NSAID Use in Cats

denice

Advisor
Staff Member
Advisor
Does using sub-q fluids make NSAIDS safer for use in cats?

I know they are used more in Canada and Europe.  The reason I have always taken the blanket stance of no to NSAIDS was the kitty's liver being unable to metabolize them meaning that the kidneys do all the work of clearing it out of the system.  It would make sense that increasing fluids would help.

I am not trying to start an argument, you certainly know more about this than I do.
 
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red top rescue

TCS Member
Veteran
I'm still of the opinion that there is no reason to use NSAIDs in cats when there are other safer pain killers and anti-inflammatory things to use.  Cats tolerate steroids very well, unlike dogs and people, so why not go that route?  I guess you were asking Dr. Kris and I just threw in my opinion, but yes, I'd like Dr. Kris to address that too, why use NSAIDs at all when there are things that are better and safer for cats?
 
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dr kris

TCS Member
Guest Expert
Im going to tell you my own experiences, and then I would want folks to make up their own mind. My opinion won’t be better or worse than anyone else’s. It does come from attention to detail in administration, blood sweat n’ tears into the science of pain management and animal welfare science, and lot’s of numbers to back them up (as in thousands of cats and counting).

 
When you graduate from vet school, people will have scared you @#$%less about NSAIDS and not just for cats, but in general. There are tonnes of rumours. All of it based on something everyone has heard (but not many people have personally experienced). But you don’t want to screw up, and harm anyone’s pet, so you refrain until you have the most perfect of circumstances to use them.

Until one day that kitty cat walks through the door. Fever of unknown origin. It is burning hot. It’s been like this for days. There are no cool fans, antibiotics, diagnostics or any amount of cool IV fluids that will quench this fever. Opiod narcotics have no effect, and some can even enhance fever as a side effect. We are on 3 days of not eating, and that liver is waiting to just check out. And besides all that, you just look at this poor cat, and he is suffering. Nevermind that the owners ran out of money a day ago, and you are now treating this kitty on your own dime. They are going to euthanize this cat if you cant fix him.

I have looked cat’s in the face before and said “there is no freaking way I am going to be the one to euthanize you”.

You grab your NSAID with the best anti-fever properties. The one everyone tells you will rot his gut out, or completely destroy his kidneys.

And in less than 20 minutes, this little guy is grooming himself, and headbutting the front of the cage.

When you have this experience, your feelings start to change. The NSAID begins to be a tool in the box that you learn how to use.

So, the first 100 cases you see like this, you sweat them, but you have some experience under your belt. You haven't seen kidney values spike yet, nor have you seen any GI issues. You think you are lucky. You also don’t suck at what you do, so you made sure to ALWAYS give fluids prior to giving them, and GI protectants when in any doubt.

By the time you reach 500 cats, your comfort level is there. You do see cases of acute renal failure. And GI bleeds. But it was never from any cat who received any NSAIDS from you. So you begin to learn the epidemiology of things - how often things just happen anyways, and when those things are tied up into some kind of ongoing treatment or drug. This is something that the you learn that internet fails spectacularly in taking into account.  

From 600 to 800 cases using NSAIDs, you start to hone your skills even further. In that you are damn good at balancing your anesthesia and analgesia. You know that there are huge benefits to be gained by addressing pain pathways by multiple modalities. You know this because instead of people being angry at you because you failed them (i.e. adverse reactions), they begin to thank you because they have never seen their pets (both cats and dogs) look so good.

When you are batting over a 1000 cases, you begin to get kind of zen with it. You completely learn what to ignore, who is a candidate for it, and safety is just built into everything you do. You’ve learned that “Do No Harm” is not equivalent to “Do Not Use NSAIDS”.

The short answer is this. You only use NSAIDS with a shorter half life in the blood stream. It is very rare to give them to a cat without fluids. You balance out your regimens. As a vet, I will fail some of my patients if i don't consider their use. 10 years into this, I still havent had a single issue. Im not saying I won’t, but I’ve got the numbers to show that im not just lucky. And the latest research is just starting to bear this out as well…

Hope that helped;

k
 

Anne

Site Owner
Staff Member
Admin
That's a very interesting history, Dr. Kris. Are there any safety studies of NSAID's in cats? I would think the manufacturers would have to conduct them before given the permission to market them for use in cats. Or is this always off-label use because there are no such studies?
 

red top rescue

TCS Member
Veteran
Thank you SO MUCH Dr. Kris!  That information is totally helpful.  In the past I had used as directed with one cat, no problems ever.  Then much later, used one oral dose of metacam in a cat whose history we did not know well (a rescue with old chemical burns, we suspected) and she was half dead the next morning, and despite vets best efforts giving her fluids etc., she died in the hospital.  I still blame myself for that one and have not been willing to use NSAIDs (metacam) on any cat since that time.  I realize that cat may have already had kidney damage from whatever had happened to her in the past, but still feel the medicine preciipitated it.  Obviously it is not to be used lightly, and she should have received fluids at the same time.  Hindsight is 20-20, but when we know better, we do better.  Thanks again.
 
OP
denice

denice

Advisor
Staff Member
Advisor
It does, I believe now, have it's place.  I do see some, not many but some people, on the boards whose vet seems to prescribe it for all pain.  One I see a lot is after a dental that included extractions.  I think Buprenex should be the general pain reliever given for things like tooth extractions.
 

oneandahalfcats

TCS Member
Top Cat
Thanks for the additional information regarding your experiences with Metacam, Dr. Kris. I had asked the same question(s) in my thread, which you had answered, but this sheds even more light. One takeaway, is the need for vets to be more aware and conscientious I feel, as you obviously are. I think people would learn to have faith again and be willing to give medications like Metacam, some benefit of a doubt. But like vaccinations, it seems the knowledge and experience among vets as to what is appropriate, is often hit and miss. For instance, we have vets giving 3-year adjuvanted vaccines, every year either in error or due to just not being aware, only later do pet carers realize the risks involved with this practice, and hopefully nothing terrible happened.
 
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dr kris

TCS Member
Guest Expert
 
That's a very interesting history, Dr. Kris. Are there any safety studies of NSAID's in cats? I would think the manufacturers would have to conduct them before given the permission to market them for use in cats. Or is this always off-label use because there are no such studies?
Hi Anne!

Here is an early retrospective study:

Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg. October 2011;13(10):752-61.

That study corresponds to what I see in practice as far as using NSAIDS in older cats, even with diagnosed kidney issues. We will hopefully see more studies like this as well! The manufacturers do some limited safety studies, and in practice is where the rubber really meets the road for a lot of these medications. There are some that I am always using far below the manufactures suggested dose, and other medications it's ok to bend up a bit more.

For NSAID's, you go off label when you use it for extended periods of time (weeks to months). I am often using much lower doses if I have to go longer and can't wean them off the NSAID (weaning them down to the least amount with least frequency of administration is always a goal of mine).

k
 

dr kris

TCS Member
Guest Expert
 
Thank you SO MUCH Dr. Kris!  That information is totally helpful.  In the past I had used as directed with one cat, no problems ever.  Then much later, used one oral dose of metacam in a cat whose history we did not know well (a rescue with old chemical burns, we suspected) and she was half dead the next morning, and despite vets best efforts giving her fluids etc., she died in the hospital.  I still blame myself for that one and have not been willing to use NSAIDs (metacam) on any cat since that time.  I realize that cat may have already had kidney damage from whatever had happened to her in the past, but still feel the medicine preciipitated it.  Obviously it is not to be used lightly, and she should have received fluids at the same time.  Hindsight is 20-20, but when we know better, we do better.  Thanks again.
You are welcome!

Yes, an experience like that would scare me too! Don't blame yourself! Who knows what that poor kitty had brewing on the inside. You are exactly right - when we know better we do better (that goes for me as well)!

k
 

dr kris

TCS Member
Guest Expert
 
Thanks for the additional information regarding your experiences with Metacam, Dr. Kris. I had asked the same question(s) in my thread, which you had answered, but this sheds even more light. One takeaway, is the need for vets to be more aware and conscientious I feel, as you obviously are. I think people would learn to have faith again and be willing to give medications like Metacam, some benefit of a doubt. But like vaccinations, it seems the knowledge and experience among vets as to what is appropriate, is often hit and miss. For instance, we have vets giving 3-year adjuvanted vaccines, every year either in error or due to just not being aware, only later do pet carers realize the risks involved with this practice, and hopefully nothing terrible happened.
Yes, all very true.

When you have a team that advocates for your cat, and is passionate and talented at what they do, the best things will happen. It is true that in my industry, knowledge and experience is hit or miss. Which is why special forums like this are great! And im going to continue to write / blog about all of these topics for people who are on the same page - wanting their cats to be in their family as long as possible!

Before giving anything like metacam off label, there is usually a long discussion with my client. And im going to tell them both sides of the coin - the best that can happen, but also the worst. My acid test for any medication is "would i give this to my own cat". I take things personally if something doesn't work out. So I try to put these guys in the best circumstances so it does work out!

k
 

dr kris

TCS Member
Guest Expert
Hi Den
 
It does, I believe now, have it's place.  I do see some, not many but some people, on the boards whose vet seems to prescribe it for all pain.  One I see a lot is after a dental that included extractions.  I think Buprenex should be the general pain reliever given for things like tooth extractions.
Hi Denise!

Buprenex is actually my most used analgesic in cats. It's particularly useful in dentals, because if i give a long acting injection, they guys are not going home with people trying to squirt liquids in their inflamed mouths!

k
 

shadowfein

TCS Member
Alpha Cat
Hi Dr.Kris

I lost my Siamese a little over six weeks ago. She had been on 4.5mls of Metacam for arthritis for the last 2 years. Daily. She had wellness bloods done every 6-12 months and when last done 8 mths ago all values were normal. But she died very suddenly of kidney failure. (It took 6 days and she had been to the vet for a general check up 3 weeks earlier with no problems picked up but safely no blood test done). She had been in an Elizabethan collar and had lost 1kgs in 2 months but I thought that was because of the collar. I am trying to work out what killed her though. I asked my vet if it could have been the metacam because i hadn't adjusted the dosage to her new weight but she didn't think do. Was more inclined to think it was something she had eaten or drunk. Is it possible that it was the metacam? I don't remember her values when she died (it was all a bit nightmarish tbh), just that creatinine was over 1000 and the other values were so high they did not register. And they didn't come down after being in the iv for 2 days.

Could it have been the metacam?
 

dr kris

TCS Member
Guest Expert
Hi Dr.Kris

I lost my Siamese a little over six weeks ago. She had been on 4.5mls of Metacam for arthritis for the last 2 years. Daily. She had wellness bloods done every 6-12 months and when last done 8 mths ago all values were normal. But she died very suddenly of kidney failure. (It took 6 days and she had been to the vet for a general check up 3 weeks earlier with no problems picked up but safely no blood test done). She had been in an Elizabethan collar and had lost 1kgs in 2 months but I thought that was because of the collar. I am trying to work out what killed her though. I asked my vet if it could have been the metacam because i hadn't adjusted the dosage to her new weight but she didn't think do. Was more inclined to think it was something she had eaten or drunk. Is it possible that it was the metacam? I don't remember her values when she died (it was all a bit nightmarish tbh), just that creatinine was over 1000 and the other values were so high they did not register. And they didn't come down after being in the iv for 2 days.

Could it have been the metacam?
Hi Shadowfein;

Im sorry for your loss.

Let me see if I can shed some light here. At least maybe give you some thoughts that might help you figure things out.

It’s the weight loss that worries me the most. The unplanned 1 pound per month.  

There isn't any medication I know of that will do that. But many other conditions will, and unfortunately I see it all to often. Most cats that I see with rapid weight loss, with a concurrent spike in the kidney or liver values have an underlying issue’s going.

Siamese cat’s can get spontaneous systemic amyloidosis that will show up as acute renal failure. Renal lymphosarcoma is another, where both the GI system and kidneys are affect - so you have weight loss and really high kidney values. These poor guys don't do well at all. You try your best to treat them and sometimes they just don't respond.

I hope that sheds some light to help you figure out what happened;

kris
 
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