New Warning on Meloxicam Label
At the request of the Food and Drug Administration, the manufacturers of meloxicam (Metacam®) have added the following warning to the drug’s label:
Warning: Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional doses of injectable or oral meloxicam to cats. See Contraindications, Warnings and Precautions for detailed information.
Meloxicam is still approved for one time injectable use in cats "for the control of postoperative pain and inflammation associated with orthopedic surgery, ovariohysterectomy and castration when administered prior to surgery." The oral form of the drug has never been approved for feline use in the United States, but veterinarians are able to prescribe it in an "off-label" manner. Take a look at the new package insert for all the cautionary details about the use of meloxicam in cats.
After reading the above, you might wonder why anyone would use this product in cats. The answer is quite simple: options for pain relief in cats are extremely limited.
Meloxicam is a non-steroidal anti-inflammatory. This class of drugs is the cornerstone of treatment for mild to moderate and chronic pain in people (think aspirin, ibuprofen, naproxen, etc.) and dogs (think carprofen, etodolac, etc.).
Veterinarians have been desperate for an equivalent product for cats, and for a while it looked like meloxicam might fit the bill. The oral formulation comes in a feline-friendly form — a dilute, honey flavored liquid, a few drops of which could be added to a cat’s food without her noticing — and it had been used in Europe for quite a while, albeit with some known adverse effects. Unfortunately, as the use of meloxicam in cats increased in the United States, so did the reports of potentially catastrophic side effects.
So, what is a cat owner to do? Forgoing pain relief to avoid any potential complication is not an option. Cats feel pain just like we do and to let a cat suffer is cruel. Thankfully, if pain relief is needed for a relatively short period, an excellent drug called buprenorphine is available. This pain reliever is safe and effective and can be given either by injection or squirted into the mouth, where it is absorbed through the oral mucous membranes.
And while you might disagree after reading all the horror stories associated with meloxicam use in cats, I would still consider it a valid option as a one-time injection for cats with no evidence of kidney problems on blood work. Adequate precautions must be taken, however. For example, intravenous fluid therapy and blood pressure monitoring should be used during surgeries that last longer than a few minutes.
Chronic pain, like that caused by osteoarthritis, presents a more difficult situation than does post-operative or post-traumatic pain. Buprenorphine is definitely still an option, but it can get quite expensive over the long haul. Joint supplements that include the ingredients glucosamine, chondroitin sulfate, methylsulfonylmethane (MSM), omega 3 fatty acids, antioxidants (e.g., vitamin C), manganese, and/or avocado soybean unsaponifiables (ASU) seem to help some, but not all cats. Corticosteroids like prednisolone or even the off-label use of drugs like gabapentin can be considered in severe cases, but these options are not without their own pitfalls.
What it boils down to is that treating pain in cats is not always straightforward. Talk to your veterinarian about the risks and benefits of the various approaches that are available so that you can make an informed decision about what is best for your cat.
Dr. Jennifer Coates
Image courtesy of Boehringer Ingelheim