Can Metacam be used after Rimadyl?

Re: Can Metacam be used after Rimadyl?

Rob Loxley — Tue, 04 Sep 2012 18:29:41 GMT

[quote user="Martin Atkinson"]3 out of the first 6 cats I put on it suffered renal failure[/quote]

Bad luck I fear, but obviously little consolation to the cats involved.

[quote user="Martin Atkinson"] I cannot be happy with an NSAID that lasts for a month with no opportunity to stop dosage if side effects occur.[/quote]

My thoughts too. Also how often do you get people who can't give 'normal' daily NSAIDs to their dog?
Did we (vets/clients) really tell Pfizer what we needed was a once-a-month NSAID, or have they just developed a market for a drug they happened to have developed?

Re: Can Metacam be used after Rimadyl?

Bob Russell — Tue, 04 Sep 2012 15:09:31 GMT

My darling, pain in the ar*e Staffie is on Trocoxil and doing brilliantly. Every month I look her firmly in the eyes and say 'cause more trouble and this will be your last dose and you can limp'. Strangely enough this threat has made no difference to her behaviour and she still runs away!

Re: Can Metacam be used after Rimadyl?

Mark Hedberg — Tue, 04 Sep 2012 12:19:35 GMT

My mother in law's dog has OA, and this was a big reason I asked the treating vet to prescribe carprofen instead of trocoxil. I know trocoxil is probably 95% safe (5% of dogs can't metabolize, according to the datasheet) but that 5% will happen 99% of the time when the patient belongs to your close relatives, friends, and any time it's extra-specially embarrassing

Re: Can Metacam be used after Rimadyl?

Martin Atkinson — Tue, 04 Sep 2012 12:07:07 GMT

[quote user="David Mills"]Whilst we're at it, the case for renal failure in cats or worsening of CKD is similarly unclear especially at low dose - how many OA cats out there are going without pain relief due to theoretical dogma?[/quote] I am very careful giving cats meloxicam and went through a phase of not giving it at all after 3 out of the first 6 cats I put on it suffered renal failure (all 3 were blood tested prior to starting mediation and their renal parameters were normal). My cat has OA and I give him Onsior on a need to have basis but still worry. I have a bigger concern not with overdosing or piggy-backing different NSAIDs in dogs but with Troxocil. I cannot be happy with an NSAID that lasts for a month with no opportunity to stop dosage if side effects occur. The one and only dog I gave it to suffered severe HGE 4 days post dosing and had to have intensive treatment to survive. I called Pfizer who said that it most likely wasn't that as the side effects would occur within 24-48 hrs and in any case treatment would be no different than for a dog which had had a reaction to a daily NSAID and the medication had been stopped as a result. This dog had had long courses of both carprophen and meloxicam with no problems before or since (and no the Troxocil wasn't given immediately after finishing one of them). I am consequently very loathe to use it again. So I have some major issues with NSAIDs but as said giving a different short acting one 24 hrs after another in a dog isn't one of them.

Re: Can Metacam be used after Rimadyl?

Hannah Wynne Richards — Tue, 04 Sep 2012 11:01:46 GMT

Mark If I was a doctor I simply couldn't morally bring myself to waste taxpayers money treating murderers/paedophiles/people convicted of animal cruelty Good ridddance to bad rubbish when they snuff it is what I would say

Wynne

Re: Can Metacam be used after Rimadyl?

Malcolm Ness — Tue, 04 Sep 2012 10:35:01 GMT

[quote user="Michael Woodhouse"]Get half a dozen specialists together and they can't agree on anything (canine cruciate disease, anyone?).[/quote]

In fact, they will agree on almost everything, including exactly where the controversies lie.

[quote user="Michael Woodhouse"]Just because someone had the free time to publish their findings doesn't make those findings worth any more or less than my own.[/quote]

If it is published following peer review, then it is worth very much more.

Re: Can Metacam be used after Rimadyl?

Rajat — Tue, 04 Sep 2012 10:02:39 GMT

[quote user="Michael Woodhouse"]Hardly any 'stronger' evidence that what we do everyday (if when I tried to fix things it didn't work, I'd do something else. I hope we all would). [/quote]

There is a difference between these 2 (a retrospective case control study and 'what we do everyday') - very obvious differences- not my place to explain it to you though.

There are prospective studies looking at efficacy of meloxicam. And there are retrospective studies looking at its effects, including on renal function. This has had a big implication on quality of cats' lives with CRF and concurrent musculoskeletal problem so the question is not whether it was a double blinded placebo controlled prospective study, but whether the study design allows us to extract meaningful information from it.Which, IMHO, it does.

I am sure more will come out - bottom line is collating the data we have leads to more informed decisions not based on our personal coloured and biased interpretation of the cases we may have seen (and the facts we may or may not remember - really do you remember exactly how your last 38 cases did how long each lived, number of a/effects and doses they recieved when these occured?), and hopefully to better patient outcomes.

[quote user="Michael Woodhouse"]Find me a double blinded study and that has more weight, yes. [/quote]

Umm- find it yourself mate! You contradict yourself, first denying the usefulness of literature, then saying you do use it but don't have time to read it, and then saying you do change your mind based on what you read and then demanding the highest level of evidence. Sounds a bit confused to me.

[quote user="Michael Woodhouse"]The medics have it easy - there are huge boards of people distilling the evidence and feeding down 'best practice'[/quote]

Right...so who has it tough? Farm vets? Orthopaedic Surgeons? Because there isn't literature around on these topics, published monthly? No members of boards of these journals doing the same distilling process.?

More confusion.

Re: Can Metacam be used after Rimadyl?

James Laidlaw — Tue, 04 Sep 2012 09:51:46 GMT

Touché!

Re: Can Metacam be used after Rimadyl?

Mark Holmes — Tue, 04 Sep 2012 09:21:14 GMT

[quote user="James Laidlaw"][quote user="Mark Holmes"][quote user="James Laidlaw"]How do you act in the best interests of an animal you loathe?

[/quote] In the same way a Doctor acts in the best interests of a paedophile/murderer/other criminal I would say.

[/quote] So... Country dependant death penalty then?

[/quote] Change that to client dependant and it sums up veterinary medicine.

Re: Can Metacam be used after Rimadyl?

James Laidlaw — Tue, 04 Sep 2012 09:18:03 GMT

[quote user="Mark Holmes"][quote user="James Laidlaw"]How do you act in the best interests of an animal you loathe?

[/quote] In the same way a Doctor acts in the best interests of a paedophile/murderer/other criminal I would say.

[/quote] So... Country dependant death penalty then?

Re: Can Metacam be used after Rimadyl?

Mark Holmes — Tue, 04 Sep 2012 08:35:11 GMT

[quote user="James Laidlaw"]How do you act in the best interests of an animal you loathe?

[/quote] In the same way a Doctor acts in the best interests of a paedophile/murderer/other criminal I would say.

Re: Can Metacam be used after Rimadyl?

James Laidlaw — Tue, 04 Sep 2012 06:57:18 GMT

How do you act in the best interests of an animal you loathe?

Re: Can Metacam be used after Rimadyl?

Michael Woodhouse — Tue, 04 Sep 2012 00:23:08 GMT

[quote user="Rajat"]Not the same as a controlled study[/quote]

mmm - you linked two retrospective series of case studies. Hardly any 'stronger' evidence that what we do everyday (if when I tried to fix things it didn't work, I'd do something else. I hope we all would).

Find me a double blinded study and that has more weight, yes.

I have changed what I do many times based on papers I have read, I have also read lots of papers that should never have made it into print. Just because one paper suggests something *may* be a good idea doesn't always mean it is.

The medics have it easy - there are huge boards of people distilling the evidence and feeding down 'best practice'. It is not possible to read every paper published, it's not feasible to search the literature with every case, so you get on doing what you believe is in the best interests of the animal.

Hell, I can even mend stuff, sometimes.

Re: Can Metacam be used after Rimadyl?

Rajat — Mon, 03 Sep 2012 23:37:08 GMT

[quote user="Michael Woodhouse"]That is licensed for daily use? That is so convenient the owners can comply? [/quote]

Nothing is licensed in CRF Michael..and yes.

Re how little we know - yes I have heard those figures. I'd rather strive to improve my knowledge and get better at what I do ,than carte blanche give Meloxicam to all CRF kitties. Or similar.

[quote user="Michael Woodhouse"] I am scientifically trained and capable of monitoring the cases in my own care - I have seen what happens.[/quote]

Right....

[quote user="Michael Woodhouse"]I have used it in more arthritic cats than that since it came out[/quote]

Do you think you're the only one? I bet most of us have treated FAR more. Anecdotes-a-plenty here. Not the same as a controlled study. If you can't be 'bovvered' don't slag off the folks doing the hard work for you and I, alright? (Reckon we would have metacam if the papers showing its safety and efficacy weren't published?)

I don't really have words for the rest of what you wrote!

Re: Can Metacam be used after Rimadyl?

Michael Woodhouse — Mon, 03 Sep 2012 21:37:31 GMT

[quote user="Rajat"]You do realise that there are other options for painkillers in cats other than Meloxicam, right?[/quote]

That is licensed for daily use? That is so convenient the owners can comply?

[quote user="Rajat"]You may not give a damn about this or that, but where do you think the information you rely on to practise everyday comes from? [/quote]

As you like your literature you will know as well as most that there is very weak evidence for most of what we do. I remember reading a fact that there is only decent evidence in about 40% of human treatments (I have no reference). Some of the literature out there is very weak and can be based on very few cases. Just looked 38 cats in the top study you link - I have used it in more arthritic cats than that since it came out. I am scientifically trained and capable of monitoring the cases in my own care - I have seen what happens. Just because someone had the free time to publish their findings doesn't make those findings worth any more or less than my own.

Literature is useful but I don't have the time to spend all day on PubMed nor can I be bothered to write everything up.

Get half a dozen specialists together and they can't agree on anything (canine cruciate disease, anyone?).

And yes, I loathe cats.

Re: Can Metacam be used after Rimadyl?

Rajat — Mon, 03 Sep 2012 18:11:47 GMT

[quote user="Michael Woodhouse"]I don't give a damn about theoretical dogma (nor papers Rajat). If the cat is painful it gets NSAIDS. Like to do bloods first, but if no money I'd rather they spent it on the painkillers.[/quote]

You do realise that there are other options for painkillers in cats other than Meloxicam, right? And by the way you don't need bloods first, you need a urine sample to investigate renal dysfunction. Cheaper than NSAIDs to do a USG!! (I won't quote you a paper or dogma for this, it's just fact.)

You may not give a damn about this or that, but where do you think the information you rely on to practise everyday comes from? How do you think textbooks are written? Through research and papers...right...

I hope what you wrote was out of frustration/emotion/end of a bad day rather than what you actually practise. Oh and I wouldn't wanna see you if I was a cat (coz I'd know you didn't like me, not coz of the paper/s you didn't give a damn about !!!)

Re: Can Metacam be used after Rimadyl?

Michael Woodhouse — Mon, 03 Sep 2012 17:55:56 GMT

I don't give a damn about theoretical dogma (nor papers Rajat). If the cat is painful it gets NSAIDS. Like to do bloods first, but if no money I'd rather they spent it on the painkillers.

I have had cats renal parameters improve markedly and the only treatment being the addition of Metacam! I use it at the licensed dose to start with and get owners to reduce after a couple of weeks to lowest effective dose.

I will actually ask them whether they would prefer a longer painful life or a shorter pain-free one. Nobody has refused the NSAID yet.

(I don't really like cats very much, but a long term cat NSAID is the best thing that has happened in terms of feline welfare in a very long time)

Re: Can Metacam be used after Rimadyl?

Rajat — Mon, 03 Sep 2012 17:26:03 GMT

I see most dogs and cats have good analgesia at recommended doses of NSAIDS

While many are fine with Overdoses, without scoping to check gastric mucosal ulceration and faecal occult bloods and so on I don't think we can say 'they were fine' so anecdote here is a dangerous thing to take at face value

I second the individual variation in response to drugs, there's quite a bit of info on this for e.g. in variability in response to opioid drugs due to genetic differences and binding differences to receptors and so on

Re metacam + cats with CRF- very interesting work came out of Australia in the last year or so in cats with CRF ( I suspect this is what you are referring to David) and since then, in selected cases with the right owners I do use metacam at very low doses in stable CRF and so far have not seen any 'problems- using the crude tool of creat/urea/USG to guesstimate at GFR... The first link below actually showed les sprogression in the CKD group given metacam compared to the CKD control not given metacam!

I don't think it is purely theoretical dogma though David, are there not cases of NSAID induced renal failure reported in the literature?

http://jfm.sagepub.com/content/13/10/752.abstract

http://jfm.sagepub.com/content/early/2012/07/19/1098612X12454418.abstract

Re: Can Metacam be used after Rimadyl?

David Mills — Mon, 03 Sep 2012 16:45:57 GMT

Ah, we free thinking professionals, enslaved to data sheets.

Recommendations for dosages rest on clincial efficacy versus toxcitiy. Clinical efficacy in NSAIDs for OA pain is notoriously difficult to judge, based mainly on subjective lameness scores or unvalidated pressure plate analysis which ignores any mechincal component. Surrogate outcomes such as COX inhibition are not well correlated with clinical efficacy. Toxicity is an easier call, but the therapeutic index is generally high for NSAIDS and most dogs will tolerate much higher doses than we currently give. Indeed much of the 'toxicity' is physical at the mucosal border rather than systemic, which is individual-specific. It is likely that individuals process the drug at different rates so expecting one dog to react exactly the same as the next is at best naieve.

Whilst we're at it, the case for renal failure in cats or worsening of CKD is similarly unclear especially at low dose - how many OA cats out there are going without pain relief due to theoretical dogma?

Re: Can Metacam be used after Rimadyl?

tess — Mon, 03 Sep 2012 16:31:56 GMT

I think more owners than we realise are overdosing with NSAIDs, especially with Metacam where the tendency seems to be to give an extra squirt if their pets are having sore days. This is despite drumming into them the importance of sticking to the dose and getting in touch if things aren't working.

I tend to check how quickly they are getting through a bottle when doing repeat prescriptions.

Re: Can Metacam be used after Rimadyl?

Bob Russell — Mon, 03 Sep 2012 13:51:22 GMT

[quote user="Michael Woodhouse"]

[quote user="James Laidlaw"]Excuse my cynicism, but I'm finding this anecdote difficult to believe... Dosed 8000 mg, or enough for a 2,000 Kg dog and no ill effect, and also Pfizer advised to do nothing???[/quote]

Was a colleague that rang and spoke to them. Told by that point that little could be done and just to monitor dog for GI signs, drinking and check renal parameters. IIRC it was a big heavy black lab, pushing 50kg.

8000mg/50kg = 160mg/kg

LD50 in mice 282mg/kg and 149mg/kg in rats.

[/quote]

My Staffie consumed 60 Rimadyl tablets in a session when she was left in the car unattended. I induced vomiting as soon as i could (probably within an hour of taking them) and various soggy tablets appeared. Other than that she was fine! That was about 8-9 years ago.

Yet another of the many lives she has squandered in her 11 years!

A lot of these reactions must be idiosyncratic rather than toxicity.

Re: Can Metacam be used after Rimadyl?

Mark Holmes — Mon, 03 Sep 2012 10:34:04 GMT

[quote user="Jenny Smith"]

Not a 'proper' anecdote, but a personal one.. I was put onto diclofenac for back pain as a student. 3 days later I was vomiting blood and admitted to hospital with a particularly nasty case of gastric ulceration. First time ever on NSAIDs, was careful about eating before taking etc as I knew the possible SEs!

Jenny

[/quote]

I went skiing a few years ago, fell and stuffe my shoulder. Lived on neurofen for a week, didn't really pay attention to the whole eating thing and my guts dropped out.

Re: Can Metacam be used after Rimadyl?

Jenny Smith — Mon, 03 Sep 2012 10:26:04 GMT

Jenny

Re: Can Metacam be used after Rimadyl?

Simon Neuhoff — Mon, 03 Sep 2012 09:57:53 GMT

All these anecdotes about overdosing are a relief to hear in general and supportive of the fact that NSAIDS are by and large very safe BUT - I have had one dog develp fairly severe GIT signs on a mere 3x overdose (boss clicked on wrong size of Rimadyl) for 5 days and another dog thsat died of a perforating gastric ulcer on a regular dose of Metacam - after no more than a week.

Clearly these are the exceptions rather than the rule but I for one am inclined to be a little less blase these days.

Re: Can Metacam be used after Rimadyl?

Utlendigur — Sun, 02 Sep 2012 23:30:16 GMT

[quote user="Joyce Whitehead"]I had a recent first as the owner had put out 2 rimadyl palatable 50mg out for their large dog (on the worktop), prior to giving them with the evening food, but their Abyssinian cat stole and ate them. [/quote]

Been there, done that - put out 50mg rimadyl on the worktop while I sorted the dog food. My elderly cat jumped up and started eating it (she was quite partial to winalot, shapes etc anyway). Luckily she didn't eat all of it, so I decided inducing vomiting would probably be OTT, and she was a little bugger to handle so ivft was out - she lived many more years, until nearly 20.

I always used to worry when we stocked noroclav and norocarp - we had a couple of near misses where cats were nearly sent home with norocarp 50mg 1 bid - I used to get very twitchy about double checking tablets.