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BACKGROUND
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, New York, 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 warning).
Patches returns to the Hudson Valley Animal Hospital on July 25 after some of the arthritis symptoms returned. The other veterinarian, Derek 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 Binkowski,VMD. She 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.
On September 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 Metacam injection.
"Foreign Experience: 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 injection." In 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.
Addendum
By Wendy C. Brooks, DVM, DipABVP Educational Director, VeterinaryPartner.com Date Published: 11/1/2004 10:46:00 AMDate Reviewed/Revised: 11/12/2007
Side Effects
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).
