Rabbit metacam dose

Re: Rabbit metacam dose

Juno Olsen — Wed, 17 Jul 2013 11:02:19 GMT

Hello,

Just echoing what a couple of others have said - if using a medicine on the cascade, the owner should give informed consent. You're not legally required to get clients to sign a consent form, although I think RCVS recommend it. It's enough, legally, to have written in your clinical notes that you have discussed off label use with the client for when situations like this crop up.

Re: Rabbit metacam dose

John Ellis — Tue, 16 Jul 2013 20:00:02 GMT

As standard I tend to use a dose of 0.5mg/kg BID in rabbits, and have regularly used doses of 1.5mg/kg SID.... I haven't yet had any problems at all with these doses, and I feel that the lower doses are really not effective in some cases.....

Re: Rabbit metacam dose

James Laidlaw — Tue, 16 Jul 2013 11:23:03 GMT

There kind of is if you start reading the research. Trials up to 1.5mg/kg at least that I'm aware of.

Re: Rabbit metacam dose

David Elbaz — Tue, 16 Jul 2013 10:40:31 GMT

Won't argue with that, as i'v had many rabbits still in pain after this dose, but there isn't enough evidence it is safe to give at higher dose, especially for more than 2-3 days.

Re: Rabbit metacam dose

Christopher Saul — Tue, 16 Jul 2013 10:09:35 GMT

See Gillian, I give you 5 stars quite a lot

Re: Rabbit metacam dose

Gillian Mostyn — Tue, 16 Jul 2013 09:55:59 GMT

[quote user="David Elbaz"]Hi there, been working in an exotics referral in Israel ( we consider rabbit as exotic around here), we never prescribe more than 0.3 mg/kg SID of Meloxicam for Rabbits or any other mammals.[/quote]

There is significant evidence that most small mammals, including rabbits, require a much higher dose than this for effective analgesia.

Re: Rabbit metacam dose

David Elbaz — Tue, 16 Jul 2013 09:34:16 GMT

Hi there, been working in an exotics referral in Israel ( we consider rabbit as exotic around here), we never prescribe more than 0.3 mg/kg SID of Meloxicam for Rabbits or any other mammals.

Re: Rabbit metacam dose

Gillian Mostyn — Wed, 03 Jul 2013 12:20:50 GMT

[quote user="Anthony Dennison"]Is that the one harvested from rectums of male bovines and diluted with fairy tears? Ah yes. Wonder drug![/quote]

But the active ingredient only becomes active when it is passed over a newborn llama. Amazing.

Re: Rabbit metacam dose

Anthony Dennison — Wed, 03 Jul 2013 08:52:27 GMT

[quote user="Gillian Mostyn"]It is Vitamin S. Newly discovered vitamin that makes all drugs safe. It's amazing. It costs 10p for a bottle that will treat 100 animals.[/quote]

Is that the one harvested from rectums of male bovines and diluted with fairy tears? Ah yes. Wonder drug!

Re: Rabbit metacam dose

Bob Russell — Mon, 01 Jul 2013 14:14:47 GMT

[quote user="Gillian Mostyn"]

[quote user="Bob Russell"]Must have missed something but what vitamins are we supposed to give rabbits on Metacam?[/quote]

Can't believe you don't know Bob. I thought everyone knew.

It is Vitamin S. Newly discovered vitamin that makes all drugs safe. It's amazing. It costs 10p for a bottle that will treat 100 animals.

[/quote]

Suspected this was the required vitamin! Sounds like the comments are owners recollections rather than what was said. I wonder if a vitamin injection was offered to boost the appetite.

Re: Rabbit metacam dose

Clive Ansell — Mon, 01 Jul 2013 13:57:25 GMT

[quote user="Suzanne Kelly"]

Hi all. I have a client claiming that I killed their bunny with metacam. They took it to another vet who said that the rabbit died from a heart attack as I hadn't given it vitamins to protect it against metacam and that I'd massively overdosed it(!)

[/quote]

Do you know the other vet actually said that, or is it the clients version of what the vet said? what is written in the clinical history notes?

If the vet did indeed make that statement, is there post mortem, laboratory, or any kind of evidence to support it?

Re: Rabbit metacam dose

mariette asselbergs — Mon, 01 Jul 2013 13:55:12 GMT

Homeopathic?

Re: Rabbit metacam dose

Gillian Mostyn — Mon, 01 Jul 2013 13:46:12 GMT

[quote user="Bob Russell"]Must have missed something but what vitamins are we supposed to give rabbits on Metacam?[/quote]

Can't believe you don't know Bob. I thought everyone knew.

It is Vitamin S. Newly discovered vitamin that makes all drugs safe. It's amazing. It costs 10p for a bottle that will treat 100 animals.

Re: Rabbit metacam dose

Bob Russell — Mon, 01 Jul 2013 13:40:52 GMT

'Higher' doses are pretty routine nowadays for rabbits. There is plenty of good evidence for its use and the safety margin seems quite acceptable. Any complaint should be quickly dealt with by the RCVS, just don't head off to Zimbabwe and make sure you answer any communication from the RCVS double quick!

Just make sure you get a signed 'exotics' consent form in future!

Must have missed something but what vitamins are we supposed to give rabbits on Metacam?

Re: Rabbit metacam dose

Gillian Mostyn — Mon, 01 Jul 2013 13:39:14 GMT

I agree-you sound like you have nothing to worry about.

I generally use 0.5mg/kg BID but have used up to 1mg/kg BID in very painful rabbits.

Re: Rabbit metacam dose

Rob Loxley — Mon, 01 Jul 2013 13:20:21 GMT

Sounds like you did everything right and and complaint wouldn't get far

Re: Rabbit metacam dose

Suzanne Kelly — Mon, 01 Jul 2013 12:19:21 GMT

Hi guys, thanks for all the help. The FB messages the owner posted were deleted minutes after they were posted and the nurses PMed the owners to tell them it was my day off and that I'd be in touch asap. I phoned them and commiserated on the death of a much loved pet and asked how I could help. I offered a post mortem in house or at the local lab. As i said before the owner's English is very poor. He declined to discuss it at all, just said he was reporting me to protect other people and their pets. I don't think I've done anything wrong. The dose I used was 0.6mg/kg BID. The rabbit was to be rested and revisit in 4 weeks with a view to referring the xrays and/or the rabbit at that time. They never came back. The owners came in whilst I was off last week and told one of the nurses that she was moving back to Poland and that I'd said it was ok for her to have the radiographs. I had said nothing of the sort, but the owner now has the radiographs. The male owner wouldn't tell me who the other vet was. I have a fair idea though and neither rabbit medicine or veterinary ethics would be their strong points!

The xrays were weird, it looked like he had mild hip dysplasia on his right hip, the right patella looked very strange, like an avulsion fracture and he had luxation of both patellas, more so the left one. Is there some way of posting photos on this forum? I posted them on Exotic DVM at the time but got no replies. I got a colleague to look at them at the time too. I explained that metacam wasn't licensed in rabbits, but I don't know how much of that they understood. I did tell them it was a high dose and if not better after 4 weeks we'd need to do more.

Suzanne

Re: Rabbit metacam dose

Nicola Lawlor — Sat, 29 Jun 2013 20:24:33 GMT

I use it at 0.5mg/kg bid as well.

Other meds used alongside would be on an as required basis but I don't automatically given vitamins (pretty much never!) or other medications because I am using meloxicam.

Agree with the above, don't post much on the facebook page but politely invite them to discuss the case further in person.

Re: Rabbit metacam dose

Gerbil — Sat, 29 Jun 2013 19:00:41 GMT

[quote user="KathW"]

From Mark Rowlands' website

http://www.exotic-cpd.co.uk/services/downloads

here is the sheet.

https://docs.google.com/file/d/0Bx6vE7xPPMcZNDA5ZGExMzEtM2VkZC00ODZhLTlmNjItNWQxMjIxOGUwZmY4/edit?hl=en&pli=1

I wouldn't discuss it on FB at all apart from a dignified comment asking them to come to the surgery and speak to you. Has the threatening post been removed - with or without an explanation as to why.

. Did the other vet request a history from you before seeing the rabbit?

It does sound worth a call to the other vet if you know who they are to find out what was said.

Does anyone else use vitamins to "protect" against metacam??

[/quote]

Thank you for the link to that download :-)

Re: Rabbit metacam dose

Marie Kubiak — Sat, 29 Jun 2013 18:17:40 GMT

[quote user="robloxley"]

[quote user="Robin Grimmer"]It pays to get a client to sign a disclaimer for any non-licensed drug. Your doses are fine though. [/quote]

But if you haven't explained the off-label use of metacam in rabbits, this could end up being the thrust of any complaint?

[/quote]

And if you can't get 'informed consent' and prescribe either nothing or a subtherapeutic dose (as per the literature written protocols) then can you be accused of causing 'unnecessary suffering' and in trouble anyway?

Re: Rabbit metacam dose

Rob Loxley — Sat, 29 Jun 2013 17:31:26 GMT

[quote user="Robin Grimmer"]It pays to get a client to sign a disclaimer for any non-licensed drug. Your doses are fine though. [/quote]

But if you haven't explained the off-label use of metacam in rabbits, this could end up being the thrust of any complaint?

Re: Rabbit metacam dose

Robin Grimmer — Sat, 29 Jun 2013 17:12:26 GMT

It pays to get a client to sign a disclaimer for any non-licensed drug. Your doses are fine though.

Re: Rabbit metacam dose

Rob Loxley — Sat, 29 Jun 2013 16:45:40 GMT

Thoughts:
Dose sounds fine and supported by peer-reviewed literature e.g. http://www.ncbi.nlm.nih.gov/pubmed/16521861
Have a word with this 2nd vet; if he has said what is reported then I'd not be happy...
Worth a look at your clinical notes (and off licence consent paperwork if separate) to be happy you've covered off-label use as far as the owner goes.
Beyond that I'd not be getting into a public slanging match - the suggestion for him to come in and chat would be sensible.
If you think it may go further, then maybe get a proper independent PM from a pathologist; in fact I'd even offer arranging it, then it's for him to decline.

Re: Rabbit metacam dose

Martin Atkinson — Sat, 29 Jun 2013 09:49:41 GMT

BSAVA formulary says 0.3-0.6 mg/kg daily up to 1.5 mg/kg for 5 days, follow that and you have no problem, I probably average 0.5 mg/kg. Definitely have a word with this vet and if what the client has said is true give him a piece of your mind then name and shame him on here!

Re: Rabbit metacam dose

Mark Holmes — Sat, 29 Jun 2013 09:38:08 GMT

Post a reply and post references then leave it at that