Patches is a 14 year
old male feline with a healthy history. In mid-February, 2008 he
is showing some difficulty in his movements.
On February 29, 2008, he is
diagnosed by Hudson Valley Animal Hospital, Valley Cottage, Ny
with a chronic arthritic condition. Blood tests reveal
borderline healthy kidney function. Otherwise he is in good condition.
He is given Metacam
injection 0.3 mg/kg by Dr.
Bridget Puzio at Hudson Valley Animal Hospital. Then oral
Metacam 0.8 ml is given once daily for two days followed by 0.2
ml once daily every other day for two weeks.
Never mentioned to the client at any time is the possible
adverse reactions from the Metacam injection nor the FDA
non-approval of oral usage in felines(see below for label
Patches returns to the Hudson Valley
Animal Hospital on July 25 after some of the arthritis symptoms
returned. The other
A. Gadino, gives Patches a second injection of Metacam. Owner is
not told of the possible adverse effects of the injection, nor
told that a second injection is contraindicated on the Metacan
label. In addition
no blood testing is done to properly evaluate Patches'
current condition. Owner
is not told of the reason or need for a physical exam or blood
test; owner is not told the name of the drug injected in either
visit; and the owner is never advised of the high risks of a
follow-on Metacam injection.
Patches begins losing
weight in mid-August with unusual sluggishness and increased
vomiting, two weeks
after the second injection.. He is barely eating, and on
September 4 is brought to the Vet at the Barn and seen by Gloria
exams him , gives a blood test and reports that he has serious
liver and kidney deterioration.
After giving antibiotics and supplements to get Patches
to eat, Dr. Binkowsi reports no improvement.
Dr. Binkowski recommends Patches be given an ultrasound
scan for a more specific diagnosis.
The scan done on September 10
shows major failure in liver, gall bladder, kidney,
stomach, pancreas, peritoneum and lymph nodes. His ultrasound is
done by Dr. Atkins at the Valley Cottage Animal Hospital and she
states that he has chronic
renal disease, pancreatitis, and cholangiohepatitis with
dehydration and jaundice..
It is recommended that aggressive medical management be
instituted with IV fluids, liver aspirate and e-tube.
12, Patches is admitted to the Valley Cottage Animal Hospital.
After two days of hospitalization, he is in organ
failure, and is euthanized on September 15.
FROM THE METACAM
LABELS AND INSERTS
"Additional doses of meloxicam in
cats are contraindicated, as no safe dosage for repeated NSAID
administration has been established. ". In black label, the
insert states, " Do not administer a second dose of
meloxicam. Do not follow meloxicam with any other NSAID."
But, a second dose was administered, despite the warning.
Also, in the Metacam Oral Suspension label, which is used
exclusively for canines, there
is an additional bold letter warning for felines, " Do
not use in cats." However, the oral suspension was used
and no warning given by Dr. Puzio for the off-label use.
" When administering any NSAID, appropriate laboratory
testing to establish hematological and serum biochemical
baseline data is recommended prior to use in dogs and cats.
All cats should undergo a thorough history and physical
examination before administering meloxicam.
Do not repeat dose in cats."
No blood test nor exam was administered before his second
Repeated use in cats has been associated with acute renal
failure and death. " This severe warning, stated in black
label, was ignored
with the second injection.
"Information for cat owners.
Meloxicam, like other NSAIDs,
is not free from adverse reactions. Owners should be
advised of the potential for adverse reactions and be informed
of the clinical signs associated with NSAID intolerance...Cat
owners should be advised when their pet has received a meloxicam
fact this narrow margin of safety with oral Metacam is reflected
in the FDA's Adverse
Drug Experience for June 9, 2006 where the agency reported that
in 320 felines, 105
suffered kidney failure, 48 died
and 35 cats had to euthanized..
Despite these statistics and warnings, neither Dr.Puzio
or Dr. Gadino ever
mentioned that Metacam was used on Patches nor the significant
health risk to him.
I am outraged by the the loss of my pet! I cannot believe I lost my cat because of this incompetence. I want to save other animals from this fate.
The side effects of concern are the same with all NSAIDs: stomach ulceration, loss of kidney function, and inappropriate bleeding. These are dependent on the dose of medication used and on risk factors of the host (for example: an aged pet may not efficiently clear a dose of medication from its body leading to stronger and longer activity of the drug). There is also a particular idiosyncratic reaction for NSAIDs that has received a great deal of press. An idiosyncratic reaction is one that is neither dose-dependent nor predictable by any apparent host factor; it simply happens out of the blue. This particular idiosyncratic reaction is a liver toxicity that is rare enough that it did not show up in any of the initial 400 carprofen test subjects, nor in the U.K., and was not recognized until carprofen was used in over a million dogs in the U.S. after its release as the first NSAID. This reaction is reviewed below. While originally it was carprofen use that led to the recognition of this reaction, it is now felt that all veterinary NSAIDs have potential to cause this reaction.
· The most common side effects of meloxicam are nausea, appetite loss, vomiting or diarrhea. If any of the above are noted, meloxicam should be discontinued and the pet brought in for a liver enzyme and renal parameter blood test. In most cases, the reaction is minor and resolves with symptomatic relief, but it is important to rule out whether or not the patient has more than just a routine upset stomach.
· If a patient has borderline kidney function, NSAIDs should not be used as they reduce blood flow through the kidneys(my underline). It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect. This is particularly true in cats.
· The hepatopathy side effect (usually occurs within the first 3 weeks of use).