Meloxicam.vp

BRAND NAME: MELONEX, METACAM, MOBIC, MOBICOX Meloxicam is a member of the class of drugs known as NSAIDs (non-steroidalanti-inflammatory drugs), the same class as such common over-the-counter pain remedies asAdvil (Ibuprofen), Aleve (Naproxen), Orudis (ketoprofen), and Aspirin. Most NSAIDs cannot be used in pets due to the following unacceptable side effects: • Stomach ulceration - even perforation and rupture of the stomach can occur. This is
not only painful but life-threatening.
• Platelet deactivation - platelets are the cells controlling the ability to clot blood and,
as a general rule, it is preferable not to promote bleeding. We would prefer platelets
to remain active and able to function should we need them.
• Decreased blood supply to the kidney - this could tip a borderline patient in to
kidney failure.
The veterinary profession has been in need of an NSAID that could effectively relieve painwithout the above risks. The key appears to lie with the enzyme responsible for manyinflammatory mediators: cyclo-oxygenase-2 (or COX–2). A different but related enzyme,cyclo-oxygenase-1 (COX-1), is responsible for producing important biochemicals needed tomaintain normal blood supply to the kidneys and GI tract. It had been previously impossible toinhibit cyclo-oxygenase-2 without also inhibiting cyclo-oxygenase-1, hence the side effects ofprevious NSAIDS.
In 1997, Pfizer Animal Health released carprofen for dogs in the U.S. as the answer to thisneed. Carprofen is what is called a preferential cyclo-oxygenase-2 inhibitor. Carprofen doesinhibit cyclo-oxygenase-1 slightly but, for the first time, it became possible to exert a differenteffect on each of these two enzymes. Meloxicam is a similar type of NSAID, preferentiallyinhibiting COX-2 over COX-1. This new ability to inhibit only the inflammatory COX proved tobe revolutionary for pain management not only for pets but for humans as well. Theintroduction of COX-2 preferential NSAIDs has reduced stomach and intestinal side effects by50% in humans and has made FDA approval of NSAIDs possible for pets. Meloxicam has onlybeen approved in the U.S. for canine use since 2003 but has been available in Canada andEurope for years before. Meloxicam has been available in the U.S. for human use for manyyears.
Meloxicam offers another unique feature that other veterinary NSAIDs do not: feline use. Asmuch as having COX preferential NSAIDs has been a boon to canine practice, these samedrugs did not offer pet cats any sort of safe relief. Cats are even more sensitive to NSAID sideeffects as a general rule and the quest for a feline NSAID is still on-going; still, meloxicam hasbeen approved by the FDA for use in cats for surgical pain so long as only one dose is given. Longer term feline protocols have been developed (though not approved by the FDA at thistime) and are in wide though cautious use in needful cats.
Another use of COX preferential NSAIDs bears mentioning. There are many forms of cancer, in particular certain types of carcinomas (Transitional Cell Carcinoma, possibly Squamous CellCarcinoma, and more) seem to exhibit COX-2 activity. This implies that these types of NSAIDs have anti-tumor effects separate from their anti-inflammatory effects and their use in thetreatment of inoperable cancers is currently being explored.
Meloxicam is generally given to control arthritis pain in dogs though can be given for manyother painful conditions such as injuries, cancer, surgery, dental infections, and more. Indogs, it is typically given as a once a day as a pleasantly flavored liquid. The veterinaryapproved product comes with a special dosing syringe marked to show how much to give forthe pet's weight (rather than in milliliters as most syringes are marked).
Meloxicam can be used in cats but with caution. The original oral solution of meloxicam wascommonly dosed in drops from the bottle. Since the wrong dose of meloxicam can be verydangerous for cats, it is important not to drop the drops directly into the cat's mouth from thebottle as squeezing too strongly could easily deliver an overdose. There is currently a newerformulation at one third the strength of the original which can be dosed more accurately withthe included syringe. In the cat this product is given either as a single one time injection inassociation with surgery (its FDA approved use) or long term 2-3 times per week.
Patients being considered for long term meloxicam use should be evaluated with a completephysical examination and initial screening blood test to identify any factors, such as liver orkidney disease, that might preclude the use of this or any other NSAID.
The side effects of concern are the same with all NSAIDs: stomach ulceration, loss of kidneyfunction, and inappropriate bleeding. These are dependent on the dose of medication usedand on risk factors of the host (for example: an aged pet may not efficiently clear a dose ofmedication from its body leading to stronger and longer activity of the drug). There is also aparticular idiosyncratic reaction for NSAIDs that has received a great deal of press. Anidiosyncratic reaction is one that is neither dose-dependent nor predictable by any apparenthost factor; it simply happens out of the blue. This particular idiosyncratic reaction is a livertoxicity that is rare enough that it did not show up in any of the initial 400 carprofen testsubjects, nor in the U.K., and was not recognized until carprofen was used in over a milliondogs in the U.S. after its release as the first NSAID. We will review this reaction below. Whileoriginally it was carprofen use that led to the recognition of this reaction, it is now felt that allveterinary 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. It is also important that NSAIDS not be
given to dehydrated patients because of this potential side effect. This is
particularly true in the cat.
• The Hepatopathy Side Effect (usually occurs within the first 3 weeks of use)
A carprofen reaction that has received special attention is hepatopathy, a type of
liver disease. Symptoms include nausea, appetite loss, and/or diarrhea as well as
marked elevations (3-4 times higher than the normal range) in liver enzymes
measured in the blood. The question of whether other veterinary NSAIDs share this
reaction has arisen. At this time, it is generally felt that the hepatopathy
idiosyncratic reaction is not unique to carprofen and should be of concern with any
veterinary NSAID and this includes meloxicam. This reaction seems to be a canine
issue only.
Dogs with hepatopathy show improvement with support 5 to 10 days after
discontinuing medication. It is important that the NSAID be discontinued and the
patient evaluated in the event of upset stomach signs in case of this syndrome.
Even though this is a rare syndrome (one in 5000), it can become life-threatening if
ignored. Appetite loss or other intestinal signs do not necessarily indicate a
hepatopathy but since they might, it is important not to ignore these signs should
they occur. There is no way to predict which dogs will experience this side effect.
The hepatopathy reaction usually occurs in the first 3 weeks after starting carprofen
but could theoretically occur later.
• All NSAIDs are removed from the body by the liver. If the patient’s liver is not
working normally due to another disease or if the patient is taking other drugs that
are also removed by the liver, it is possible to “over work” the liver and exacerbate
pre-existing liver disease. If there is any question about a patient’s liver function,
another class of pain reliever should be selected.
It is important to realize that COX-selectivity is not the sole factor in safety. In humans, theincidence of kidney function-related side effects was unchanged by the development of COX-2 preferential NSAIDs, such as meloxicam, and we expect the same is true with dogs. Still, thesedrugs have an excellent track record for safety. The important issue is to recognize risk factors for adverse reactions and take preventive steps (see the Concerns and Cautions sectionbelow).
One might wonder how this is possible given the COX-2 selectivity and the answer is complex.
While it is easy to think of COX-2 as the “bad” enzyme, COX-1 as the “good” enzyme, andCOX selectivity as seeing that only the "bad" enzyme is suppressed, this kind of thinking would be a drastic over-simplification. In fact, COX-2 is important in activities involving the healing ofstomach ulcers and other important processes. There is also a COX-3, of which very little isknown, and studies show there may very well be a COX-4. Further, at higher doses, meloxicam and other COX-2 selective NSAIDs will lose their COX-2 selectivity and significantly inhibitCOX-1 as well.
As with all veterinary NSAIDs periodic monitoring tests are important to check liver enzymesand kidney function, and to generally screen the patient's health. Typically an every 6 monthsschedule is recommended for dogs. There is no general consensus on what is appropriate forcats but because of feline sensitivity towards NSAIDs, feline monitoring is especially important. If you are using this product in the cat, be sure you understand what monitoring schedule your veterinarian is recommending for your specific pet.
Drugs of the NSAID class should not be used concurrently as the potential for theaforementioned side effects increases. For similar reasons, NSAIDS should not be used inconjunction with corticosteroid hormones such as prednisone, dexamethasone, etc. Pfizerrecommends a 5 to 7 day rest period when changing from one NSAID to another. Aspirinposes an exception due to its strong platelet inactivating abilities so 10 to 14 days isrecommended when switching to another veterinary NSAID from aspirin. Allow at least oneweek between prednisone and meloxicam.
If meloxicam is used concurrently with phenobarbital, it is especially important that appropriate liver monitoring be performed. These two drugs interact such that neither may work well if they are used together.
ACE inhibitors such as enalapril, benazapril, or captopril may not be as effective in thepresence of meloxicam. (ACE inhibitors are used in the treatment of hypertension or heartfailure.) This is because ACE inhibitors depend on the dilation of blood vessels in the kidneysand such dilation can be interfered with by NSAIDs).
Meloxicam works as well when given on an empty stomach as when given on a full stomach. If a patient has had some upset stomach issues with meloxicam these can often be minimizedby administering the drug on a full stomach.
Maximum effect is seen approximately 8 hours after administration. When beginning a trialcourse of meloxicam, a response may take 3 or 4 days to show. If no response has been seenin 10 days, meloxicam has failed and a different pain medication should be tried. If one NSAIDfails, another may well work.
The veterinary formulations of meloxicam are oral liquids (either 1.5mg/ml or 0.5 mg/ml). It isimportant to compare these sizes to the human tablets which are available in much higherstrengths. In general, human strength pills will be too strong except in very large dogs. It isimportant not to use human medications on pets unless your veterinarian has provideddetailed dosing instructions.
Meloxicam should not be used in pregnancy or in lactation.
Meloxicam should not be used in puppies under 6 months of age (safety has not beenproven).
Meloxicam should be avoided, if possible, in patients with impaired function of the liver, kidney or heart. It should also be avoided in dehydrated patients and patients with known GI ulcers.
ALWAYS SHAKE THE BOTTLE OF MELOXICAM BEFORE DRAWING UP THE DOSE
The manufacturer of veterinary meloxicam (Boehringer Ingelheim) has launched a web site formore information at: www.metacam.us
3850 Grand View Blvd., Los Angeles, CA 90066 l (310) 391-6741 l Fax: (310) 391-6744 Additional drug and general pet care information can be found on our world wide web site:

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