesthesia and pain relief in cats, and I knew she’d had good experiences with the use of oral meloxicam in certain cases, such as cats with renal disease who had no other alternative for pain relief.

Because of the label change, she says, the days of using oral meloxicam are over.

As a pain management expert, I find this particularly distressing as we already have so few pain medications for cats, and oral meloxicam is labeled for long-term use in cats in Europe. As a practitioner, I will never know all the details that led to the FDA requesting the ‘black box’ warning. I can say that we have used meloxicam in thousands of cats in the perioperative period with good effect and without issue.

The FDA still approves the use of a single injection of meloxicam to treat postoperative pain in cats. Downing says that at her clinic they will continue to use injectable meloxicam, delivered after surgery, at a dose lower than that recommended on the label. She avoids giving the drug until after surgery because use of an NSAID during anesthesia has the potential to damage the kidneys if blood pressure drops too low. For cats with no evidence of kidney disease, use of injectable meloxicam post-operatively for pain relief is not a bad choice, Downing says. That said, she has come to use it even more carefully than before.

I must report that since we last spoke, my approach to NSAIDs for long-term use in cats has changed dramatically. I do not use NSAIDs at all in old cats with pain, whether or not they have evidence of renal disease. With greater knowledge of and access to alternatives like buprenorphine, gabapentin and amantadine in particular, plus additional tools like Prescription Diet j/d Feline and microlactin and physical medicine options like chiropractic and acupuncture, I just do not reach for NSAIDs any longer for this population of patients who are by definition at higher risk of renal disease.

Good to know.

Filed under: pets, connected,veterinary medicine — Kim Campbell Thornton @ 2:51 pm

3 Comments »

  1. I, for one, am glad to see this warning. One of my cats was given metacam after eating the toxic pet food and between the two, she went into acute kidney failure. Spent two weeks in ccu at a vet teaching hospital and, although she recovered, she still struggles with kidney disease today. I’ve no doubt that her life span will be limited because of this. Better safe than sorry, far as I’m concerned.

    Comment by catmom5 — November 2, 2010 @ 8:08 am

  2. This is interesting news, even though it doesn’t currently affect any of my cats.

    Two years ago, though, my 18-year-old cat was diagnosed with oral squamous cell carcinoma. It was an especially brutal case, as the cancer was under her tongue (which she lost in pieces gradually as the disease progressed). No plans for treatment, just pain management and quality of life. Given her age and the advanced state of the cancer, she wasn’t expected to live long. (She did exceed the expectations slightly by living 2.5 months post-diagnosis.)

    She already was in the early stages of chronic renal failure, and was on fluid therapy twice a week. Both my regular vet as well as the hospice vet who usually saw her once a week prescribed *some* use of Metacam, but with specific restrictions:
    - Metacam was administered EVERY OTHER DAY only.
    - Metacam was given with an oral antacid to prevent the GI problems that this drug can cause.
    - Metacam was eventually given with another drug (amantadine, I think) that, according to the hospice vet, enhanced the pain-management capacity of Metacam at a lower dose.

    My cat’s primary drug for pain control was injectable buprenorphine, which worked very well. The Metacam was just one, rather minor, part of the arsenal. Given these new warnings, I don’t know if my vets would prescribe it again. Hope I don’t have a cat with cancer again anytime soon to find out (or maybe I don’t want a cat with cancer again, full stop.)

    As this is a new restriction and not all vets or pharmacies, unfortunately, will stay up to date, I recommend that people do their homework and understand the protocol, for this or any drug. A compounding pharmacy I has used for years filled the first Metacam scrip, but the label said to administer daily. When I called them to ask about this, they were dismissive and told me to just call my vet. My regular vet confirmed that the dosage was EOD. I called the pharmacy back later – and so did the hospice vet – to point out their mistake, and they were remarkably unconcerned. Needless to say, I haven’t used them since.

    Comment by cerridwen — November 2, 2010 @ 11:50 am

  3. Very happy to know this, my vet prescribed it for my cat after spaying surgery but i did not give it to her after reading up on it…it really scared me so i am so happy i never gave it to her but i hope vets acknowledge this asap

    Comment by eddy — December 10, 2010 @ 1:21 pm

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