The Metacam Debate

You may have noticed by now that I'm not a Vet, but I play one on my web site. Part of being a good pet owner is being responsible for maintaining my cat's good health. I don't follow Doctors orders blindly. In fact, I constantly ask if there's another way to look at a prognosis or another way to treat a problem, or a way to have prevented it in the first place.

A serious subject I've noticed that's painfully lacking is the element of proper nutrition and it's health effects on our cats. Time and time again, I've been told to get this "Prescription Diet" because it has the word "prescription" in it and can only be gotten at my Vet, so therefore it must be good, even if it's DRY food, full of grains and lacking in decent source protein. Even though my cat's health problems might have been solved by feeding my cat a raw diet or grain-free canned diet, that's much more nutritious and doesn't tamper with their digestion and throw them into cycles of illness, inflammation of the liver, pancreas, stomach, etc...give them diabetes and crystals in their urine. Are Vet's reading the labels on this stuff or enjoying too many perks from the sales staff of all those "specialty" diets?

I want my Vet to know MORE about nutrition and sell high quality, species appropriate food in his Clinic, not heaping bags of dry diets.

I'm also peeved about the Metacam debate. As I've ranted previously, there are many in our community who feel using Metacam in small doses is perfectly fine, even though Metacam is "for dogs only." Cats don't mix well with NSAIDs (Non-steroidal anti-inflammatory drugs). In fact "NSAIDs decrease production of substances that protect the stomach and GI tract from the acid and reduce blood flow to the area. This can cause ulceration and perforation of the stomach or intestines. NSAIDs also decrease the blood flow to the kidneys causing damage and renal failure."*

I've spoken with three Vets. One at Mill Plain Vet in Danbury, CT, Dr. Whitney at VREC in Norwalk, CT and Dr. Louise Murray, Director of Medicine at the Bergh Memorial Animal Hospital, which, if you watch Animal Cops, yes, it's THAT hospital, which is part of the ASPCA in NYC.
Each Vet told me their concerns about using Metacam. Two of the three just won't use it in cats and have never seen a good outcome using it. Dr. Murray shared her concerns with me regarding giving Bob metacam after he fell over 16 feet off my deck and needed something for the pain. Bob's ALT was sky high at over 700, yet he was given Metacam. Then, I read this in an email from Dr. Murray:

"If you read the insert it clearly says " Do not give in cats" and it has caused renal failure in a number of cats after just one dose. You should also know that NSAIDs in general are contraindicated with liver disease."

Bob may not have liver disease, but clearly something is causing his high ALT, so why give him this stuff? Another web site declares that
Metacam Kills! Maybe not all of this is true information, maybe only half of it is? Maybe only two cases? The thing is, even if ONE is true then something is going on here. I know someone who's using Metacam for long term pain management in their cat, but the dose is ONE DROP and Bob got far more than that i his first, of two doses.

So now I'm going to sit here and wait. Next week I'll pay to have another blood test done to check's Bob's ALT AND to check his kidney function. I shouldn't have to do this and I shouldn't have to worry that I've done something irreversible to my cat, but I'm stuck. I've done the deed. Yes, I will say Bob seemed much happier after the Metacam, but was that happiness to be short lived?

I still have the damn bottle of this stuff on my desk. The purple box is lying their taunting me. I want to stomp on it. I think I will. I wish there WAS a safe NSAID for cats and I just read that now Metacam IS supposedly "safe" as an injectable, but I believe it's only for use in post surgery pain relief, certainly not for every day pain management or even for a short course treatment.[note: after this post went live, Dr. Murray cautioned me again, noting that even after ONE INJECTION, Metacam can cause renal failure, so referring to metacam, in any form, as being "safe" would not be accurate.]

Dr. Murray and a few others have suggested using buprenorphine, a semi-synthetic opiate, also called Buprenex. Dr. Murray told me that it's " a mild narcotic that can be given under the tongue (it absorbs from the oral mucosa and the kitty dose is usually only about 0.1 ml so a tiny volume which is nice too)." This is a much safer alternative, but does it answer every cat's health needs when they are in pain? I can't say. My guess is probably not.

One day there will be a truly safe NSAID or something equivalent to help cats who are in pain. For now, please, read the label, ask your Vet when the meds say "for dogs only" and push back if they say not to worry about it. There IS cause for worry, not panic. There IS cause to ASK QUESTIONS. It can save your beloved pet's life.

I'd like to add a special "Thank You" to Dr. Louise Murray for her helpful suggestions and for sharing her wisdom with me, so I can share it with all of you. If you'd like to know more about Dr. Murray, you can visit her web site: Vet Confidential or follow her on Twitter: VetLouiseMurray

*NSAID

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Comments

im am now very worried

I have a little tabby almost a year now, i noticed the past couple of months she has a slight limp on her back legs. I also noticed that she wont come to ther front door when i get home and other things she used to do due to what i assume is pain.  I took her to a vet and after a couple of xrays she says there is a problem with her spine due to an injury which might have been caused by a dog bite or a car or even maybe a fall (if anyone would like to take a look at them, i will gladly show them as i dont see any differnce between the Vertebrae thats supposed to be the problem). 

The vet prescribed metacam (for cats) and this is where my question comes in. I noticed a lot of these posts are quite old, i am assuming that metacam for cats didnt exist when these posts were written, am i right or am i wrong? I am very confused and would really like to know what to do.

Thanks in advance

Pain relief

Given your aversion to all pain relief for cats, apparently without exception, what do you suggest to give cats when they are in pain, for example before, during or after orthopaedic surgery? Or would you say just not to bother?

I'm SO sorry!

My vet prescribed metacam for my cat for hip dysplasia. As I gave her the drug, I noticed she became constipated. I called the vet to find out if the metacam could be causing this. The vet's office told me that metacam wasn't known to cause that problem. I wasn't convinced, so I backed off the dosage, and she got better. But then she started having issues with her hips again, so I started giving her the metacam again. Over time, she became listless. She wasn't eating well. She wasn't pooping well, but began to urinate a lot more. I tried all kinds of things to get her to eat, making sure she got her metacam so at least her hips wouldn't hurt her. Yesterday the constipation became so severe that she began to howl when she tried to go number two. Then she started to vomit. I became so concerned I took her to the emergency clinic. They took x-rays, and it showed she was quite blocked up! I told them she was on metacam, and asked if that could be causing the problem. I told them I had her on the drug, and the constipation started, then I backed her off, and it went away, then I started giving it to her again and it started back up. They said "based on what we know about the drug, it's highly unlikely.”


They did blood work on her, and told me her BUN was >140 and creatinine was 6.8. She was going through renal failure. They said her body was trying to get water from wherever it could, and it was absorbing it from the food in her system. That's why she was constipated. I asked what the best-case scenario was. They said that if she takes to the treatment they were going to give her, nine months tops. If not, a matter of days. She was 13, and I didn't want her to have a "best-case" where she was uncomfortable for maybe nine months at best, so I opted to put her down. I cried so much when it was time to say goodbye! It's only been a day, and I'm still so sad that I had to put her down.


The thought that the metacam and constipation problems seemed to be linked bothers me, so I started doing some internet research and found all these horror stories of metacam and renal failure in cats! I also read about how aggressive rehydration and stopping the drug have often brought the cats back to health!


All I wanted to do was make what I thought was the best decision, even if that meant putting her down. And now I know, a day too late, that I quite possibly made horrible choice! And to top it off, the ER people even said that, as far as my decision to put her down right away, "most people wait too long with their pets." And neither the vet nor the ER gave me any indication the metacam could have played a role in this! And these people are supposed to be "professionals" there to help me?!


It's too late for me now. To my little girl, I AM SO SORRY I opted so quickly!


To everyone else out there, PLEASE BE CAREFUL using metacam on your cats! WATCH THEM CLOSELY if you do!!And don't make the same mistake I did. I'm SO sorry!!

This is what just happened to

This is what just happened to me in teh past few days too.

My puss lasted 6 weeks on Metacam.  I thought I was doing the right thing.  Ihad to put him down and I researched and found it was the medication that killed my boy.

I am so sorry and so angry adn so upset that I can hardly even think straight.

 

Don't ever, under any circumstances, give a pussy cat this drug.

I'm so sorry for your loss.

Linda, I'm so very sorry. Metacam is NOT made for cats. I know some vets, even my own, think it's OK to give, but I have notes on all my files that say NOT to EVER give it to my cats. You should NEVER have to learn something like this the hard way. It's completely WRONG..and disgusting that you should have to suffer..and your cat..I'm so sorry. Thank you for sharing your story with us. It's important that other people see this so they know to talk to their Vet about it before administering it to their cat.

How Heartbreaking

Hi Kevin, I'm very sorry to read your story. I've been in your shoes and had to make what I thought were good choices for my cats, only to find out later that I was wrong. Yes, you could have given your cat sub Q fluids and she probably would have lived longer and been comfortable as well, but you didn't know that and you trust what the vets tell you. Going forward, if you have other cats or choose to adopt, in the heat of the moment, when your cat is sick, take a step back, ask questions, challenge your vet. My vet has told me more than once to put my cat down so she doesn't suffer, but he would do it when she is FINE and has months left to live. I think Vets want to stop the human-owner's suffering because watching your cat decline is very painful, BUT to rob your cat of this natural process just so we don't feel bad is wrong. I'm not saying that's what you did. You did what you thought was best and I'm very sorry you felt you had to act so fast. Unless the cat is on the brink, you usually have time to try fluids or try something to see if it helps. To give yourself and the cat time..that way you can do some research, get a second opinion-if you can. I find that the more I learn, the more I prefer to work WITH my Vet as part of the team that helps my cat. I will NEVER simply listen and obey. That's how I've lost cats in the past. You've learned a heartbreaking and terrible lesson and I'm so very sorry for your loss. Please don't beat yourself up. You did this with love and the intention of doing right by your cat. It's just sad how it all came to pass and I wish I could have been there to help you so it could have been avoided. My deepest sympathy to you- Robin

Cat died after metacam injection

I took my cat Limpy had very bad tooth and gum disease she was about 12 years old. I found her living in a warehouse parking lot when she was about 2 year old. We took her to have some teeth pulled because her mouth was hurting her very badly and she wasn't eating much. The vets didn't tell us but they gave her a injection of metacam after surgery. Limpy came home seemed fine started eating again , her mouth healed up fast, but about a week and a half later she stops eating . We took her back to the vets and they run all sorts of test and xrays. They find fluid all in her chest. They can't find cancer but keep telling me it must be a mass. I took Limpy home and gave her anti biotics but she died just a few days later. I never found peace with what happened. I now believe it was the metacam. I will never go to these vets again, I think I will be looking for a holistic vet in the future.. I may have to drive a long way. But when you have the best cat in the world like my Limpy was why take chances.

Should have gone with my gut...

I lost my cat a week ago and although I am not 100% sure, think Metacam was the cause. My gut told me at the time that I might be doing the wrong thing by giving it to her and it ended up being right. She had a corneal ulcer and was being treated with Buprenorphine for the pain, plus drops for the eye which has been stitched closed so it would heal. She was in good health otherwise. I was administering this via injection as she would not take it orally and she was doing fine. Eating, drinking, purring. After three days on Metacam, she stopped eating and appeared to be in tremendous distress. I had previously voiced my concern to the vet about Metacam and she assured me it should be fine and that my cat needed this. I took her to the emergency room and asked them to put her out of her misery. She was 17yrs and I had already been back and forth to the vet four times since she was originally diagnosed. This was always incredibly stressful for her and she would have to be boxed down pretty much each time. I could not bear to put her through any more. I feel my cat would still be alive today if I had not given her the Metacam, but I will never know. I miss her terribly and harbor tremendous guilt. A month ago she was in perfect health, today she is a pile of ashes.

:-(

I am very sorry for your loss-and possibly at the hands of Metacam...well that is just not right. My Vet STILL teases me about giving it to my cats because he knows I will not. I did give them Buprenex ONCE, but normally I just let them feel awful for a day or two. Yes, it's mean, but it's not cruel. Their overall health will be much better not having their liver or kidneys ruined by metacam. I have come to a point where giving my cats ANYTHING turns into a careful discussion with dr Larry. We have to weigh the options and the "what ifs"...just the other day even I was diagnosed with something that needed antibiotics. I asked if it would go away without them-the answer was YES-in the same amount of time. I'm more uncomfortable in some ways not being on them, but I won't get a secondary infection-like a yeast! infection because of it.

You did what you felt was what right for your cat. We will not know if it was Metacam or not, but it's vital for people like you to share this info with the rest of us. Maybe, in total, all our stories will shed some light on whether or not this stuff is REALLy safe for cats.

I wish I could give you a big hug. I know how it feels to loose a beloved cat after so many years together. Your cat was lucky to have someone who loved her so much. I know it's not a comfort to you, but you did great by her when she needed you most.

Metacam did kill my cat

I had a sweet 6 year old tabby who got a scatch on her eye. She was seen at the vet and given eyedrops, and an otherwise perfect bill of health. But she was also given a Metacam shot for the pain. Within a week, she had stopped eating for several meals and then I found her dead on my office floor the next morning.

I don't understand why its being used in cats when the therapeutic dose is so close to the dangerous dose level. Why not just give opiates for pain, when its so much safer and has a longer track record.

This is where the drug war becomes ridiculous - vets aren't prescribing safer opiates because the federal rules for handling them are so convoluted and stringent.

!!!!!

Wow. That's shocking and sick. I'm SO SORRY that happened to your sweet kitty and how AWFUL it must have been for you!!! THANK YOU for sharing that information. I keep reading about this and seeing "one shot" then death...it's not worth the risk. I agree about the opiates. Buprenex will be our drug of choice should the cats need pain relief. I am so worried about my own cat, now that he got Metacam two weeks ago. Am waiting on blood test results today to see how his kidneys are doing. I will never let my Vet use this stuff again. Case closed.

That's interesting. I work at

That's interesting. I work at an animal sanctuary in the UK (200+ cats) and metacam is what usually gets prescribed (I was given it to mix with the food for one of my cats as we weren't confident we could get pills into her). It might be that metacam is the only liquid painkiller avaliable (at least here)? Candy, the cat that had it was having it after being attacked, and then when an abcess developed - The vet said we could have tablets, or tablets we could break open and mix in and came back with metacam - had it every day for about a week with a little syringe used to measure out against her body weight. Candy didn't seem to have any issues and it certainly helped get her back to feeling herself.

Possibly its one of those drugs that if a cat has x/y/z going on, it can aggravate it? That said I know of one cat who was on painkillers and anti-inflammatories for a broken foot who developed kidney failure soon after but at the same time she wasn't a young cat, at least 10 if not older.

It depends...

I've heard from 3 vets NOT to touch the stuff-that it's too risky. After ONE dose the cats can suffer renal failure and die, just like the cat you mentioned. Over 10, yes, old cat, but could have lived much longer. Sadly there isn't an anti-inflammatory that cats can safely tolerate. Metacam is not the answer. Today I'll find out if it's hurt my own cat's kidneys. I took a chance, too. Now we'll see what price I have to pay.

Metacam

I'm glad to see there is more information available on Metacam these days. My vet offered to prescribe it for my elderly kitty who was suffering from arthritis. I did a little internet research and found enough information to give me pause, so I stuck with the prednisone he was already on and nixed the Metacam. Too scary. (My vet felt it was safe enough but was respectful of my decision. He's been a good vet to both my cats.)

I finally decided to go ahead and give the Metacam when my cat was terminally ill with cancer and had nothing left to lose. It did give him some blissfully pain-free hours in his last days. A dose was supposed to last 48 hours (if I recall) and he got about 6 hours out of each dose, but in those hours he cuddled and purred and acted like his old self. Those hours were a gift. I'm glad I took a chance then. I sometimes wonder if I should have taken the chance earlier and spared him from some pain -- but I just don't think I could give Metacam to a cat who had a reasonable quality of life and life expectancy.

Steroids/Metacam

Steroids are called "the silver bullet"...that's usually the last resort when a cat is in a lot of pain or skin issues because it, too can cause problems, like diabetes. You did the best you could for your cat, but if he had terminal cancer, there's nothing you could do to fix that, so keeping him comfy was the key and you did that. Please don't beat yourself up. You sound like a great caregiver and sensitive owner. I wish you all the best and am sorry for your loss.

I am an infectious diseases

I am an infectious diseases physician, a relative newcomer to your blog (which I truly enjoy reading) and I do not possess any insight or knowledge into veterinary drugs. Having said that, it seems to me that part of this post seems to reflect a disagreement with your vet about what would have been the best medication to use for your cat. I am not taking any sides, but it appears that you have a basic disagreement with your vet's approach to the care of your cat. When this happens with a patient of mine, I take no offense , and indeed try to help them find a doc whose approach to care is more in line with their own. We both want the same thing, for the patient to be healthy, and I cheerfully admit that I do not have the only path to a cure of "fill in the blank". You might be happier seeking out a vet who is more compatible with you.
If I have missed the earlier posts which show a wonderful vet - patient relationship, I apologize for butting in. I truly admire your dedication to cats, and my 2 rescue feline best friends give their paws up in salute as well.

:-)

Thank you for your comments. They are very helpful, indeed. My Vet and I always have debates on what is the best course to take for the cats. Some times it's not clear at all, other times I depend on him to give me advice and I am comfortable taking it. Dr. Larry is like the brother I wish I had. Sure we cut it up, but we do so laughing. I feel like we approach my cats care as a TEAM. He gives me crap about Metacam and I push back about it and ALL meds my Vet wants to give my cats. I would do this with EVERY VET because I need to make SURE they are prescribing the right thing based on a clear knowledge of my cat's health. I know them better than he does. He has his notes, but I know their issues best. Yes, he knows them better clinically, but I live with them. He has hundreds of patients, cats and dogs. He can't remember every detail about my guys and I wouldn't expect him to. So that why I feel like we're a team. I can recall all the details of each cat's issues and better help them get the care they need. I would never want to just stand there and be told what to do and blindly leave it at that and I'm sure you're not suggesting that.

So in a long-winded way I'm saying, while my Vet and I don't agree on everything, we respect each other's opinion and we care about each other as people, too, so I'm good! Thank you for your concern and thank you for coming to visit! I hope you'll share your advice about infectious disease because I know we would all benefit from any information you can share!

Best to you and your kitties!

Double check dosage info with vet

Hi Robin. Not sure that this comment fits here but I wanted to share it. Recently my vet prescribed an oral medication for my cat. He mentioned that it was an amount slightly less than a half teaspoon. When I picked up the medication at Walgreens I pointed to the oral syringe and said "the amount he gets is this line right?" to which the pharmacy tech said "yes". 5 hours later when the medication did not seem to be having any effect, I remembered the vet saying the dose was about a half teaspoon and thought that the amount I gave him was not correct. I drove back to Walgreens and spoke directly with the pharmacist. Sure enough, the dose the pharmacy tech indicated as being correct was WRONG!!! Fortunately it was an underdose not an overdose but I was pretty upset.

Once again, we are our cats advocates and it's up to us to ensure there is no misunderstanding about medication doses, especially those given with a syringe. Regular people don't think of things as in the 'cc" markings on a syringe.

Dosage

That's an excellent point! With Metcam, it doesn't matter. Even after ONE dose, the cats can DIE. This is not to say that some cats are OK on it, but I haven't heard from anyone saying it's working great. Next week Bob will have an updated blood test. I have a baseline from last week so I know if this BUN is off, that it has to be from the Metacam...crossing fingers it's going to be OK for him.

Thanks for writing and for being a great cat mom!

Dose

You mention that even after 'one dose', Metacam can kill. What size dose are you talking about?

Not much

A few drops...doesn't take much. I'd avoid that stuff like the plague.

Awesome, Lizzie!

You sound like you're on the right track all around and thank you for sharing what you've learned about NSAIDs. I agree about fish oil, too. I hear raves about it. I just can't seem to get my guys to eat it, yet.

As with any medication, I firmly believe to ASK about known side effects BEFORE I take anything or give anything to my cats. Read up. You don't want to learn the hard way-even if you're just trying to do the best for the animals in your care.

:-D

Metacam

Thanks for all this, Robin. I did not realise that Metacam was linked to digestive or liver problems in cats. It's interesting that NSAIDs can cause similar issues in many humans (including me!). My cat has never needed pain medication (touch wood... furry wood is best... where is that cat anyway...), but if he should, I will bear your information in mind. He is getting on a bit and we've put him on fish oil and glucosamine sulphate supplements. They have helped his arthritis very much and he hasn't needed pain relief at all - in fact his coat is more shiny and he got his old "spring" back.
I agree with you about many of the dry "prescription" diets. My sister studied animal nutrition at college for part of her degree. She warned me off dry foods, as many do not have the correct nutrient balance and cause kidney problems.
So, question Metacam and "special diet" foods... I will bear it in mind.

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