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I have a cat who was given Metacam oral suspension for pain and swelling after having a abscess cleaned on his paw. The dosage was 9 drops by mouth once daily for 4 days. A few days after that he went into renal failure. Creatinin levels and BUN levels through the roof. Impending cardiac failure. He was put on IV fluids, has recovered some, but worried about permanent damage. What is the protocol for a vet prescribing "off label" medication? Should there have been a release form? Should there have been level set's done on blood work to determine if he was at risk for taking NSAID's? Since there is not a licensed dosage for cats in the US it is hard to tell if he was overdosed, but appears to be when looking at the 2 drop loading dose, and 1 drop maintenance dosage for a dog. Any help would be appreciated.

Submitted: 1697 days and 20 hours ago.
Category: Cat
Value: $5
Status: CLOSED
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Posted by DanaDVM 1697 days and 20 hours ago.

Info Request

 In veterinary medicine, we use many medications in "off label" situations...especially in cats. Why? The same as most reasons $$ in research.  Metacam has been used safely in many cats and does have FDA approval for cats now...but I don't think the packaging reflects that. 

How much does your cat weigh?

No prior bloodwork was run? 9 drops...it takes 15 drops to make an ml so I am assuming that your cat got 0.6mls of Metacam a day...which is a HIGH dose and did throw your cat into renal failure. There are well documented dosages for this drug, so I am concerned as to the protocal this clinic is using.



Dr.V  



Edited by DanaDVM on 3/30/2005 at 3:52 PM

1697 days and 19 hours ago.

Reply

Reply to Dr. Vamvakias's Post: Thank you for this answer. My research has shown that the injectable form of Metacam is approved (November or December) by the FDA, but the oral suspension has not been. The cat ways about 7 lbs. No prior blood work that I know of, and the cat was not in chronic pain. He had an abscess that was cleaned out. Wear can I find the documented dosages for cats. Meric will not provide as it is not licensed for use in cats.   For dogs it is way below what was given to my cat. The vet indicates that he is within range as far as what has been used in Europe.

Accepted Answer

 The correct dose would have been 0.1 mg/kg (0.45 mg or 0.3 ml for this cat) for the initial dose then 0.1 mg (0.06 ml) TOTAL dose once daily for maintenance.

The company recommended the 0.1 mg/kg dose for 5 days and then go to 0.1mg per cat after that.

NC State (Duncan Lascelles and Lizette Hardie) now recommend meloxicam in cats at 0.1mg/kg on day 1, then 0.05mg/kg for 4-6 days then 0.25mg/kg once daily or lowest effective dose.

 

All three of these are taken from www.VIN.com which is a support network for vets, I am sure your vet is familiar with the site.  The overwhelming problem is the "drop" is not controlled and it depends from what syringe and so forth...

The problem that most of us face is an increasing surge to control pain in animals...it sounds like your vet was taking that into account.  If anything it is reflective of caring and support more than $ or malice.  We underestimate animal pain...and that is why these pharmaceuticals are out there now.  Metacam is a wonderful medications, but certain cats can develop renal failure...so it  is a hard decision.

It is a lesson both for your vet/vet clinic and others reading...as to whether specific waivers should be signed. Unfortunately, animals have acute episodes with vaccines and other medications and go into liver and kidney failure as well.

I hope this helps clarify the metacam dose.  TO ME, it seems like a high dose for your cat...but it depends on the drop size!!! And because no pre-medication bloodwork was done, we don't know if 50% is the drug or 95%.

Let me know how I can further help you.

Dr.V

 

Edited by DanaDVM on 3/30/2005 at 5:51 PM

Expert: DanaDVM
Pos. Feedback: 100.0 %
Accepts: 
Answered: 3/30/2005

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