Metacam 0.5% Injection (Canada)

for Dogs and Cats

Sterile

Veterinary Use Only

DIN 02240463

Description

A clear, yellow solution containing 5 mg meloxicam per mL. Ethanol (dehydrated) Ph. Eur. 150 mg/mL is the preservative.

Clinical Pharmacology

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) of the oxicam class which acts by inhibition of prostaglandin synthesis, thereby exerting anti-inflammatory, analgesic and antipyretic effects. Maximum plasma concentrations are obtained after approximately 1.5 hours (cats) to 2.5 hours (dogs) post subcutaneous injection. There is a linear relationship between the dose administered and plasma concentration observed in the therapeutic dose range.

Approximately 97% of meloxicam is bound to plasma proteins. The volume of distribution is 0.3 l/kg. Meloxicam is predominantly found in plasma and is also a major biliary excretion product whereas urine contains only traces of the parent compound. Meloxicam is metabolized to an alcohol, an acid derivative and to several polar metabolites. All major metabolites have been shown to be pharmacologically inactive. Meloxicam is eliminated with a half-life of 15 hours (cat) and 24 hours (dog). Approximately 75% of the administered dose is eliminated via faeces and the remainder via urine.

Metacam 0.5% Injection Indications

Metacam^® 0.5% injection is a nonsteroidal anti-inflammatory drug (NSAID) for use in dogs and cats. It is indicated for the alleviation of inflammation and pain in both acute and chronic musculo-skeletal disorders in dogs and also for the control of perioperative pain following orthopedic and soft tissue surgery in dogs and cats.

Dosage: Musculo-skeletal Disorders: Dogs: Metacam^® 0.5% injection should be given as a single subcutaneous injection at a dosage of 0.2 mg meloxicam/kg body weight (0.4 mL per 10 kg body weight). The product Metacam^® Oral Suspension should be used for continuation of treatment beginning after 24 hours and employing a dosage of 0.1 mg meloxicam/kg body weight.

Control of Perioperative Pain: Dogs: Single intravenous or subcutaneous injection at a dosage of 0.2 mg meloxicam/kg body weight (i.e. 0.4 mL per 10 kg body weight) before surgery, for example at the time of induction of anesthesia. Cats: Single subcutaneous injection at a dosage of 0.2 mg/kg (0.04 mL/kg) before surgery. Give the lowest effective dose; giving a dose of 0.2 mg/kg is not always necessary. Do not exceed the recommended dose (see Contraindications and Cautions sections). The use of parenteral fluids during surgery should be considered to reduce the risk of renal toxicity when using NSAIDs perioperatively.

Concurrent Perioperative Therapy: Metacam^® has been used in combination with the following anaesthetic protocols with no adverse events having been reported.

Dogs

- Diazepam/Propofol/Isoflurane*

- Acepromazine/Thiopentone/Isoflurane*

- Acepromazine/Ketamine + Diazepam/Halothane*

- Acepromazine + Butorphanol/Thiopentone sodium/Halothane*

Cats

- Acepromazine, thiopentone and halothane

- Acepromazine, glycopyrrolate, propofol and isoflurane

Contraindications

Metacam^® 0.5% injection should not be administered if gastric or intestinal ulceration or bleeding is suspected; if there is evidence of cardiac, hepatic or renal disease; or if there is evidence of a haemorrhagic disorder or individual hypersensitivity to the product. Do not administer concurrently, other steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs), aminoglycoside antibiotics or anti-coagulant agents. Pre-treatment with other steroidal or nonsteroidal anti-inflammatory drugs (NSAIDs) may result in additional or increased adverse effects and accordingly a treatment-free period with such drugs should be observed for at least 24 hours before commencement of treatment depending on the pharmacokinetic properties of the products used previously. Additional doses of meloxicam or other NSAIDs in cats are contraindicated, as no safe dosage for repeated NSAID administration has been established.

Cautions: Use only as a single injection in cats. Particular care should be taken with regard to accuracy of dosing in cats. The safe use of this drug has not been established in breeding, pregnant or lactating animals; the potential benefits vs. the potential risks must be considered in each case. Do not exceed the stated dose. In case of overdosing, symptomatic treatment should be initiated. Perioperative use requires careful assessment of risks and benefits for each individual patient. Increased risks of drug intolerance may occur in patients already debilitated or highly stressed, when there is concurrent use of other drugs (premedication, anaesthetics) which may lower blood pressure or increase the risk of renal or hepatic toxicity or in cases where there is surgical blood loss resulting in reduced tissue perfusion.

Animals being treated with meloxicam should be monitored for the occurrence of adverse effects as susceptibility varies with the individual. Adverse reactions reported with the NSAID class of drugs include gastrointestinal signs, renal and hepatic toxicity as well as hematological, neurological and dermatological abnormalities.

If gastrointestinal or other adverse effects occur, treatment should be discontinued. The most common adverse reactions reported involve the gastrointestinal tract in the dog (inappetence, vomiting, diarrhea, potential ulceration) and the renal system in the cat (elevated creatinine and BUN, acute renal failure).

As for all NSAIDs, use in any dog less than 6 weeks of age or cat less than 4 months of age or in debilitated aged animals may involve additional risk. If use in such animals cannot be avoided, a reduced dosage and careful clinical management may be required.

When additional pain medication is administered, a non-NSAID analgesic should be chosen (see Contraindications).

When administering any NSAID, appropriate laboratory testing to establish hematological and serum biochemical baseline data is recommended prior to use.

Safety has not been established for intravenous (IV) or intramuscular (IM) use in cats.

Appropriate monitoring procedures should be employed during all surgical procedures, particularly with cats.

The use of concomitantly protein-bound drugs with Metacam^® 0.5% injection has not been studied in cats. Commonly used protein-bound drugs include cardiac, anticonvulsant and behavioural medications. The influence of concomitant drugs that may inhibit metabolism of Metacam^® 0.5% injection has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy.

Warning: Keep out of reach of children.

Safety Studies (controlled Studies)

Dogs: The safety profile of meloxicam has been evaluated in well controlled target animal safety studies. Dogs treated with placebo, 1X, 3X and 5X label dosages were closely monitored over a 180 day (26 weeks) period. The study determined that there were no drug related adverse effects on clinical observations, normal body weight gain, food consumption, physical and ophthalmic examinations, clotting times, mucosal bleeding times or on a panel of clinical pathology parameters monitored throughout the study.

Cats: Studies on cats have demonstrated much higher sensitivity to NSAIDs than dogs.

Cats receiving 1.5X or 3X the recommended subcutaneous dose followed by the same dose orally for 8 additional days had decreased appetites, acute gastrointestinal and circulatory disorders after day 7. Necropsy (day 9) confirmed treatment related pyloric/duodenal ulceration and secondary peritonitis. In a second study, cats received 1.5X or 3X the recommended subcutaneous dose followed by 0.1 or 0.2 mg/kg orally for 9 additional days. One cat in each group was clinically depressed on the last day of treatment. Duodenal ulceration and secondary peritonitis were observed at necropsy. A third study evaluated 1.5X, 4.5X and 7.5X subcutaneous injections for 3 consecutive days. Histopathology demonstrated slight to minimal papillary necrosis in the kidneys and mucosal erosion in the 4.5X and 7.5X groups. No treatment related changes were noted in the 1.5X group.

Adverse Effects (pharmacovigilance Reports)

Dogs: Postmarketing Reports of suspected adverse drug reactions (SADRs) following field use of Metacam^® (meloxicam) have been monitored worldwide since 1995.

Based on case reports received under a voluntary reporting system by veterinarians or pet owners/caregivers, the most important affected body system was the gastrointestinal tract followed in decreasing order by central nervous system/behavioural signs, renal and dermatological system. Case reports often did not provide sufficient information to establish cause of the signs observed. In most cases, adverse effects were transient and disappeared after termination of treatment. In rare cases however, death has been associated with some of these adverse reactions. The following suspected adverse effects have been reported:

Gastrointestinal: Vomiting, diarrhea, inappetence, melena, hematemesis, ulceration.

Central Nervous System/Behavioural: Ataxia, personality change, seizures, sleepiness, hyperactivity, depression, trembling.

Renal: Elevated creatinine and BUN, acute renal failure.

Dermatologic: Pruritus, eczema, focal alopecia, moist dermatitis (hot spots).

Hypersensitivity: Urticaria, allergic dermatitis.

Hematologic: Immune mediated hemolytic anemia, immune mediated thrombocytopenia.

Hepatic: Elevated liver enzymes, jaundice.

Cats: Based on case reports received under a voluntary reporting system by veterinarians and pet owners/caregivers, the most important body system in cats was renal followed in decreasing order by anaphylaxis and gastrointestinal. In rare cases, death has been associated with some of these adverse reactions.

Renal: Elevated creatinine and BUN, acute renal failure. Repeat dosing in cats has been associated with acute renal failure and death.

Anaphylaxis/Sudden death: Body twitching, temporary cardiac arrest within 1-7 minutes of administration.

Gastrointestinal: Vomiting.

Information for Dog Owners: Metacam^® (meloxicam) is a nonsteroidal anti-inflammatory drug (NSAID) and as with others in this group, side effects may occur in treated animals. The most common adverse effects reported involve the gastro-intestinal tract and usually occur within the first week of treatment. Typical symptoms include loss of appetite, vomiting, diarrhea, dark stools and depression. It is important in these situations to discontinue treatment and contact your veterinarian. In most cases, the side effects are transient and disappear after termination of treatment but in rare instances may be serious. Dogs undergoing prolonged treatment with Metacam^® should be monitored periodically. Consult your veterinarian.

Storage

*References available upon request.

Boehringer Ingelheim (Canada) Ltd., Burlington, Ontario L7L 5H4

43774/005

Presentation: 20 mL.

CPN: 12300288