Metacam Side Effects?

[RedFawnMom]

Lucy developed some diarrhea Friday evening and it's been getting progressively worse, and she vomited yesterday as well. We started the bland diet on Saturday morning but the diarrhea continued. Today she started refusing food. I have spoken with the vet on call, and he called in some Flagyl, which we gave her about two hours ago. (We are watching for dehydration or anything else serious and will take her to the e-vet if we don't feel comfortable waiting until our vet is open in the morning.)

 

We're trying to figure out the cause of this, and while it could be just a bug she picked up (we were in a vet's office on Wednesday), the vet mentioned it could be the Metacam. Lucy had taken Metacam for about one week a few weeks ago, and had about a week break from it. She had no problems with it the first week. We started it again last Wednesday and she started getting sick on Friday (Friday was her last dose). My mom had a dog on Metacam that had exactly the same symptoms after being on it for a week -- he was totally fine, then all of sudden developed diarrhea and vomiting on the 8th day. The vet mentioned that if she's not feeling better with the Flagyl, we should get some bloodwork done in case the Metacam affected her liver or kidneys. Is this common with Metacam? Has anyone else had a dog get sick from it?

[Houndtime]

I know you are asking about Metacam, but Fuzzy got sick, the same way, on Deramaxx. I think the different anti inflamatories can upset the stomach.

[TheFullHouse]

I've used it for several of mine and had no side effects at all. I think the most common are upset stomach, diarrhea and after prolonged use, it may affect the liver and kidneys. I would think the Flagyl would help with the stomach issues.

[Guest Energy11]

Sorry Lucy is sick ...

 

I have used the Met acam in all of mine without any side effects, BUT, I would give it with a 20 mg Pepcid AC/or generic, as NSAIDs are hard on the stomach.

 

Good Luck, and I hope she feels better!

[RedFawnMom]

I gave her a Pepcid yesterday with breakfast and just gave another when we gave her the Flagyl. I asked the vet about Pepcid and he said it was fine (I have used it before and it does really seem to help her when she has GI upset). Do you know how often it can be given to a grey? I forgot to ask the vet. The info I could find online said 1 or 2 times a day.

[joejoesmom]

I gave her a Pepcid yesterday with breakfast and just gave another when we gave her the Flagyl. I asked the vet about Pepcid and he said it was fine (I have used it before and it does really seem to help her when she has GI upset). Do you know how often it can be given to a grey? I forgot to ask the vet. The info I could find online said 1 or 2 times a day.

 

Giving her stuff to protect her stomach and encouraging ample hydration (give unsalted broth, add water to food, etc.) are great steps to take.

 

20 mg Pepcid (famotidine) is typically given twice a day, 15 to 60 minutes before the meal. This dose is for a typical greyhound (about 75 pounds). Some vets will use ranitidine but OSU has always had me use famotidine. You can also give pepto-bismol tablets (2 caplets at a time) up to 3 times a day. I would check with your vet before doing so. (I believe in always checking with your vet before changing anything if at all possible). Both these can help control stomach upset. The prescription drug Reglan (low cost generic is available but I can't remember the name) can also be used. It is typically just used for a week or so. There are other prescription drugs that can be used. For 5 days after each chemo, OSU put Joe on a drug called Cerenia (at least I think that is what it was, but my memory is hazy) to prevent upset.

 

The prescription drug Carafate (sucralfate) can be given to protect the stomach. Since it needs to be given at least 2 hours before or after a meal or meds, it can be a pain to use. But it does help.

 

Flagyl (metronidazole) is the go to drug for diarrhea. It should start helping pretty quickly. In my experience, I have seen improvement in as little as 12 hours with complete control usually in 48 hours. Of course, this is in a greyhound that does not have chronic diarrhea problems.

 

Any NSAID (non-steroidal anti-inflammatory drug) can cause stomach upset and digestive problems. At the extreme, an NSAID can cause gastrointestinal bleeding. With prolonged use or high doses, an NSAID can also cause liver damage and kidney damage. There have been isolated instances where normal doses of an NSAID have caused liver and or kidney damage in dogs. In humans, over use of ibuprofen for example can cause liver failure. Normal but sustained use of any of the NSAIDS (less so with Celebrex) can cause gastrointestinal bleeding (think Aleve, ibuprofen, meloxicam, etc.) in humans.

 

Common NSAIDS used in dogs are Metacam (meloxicam), Deramaxx (deracoxib), Rimadyl and Novox (carprofen), Etogesic (etodolac), and Previcox (firocoxib). All of these carry the above risks. Increasing water intake (you can mix water into their food) can help protect the kidneys. Any dog on long term NSAID use should have regular tests to check liver and kidney function. Likewise, if your dog has liver, kidney, or heart disease, use of NSAIDs should be closely monitored by your vet, if used at all.

 

I hadn't realized that I have learned so much about this stuff. I guess 5 months of chemo and another dog with arthritis and another dog with liver and kidney disease forces you to learn it all.

 

I hope Lucy is feeling better soon.

 

Jane

 

edited to add: If you see black tarry stools go to your vet immediately. This is a sign of a gastrointestinal bleed. Yellow skin, eyes, or gums also merits an immediate phone call to your vet as this is a sign of liver toxicity. Both these are rare side effects.

 

If you use pepto-bismol, I believe it can turn the stool dark -- so don't panic.

 

Also for what its worth: I have taken various meds for my arthritis. The cox inhibitor types work well and don't upset my stomach, but I am allergic to them. Meloxicam (same as Metacam) worked but really tore up my stomach (despite using pepcid, pepto, and carafate) so bad it took me 6 weeks to recover from a 2 week trial. Anyway, because of this, I tend to be biased against Metacam but toward Deramaxx (a cox-2 inhibitor) -- despite being told by a number of people that dogs tend not to react to meloxicam like I do. I am a mere human as opposed to the more superior canine species.

Edited December 27, 2010 by joejoesmom

[Batmom]

I would stop the Metacam. You can use Tramadol for pain relief for a few days, then try a different NSAID. Hugs and best luck.

[RedFawnMom]

I think that either the Flagyl or the Pepcid is making her feel much better already. It's been less than 12 hours since we started Flagyl so I'm doubtful it could be working so soon. But either way, she's feeling better, not 100% but a definite improvement. She started to perk up and came into the kitchen looking for food. We fed her a 1/4 cup of rice/chicken and a cup of water, and she ate/drank it all and it has not made its way back out either end yet 90 mins later. We've been offering water and if she doesn't seem to be taking enough in, we've been giving her water with a large medication syringe. We squirt it at the front of her mouth and she licks it from the syringe. She's enjoying that. As long as she's getting hydration, I don't mind doing it.

 

In a few more hours, we'll repeat the Pepcid, Flagyl, and offer a little more food.

 

Jane, you're right, that drug is Cerenia. Lucy had this exact same set of symptoms (a bit worse, though) last year and we ended up in the e-vet. I pulled out the invoice from them, and saw that they gave her an injection of Cerenia along with IV fluids since we couldn't get her to keep down the Flagyl and she was getting dehydrated. It made a huge difference.

 

Who knows if it was the Metacam or just a bug. Either way, she doesn't seem to be having any pain, so we're going to stop the Metacam. If she shows any signs of pain, I'll put a call into the vet and ask for something else to try.

[NeylasMom]

If you end up switching NSAIDs, a wash out period of 7-10 days is recommended. I am pretty sure Neyla's episode of acute renal failure years ago was because I wasn't aware of that and the vet for whatever reason didn't think to mention it.

 

I would be cautious about the risk of a gastric ulcer if you are seeing these signs. We decided to use both pepcid and carafate to try to minimize the risk while Neyla was on Deramaxx. I don't know a whole lot about Metacamm as compared to Deramaxx, but I would imagine the risks are similar so it might be worth it to just go ahead and do both. The timing of the carafate can be a pain though as it has to be given 2 hours away from food and meds on both sides and my oncologist said it works using the stomach acid so you'd want to do carafate first, wait 2 hrs, then give pepcid, then feed. Perhaps it's not necessary but my oncologist kidn of scared the crap out of me with the gastric ulcer talk so now I'm probably going to go around scaring the crap out of other people.

[kudzu]

What Batmom said. What form of meloxicam are you using? You wrote Metacam so does that mean you are using the vet brand liquid? With the liquid the dosing can be much more exact.

 

Metacam is a good drug. Many of us use it with our dogs for an extended period of time without issue. However, of all the common veterinary NSAIDs meloxicam (Metacam) had about the smallest safety margin were GI symptoms are concerned. The GI proba are one of the reasons some vets hesitate or even refuse to prescribe the human pills for dogs.

 

Please be cautious with Flagyl as well. Like meloxicam it is commonly prescribed & used safely but it can also ha e some nasty side effects. Stop it if you notice anything strange or as soon as the diahrrea My preference would be to stop the meloxicam.

[Guest Swifthounds]

I would stop the Metacam. You can use Tramadol for pain relief for a few days, then try a different NSAID. Hugs and best luck.

 

[kudzu]

What Batmom said. What form of meloxicam are you using? You wrote Metacam so does that mean you are using the vet brand liquid? With the liquid the dosing can be much more exact.

 

Metacam is a good drug. Many of us use it with our dogs for an extended period of time without issue. However, of all the common veterinary NSAIDs meloxicam (Metacam) had about the smallest safety margin were GI symptoms are concerned. The GI proba are one of the reasons some vets hesitate or even refuse to prescribe the human pills for dogs.

 

NTW, Flagyl can & frequently does work in under 24 hrs. That's why it's a go to med. It is a strong med. For that same reason please be cautious when using it. Like meloxicam it is commonly prescribed & used safely but it can also ha e some nasty side effects. The neurological side effects include difficulty walking & hind end weakness. Stop it if you notice anything strange & contact your vet. My preference would be to stop the meloxicam before trying Flagyl but sometimes things are already bad enough that you need it. Even after one of my dogs had a near fatal reaction to it I used it to help with my Grey's colitis.

 

Hope things are much better today.

[Burpdog]

Stop the metacam. Did you do blood work when you started it?

 

If she is getting sick from metacam, I would not try any NSAID. They all have the same side effects.

[NeylasMom]

Stop the metacam. Did you do blood work when you started it?

 

If she is getting sick from metacam, I would not try any NSAID. They all have the same side effects.

I'll just mention that Neyla could not take Rimadyl - never confirmed with blood work but I believe her platelet count would drop (typical side effect) as she would start bruising very easily. Happened on 2 separate occasions. But, she was able to take the maintenance dose of Deramaxx for some time without issue. These weren't stomach side effects though, which may be different.

 

Having said that, we absolutely had to use an NSAID to control her pain. If you don't, I agree with Diane that I would try an alternative to NSAIDs, at least for now until you have more information.

[RedFawnMom]

Just to clarify, we stopped the Metacam several days ago, Friday was her last dose. We were using the veterinarian form (liquid). I'm not certain it was the Metacam causing issues, but I'm suspicious since my mom's dog had the exact same reaction. It could be a bug, though, she's been in two different vet offices in the past 2.5 weeks. She had this exact set of symptoms, to a T, about a year ago (way before she was on Metacam), also shortly after a vet visit. The other thing I didn't mention is that she had some IV sedation and a muscle relaxant on Wednesday evening for some X-rays. She didn't have any GI issues when she had IV sedation 12 days prior to that (again for X-rays), but it's possible this was a different kind of sedation and it caused some issues, but I'd doubt it would cause such extensive diarrhea/vomiting over the course of three days.

 

Anyway, she's had three Flagyl doses and three Pepcid doses and is back to her self. We'll stick with the bland diet until at least Wednesday and are feeding her very small meals more frequently throughout the day. No diarrhea since yesterday afternoon. She's drinking plenty of water now.

 

We did not do any bloodwork prior to the Metacam - her last round of bloodwork was last Feb prior to her dental. The vet that prescribed the Metacam told me there were no side effects and just not to give it to her if she wasn't eating at all. He basically said we might need it long-term and to get the human generic form since the liquid is so expensive, but never said anything about possibility of bleeding or liver/kidney damage, and we were so upset by finding the bone lesion that I didn't do my homework on it like I usually do prior to giving a new med.

 

Getting a new panel is probably a good idea given her bone lesion. I will have that done prior to biopsy or treatment to get a baseline and will ask Dr. Couto if there is anything specific we should test for as well. If we end up needing a pain med again (she's fine right now) for something short-term like post X-ray or biopsy pain, I'm going to ask about Tramadol.

 

Thanks for the wealth of advice and information, it has been tremendously helpful.

[Guest Stefaniedurbin]

Topic: Never combine Pepto Bismol and NSAIDS (for humans dogs, cats and and any other animal).

 

Hello,

 

For what it's worth, I'm a veterinary student whose dog is currently having the same GI upset issues with Meloxicam (Metacam oral suspension). She vomited twice yesterday, and had some lower GI bleeding just a few minutes ago (bright red blood). She is recovering from a bilateral FHO to fix severe hip dysplasia. She is 10 days post surger and was on metacam for about two weeks before that as well. Her surgeon here at Kansas State said I was right to stop the metacam yesterday because GI bleeding is a serious issue with this medication. Also, I am to continue with the Famotidine (ant acid) to promote GI healing. I'm waiting for them to call in something else for her, I'm guessing it will either be metronidazole or sucralfate.

 

In the mean time. I just want to note that dogs and cats should NEVER be given Pepto Bismol in this situation. The bismuth component is a gastroprotector, but the subsalicylate is a similar drug to aspirin, and can and will make GI bleeding worse in a dog that already has GI issues. Therefore, it should NEVER be given to a dog or cat that is on NSAIDS. Actually, my professor said that Pepto should just never be given to dogs or cats anytime because he's seems too many bad outcomes from its use. The FDA finally issued a warning recently warning about the danger of concomitant use of NSAIDS and Pepto bismol (or any other drug containing bismuth subsalicylate). This warning is also for humans, so take not.

 

********Conclusion, DON't give NSAIDS with Pepto Bismol! ********

 

Also, some formulations of other GI liquid meds have recent added bismuth subsalicylate (I think Philips and Maalox Total Relief), so check the label.

 

References: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm199476.htm

http://www.fda.gov/downloads/drugs/drugsafety/medicationerrors/ucm080666.pdf

 

 

[Hubcitypam]

I pulled out the invoice from them, and saw that they gave her an injection of Cerenia along with IV fluids since we couldn't get her to keep down the Flagyl and she was getting dehydrated. It made a huge difference.

Not to hijack, but how much was the shot of Cereina? Buddys one shot was over $100 two months ago and I'm still in shock.

[tbhounds]

Not to hijack, but how much was the shot of Cereina? Buddys one shot was over $100 two months ago and I'm still in shock.

That's ridiculous! It's $38 here.

[Guest Stefaniedurbin]

I don't know the exact price of Cerenia (drug name is "Maropitant"), but it is a lot cheaper in tablet form. The reason a vet may not offer the tablet form though is that cerenia has a very low bioavailability in dogs (about 30%) with oral administration. WIth the injection of Cerenia, the bioavailability jumps to over 90%, so you can give less and cause less harm to the liver and kindey's this way.

[Guest MnMDogs]

Topic: Never combine Pepto Bismol and NSAIDS (for humans dogs, cats and and any other animal).

 

Hello,

 

For what it's worth, I'm a veterinary student whose dog is currently having the same GI upset issues with Meloxicam (Metacam oral suspension). She vomited twice yesterday, and had some lower GI bleeding just a few minutes ago (bright red blood). She is recovering from a bilateral FHO to fix severe hip dysplasia. She is 10 days post surger and was on metacam for about two weeks before that as well. Her surgeon here at Kansas State said I was right to stop the metacam yesterday because GI bleeding is a serious issue with this medication. Also, I am to continue with the Famotidine (ant acid) to promote GI healing. I'm waiting for them to call in something else for her, I'm guessing it will either be metronidazole or sucralfate.

 

In the mean time. I just want to note that dogs and cats should NEVER be given Pepto Bismol in this situation. The bismuth component is a gastroprotector, but the subsalicylate is a similar drug to aspirin, and can and will make GI bleeding worse in a dog that already has GI issues. Therefore, it should NEVER be given to a dog or cat that is on NSAIDS. Actually, my professor said that Pepto should just never be given to dogs or cats anytime because he's seems too many bad outcomes from its use. The FDA finally issued a warning recently warning about the danger of concomitant use of NSAIDS and Pepto bismol (or any other drug containing bismuth subsalicylate). This warning is also for humans, so take not.

 

********Conclusion, DON't give NSAIDS with Pepto Bismol! ********

 

Also, some formulations of other GI liquid meds have recent added bismuth subsalicylate (I think Philips and Maalox Total Relief), so check the label.

 

References: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm199476.htm

http://www.fda.gov/downloads/drugs/drugsafety/medicationerrors/ucm080666.pdf

 

 

Thank you for this post. We never use Pepto, but this is really good info.