Metacam is often discussed on our cat boards, with concerned members wondering whether it's a safe choice for their cat. This guide explores Metacam and its use in cats, including side effects and risks, so that cat owners can make an informed decision about this pain relief medication for their cat.

What is Metacam?

Metacam is the commercial name of meloxicam: a non-steroidal anti-inflammatory drug (NSAID) manufactured by Boehringer Ingelheim and used for pain management in dogs and cats. Many vets recommend using Metacam for post-surgery pain relief in cats and outside the US it is also used for managing pain from feline arthritis.

Metacam (meloxicam) works by inhibiting a certain enzyme - cyclooxygenase - necessary for the body's inflammatory reaction. Lowered levels of cyclooxygenase mean the tissues are less swollen, creating less pressure on delicate nerve endings, and thus causing less pain.

The use of Metacam in Cats

Metacam is available in an oral solution form and injectable form. In the US, oral Metacam is intended for use in dogs only, usually as pain management for osteoarthritis. According to the FDA "METACAM Oral Suspension is approved for dogs only. No safe and effective dose of the oral suspension is approved for cats".

The FDA also limits the use of the Metacam solution for injection to a single dose. A black-box warning has been added to this product -
Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats.
Metacam is therefore usually used by American vets solely for postoperative pain management where it is given in a single shot during surgery. However, veterinarians around the world, including in Canada, Australia and many European countries, use oral Metacam for pain management in cats with arthritis as well.

It is worth noting that the recommended dosage is lower in those countries and many cats receive the medication with no ill effects.

Is Metacam safe for cats?

Most cats don't experience any side-effects from the use of Metacam, however as with any drug, some do. In a field study conducted by the manufacturer, 8.3% of the cats experienced elevated levels of kidney functions in blood tests. 12.5% of the cats experienced post-treatment anemia (compared with 6.3% in the control group).

In Canada, where oral Metacam is prescribed for cats, the following conditions are listed as contraindications to using the drug: Gastric or internal ulceration or bleeding; evidence of cardiac, hepatic or renal diseases; or if there is evidence of a haemorrhagic disorder or individual hypersensitivity to the product. As with any medication, drug interactions can be an issue. Metacam should never be administered alongside other steroidal or nonsteroidal anti-inflammatory drugs, aminoglycoside antibiotics or anticoagulant agents.

Acute renal failure (ARF) seems to be the effect many cat owners fear when considering Metacam. Reports of ARF in cats were what led to the FDA issuing the black box warning for the drug. We've had quite a few testimonies from members of about such experiences, including one by TCS team member @stephanietx who posted: "My Callie girl got a couple of shots of Metacam and shortly thereafter developed renal failure. After doing research, I decided to put that on my "Never give without my permission and after all other options exhausted" list at the vet's office."

ARF is a life-threatening condition and should be taken in all seriousness. That said, testimonies of ARF in cats following administration of Metacam, do not necessarily mean that Metacam is less safe than other drugs. Many veterinarians across the globe regularly prescribe Metacam for pain relief in cats without ever seeing serious adverse reactions to the drug.

Canadian veterinarian Dr. Kris Chandroo shares his experiences with metacam in a blog post on the topic. So far, he has successfully and safely used over a thousand metacam doses on his patients, but warns that caution should be used when deciding which cat to medicate with the drug. "I can know within 90 minutes if a cat is a candidate for an NSAID, or if it should be not considered at all", Dr. Chandroo says. "It’s about using methods with accountability to the cats individual requirements, and not using medications as a preset recipe. The dose is always tailored to the individual now and over time, regardless what the box might say", he adds.

Veterinarian Dr. Marie Haynes suggests that the cases of acute renal failure reported in the US may be due to the difference in dosage instructions. In a blog post about Metacam, she says -
I do really believe that when Metacam is given appropriately, at the correct dosage, to a healthy cat the chances of developing kidney problems are extremely rare. But, it can happen.

I have also noticed that in the US, the dose for a Metacam injection for cats is 0.3 mg/kg. In Canada it is 0.2 mg/kg. It may be that there are more issues with Metacam for cats in the US because of the higher recommended dose.

Alternatives to Metacam

Pain management in cats is challenging. Many drugs are toxic to cats, including some that humans and canines tolerate quite well.

Rare reactions can happen with any drug. For example, Tramadol, a common alternative to Metacam, can induce seizures, hallucinations and other neurological side effects. Buprenex (buprenorphine), a different opiate commonly used in postoperative pain management, carries its own risks, not least of which is kidney damage. What's more, research shows that this drug has inconsistent response in cats, meaning it does not always deliver the pain relief it should be providing.

At this point, there is not enough research data to say which of the options is in fact safer for cats. Is a low dose of Metacam safer or more dangerous than the equivalent dosage of Tramadol needed for pain management? Acute renal failure and similarly severe reactions do happen but they are rare and there is no way to tell in advance which drug will induce them in a specific cat.

So, should I accept my veterinarian's recommendation to use Metacam?

If your cat is about to undergo an operation you definitely should discuss pain management with your vet. The cat's age, chronic conditions and current medications should all be taken into account when deciding on the drug of choice. You may prefer to have blood tests done to determine the cat's renal functions prior to the operation so that hidden kidney issues will be made more apparent.

Ask your cat about hydration for the cat. A dehydrated cat's kidneys may have a harder time dealing both with the anesthetics and Metacam. Many cats tend to be dehydrated during surgery because they had not been fed for six hours prior to the procedure (sometimes longer). Make sure your vet is aware of that and plans on providing fluids before administering Metacam.

If your vet recommends Metacam you should discuss the issue of dosages with her or him. Refer them to the lower dosages recommended in Canada and other countries and discuss the way these may affect the risk associated with this drug. If you live in the US, you may want to print out this FDA announcement about Metacam as well as this statement by the American Association of Feline Practitioners, and discuss any off-label use of the drug.

Don't rush into saying "yes" to Metacam but don't rush into saying "no" either. Keep an open mind and discuss the options with your vet so together you can find the best course of pain management regime for your cat.