Metacam - off topic

[Karrie and Maverick]

Another cat was lost to metacam on the assisted feeding forum this week - acute renal failure. The owner told the vet she didn't want to do this - she had read the metacam kills website and the vet talked her into using it. Her cat passed away yesterday after fighting renal failure for one week.

I understand one of the LL'ers is considering metacam. I don't want to scare away this person. But I wanted the group to know the dangers of metacam if they aren't already aware.

It has a black box warning. Why are vets ignoring this and pushing it on cat owners?

Also:

the UK National Office of Animal Health which states "Do not use in animals suffering from gastro-intestinal disorders such as irritation and haemorrhage, impaired hepatic, cardiac or renal function and haemorrhagic disorders".

 

[CD and BigMac]

Oh how incredibly sad. It is especially frightening because initially the owner did not want Metacam used but was talked into allowing it. Yikes!
I wonder why the vet wasn't concerned about the black box warning. That is scary to me.

 

[Karrie and Maverick]

CD I can't wrap my mind around it. I don't get it. You'd think they would be on top of the literature before their patience. Its like they are brain washed or don't care.

 

[Julia & Bandit (GA)]

I'm not going to say that Metacam should *never* be used, because there are some cases where it is the best choice since it's the only nsaid option. Bandit has had it before with no problems when the circumstances were appropriate, and the dose double checked. However, I vetoed the Metacam with Gabby because of her age, heart murmur, and reduced kidney function, and I vetoed it with Bandit recently for an inflamed nerve because of an elevated liver value and diarrhea. My vet agreed with me in each situation. The big places where it should NOT be given is with any cat that is likely to have reduced kidney function (which is any cat over the age of 12!), any gastro-intestinal problems, liver problems, or heart problems. Also, you really have to trust that your vet is getting the dose correct and I researched safe dose amounts before administering it, because giving too much metacam is deadly. Because Bandit is getting older and kidney function reduces with age, I would probably never opt for it again unless in an extreme situation.

Vets should be aware of the dangers of metacam, and should not suggest it inappropriately, which is in A LOT of cases. And sometimes giving it to an at-risk cat may be worth the benefits, especially in palliative care situations, but this is all information the owner needs to have BEFORE making a decision, and they should not be pressured into a decision to use it.

 

[Michelle and Mannie (GA)]

I am deeply saddened to read this, and share the agony with the person who lost their kitty - sadness beyond words. ... I know first hand the dangers of metacam - it did cost me the life of one of mine... in days before the black box, before vets warned their client. I do hope whoever is considering this med will heed the warnings. metacam can kill... I know.

My sympathies to that kitties family...

 

[Karrie and Maverick]

((((Michelle))))) I'm sorry. I didn't know that.

Julia - I appreciate the additional background info. I think about it from the pain management perspective and why vets don't propose the newer drugs. This is very good information and does balance out my original post and explains some reasons why vets would use it responsibly.

 

[CD and BigMac]

I'm not going to say that Metacam should *never* be used, because there are some cases where it is the best choice since it's the only nsaid option.

Vets should be aware of the dangers of metacam, and should not suggest it inappropriately, which is in A LOT of cases. And sometimes giving it to an at-risk cat may be worth the benefits, especially in palliative care situations, but this is all information the owner needs to have BEFORE making a decision, and they should not be pressured into a decision to use it.

Of course. These are valid points. If it is still available for cats, it must be useful in certain limited situations.

 

[Julia & Bandit (GA)]

I wonder why the vet wasn't concerned about the black box warning. That is scary to me.

I think some vets don't get concerned about kidney function until it shows up in blood tests--however, by the time blood testing detects it the cat has already lost 75% of their kidney function. Gabby had renal insufficiency, but it did not show up in blood tests because she still had about 50% of her kidney function. Like people, cats naturally lose kidney function as they age, so senior cats should NEVER be given Metacam unless the situation is palliative and it's the only option.

That "impaired renal function" black box warning is not just for cats in kidney failure--it's for cats with ANY reduced renal function.

EDIT: This is a little off topic, but this is the same reason why I encourage my friends with senior cats to feed high quality protein, low phosphorus foods, because helping out those kidneys at 12 years is going to help prevent kidney problems down the road.

 

[CD and BigMac]

I think some vets don't get concerned about kidney function until it shows up in blood tests--however, by the time blood testing detects it the cat has already lost 75% of their kidney function. Gabby had renal insufficiency, but it did not show up in blood tests because she still had about 50% of her kidney function. Like people, cats naturally lose kidney function as they age, so senior cats should NEVER be given Metacam unless the situation is palliative and it's the only option.

That "impaired renal function" black box warning is not just for cats in kidney failure--it's for cats with ANY reduced renal function.

Wow. Good info! Thanks Julia! All my kitties are older. I refused Metacam for one kitty last year. I'm glad. (Situation wasn't palliative - pain wasn't deep and kitty recovered nicely.)
Now I know what to say if it is ever suggested again.

 

[Jill & Alex (GA)]

I'm not going to say that Metacam should *never* be used, because there are some cases where it is the best choice since it's the only nsaid option. Bandit has had it before with no problems when the circumstances were appropriate, and the dose double checked. However, I vetoed the Metacam with Gabby because of her age, heart murmur, and reduced kidney function, and I vetoed it with Bandit recently for an inflamed nerve because of an elevated liver value and diarrhea. My vet agreed with me in each situation. The big places where it should NOT be given is with any cat that is likely to have reduced kidney function (which is any cat over the age of 12!), any gastro-intestinal problems, liver problems, or heart problems. Also, you really have to trust that your vet is getting the dose correct and I researched safe dose amounts before administering it, because giving too much metacam is deadly. Because Bandit is getting older and kidney function reduces with age, I would probably never opt for it again unless in an extreme situation.

Vets should be aware of the dangers of metacam, and should not suggest it inappropriately, which is in A LOT of cases. And sometimes giving it to an at-risk cat may be worth the benefits, especially in palliative care situations, but this is all information the owner needs to have BEFORE making a decision, and they should not be pressured into a decision to use it.

EDIT: This is a little off topic, but this is the same reason why I encourage my friends with senior cats to feed high quality protein, low phosphorus foods, because helping out those kidneys at 12 years is going to help prevent kidney problems down the road.

excellent points, julia! i'm glad you brought them into this discussion. metacam and for that matter covenia scare the you know what out of me and yet there are times when each of them may be appropriate. being informed and weighing the pros and cons with your vet is important.

i also agree with your comment on preventing kidney damage in senior cats. both my "seniors" are on a kidney friendly diet.

karrie, thanks for bringing up the issues with metacam. we have a high turnover. not everyone may be aware of the risks.

 

[carolyn & jesse (GA) & spock]

I agree with Julia and will add my two cents that there are times where there is no other option. One of my cats that had SEVERE stomatitis (and FIV+) was on a low dose for over a year - it was the only way he could eat. I had to weigh the risks with his current quality of life. Several years later and he is fine.

It's just a shame that vets don't heed the warnings when they are presented to them.

 

[Julia & Bandit (GA)]

I agree with Julia and will add my two cents that there are times where there is no other option. One of my cats that had SEVERE stomatitis (and FIV+) was on a low dose for over a year - it was the only way he could eat. I had to weigh the risks with his current quality of life. Several years later and he is fine.

It's just a shame that vets don't heed the warnings when they are presented to them.

I used it briefly with Bandit when he had severe tooth resorption problems and inflamed gums, but he was only on a low dose for about a week, and he was 8 at the time with no other problems except his diabetes, so Metacam was the best option for him. It worked wonderfully, far, far better than an opiate could for that problem.

I actually did decide to use it with Gabby despite the huge risk of kidney failure if we got to a point in her cancer where she needed pain meds. She did not tolerate opiates well at all and they made her miserable, and at that point I was just trying to extend her quality of life as long as possible. Renal failure is not a painful way to go, and if my only other option is a miserable cat with cancer then I would surely take that risk. Fortunately, her tumor never became painful for her before the end.

 

[Sienne and Gabby (GA)]

I couldn't agree more that the use of any medication, black box warning or not, should be given with informed consent. And, it is this issue where IMHO, vets are lax. It drives me crazy. There would be huge malpractice suits if the same prescribing practices were occurring with humans. I do wonder how many of us ask about side effects when a drug is prescribed. I've learned to look a medication up on my phone before I leave the vets office. More importantly, our vets telling us about side effects or interactions with other medications or even foods should be the standard of care. If a medication has a black box warning, it is the vet's responsibility to inform us as to why the warning is there, the risks, and in light of this severe of a warning why a drug like Metacam is indicated. I would love to see a few vets sued for malpractice in order to get the word out.

 

[Sandy and Black Kitty]

I would love to see a few vets sued for malpractice in order to get the word out

ditto.
Sad to think that's what it would take.