Metacam For Cats: The Pros And Cons Of Meloxicam For Pain Relief

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.
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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 TheCatSite.com 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.
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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 vet 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.

15 comments on “Metacam For Cats: The Pros And Cons Of Meloxicam For Pain Relief

SONJA May 9, 2020
I took my kitten krazycat after it was attacked by a very large dog we took it inside it 1st vomited all its food up then he pooped but not in his litter box we noticed he was very tender on his right back leg so we then took it to the Whyalla veterinary clinic he was treated by Dr.Andrew Melville-smith he then said that my cat was just traumatized but wanted to keep him over night my poor kitten wasnt even 4 months old we were told the morning that krazy didnt survive we were then handed the bill he didnt take any xrays but he administered him a metacam injection without asking us whether he should or shouldn't proceed we were left in the dark just like poor crazy all alone we now have a bill and no cat the vet showed no empathy what so ever no apology what so ever he was told the cat was attacked yet didn't bother with xrays he has done this to many animals he was videoed by phone who witnessed him being cruel to her toy poodles but he threatened not treat her dogs and to close her account she needed her account open as her dogs had on going issues she wanted desperately to go public she couldn't but I can.
Raven Pittman March 23, 2020
I have a 11 year old cat that has recently started having pain from arthritis the vet prescribed metacam I am concerned now after seeing all these comments is it safe for cats???
    StacyH March 31, 2020
    Don't do it! There are other things they can give your cat. I wish someone had told me what the risks were and what other options were available. My cat was only 6 and had the start of arthritis, the reason I took her to the vet was because she had been limping and I had not seen any injury take place. They prescribed Metacam for 4 days orally and the only thing they told me was that they can't use it long term because it can have bad side effects so if she did not get better we would have to look at other options. A week and a half later her she was not eating or drinking or going to the bathroom and throwing up. Took her to back to the vet and they did a blood test and found that her kidneys and liver were failing and told me they wanted to keep her and pump fluids through her to try and flush it. A day and a half later she was breathing heavily and having heart issues, still had not eaten, drank or gone to the bathroom. They did another blood test and all her kidney numbers had gotten even worse. They told me she wouldn't make it through the night and would most likely have a heart attack and even if she didn't her kidneys were too badly damaged at this point to do anything more for her. I had to make the decision to put my cat to sleep simply because I took her to the vet and followed their instructions. She was a young, happy, healthy, sweet girl and now she is gone for no reason.
mentat March 12, 2020
If on meloxicam or Onsior long-term, for chronic pain/inflammation, vets' consistent recommendation is labwork assessing kidney health (blood chemistry) and red/white blood cells every 4-6 months. Once we had kidney enzyme increases indicating chronic kidney disease, employed more treatment options and increased frequency of labwork rechecks. Many have labwork return to normal, in early kidney disease, when appropriately managed, while still treating pain and/or DJD with NSAID therapy.
mentat March 12, 2020
Cats metabolize NSAIDs like meloxicam via kidneys; dogs metabolize NSAIDs via liver and kidneys, but more prone to hepatotoxicity if overdosed. Hydration is key. We advocate and question our vets about pre-anesthesia infusion of IV fluids for multiple hours, to ensure kidneys are "fluffy and happy," prepared to metabolize the NSAID prior to it being administered. All my chronic kidney disease/insufficiency cats were also on NSAIDs at end of life, for quality of life, as their arthritis and back pain were considerations in their quality as much as their kidney health, perhaps more. Without the NSAID, they weren't as mobile, weren't as regular with appetite or elimination, and weren't as happy/social. It's a balanced decision to make with your cat's care team, self educating, inquiring, and comparing information and experiences. Onsior is a great alternative to meloxicam, but is only available as oral tablet for home administration; this was limiting for some of my cats daily dosing, whereas liquid meloxicam was very small volume and unnoticed in food or easy to syringe orally.
    Judy Jordan April 21, 2020
    Onsior is also much more expensive, running from $3-9 per pill. That makes a 30 day supply $90-270 -- out of budget for many cat owners. Apparently, metacam is used in Australia, Great Britain and Canada for ongoing treatment, just at smaller does.
jjk308 April 4, 2018
I've been using Ostilox, a meloxicam suspension for dogs, for my 15 year old cat Spot for 5 months with zero side effects. The dose is less than 1/4 of the recommended canine dose, only .01 mg. of Meloxicam per lb., about the dose recommended for cats in other countries, and Spot is doing very well on it. She was completely crippled by arthritis, simply refused to walk or even get up, and is now more limber and active than she's been in years. Apparently cats kidneys can't tolerate anything near the amount a dog can tolerate, the reason Meloxicam got a bad press for cats, but these tiny doses are both easily tolerated and effective.
jennyr July 19, 2016
My Dushka has just developed a urinary infection. The vet I saw this morning (not my regular one but a member of the practice) wants me to give her Metacam to relieve the pain. He knows I am against it and said that the last time I raised this they had a practice meeting to discuss it and did some research, which at least means they took me seriously. But their conclusion was that in Europe the Metacam for cats is at a lower dosage than the US version and has been demonstrated to be safe. He refused me any alternative, saying the Metacam is safer. I brought it home prior to doing some more research. Having read up a bit more, I will not give it to Dushka, who already has severe renal issues and is on kidney meds and diet, prescribed by this same vet 6 months ago! Faced with the alternatives of high risk AKF and 3 days of diminishing pain, I am afraid I have opted for the latter.
tarasgirl06 March 15, 2016
My family, on both sides, did/do not believe in allopathic medicine or in taking drugs, except when absolutely necessary.  That said, of course it is very hard for those of us who share life with beloved cats (or kids, or any others in our care) to know they may be in pain and not try to alleviate that pain; but because of the level of risk these drugs ALL carry, I would not use them.  (Btw, one time I was in pretty bad pain and took a Tramadol.  It made me "stoned" for 3 days.  No more for me!)
otto February 27, 2016
No metacam for my cats, ever. Perhaps in a nothing to lose situation. But if there was "nothing to lose" I'd be setting kitty free of suffering anyway. I don't believe it is safe and am shocked at the casual use of it, especially in the UK.
kittens mom February 19, 2016
http://livertox.nih.gov/Meloxicam.htm  This came up while researching antibiotic induced liver failure in cats.
rickr February 18, 2016
Quick follow-up.  I spoke to my vet.  She said that most of the issues with Metacam date from the release of the drug and were related to improper dosing - especially on older cats.  She assured me that as long as I stay at the recommended dose the risk is minimal. I feel better now.   
rickr February 18, 2016
Thanks for the clarification.  The article is well balanced - it wasn't scary.  I just worry about my cats, especially when one of them is out of sorts.  I will talk to my vet.  I trust her.  She is generally conservative about treatments and medications.  I am surprized, though,  that she didn't mention anything related to Metacam.  In fact, when Archie was in for a checkup recently, she said that it is very safe and that she has used it with great success. 
Anne February 18, 2016
I didn't mean to be scary. Every drug has potential side effects and risks. Metacam isn't different in that regard.  You should discuss this with your vet though. In the US it's off-label use to prescribe oral metacam for cats and that's something your vet should have mentioned. Depending on the dosage, it can actually be fairly safe, compared to the alternatives. 
rickr February 18, 2016
Gosh.  What a timely and somewhat scary article.  My cat only vet recently prescribed oral Metacam for my tabby Archie,  He is receiving physical therapy for some spinal issues.  Metacam was recommended to help control the inflamation.  I didn't think much about it.  Since Metacam is not a steroid, I assumed the drug would be safe.  He loves taking it; in fact, on more than one occasion he has carried the box to me, suggesting he wanted a dosage (every other day).   Now I am concerned.  The box does not show the black label warning mentioned in the article, but the instructions (which I didn't read at the time) do say for dogs only.  I need to have a conversation with my vet.  The only warning I was given, was to make sure that he is eating and drinking, which he is.

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