I probably already know the answer to this, but want some insight here.
My vet just gave, and prescribed, Metacam to my 12 pound Bengal kitty for inflammation in her knee. She wants her on 12 ml for 5 days and 6 ml for another 5 days to reduce inflammation. Knowing that this is not for cats, I am concerned and asked if I could just restrict her activity instead. She told me it would be harmless and she would do it for her own cat.
So she gave Lola 12 mg (mg?) tonight.
Lola had a case of pylonephritis in the past and we are monitoring her kidneys as it is because a bit of renal damage.
Is Metacam safe or should I throw this out and find a new vet?
She also has a current struvite problem that we are feeding eukanuba low/ph s for.
I'm worried about this metacam. [b]Can the one oral dose that they gave her hurt her? [/b]Would it hurt her if I didn't give her anymore?
Metacam
Re: Metacam
Is there a decimal in there? Look at the Rx, what exactly does the label/vet's prescription say? What syringe are you using, a 1 cc syringe or up to a 3 cc syringe or?
If no decimal, then yes, the dose is too high. Typically, one should only be giving a drop or so of the medication for around 3 days, but this varies per patient, and when given in this manner (orally), is off-label. The medication is only approved in cats as a one-time injectable form for surgical pain management (in a very small dose). The problem is that no one truly knows the median dose for cats when given orally, and the manufacturer has done NO long term studies on this in cats, particularly for extended use beyond the first injection. (studies were only done on higher doses (injectable) and only for a limited period of time). Some vets are comfortable with extending the dose for a couple days, others are not. Since it's off-label in this manner, there is no gaurantee of safety or efficacy.
I'd ask your vet her reasoning for this. I'd also see a feline orthopedic specialist or sugeon to determine why there is inflammation on the knee, is she possibly at risk for a luxating patellar or cruciate rupture?
Knowing some bengals are typically larger than your domestic cat, is she possibly overweight? If so, vet needs to rule out arthritic conditions or stress on the joints. Cosequin might help, but I'd seek a second opinion anyway, get the knee totally evaluated, etc.
Personally, I would not continue the metacam without a second opinion (also, confirm the dose with your vet, decimals, make absolutely certain the syringe is marked, etc). You've mentioned more than once that Lola is prone to kidney problems, and the metacam wouldn't help this.
Are the struvites resolving?
If no decimal, then yes, the dose is too high. Typically, one should only be giving a drop or so of the medication for around 3 days, but this varies per patient, and when given in this manner (orally), is off-label. The medication is only approved in cats as a one-time injectable form for surgical pain management (in a very small dose). The problem is that no one truly knows the median dose for cats when given orally, and the manufacturer has done NO long term studies on this in cats, particularly for extended use beyond the first injection. (studies were only done on higher doses (injectable) and only for a limited period of time). Some vets are comfortable with extending the dose for a couple days, others are not. Since it's off-label in this manner, there is no gaurantee of safety or efficacy.
I'd ask your vet her reasoning for this. I'd also see a feline orthopedic specialist or sugeon to determine why there is inflammation on the knee, is she possibly at risk for a luxating patellar or cruciate rupture?
Knowing some bengals are typically larger than your domestic cat, is she possibly overweight? If so, vet needs to rule out arthritic conditions or stress on the joints. Cosequin might help, but I'd seek a second opinion anyway, get the knee totally evaluated, etc.
Personally, I would not continue the metacam without a second opinion (also, confirm the dose with your vet, decimals, make absolutely certain the syringe is marked, etc). You've mentioned more than once that Lola is prone to kidney problems, and the metacam wouldn't help this.
Are the struvites resolving?
..........Traci
Re: Metacam
Hi Traci,
Thank you for reply. The dose is a bit irregular: it is the same dose as for a dog. It is .09 mg/lb (.2 mg/kg), but the syring is lined in pounds, so I was told to give her to the 12 mark, being she is 12.4 pounds. Does that make sense? I believe it is the same for her as it is for a dog.
So she prescribed it for 5 days at the 12 mark, then 5 days at the 6 mark. I told her I didn't want to do it, she told me if it were her cat she would do it in a heartbeat, and the only risk is gastro upset like asprin in us. So I come home and find it is far worse than that.
I have made the decision to not continue, I am still worried about the dose she was given, which was 15 hours ago now. Lola seems fine, thank God, but how long would it take to know if any damage occurred?
I have also made the decision to find another (yet another) vet, because I do not feel she was completely honest with me, and talked me into doing something I did not want to do.
As for the struvites, which was the initial reason of going, she couldn't get a sample via syring (Lola's bladder is small) and said hold off til Monday, when we could get it via ultrasound. I wanted to ask if the struvites could also be in her kidneys, and also if she is at risk for a silent pylonephritis, but she didn't let me get a word in edgewise.
She seems to be feeling better, struvite wise. She is not scooting nearly as much, and she is urinating alright. Thankfully.
Thank you for reply. The dose is a bit irregular: it is the same dose as for a dog. It is .09 mg/lb (.2 mg/kg), but the syring is lined in pounds, so I was told to give her to the 12 mark, being she is 12.4 pounds. Does that make sense? I believe it is the same for her as it is for a dog.
So she prescribed it for 5 days at the 12 mark, then 5 days at the 6 mark. I told her I didn't want to do it, she told me if it were her cat she would do it in a heartbeat, and the only risk is gastro upset like asprin in us. So I come home and find it is far worse than that.
I have made the decision to not continue, I am still worried about the dose she was given, which was 15 hours ago now. Lola seems fine, thank God, but how long would it take to know if any damage occurred?
I have also made the decision to find another (yet another) vet, because I do not feel she was completely honest with me, and talked me into doing something I did not want to do.
As for the struvites, which was the initial reason of going, she couldn't get a sample via syring (Lola's bladder is small) and said hold off til Monday, when we could get it via ultrasound. I wanted to ask if the struvites could also be in her kidneys, and also if she is at risk for a silent pylonephritis, but she didn't let me get a word in edgewise.
She seems to be feeling better, struvite wise. She is not scooting nearly as much, and she is urinating alright. Thankfully.
Re: Metacam
Doesn't make sense. What size is the syringe? (1 cc or up to 3 cc or??) Does the syringe have lines that are marked 1, 1 1/2, 2, 2 1/2, 3, etc....or are they marked .10, .20, .30 etc? I also don't know the starting dose (the mg amount per ml in the starting bottle of metacam, it is then dosed by weight, which equals out to be only about .25 ml or so once a day, notice the decimal!!).
I advise calling and confirming the dose, since I assume there is a decimal in there somewhere, and need to know what size syringe you used.
Since I don't know what size syringe was used, nor starting dose, nor if there is a decimal in there in dosing, etc, I cannot advise further, except to say the dose may be high (without knowing the above), and the number of days she has prescribed is not common, particularly not knowing the extent of the inflammation, nor the cause. So, without knowing any of the above, if it were too high a dose, I'd recommend getting kidney and liver enzymes tested within 3-4 weeks. If Lola didn't or doesn't develop adverse reactions, it might be safe to say she is ok, and no harm done. But, this is providing your vet dosed correctly.
You can try to get a urine sample at home on your own, providing you can get the sample to your vet promptly, to avoid temperature and contamination problems. Ideally, a cystocentisis is better since contamination is virtually non-existant, but no full bladder, no sample. Another way would be to have your vet appt first appt in the morning, feed and give water directly before leaving for the appt, do not use blankets etc in carrier, and then would have a better chance of collecting urine either expressing the bladder or cystocentisis.
Doubtful there would be struvites in the kidney, although kidney stones are possible, in which the ultrasound would be handy to detect them. Otherwise, a full urinalysis should suffice to get an indication on number and size of the struvites, including ruling out predisposing bacterial infection, hematuria, etc.
If you're not comfortable with your vet, and you feel she is being less than honest with you, and does not answer your questions, by all means, see a new vet promptly, preferrably feline-only if possible.
I advise calling and confirming the dose, since I assume there is a decimal in there somewhere, and need to know what size syringe you used.
Since I don't know what size syringe was used, nor starting dose, nor if there is a decimal in there in dosing, etc, I cannot advise further, except to say the dose may be high (without knowing the above), and the number of days she has prescribed is not common, particularly not knowing the extent of the inflammation, nor the cause. So, without knowing any of the above, if it were too high a dose, I'd recommend getting kidney and liver enzymes tested within 3-4 weeks. If Lola didn't or doesn't develop adverse reactions, it might be safe to say she is ok, and no harm done. But, this is providing your vet dosed correctly.
You can try to get a urine sample at home on your own, providing you can get the sample to your vet promptly, to avoid temperature and contamination problems. Ideally, a cystocentisis is better since contamination is virtually non-existant, but no full bladder, no sample. Another way would be to have your vet appt first appt in the morning, feed and give water directly before leaving for the appt, do not use blankets etc in carrier, and then would have a better chance of collecting urine either expressing the bladder or cystocentisis.
Doubtful there would be struvites in the kidney, although kidney stones are possible, in which the ultrasound would be handy to detect them. Otherwise, a full urinalysis should suffice to get an indication on number and size of the struvites, including ruling out predisposing bacterial infection, hematuria, etc.
If you're not comfortable with your vet, and you feel she is being less than honest with you, and does not answer your questions, by all means, see a new vet promptly, preferrably feline-only if possible.
..........Traci
Re: Metacam
I'll take photos if I have to...she said the dosing is confusing, and she was right there.
The box says .5mg/mL oral suspension/net contents 15 mL.
The dropper has 30 lines on it and says on the side Metacam 0.5 and has 10////////20////////30 lbs on it as a measurement. She said to dose to the 12th line, for 12 pounds.
The prescription says "metacam 10 ml oral suspension qty 1
give dose based on poundage for next 4 days, then 1/2 dose for next 5 days."
and the side of the box says "Metacam oral suspension should be administered initially at 0.09 mg/lb (0.2mg/kg) body weight only on the first day of treatment. For all treatments after day 1, metacam oral suspension should be administered once daly at a doseage of 0.045 mg/lb (0.1mg/kg) The syring is calibrated to deliver the daily maintenance dose in pounds."
Does this make anymore sense? I too have not seen a syring like this.
The box says .5mg/mL oral suspension/net contents 15 mL.
The dropper has 30 lines on it and says on the side Metacam 0.5 and has 10////////20////////30 lbs on it as a measurement. She said to dose to the 12th line, for 12 pounds.
The prescription says "metacam 10 ml oral suspension qty 1
give dose based on poundage for next 4 days, then 1/2 dose for next 5 days."
and the side of the box says "Metacam oral suspension should be administered initially at 0.09 mg/lb (0.2mg/kg) body weight only on the first day of treatment. For all treatments after day 1, metacam oral suspension should be administered once daly at a doseage of 0.045 mg/lb (0.1mg/kg) The syring is calibrated to deliver the daily maintenance dose in pounds."
Does this make anymore sense? I too have not seen a syring like this.
Re: Metacam
I just measured it out with water in the syringe. The 12th mark that they gave her is about 1/4 tsp, or 1.25 ml by my measuring spoon.
Re: Metacam
This is the problem when vets give the client the accompanying measuring syringe with the metacam, as packaged. Vets should always give the client a regular 1 cc syringe, dose correctly and mark on the syringe where to draw the medication up to.
If using the ml calculation (this is not exact, keep in mind), Lola's daily dose should only be between .28 to .56 ml once a day (and only for 3-4 days, period). Might want to call her and ask if that is how it is calculated for Lola since she's using a different calibrated syringe. Just by doing a quick calculation, she's expecting you to give approximately .75 ml to 1.25 ml once daily, but I could be wrong about that, so don't take that as confirmative, you need to find out from her specifically. Did Lola recieve an initial injection of metacam before any oral dose was given?
Another problem is when vets use the doseage assuming a small dog doseage equals a cat dosage, which is NOT good practice. Not saying your vet did this, but it's possible. In any event, I would confirm this with a new vet, ask about testing kidney/liver enzymes in 3-4 weeks just to play it safe, and use the new vet for a new urinalysis/exam regarding the struvites, and re-evaluate the knee/joints. And yeah, I'd cease giving the metacam entirely, since she didn't have a specific diagnosis on the knee problem anyway, and metacam might not even be indicated for this.
If using the ml calculation (this is not exact, keep in mind), Lola's daily dose should only be between .28 to .56 ml once a day (and only for 3-4 days, period). Might want to call her and ask if that is how it is calculated for Lola since she's using a different calibrated syringe. Just by doing a quick calculation, she's expecting you to give approximately .75 ml to 1.25 ml once daily, but I could be wrong about that, so don't take that as confirmative, you need to find out from her specifically. Did Lola recieve an initial injection of metacam before any oral dose was given?
Another problem is when vets use the doseage assuming a small dog doseage equals a cat dosage, which is NOT good practice. Not saying your vet did this, but it's possible. In any event, I would confirm this with a new vet, ask about testing kidney/liver enzymes in 3-4 weeks just to play it safe, and use the new vet for a new urinalysis/exam regarding the struvites, and re-evaluate the knee/joints. And yeah, I'd cease giving the metacam entirely, since she didn't have a specific diagnosis on the knee problem anyway, and metacam might not even be indicated for this.
..........Traci
Thank you. I agree with you.
I do believe she was given the oral. All I was told is she received her initial dose.
I do believe she was prescribed the small dog equivilent.
I do have a new hospital in mind.
If she was given too much yesterday, would I have seen signs of toxicity by now? It has been 19 hours.
If she was given too much, how long would it take for signs of toxicity/damage to appear?
Is there anything in the meantime that I can do to prevent any damage, (has damage already been done?) When you say retest in 4 weeks, I agree, but I wonder if we test sooner if we can prevent some long term damage?
She was scheduled for a kidney ultrasound on Monday. If I do an ultrasound with the new vet around this timeframe, would it show any signs of damage from this or should I wait a few weeks? I want to stress her as little as possible.
The vet said she has treated hundreds of cats like this and never had an issue. Trusting her on this, with the pylonephritis background, could it hurt her kidneys even if it was a "safe" one time dose?
Safe or not, it doesn't seem to be erring on the lowest possible dose side. Seems high no matter how I look at it.
I'm furious that I let this happen.
I do believe she was given the oral. All I was told is she received her initial dose.
I do believe she was prescribed the small dog equivilent.
I do have a new hospital in mind.
If she was given too much yesterday, would I have seen signs of toxicity by now? It has been 19 hours.
If she was given too much, how long would it take for signs of toxicity/damage to appear?
Is there anything in the meantime that I can do to prevent any damage, (has damage already been done?) When you say retest in 4 weeks, I agree, but I wonder if we test sooner if we can prevent some long term damage?
She was scheduled for a kidney ultrasound on Monday. If I do an ultrasound with the new vet around this timeframe, would it show any signs of damage from this or should I wait a few weeks? I want to stress her as little as possible.
The vet said she has treated hundreds of cats like this and never had an issue. Trusting her on this, with the pylonephritis background, could it hurt her kidneys even if it was a "safe" one time dose?
Safe or not, it doesn't seem to be erring on the lowest possible dose side. Seems high no matter how I look at it.
I'm furious that I let this happen.
Re: Metacam
I don't think it would show up in bloodwork for at least a couple weeks, but you can ask the new vet and get recommendations for testing. You might see actual clinical symptoms within a few days after administration, but every cat is different, bloodwork is the only way to determine for certain.
Metacam is contraindicated for renal patients and for any reason metacam is used for pain problems in a renal patient, fluids administration must be given to ward off dehydration and further renal damage (at least in the clinical setting, IV fluids are ideal when injections of metacam are given, since it is usually necessitated by a surgical procedure) -- at home, as long as the cat is otherwise healthy and well hydrated, this is not so much a concern (unless in CRF or renal failure). This is why blood parameters should be checked when a cat is on a "maintenance" dose of metacam, and particularly if prescribed the highest dose. This is true of ANY NSAID. It's possible a one-time dose only did no harm, but only the vet and bloodwork can say for certain. We can certainly hope the vet dosed correctly and not too high a dose, but the "prescription" is just too confusing at this point, and I shudder to think how her other clients react or get confused when the syringe is calibrated like that. (not that this is a problem in the clinic, but one should always give the client a syringe that is easier to use and interpret dosing)
Regardless of the vet's comments about treating many cats with metacam, not all cats are going to respond favorably (nor is it always the best choice for certain patients. It's an NSAID, and although metacam is approved in cats (and seems safer than other NSAIDS) as the manufacturer intends, per label instructions, any off-label use may cause reactions in any number of cats.
See if you can get an appointment with a new vet ASAP. Not that you should be overly concerned about the kidneys, but because you want to confirm the doseage of metacam, re-evaluate her knee, get new urinalysis and/or ultrasound discussed.
Metacam is contraindicated for renal patients and for any reason metacam is used for pain problems in a renal patient, fluids administration must be given to ward off dehydration and further renal damage (at least in the clinical setting, IV fluids are ideal when injections of metacam are given, since it is usually necessitated by a surgical procedure) -- at home, as long as the cat is otherwise healthy and well hydrated, this is not so much a concern (unless in CRF or renal failure). This is why blood parameters should be checked when a cat is on a "maintenance" dose of metacam, and particularly if prescribed the highest dose. This is true of ANY NSAID. It's possible a one-time dose only did no harm, but only the vet and bloodwork can say for certain. We can certainly hope the vet dosed correctly and not too high a dose, but the "prescription" is just too confusing at this point, and I shudder to think how her other clients react or get confused when the syringe is calibrated like that. (not that this is a problem in the clinic, but one should always give the client a syringe that is easier to use and interpret dosing)
Regardless of the vet's comments about treating many cats with metacam, not all cats are going to respond favorably (nor is it always the best choice for certain patients. It's an NSAID, and although metacam is approved in cats (and seems safer than other NSAIDS) as the manufacturer intends, per label instructions, any off-label use may cause reactions in any number of cats.
See if you can get an appointment with a new vet ASAP. Not that you should be overly concerned about the kidneys, but because you want to confirm the doseage of metacam, re-evaluate her knee, get new urinalysis and/or ultrasound discussed.
..........Traci
Re: Metacam
I agree with what you are saying. I will make the appointment.
Luckily, her bloodwork was done last week with perfect results; BUN 20, Crt 2.2, no proteins found in urine. Let's pray it stays this way.
I'll let you know how this turns out.
Thank you for your help, it's priceless right now.
Luckily, her bloodwork was done last week with perfect results; BUN 20, Crt 2.2, no proteins found in urine. Let's pray it stays this way.
I'll let you know how this turns out.
Thank you for your help, it's priceless right now.