Metacam for arthritus pain, I hear bad things

My vet has given Harley Metacam oral medication for arthritis pain but after checking on line I am terrified to give it to him anymore!

I found one page that says this KILLS cats. What should I do. What are my other options for arthritis pain for cats?

 

Metacam can cause kidney failure in cats. In the USA it is only approved by the FDA as a one-time injection before surgery. A good pain med for cats is Buprenex. However, it is only a pain med while Metacam is both a pain med and an anti-inflammatory med. If near end of life, Metacam would probably be OK.

 

I would not use metacam. My preference would be Dasequin, it's a supplement for the joints.

I also like to use bedding that is made for athritic pets, ortho beds, the egg crate kind. I add self warming matts to them, I don't care for plug in matts but prefer the kind that radiate heat back up to the kitty using the kitty's own body heat.


matts
http://www.petedge.com/product/Home-Ken ... /53194.uts

bedding
http://www.petedge.com/catalog/thumbnai ... goryId=826

Adding pet stairs helps too, less stress on the legs when jumping and gives the kitty more freedom to go places they liked to go in the past.

 

Adequan is an injectible form of glucosamine. It is FDA approved for use in horses and dogs. It has been proven with drug trials to increase the viscosity of joint fluid. Here is the link to their website: http://www.adequancanine.us/

My vet found research on VIN (Veterinary Information Network) that shows it works equally well in cats and that the injections can be done subcutaneous, like insulin injections, rather than intramuscular. The FDA has not approved it for cats because the drug trials they did were on dogs and horses. Similarly, they have only approved it for IM injection because that was the way it was administered during the trials.

Angus received injections twice per week for the first four weeks. He now gets one injection every four weeks. He has mild to moderate arthritis in both hips and his right knee, confirmed by X-ray. He was having difficulty with stairs and with jumping. This has improved considerably since starting the Adequan in late October.

The dosage is by weight. A vial of Adequan at Angus's weight (18 lbs) contains 12 doses and cost me $120. So, it is expensive initially, but averages $10/month after the loading period. It does not need refrigeration.

 

I started using dasuquin when Callliope was first diagnosed. I recently opted to try the adaquan injections at home, subq, a few weeks ago. The dasuquin worked pretty well, but Calliope needs something stronger now, though I do continue to give the dasuquin, as well.

Vet offered metacam, first, but she knew I would only be interested in that, as a last resort and at the same time, this came up, Calliope was diagnosed with early CRF.

There are some folks on the board who have used metacam without any problem. My vet uses it frequently and reported no issues, when she was suggesting that I use it.

 

metacam can be quite dangerous in cats as it is difficult to get the right dosage and not give too much and send a cat into organ failure. That said, there are times when it is a valid painkiller. As others have said, there are many other options for arthritis that I'd consider first, with metacam much further down the road.

Conversely, I give a very low dose of metacam to my dog who has arthritis in many joints after getting blood work done. She's also had cartrophen shots (like adequan) and gets omega 3 supplements as well as a joint/tendon supplement.

 

I have a "no metacam" note in my cats' vet files, and here's why: When I'm thinking about taking a risk, I ask myself:

1) what do I know and don't know about the cause & effect of my proposed action?
2) what is the likelihood that the bad effect(s) will happen?
3) what are the consequences of those bad effects?

If the consquences are bad-severe-permanent (eg., incurable, degenerative disease leading to death), and the probability is "likely - probably-high", then I'm not going to gamble. If the consequences are bad-severe, but probability is "highly unlikely-extremely low" then I *might* take the risk, depending on the circumstances.

Metacam? Here are some considerations (as I understand them):

1) like other NSAIDs, metacam is nephro-toxic; it can reduce bloodflow to kidneys, and tissue damage results; damaged tissues don't function as well; high doses probably cause more severe and extensive damage than low doses, but *some* damage is likely;

2) unlike bladder tissue, kidney tissue doesn't regenerate itself; once tissues are damaged or scarred, their loss of function is thought to be permanent; eg., if 10% of the kidney tissue loses 50% of its function, that tenth of the kidney will probably never do more than about half of its work;

3) as cats age, their renal function declines; one estimate is that about 10% of cats over 10 yrs old will develop CRF;

4) kidney disease isn't usually detectable by standard labwork until around 65-70% of kidney function is already lost; so, a cat's bloodwork may be within "normal" range but it doesn't necessarily mean the kidneys are "just fine"; the kidneys might be functioning at 70% or 60% or 50% capacity and you may not know it.

So if the kidneys take a hit each time metacam is used, and each insult is cumulative (additive), and I don't know how much kidney function (or loss) the cat already has, then for me, personally, the risk and uncertainty are just too great, especially if alternatives are available. Exceptions (IMHO) would be a cat in pain w/ no alternatives, who is facing euthanasia w/o metacam.

Buprenex (buprenorphine) is considered safer for cats, but I don't know how effective it is for arthritis pain and/or longterm use. You might consider asking your vet about Gabapentin (neurontin), in conjunction with one of the glucosamine/chondroitin supplements others have mentioned. A listmember on the Yahoo CRF group has used Gabapentin for her cat's arthritis for over a year (he is 21 yrs old, hypertension, hyperT, CRF dx 2008); has worked wonders for him, with no apparent side effects or interactions w/ his other meds. Her vet compounds a mixture with VAL syrup, so that she gives a 0.2 ml oral dose once a day.

The Veterinary Anesthesia & Analgesia Support Group (VASG.org) site has an overview on longterm use of meds for chronic pain in cats. Its not very specific about different kinds of pain, but does have some info on side effects and cautions.
http://www.vasg.org/newer_options_for_c ... ment_2.htm
http://www.vasg.org/chronic_pain_management.htm

-- some notes from the VASG overview on gabapentin --
Use alone or adjunct (w/ other meds);
Possible side effects - weight gain, transient sedation;
Particularly effective for neuropathic pain and cancer related pain;
Dosed at 2 to 5 mg/kg BID PO;
Metabolized by liver; primarily excreted unchanged by kidneys;
Short half life; fast clearance, requires frequent dosing;
Cautions: dose reduction for impaired renal function (no cautions listed for liver).

I read somewhere that Gabapentin is being studied on a Winn Feline Foundation grant at UC/Davis to determine accurate dosages and adverse effects in cats.

More info on pain meds: AAHA/AAFP Pain Management Guidelines for Dogs and Cats (2007):
http://tiny.cc/PainMgmtGL
(although I was disappointed at the lack of cautions re: metacam... but then Merial was a sponsor for this publication)

This CRF site discusses issues re: metacam and kidneys:
http://www.felinecrf.org/causes_of_crf.htm#metacam

A couple of discussions re: metacam on FDMB:
viewtopic.php?f=3&t=1557#p13128
http://www.felinediabetes.com/phorum5/r ... ?8,1867651


Hope this is helpful -
Deb, angel Evie, and the boys