Metacam in cats.

RE: Metacam in cats.

Aine Seavers — Tue, 09 Feb 2016 23:37:17 GMT

yes, found the same. We love gabapentin,slightly lower dose in older cats as renal function can be a concern but it transforms the cat but esp in dogs for IVDD- so much happier so much faster. The dose range is quite crazy in the formulary, here we start at 5mg/kg bid and if no ataxia or diarrhoea then up to 10mg where most stabilise. An odd one at 20mg and we use the 30mg.kg as a once off bolus for dogs in big trouble at home so owner can move them to the clinic.

RE: Metacam in cats.

Charlie G — Tue, 09 Feb 2016 19:09:42 GMT

Hi,

I'm not sure about tramadol in cats - I read that the half-life is much shorter than in dogs and have had quite a few owners finding that the 10mg tablets have caused dysphoria and weird behaviour even in biggish cats. Have fairly recently started using the small 50mg gabapentin tablets from Summit and so far have had pretty positive feedback from owners and found them to be a pretty good NSAID alternative or adjunct. I've mainly used them post-op in older cats with suspect renal function, dentals etc.

RE: Metacam in cats.

Aine Seavers — Mon, 08 Feb 2016 23:00:33 GMT

I work in Aus and they have some funny ideas about meds esp Domitor but was not aware of the Metacam phobia. In fact the King of Feline Medicine Richard Malik and his mate Richard Gowan wrote a paper last couple of years showing protective effect of meloxicam in some renal conditions. My own cat on it 7 years and many clients cats on it long term. Pre-op NSAID use (any drug) here not popular- Jill Maddison pushes waiting until you at end of op so you know if you had a bleeder or hypovol then if ok use it. The licence here says an injection at 0.3mg must not be followed for 48hrs with an oral dose-many do do it but that is the licence. Now the change is that BI promotes 0.2mg as the surgical dose and you can follow that with orals in 24hrs or if long term arthritis then start on 0.1mg dose then oral 24hrs later. That is the actual data on the drug in aus so you can show your colleagues that or get BI to send you their protocols.If renal disease already well established when first consider using it then yes, most vets here wont use it and use j/d and or low doses of gabapentin and or carthrophen for the arthritis-unless life so poor that the metacam is a salvage option which can provide great relief.

Tramadol in cats different to in dogs and different in humans-I just dont use it at all as found a significant % of my canine patients were the genetic non responders as is the major problem with this drug and havent used it in cats at all both because I find human abuse use a concern and am worried so little work done on cats in it as well. If you are in Australia, we did a fairly extensive review of the drug with vets who didnt like it and a pharmacologist who did reference work on when it might. I can send it to you privately if you like, just send me an email address for direct send.

RE: Metacam in cats.

Michael Woodhouse — Mon, 08 Feb 2016 14:07:18 GMT

We've used a lot and had zero problems - including cats clinically azotaemic. I've had a number where their blood parameters improved with treatment. We routinely use either carprofen (usually) but sometimes meloxicam pre operatively and have never had a problem.

It's nice there is some data backing up the view.

RE: Metacam in cats.

Rob Loxley — Mon, 08 Feb 2016 13:29:06 GMT

[quote user="Virginia Campbell"]I would continue to use at the lowest effective dose and take the (currently unquantifiable) risk of shortening the life of the kidneys[/quote]

[quote user="Joyce Whitehead"]Anecdote alert but I have two brother cats, both over 16 now, both with early stage renal disease, but clinically well. Both getting stiff, one with bilateral elbow arthritis. They both had daily metacam for the last 3 years[/quote]

There is some evidence (http://www.ncbi.nlm.nih.gov/pubmed/21906984) that longterm judicious use of metacam in cats with concurrent CKD is not necessarily detrimental and may potentially be beneficial

RE: Metacam in cats.

Neil Wheadon — Mon, 08 Feb 2016 12:58:48 GMT

[quote user="Jenny Boyd"]The ISFM paper/guidelines on long term NSAID use in cats I found useful. Available on wsava.org. That website also has very comprehensive guidance on analgesia in cats and dogs- the global pain council guidelines document[/quote]

Really useful thankyou

Looking at the NSAID part

Contraindications

In a few patients NSAIDs may cause adverse effects: these are most commonly related to the gastrointestinal tract and, less frequently, the renal system. Adverse effects appear commonly in conjunction with hypovolaemia, hypotension or co-treatment with drugs influencing kidney function, and these clinical scenarios should be corrected or stabilized prior to NSAID use. Similarly, NSAIDs should be used cautiously in animals with pre-existing renal disease and, if contemplated, should follow a risk-benefit assessment and close monitor- ing regimen appropriate for the patient’s condition. Periodic monitoring is recommended with long-term use. NSAIDs with selective COX-1 antagonism (e.g., ketoprofen, aspirin, ketorolac) have been reported to cause inhibition of coagulation via anti-thromboxane activity. This class of NSAIDs should be avoided preoperatively, and only administered postoperatively when adequate clot formation has

occurred (usually upon completion of surgery), this is especially important for non-compressible surgical procedures and dental extrac- tions.82,83 While there is no clear evidence stating that the use of NSAIDs in patients with hepatic disease is an absolute contraindication,

gastrointestinal ulceration is known to be more frequent in animals with hepatic disease. Paracetamol should not be used in cats.

RE: Metacam in cats.

Virginia Campbell — Mon, 08 Feb 2016 12:58:27 GMT

I think the older arthritic cats are a good case to discuss "what if it was your cat?" with owners. I always tell owners that if it was my cat and long term NSAIDs were making a difference to its arthritis, I would continue to use at the lowest effective dose and take the (currently unquantifiable) risk of shortening the life of the kidneys.

RE: Metacam in cats.

Jenny Boyd — Mon, 08 Feb 2016 12:33:11 GMT

The ISFM paper/guidelines on long term NSAID use in cats I found useful. Available on wsava.org. That website also has very comprehensive guidance on analgesia in cats and dogs- the global pain council guidelines document

RE: Metacam in cats.

Joyce Whitehead — Mon, 08 Feb 2016 09:56:14 GMT

Obviously I meant excision!

RE: Metacam in cats.

Joyce Whitehead — Mon, 08 Feb 2016 09:55:00 GMT

Total femoral head and neck incision I suspect...

RE: Metacam in cats.

Hannah Wynne Richards — Mon, 08 Feb 2016 09:53:13 GMT

What's TFHNE?

Wynne

RE: Metacam in cats.

Joyce Whitehead — Mon, 08 Feb 2016 09:51:34 GMT

We also use a lot of metacam, both pre op and post op. I don't ever give it intra op though, if something ends up having more major surgery I will give opioid until they are up and recovered.

Long term I have no issue with it in otherwise well cats, and even in those with mild renal disease. Anecdote alert but I have two brother cats, both over 16 now, both with early stage renal disease, but clinically well. Both getting stiff, one with bilateral elbow arthritis. They both had daily metacam for the last 3 years, and their last renal checks showed no deterioration. Sadly we lost one at Christmas (but unrelated, had a nasal tumour). His surviving brother waits till the metacam is on his food before he eats it in the morning.

RE: Metacam in cats.

Neil Wheadon — Mon, 08 Feb 2016 09:35:31 GMT

5 million doses of metacam in this country. I've personally never seen an issue and will use metacam in cats at lower doses in older cats following the Australian paper that suggested longer life span as it kept cats out of pain. I can't deny that you do get occasional reports but things need to be placed into context, no drug is 100% safe. One for evidence based medicine, has the RVC project looked at this? (They are interrogating practice software - see Vet Record)

Tramadol. For me the jury is out. I ask lots of clients about it and I get variable responses with a number saying it did nothing and the dog was spaced out.

Flipping the question round. In Australia, if they don't use Metacam/NSAID and you're not used to Tramadol, then what is used for long term pain?

Neil

RE: Metacam in cats.

Stephanie Wellings — Mon, 08 Feb 2016 08:58:11 GMT

We give Metacam routinely pre op for cat spays, dentals etc, but usually they are on fluids and have BP monitored during anaesthesia. I have seen one post surgery metacam reaction, which was sedated for x-rays, then induced and had a TFHNE (so our reasoning was that maybe because it had medetomidine for sedation plus propofol, there was more hypotension than for our usual anaesthetic protocol).

In concious patients (i.e. long term chronic patients), as long as they are monitored and the metacam is only given if they are well and eating, I don't excessively warn people off, because I think the tendancy then is for some owners to be so afraid of 'side effects' that they don't give any pain relief, and let the animal hobble around in pain.

I have also had a couple of patients in stable, early stage CKD who have continued on low dose metacam following discussions with the owners about the risks.

I find tramadol (even the teeny tiny Summit tablets) make cats really spaced out and dopey. If I can't use an NSAID then I use gabapentin (this was on the advice of the Oxford Cat Clinic) and so far the owners and I have been quite impressed with the effects.

RE: Metacam in cats.

Charlotte Marshall — Mon, 08 Feb 2016 08:49:28 GMT

Well, I use a lot of metacam in cats and I would say it is pretty rare to see a problem. I have had several arthritic animals on it long term as well with no issues.

RE: Metacam in cats.

John Flynn — Mon, 08 Feb 2016 08:22:18 GMT

i like the paper in the New Zealand journal I think it is following cats with CKD on metacam orally and those not on it long-term - I'll find the ref for you if you like.

I'd use transmucosal buprenorphine in preference to tramadol

I think the thingw ith giving it pre-op is what if you DO get low BP during prolonged GA - you can't undo the injection, so I have sympathy witht he not pre-GA approach (though I do use it both ways myself).