# Alternatives to Metacam?



## ameliajane

My 10 yr old dog has been on Metacam for some time for hip displasia and luxating patella. I've noticed she's been a bit quiet and wobbly on her feet lately but put it down to age/arthritis. Then a couple of days ago, she became very weak and collapsed repeatedly. Rushed her to vet who took blood samples which have shown low blood volume and kidney and liver damage. She also found a heart arrythmia.

Vet suggested she had a low grade internal bleed. I asked about the Metacam and she seemed a bit vague but suggested she stay on it and if she has any more problems (the weakness/collapsing have now stopped) they'll take another blood sample and send her urine for analysis to establish the extent of the kidney damage.

Does this sound right? 
Surely if there's already signs of damage the Metacam should be stopped - i don't want to wait for a crisis. The vet is very young, newly qualified i think, and, although kind and concerned, does seem a bit unsure of herself.

Are there alternatives to Metacam? 
She's already on a good joint suppliment containing Glucosamine, MSM, Chrondroitin, Hyaluronic acid, and DHA/EPA and i give her two small tins of sardines a week.

I don't want to stop the Metacam if it means she'll be in pain but if it's slowly killing her anyway...

Don't know what to do


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## rona

I personally would take her off Metacam if she wouldn't be in great pain, can you get a second opinion?
Tramadol may be an alternative
Treatment of Pain in Dogs and Cats
quote
Tramadol is a medication that a lot of vets discuss recently as a possible safer option for pain control in your pet. It's side effects seem to be considerably less than the potential ones of NSAIDs, traditional narcotics or corticosteroids. The medication is inexpensive.

Unlike NSAIDs, tramadol works directly on pain sensation in your pet's brain, not on the source of the pain itself. It is being used to control post-surgical pain and, sometimes chronic pain, in pets. Although it works on the same portions of the brain as narcotics, it is not considered a controlled substance by the DEA. That may soon change. (ref)

Tramadol has not been used in pets for very long. We know less about possible long-term toxicity when it is used in cats. Perhaps will turn out to be an effective alternative to NSAIDs. Pets with liver or kidney disease need lower doses of tramadol. Tramadol is not an FDA-approved medication for pets, but you can read the human product label information here.

For the weakness in the back end, have you considered hydrotherapy?


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## ameliajane

Thanks. 
I think i'll take her to another vet for a second opinion and to ask about the Tramadol. I do feel really uncomfortable about continuing the metacam.

I've keep thinking about hydrotherapy and there is a place near where i live but she's very prone to ear infections (as a result of her previous owner leaving her with severe untreated infections for years) and we've only just got this under control. I fear the water would set the infections off again.

ETA: That's a really interesting link too - thanks...


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## rona

Difficult bit of judgment there between the ears and the muscle wastage.
Quality of life juggling 
How bad do the ears get?


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## rona

I believe you can give Catrophen injections alongside Tramadol, so that may help too.
Cartrophen and Osteoarthritis

Mines going for his top up injection tomorrow


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## kat&molly

Our dog has Trocoxil- its one tablet a month, for Arthritis and shes doing really well on it.
Our vet told us it was kinder on liver and kidneys. Good luck


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## Nonnie

Previcox is another option. Whilst still an NSAID, it seems to be tolerated better compared to the likes of Metacam or Rimadyl.

Id personally not use Tramadol on a long term basis. If a dog is in so much pain that such a heavy duty pain relief is needed, id question the animals quality of life.


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## flixmum

I have just joined this forum to ask about Tramadol which has beeb prescribed for my cat for arthritis. I was concerned as this is a drug given to me after surgery and as had never heard of it being given to animals. However, having read the previous comments my next problem is ....how do I get him to take it? Holding him and putting the tablet in his mouth is a non starter as the fight he put up stresses him -and must hurt his already painful joints -to such an extent that it is impossible. I have tried mixing it with all his favourite foods and he just won't eat any of it...tried not giving him anything else but no joy. He backs away from the dish as if it is poison. Can anyone help?


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## Sled dog hotel

ameliajane said:


> My 10 yr old dog has been on Metacam for some time for hip displasia and luxating patella. I've noticed she's been a bit quiet and wobbly on her feet lately but put it down to age/arthritis. Then a couple of days ago, she became very weak and collapsed repeatedly. Rushed her to vet who took blood samples which have shown low blood volume and kidney and liver damage. She also found a heart arrythmia.
> 
> Vet suggested she had a low grade internal bleed. I asked about the Metacam and she seemed a bit vague but suggested she stay on it and if she has any more problems (the weakness/collapsing have now stopped) they'll take another blood sample and send her urine for analysis to establish the extent of the kidney damage.
> 
> Does this sound right?
> Surely if there's already signs of damage the Metacam should be stopped - i don't want to wait for a crisis. The vet is very young, newly qualified i think, and, although kind and concerned, does seem a bit unsure of herself.
> 
> Are there alternatives to Metacam?
> She's already on a good joint suppliment containing Glucosamine, MSM, Chrondroitin, Hyaluronic acid, and DHA/EPA and i give her two small tins of sardines a week.
> 
> I don't want to stop the Metacam if it means she'll be in pain but if it's slowly killing her anyway...
> 
> Don't know what to do


Side effects of NSIADs can be kidney and liver problems and gastric problems.
In fact in all honesty I believe most manufacturers of the medication say that blood tests should be carried out prior to starting medication to check kidney/liver function. Probably to cover themselves. Ive found that you tend to find out a lot on FDA data U.S. Drug and food Administration. Looked this up, hopefully the link will work.

Veterinary Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Hope this might be of some help


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## Sled dog hotel

Have also found the FDA approved Professional insert for Metacam in the states.
There is a lot of information on there too that my answer your questions.

http://www.fda.gov/downloads/Animal...edAnimalDrugProducts/DrugLabels/UCM050395.pdf


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## ameliajane

Thanks for all the replies and links - it's all really helpful.

I haven't given her the Metacam today and from reading the links i really don't think she should take it again. It's good to know there are alternatives and i'll find another vet to discuss the options (any recommendations for a good vet in Birmingham..?)

Floss has had bloods taken several times since starting the Metacam as pre-op/anaesthetic screening (she's had 4 anaesthetics and 3 operations). At no time was i informed of any abnormalities in her blood results until these latest ones, so i'm assuming the damage is new.

As for the hydrotherapy - i suppose i don't _know_ that it _would_ cause ear infections because i haven't tried it. Perhaps it wouldn't. And the ear infections are treatable and they are probably the worst of the two evils. So i'll give the hydrotherapy a go - i know many people on here swear by it.

(and to flixmum - talk to your vet, they may be able to show you how to administer the pills or suggest an alternative. Liquids from a syringe into the corner of the cat's mouth are easier to give or if the pill can be crushed and mixed with gravy and then drawn up in a syringe - ask your vet. You have my sympathy, giving pills to cats is my worst nightmare )


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## rona

Good luck with it all.
Let us know how you get on. I know I will be very interested and I'm sure the info could be of use to someone in the future


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## ameliajane

Day 3 without the Metacam and Floss has slowed down and lost some of the spark 

I had hoped she might be ok without the Metacam as she is now a lot fitter and slimmer than when it was first prescribed.

Have called the hydrotherapy place and they've booked her in to see a physio on Wednesday - he said he'll assess her to see whether anything they can offer would help. 

Just looking now for a new vet.


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## WarFlyball

Willows in Solihul is meant to be very good, but not sure if you need a referral - our friend went there when her staffie had cruciate problems as a referral. With the hydro the ears may be fine - we had it for our last dog and he was using a treadmill so his head never got wet so I would think it depends what method they decide will be best if they go down that route...

Hope you get it all sorted


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## rona

ameliajane said:


> Day 3 without the Metacam and Floss has slowed down and lost some of the spark
> 
> I had hoped she might be ok without the Metacam as she is now a lot fitter and slimmer than when it was first prescribed.
> 
> Have called the hydrotherapy place and they've booked her in to see a physio on Wednesday - he said he'll assess her to see whether anything they can offer would help.
> 
> Just looking now for a new vet.


She must be in pain  
Are you going to start the Metacam again?


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## rona

Lilb said:


> Abbie is on this too but has a dose of 2 tablets per month.
> 
> We've only had her 6 months but in that time she's responded really well to her treatment and is due for a review next month.
> 
> She has arthritis in her rear hock, however is only 2.5 years old, so much younger.


NOAH Compendium of Animal Medicines: Trocoxil chewable tablets for dogs - Contra-indications, warnings, etc

The main problem with it is that they only recommend short term use 6.5 months
If your dog reacts to it you cannot withdraw treatment 
What do you go onto after that?


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## Sled dog hotel

Lilb said:


> Abbie is on this too but has a dose of 2 tablets per month.
> 
> We've only had her 6 months but in that time she's responded really well to her treatment and is due for a review next month.
> 
> She has arthritis in her rear hock, however is only 2.5 years old, so much younger.


It does say Contraindications for Trocoxil
Do not use in dogs suffering from fastro-intestinal disorders including ulceration and bleeding,
Do Not use where there is evidence of a haemorrhagic disorder.
Do not use in impaired kidney or liver function.
Do not use in cases of heart insufficiency.
Do not use in pregnant,breeding or lactating animals.
Do not use in dogs less than 12mths of age/and less than 5Kg weight.
Do not use in cases of hypersnsitivity to the active substance or any of the excipients.
do not use in cases of hypersensitivity to sulphonomides.
Do not use concomitantly with glucocorticoids or other NSAIDs.

Under special warnings it says.
Advice for dog owner.
Before prescribing trocoxil and during treatment, your vet will check your dog for kidney and liver problems as well as diseases of the intestines.

trocoxil should not be used in de-hydrated dogs.
If your dog needs surgery inform the vet that the dog is using trocoxil.
Do not administer other NSAIDs or glucocorticoids concurrently or within at least 1month of the last administration of Trocoxil.

Trocoxil has an extended effect duration (up to 2mths after administration of the 2nd dose and following doses) adverse reactions could occur at any timepoint during this period.

Unfortuanately it doesnt look as if its safe to use for the OP as she already has impaired kidney and liver function.


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## Sled dog hotel

JennyClifford said:


> NOAH Compendium of Animal Medicines: Trocoxil chewable tablets for dogs - Contra-indications, warnings, etc
> 
> The main problem with it is that they only recommend short term use 6.5 months
> If your dog reacts to it you cannot withdraw treatment
> What do you go onto after that?


Must have been posting the same time,I wish had seen yours before, would have saved typing a neighbour gave me the leaflet thats in the product to read up on and as a consideration for one of mine. Must admit the fact that it was in the system and active for up to two months put me off, whereas daily tabs you could cease instantly if there was a problem.


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## Sled dog hotel

Lilb said:


> I was aware it was only short term hence the 6 month review - it's a shame as she's doing so well with it.
> 
> I don't know what the vet will suggest, although this is what he specialises in, I trust we will find something that will suit Abbie though.
> 
> Whoops!  I'm no expert and just thought I'd put my suggestion forward.


You werent to know, it seems a lot of the NSAIDs shouldnt be used with kidney and liver problems.

I just checked up Onsior which is a newer Cox hib NSAID and even that says dont use in dogs with liver disease, and again regular monotoring should be carried out for kidney and liver. That one is supposed to be gentler of the stomach and kidneys I think too. But still has cautions. Think this is going to be the problem for conventional NSAIDs they all carry risks to a degree. However it becomes catch 22, do you use them if the dogs pain free and gives him/her a really good quality of life and take the risks that may be associated? I had to make the decision to use Rimadyl long term a few years back on one of my oldies. With it she was terrific and pain free, without it she was in pain and it also affected her movement. So weighing up the pros and cons she was better with it,
so thats what she had.


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## ameliajane

I must admit when i stopped the metacam i swore she wouldn't ever have it again but seeing the difference in her i'm begining to think that even if it does shorten her life i would rather she had a shorter joyful, pain-free life than a longer miserable one.

I'm going to keep her off it until she sees the physio on Wednesday and see what he suggests - he does seem to know his stuff. And i'll take her to another vet for a second opinion on the medications too. But it does seem as though all of the best arthritis ones are likely to further damage the liver and kidneys. I suppose we can live with that as long as she doesn't have the low blood volume/internal bleeding and collapsing again - that was really scary.

She definately needs something - i hate to see so much of the joy gone from her - she's just not being naughty or cheeky anymore... i had no idea how much i could miss that..!

Every day i wish i could just turn back the clock for her and she could just be young and carefree again...


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