Question about Metacam and other painkillers

Hey everyone,

A few days ago I posted in another thread about my soon to be 9 year old boy kitty Christopher Robin having some health issues, and he had 2 teeth extracted today. I have a few questions about his meds, especially the pain killer situation.

The vet gave him an injection of painkiller last week which I'm pretty sure was meloxicam (same as Metacam), and also gave us meloxicam for him to take orally at home (called Novacam here, I am in Amsterdam). The dosage was 0.5mg/ml and I was giving him 5ml. I gave this to him for 2 days. 

Today, they gave him a painkiller injection that the vet claims will last 48 hours, and I would assume it was also meloxicam?

She instructed me to start giving him the pain killer orally again once daily in 2 days. When I realized today that this was meloxicam and remembered having read about it online, I expressed my concern to the vet. She seemed to think that my concern was unwarranted (said that the issues with Metacam are with cats who already have renal problems and my cat has had his blood tests), but prescribed Onsior instead (6 mg per day). She wants me to give the Onsior for 1 month (!) because my cat may also be experiencing arthritis pain.

I looked up this medicine now and it seems that it may not be so different from Metcam? It also seems that it's only labelled for use in the US for 3 days? 

Does anyone have any experience with this, have any thoughts, etc.? I of course don't want my cat to experience a great deal of pain, but I would frankly rather him experience a small amount of pain than be at a great risk for renal failure, so any advice or thoughts would be much appreciated.

The vet also said that she gave him an injection of antibiotics that should last 2 weeks... I have not had experience with vets in the US prescribing antibiotics that last that long, is that normal? 

Thanks very much,
Maya

Poor baby, I hope he feels better soon.

I'm familiar with the antibiotic injection that lasts two weeks (Convenia)--Ritz had it because I cannot pill her.  She experienced no side effects.

Regarding Metacam, personally I would avoid it at all costs.  In the US, it is labeled for one time use only, mainly because it's like a NSAID which is toxic to cats. Onisor is another NSAID-like drug.  Same concerns.  I understand in Europe it is available in smaller doses than in the USA.  Maybe that makes it safer, but certainly not long term.

There are better pain meds (like Tramadol or butorphenol [Buprenex]), assuming they are available in Netherlands.

Like you I would rather my cat suffer pain for a few days than kidney failure for years.  When Ritz was spayed, I refused to give Metacam to her because I knew the pain would be only temporary.  But I gave permission for Ritz to have an injection of Metacam when she came down with cystitis and she had horrible side effects (luckily, only temporary).  Never again.

If you're talking about chronic pain like arthritis, I would treat it with natural supplements.  Ask you vet about Cosequin and/or Chrondroitin, Glucosamine and Fish Oil (Omega 3/6).

I'm hoping some members from Europe will better address the pain med issue, since I'm in the U.S. and the have read that, oddly, the use of Metacam here causes more problems than in Europe, mainly because our Vets aren't given enough information about it.  My guess is that with Onsior, it's the same. 

But I can address your question about the 2 week antibiotic injection, since my Callie was given that last time she needed an antibiotic.  I think it's called Convenia.  Is that what he was given?  Anyway, it seemed to work great for Callie...she healed up with no issues

I thought Christopher Robin was only having one tooth extracted.  (guess I need to go back and find your other thread).  Well, here's hoping that the extractions solve his issues, AND that if he does have arthritis, whatever pain killer you end up with helps with that. 

for a quick recovery.

Once a cat has the shot of metacam, that cat should never have metacam in any form again, ever. The risk of acute kidney failure is extremely high.

Metacam is not approved for use in cats in the USA, in fact there is a box outlined in black on the packaging (by law) that says do not use in cats.

I hope you haven't given him any. Take it back and ask for something else. Buprenex (buprenorphine) or torbogesic or tramadol. Don't use that metacam!

The dosage was 0.5mg/ml and I was giving him 5ml.

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Are you saying you gave him 10 times the dose he was prescribed? Or is there a typo in your post? On top of the shot he had last week, and another today?

Metacam causes acute renal failure in healthy cats.

mrsgreenjeens - he was supposed to have only one tooth extracted, but during the procedure they called me and said that they saw another one had to go. i felt pretty helpless about it, but hope that was the right thing to do. i decided it was probably better to have them both removed now in one go than if he were to have problems and have to go back to do it later..

otto - unfortunately i believe he has had metacam a few times already. i imagine that they gave it to him when he was neutered in the US (if that is standard procedure?) and i'm pretty sure i gave it to him orally at least once in the US if not more (without knowing). also i imagine that they gave him an injection of that today for the procedure, and i think they gave him one last week as well. i also gave it to him orally for 1 or 2 doses last week....

regarding the metacam - i will never allow this to happen again, but in the meantime what should i look for to know if he is okay? i imagine that some (or hopefully many??) cats are given metacam without problems? (i hope???) 

he had a full blood panel done last week and his kidney function looked fine, so i'm hoping there was nothing underlying that i should worry about? the vet did not seem concerned when i raised this issue with her, and i believe she conducts frequent dental procedures. it's too late now for what has already been administered, so i'm really hoping that i don't have to worry...

it would be helpful to know what specifically to look out for and if there's anything at all that i can do to help reduce the risk of anything bad happening now. i will not give him anything else in the future.

 in general, is there anything that i should look for post anesthesia? the vet seemed pretty confident that everything would be okay, and said that he might vomit or seem out of it for a couple of days, but i'm wondering if there is anything to really keep an eye out for that could be dangerous. 

thanks again!

otto said:

Are you saying you gave him 10 times the dose he was prescribed? Or is there a typo in your post?

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The 0.5mg/ml is the concentration. 5ml is the dose, for a total of 2.5mg of the drug.

Mayadot, how much does Christopher Robin weigh? I thought I heard that a typical oral dose for Metacam is 0.2mg per kg of cat. That would mean the 2.5mg dose above is appropriate for a 12.5kg cat, which would be huge! Or maybe that was per pound. Either way, there are much safer pain med choices than Metacam.

otto- Sugarcatmom is correct about the concentration vs. dose.

Sugarcatmom - i certainly hope it's per pound and not kilo... he is about 12 lbs, or 5.5 kilos, so that would make much more sense...

the thing is, i can't undo whatever Metacam he's already received, so while I understand that might be really risky, there is absolutely nothing i can do so terrifying me won't help. if there is anything i can do after the fact to minimize his risk, i would really appreciate that info, as well as what exactly i should look out for so that if he does have a problem i can catch it as soon as possible.

also how long after the administration is he at risk? 

i will never give him metacam again, but i'm really hoping that he will be okay...

Try not to stress too much. I am in Canada, and though they still use Metacam
"off label", I believe the doses are smaller than the doses which were
considered harmful in the US. Granted, I still wouldnt use Metacam
again, and you have made that decision, so stay positive.
I agree with the Buprenex and other pain killer choices. I give my kitty
Buprenex when she is dealing with any very pain issue.
I know we are mostly all against Metacam here due to the risks, but
even so, it doesn't mean your kitty will have ill effects. If every kitty
had side effects it would be pulled. It should be pulled in my opinion,
but again, that is only my opinion.
I know you are worried, but try to stay positive. You are trying to make good choices for
your kitty and that shows what a great pet parent you are.
Sending you vibes!

You made the best choice with the information you had at the time.  That is all anyone can do.

Symptoms of acute kidney failure may include excessive drinking, hanging over the water bowl constantly even when not drinking, huge pees, loss of appetite, lethargy, and hiding away.

What's done is done. Just make sure that it says in his records, to ANY vet he goes to now, "NO METACAM EVER"

He'll feel a lot better without those teeth. Be sure to let us know what the results of his tests are. Oh wait, that's in the other thread.

Most of you know Rosie had surgery on Monday, and l came home with Metacam. I have to give her a 5ml syringe per day. She's had it for 3 days now.

Obviously Rosie's is short term,  but l'll hold off it tomorrow until l see her vet when we go to have her wound checked and get his thoughts on it?.

Thank you. Is there any reliable data anywhere about what percentage of otherwise healthy cats have problems? I've done some research online but not found much. I imagine that many vets continue to prescribe this to all cats (even though they shouldn't), and that most of them are okay? (Just trying to find some hope and reassurance).

Also, any idea how long he has at higher risk following the administration of Mecatam? Or is it for life?

Thanks again and sending good vibes to Rosie. 

mayadot said:

 I imagine that many vets continue to prescribe this to all cats (even though they shouldn't), and that most of them are okay?   

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Try and not stress too much. Personally l would voice your concerns with your vet on what you've heard and see what they say.  As l say i'll have a word with my vet,  Myron tomorrow about it and l'll report back

Just to clarify, your having to use Metacam or the Onsior over long term use?

The vet wanted me to use the Onsior for 1 month post-extraction, both to counteract pain from the mouth and because she saw a little bit of arthritis on my boy in an xray and is wondering whether that has been causing his strange behaviors, but I think I'm going to try not giving him any pain meds first and seeing how he does. I of course don't want him to suffer but I would prefer that he be in a little bit of pain than be at risk for something far more serious. 

I'm also seeing now on the receipt that Ketamine was also administered during his tooth extraction.. In my continued research of Metcam yesterday I'm seeing that's risky for cats as well? 

I'm wondering how long it is until he's "out of the woods" so to speak with regards to anesthesia/drug complications? The procedure took place probably about 22 hours ago and right now he's still behaving strangely. He seems kind of confused/disoriented and is still not walking great, though much better than when he first arrived. He also seems restless and agitated. Occasional agitated meowing and, he keeps walking around and can't seem to relax. He didn't sleep much during the night. He ate half of his normal food last night and didn't seem to have problems with that, and so far his litter box usage seems normal. 

Any ideas on how long these effects should last and how long I should be extra-monitoring him for before I can relax about the potential side effects?

I come from Britain and now live in France, and I have had to argue over the use of metacam or similar drugs with every vet bar one that I have ever had. Most vets in Europe have no idea about the US FDA withdrawal of it for use in cats. They insist it is safe even for long-term use. But the last vet I tried (only once!) showed me a research paper on effects of metacam on 76 cats in Marseilles, showing no ill effects for a couple of years afterwards. WHen I took it home to read it I discovered the study had been commissioned by the manufacturers! I will never knowingly allow its use on my cats and all their vet dossiers are marked as such. It is too controversial, although much of what is said is anecdotal in scientific terms. No impartial study has ever been done. My vet uses Tolfadine as a pain killer, though there is no pain killer that should be used in cats for more than 3-4 days - the cat's renal system is extremely delicate and damage can easily be caused. Long term supplements like Cosequin are safe as anti-inflammatories, and that has made a huge difference to my senior cat with arthritis.

yeah, i asked the vet about Metcam after i found out and she said she had no concerns about it...

another small update: he has urinated 2 or 3 times since we got back (about 18 hours ago?), which is more frequent than normal. is it likely that he might do this a bit at first? I am now so anxious about the Metcam/Ketamine that i'm not sure how to gauge when to be concerned. 

When Rosie came home after surgery on Monday she drank a lot, but l imagine that's because she had no water from early morning because she's just drinking as normal now?. She's peed in her litterbox about twice a day

With regards to the Ketamine. When Rosie was spayed at her old surgery she had a bad reaction to the anaesthetic, so when l took her on Monday l explained this to the nurse. She asked if l could remember which type she had been given and if it was the one that contained Ketamine, because that can give a bad reaction. I didn't know, but she said they didn't use it anyway,  and sure enough she was fine afterwards. Rosie is still on my bed because l want to keep her still as much as possible with having stitches, but she runs across the bed as soon as she sees me, and l'm seeing an improvement every day?

It sounds like you might need to give the vet a ring if he's disorientated?. 

I'm just thinking?, does he have a cone on like Rosie, because that might be confusing his walking as well?

Rosiemac said:

I'm just thinking?, does he have a cone on like Rosie, because that might be confusing his walking as well?

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he doesn't have a cone, no, since it was just his teeth that they did. he seems to have mellowed out a little bit but is still just sitting there a little confused, not sleeping. i hope everything will be okay!

Number one rule....Don't Google!. Googling will have you a nervous wreck.

It might be just be that your little boy is taking longer to get the anaesthetic out his system, or that he still has a bit discomfort with his mouth?.

Sit with him and give him lots of scritches, because l know my Rosie has been extra loving and really clingy since Monday

hah, probably sound advice, i just wish i had known about the risks of metacam and ketamine prior to his receiving them, and now i don't know how long i should keep an extra close eye on him.

i don't think he's slept at all since getting home (close to 24 hours ago at this point). he might have slept a little during the night, i'm not sure, but he was running around pretty hyperactively much of the night/morning. now he seems to have mellowed and is laying beside me, but still not able to sleep. is that normal?