Metacam (Meloxicam) is a member of the class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), the same class as such common over-the-counter pain remedies as Ibuprofen, Paracitamol and Aspirin. Most NSAIDs cannot be used in pets due to unacceptable side effects:
· Stomach ulceration – even perforation and rupture of the stomach can occur. This is not only painful, but also life threatening.
· Platelet deactivation – platelets are the cells controlling the ability to clot blood and, as a general rule, it is preferable not to promote bleeding. We would prefer platelets to remain active and able to function should we need them.
· Decreased blood supply to the kidney – this could tip a borderline patient into kidney failure.
The veterinary profession has been in need of an NSAID that could effectively relieve pain without the above risks. The key appears to lie with the enzyme responsible for many inflammatory mediators. A different but related enzyme is responsible for producing important biochemicals needed to maintain normal blood supply to the kidneys and Gastro Intestinal tract. It had been previously impossible to inhibit this enzyme, hence the side effects of previous NSAIDS.
This new ability to inhibit a specific proved to be revolutionary for pain management not only for pets but for humans as well. It has reduced stomach and intestinal side effects by 50% in humans and has made approval of NSAIDs possible for pets.
Metacam offers another unique feature that other veterinary NSAIDs do not: feline use. Cats are even more sensitive to NSAID side effects as a general rule and the quest for a feline NSAID is still on going. Metacam has been approved for use in cats for surgical pain so long as only one dose is given. Longer-term feline protocols have been developed and are in wide though cautious use in needful cats.
Another use of Metacam bears mentioning. There are many forms of cancer, in particular certain types of carcinomas, seem to exhibit COX-2 activity. This implies that Metacam have anti-tumour effects separate from their anti-inflammatory effects and their use in the treatment of inoperable cancers is currently being explored.
How this Medication Is Used
Metacam is generally given to control arthritis pain in dogs though can be given for many other painful conditions such as injuries, cancer, surgery, dental infections, and more. It is typically given as a once a day as a pleasantly flavoured liquid. The veterinary approved product comes with a special dosing syringe marked to show how much to give for the pet’s weight (rather than in milliliters as most syringes are marked).
Metacam can be used in cats but with caution. The original oral solution was commonly dosed in drops from the bottle. Since the wrong dose can be dangerous for cats, it is important not to drop the drops directly into the cat’s mouth from the bottle as squeezing too strongly could easily deliver an overdose. There is currently a newer formulation at one-third the strength of the original, which can be dosed more accurately with the included syringe. In cats, this product is given either as a single one-time injection in association with surgery or long term 2 to 3 times per week.
Patients being considered for long-term Metacam use should be evaluated with a complete physical examination and initial screening blood test to identify any factors, such as liver or kidney disease, that might preclude the use of this or any other NSAID.
Side Effects
The side effects of concern are the same with all NSAIDs: stomach ulceration, loss of kidney function, and inappropriate bleeding. These are dependent on the dose of medication used and on risk factors of the host (for example: an aged pet may not efficiently clear a dose of medication from its body leading to stronger and longer activity of the drug).
· The most common side effects are nausea, appetite loss, vomiting or diarrhoea. If any of the above is noted, Metacam should be discontinued and the pet brought in for a liver enzyme and renal parameter blood test. In most cases, the reaction is minor and resolves with symptomatic relief, but it is important to rule out whether or not the patient has more than just a routine upset stomach.
· If a patient has borderline kidney function, NSAIDs should not be used as they reduce blood flow through the kidneys. It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect. This is particularly true in cats.
· The liver side effect (usually occurs within the first 3 weeks of use), and seems to be mostly a canine issue.
Dogs with hepatopathy show improvement with support 5 to 10 days after discontinuing medication. It is important that the NSAID be discontinued and the patient evaluated in the event of upset stomach signs in case of this syndrome. Even though this is a rare syndrome (one in 5000), it can become life threatening if ignored. Appetite loss or other intestinal signs do not necessarily indicate a hepatopathy but since they might, it is important not to ignore these signs should they occur. There is no way to predict which dogs will experience this side effect.
Interactions with Other Drugs
Drugs of the NSAID class should not be used concurrently as the potential for the aforementioned side effects increases. For similar reasons, NSAIDS should not be used in conjunction with corticosteroid. It is recommended a 5 to 7 day rest period when changing from one NSAID to another. Aspirin poses an exception due to its strong platelet inactivating abilities so 10 to 14 days is recommended when switching to another veterinary NSAID from aspirin. If meloxicam is used concurrently with Phenobarbital, it is especially important that appropriate liver monitoring be performed. These two drugs interact such that neither may work well if they are used together.
ACE inhibitors such as Enalapril, Benazepril, or Captopril may not be as effective in the presence of Metacam. (ACE inhibitors are used in the treatment of hypertension or heart failure.) This is because ACE inhibitors depend on the dilation of blood vessels in the kidneys and such dilation can be interfered with by NSAIDs).
Concerns and Cautions
Metacam should be given on a full stomach to minimise side effects. Maximum effect is seen approximately 8 hours after oral administration. When beginning a trial course, a response may take 3 or 4 days to show. If no response is seen in 10 days, Metacam has failed and a different pain medication should be tried. If one NSAID fails, another may well work.
The veterinary formulations of Meloxicam are oral liquids (either 1.5mg/ml or 0.5 mg/ml). It is important to compare these sizes to the human tablets, which are available in much higher strengths. In general, human strength pills will be too strong except in very large dogs. It is important not to use human medications on pets unless your veterinarian has provided detailed dosing instructions.
Where to get Metacam?
Metacam can be supplied by your local vet. This might be the most expensive way, but it is easy. However metacam is not a cheap drug and can be supplied legally online. The best way to get metacam is to go to CompareVetDrugs.com and seek for the best price. Many people use online suppliers these days to help with the costs of medication.
Metacam must first be prescribed by the vet, who is directly responsible for the care of the animla in question. This means that a vet must assess the animal’s condition and then decide, in conjunction with the owner, what treatment is most appropriate. If the decision is to use Felimazole, then the vet is legally obliged to provide a written, signed prescription on request. This can then be forwarded to the chipset Internet pharmacy found at CompareVetDrugs.com, so that the drug can be supplied.