[Lara's mom]

I think you both present very valid points. Just as we have to be advocates for our own health care, we have an equal responsibility to be advocates for the health of our dogs. There was a time that when a doctor prescribed something, we would take it; no questions asked. Likewise, when the vet prescribed something for our pet, we wouldn't question it. Today, we are more informed as consumers of these services or, at least we should be. There are more new drugs being approved every day and, some of them can have some pretty frightening consequences as is evident with rimadyl.

On the other hand, Internet research can be somewhat deceptive. If you're looking for adverse effects with any given medication, that's exactly what you'll get; you won't get a well rounded analysis. Just as we need to have an open dialogue with our own doctor, we must also do so with those who care for our pets. We need to be informed consumers and ask questions. A good vet will make you a partner in determining the best course for the health and well being of your pet.

[CorkyMax]

Now I can't find the article---the link I gave will not work
I do know it was written by a holistic vet---It is not just some 'junk' you would find on the net! And all vets are not good vets, so you can not necessarily trust them--and to be blunt, can end up causing your dog's death! (and I would be curious to know what % of them are good, caring, knowledgeable vets!) And they indeed know about Rimadyl and other bad meds. but they still prescribe the junk!!! Am going to print here another article from same site: NSAID (nonsteroidal anti-inflammatory drug)
What Is An NSAID?
An NSAID, or nonsteroidal anti-inflammatory drug, is a medication that relieves pain, relieves fever, and relieves inflammation.
What are examples of diseases NSAIDs are used for in pets?

Nonsteroidal anti-inflammatory drugs are used for arthritis, inflammation in the eye (anterior uveitis), knee ligament injury (cruciate disease), hip and elbow dysplasia, knee cap dislocation (patellar dislocation), rheumatoid or septic arthritis, abnormal joint cartilage development (osteochondritis dissecans or OCD), spinal arthritis (spondylosis deformans), and cancer pain.
How do NSAIDs work?
Nonsteroidal anti-inflammatory drugs work by blocking production of prostaglandin molecules that promote pain. NSAIDs revive the spirits of pets by resolving pain, allowing them to exercise so that the heart, lungs, and gut all function normally. With exercise, pets maintain their muscles, and this helps them hold their joints in correct alignment, another reason they experience less pain.



Making NSAID use safer

1. Use NSAIDs with chondroprotectives like Glyco-Flex, and with Omega 3 Fatty Acids like Lipiderm to reduce the amount, or the frequency, of NSAID use.
2. Never give NSAIDs without your veterinarian's advice. Dogs and cats can be killed by the wrong medication, or the right medication given too often. Since the NSAID Ibuprofen was released as an over-the-counter tablet, it has generated more calls to the National Animal Poison Control Center by dog and cat owners than has any other single drug.
3. Without specific instructions from your veterinarian, don't give NSAIDs to cats.
4. Don't use two NSAIDs at the same time unless specifically instructed to do so.
5. Don't use an NSAID and a steroid at the same time unless specifically instructed to do so.
6. Do the lab tests for your pet as requested by your veterinarian.
7. Check the pet's stool for the presence of blood. Pets on NSAIDs can develop stomach and intestinal ulcers. Blood that leaks from an ulcer passes through the gut along with food and is digested into a black, tarry substance. Finding a blackish stool, or a stool that looks like it contains coffee grounds, is reason to stop medicating with NSAIDs and notify your veterinarian immediately.
8. Store the medication out of reach of children and pets. Considering the ingenuity of cats, kids, and puppies, you may need a locked cupboard. These medications are sometimes flavored, and pets go to great lengths to find and eat them.
What's a prostaglandin?

All the cells in the body are surrounded by membranes. One of the molecules found in cell membranes is arachadonic acid. Arachadonic acid can be modified to produce several different types of prostaglandins (PG) molecules, according to what the body needs. Prostaglandin molecules tend to have two functions: they either promote inflammation or promote normal cell function. The type of PG produced is determined by which enzyme modifies arachadonic acid. If the enzyme cyclooxygenase 1 (COX 1) transforms arachadonic acid, PG E1 prostaglandin is produced. If the enzyme cyclooxygenase 2 (COX 2) transforms arachadonic acid, PG E2 prostaglandin is produced.

Generally, prostaglandins of the E1 series work to promote normal function, including normal function of the stomach, liver, heart, and kidney. For example, in the stomach PG E1 helps maintain the mucus lining that protects the stomach from hydrochloric acid. In contrast, prostaglandins of the E2 series work to promote inflammation. Inflammation can be good when the body needs to attack diseases, such as cancer, feline leukemia, or canine parvo. But inflammation can also be bad—for example, when it causes the body to attack itself, as with an immune-mediated disease such as pemphigus, some thyroid diseases, rheumatoid arthritis, and lupus. Inflammation is also bad when it occurs to excess, and immune cells attack like a swarm of bees. This type of excessive inflammation can occur with wear-and-tear osteoarthritis, and with elbow or hip dysplasia.

Understanding prostaglandins and the COX enzymes that produce them allows us to understand how NSAIDs work. NSAIDs either target COX 1 enzymes and the PG they produce, COX 2 enzymes and the PG they produce, or both COX 1 and COX 2.
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[CorkyMax]

What's a prostaglandin?

All the cells in the body are surrounded by membranes. One of the molecules found in cell membranes is arachadonic acid. Arachadonic acid can be modified to produce several different types of prostaglandins (PG) molecules, according to what the body needs. Prostaglandin molecules tend to have two functions: they either promote inflammation or promote normal cell function. The type of PG produced is determined by which enzyme modifies arachadonic acid. If the enzyme cyclooxygenase 1 (COX 1) transforms arachadonic acid, PG E1 prostaglandin is produced. If the enzyme cyclooxygenase 2 (COX 2) transforms arachadonic acid, PG E2 prostaglandin is produced.

Generally, prostaglandins of the E1 series work to promote normal function, including normal function of the stomach, liver, heart, and kidney. For example, in the stomach PG E1 helps maintain the mucus lining that protects the stomach from hydrochloric acid. In contrast, prostaglandins of the E2 series work to promote inflammation. Inflammation can be good when the body needs to attack diseases, such as cancer, feline leukemia, or canine parvo. But inflammation can also be bad—for example, when it causes the body to attack itself, as with an immune-mediated disease such as pemphigus, some thyroid diseases, rheumatoid arthritis, and lupus. Inflammation is also bad when it occurs to excess, and immune cells attack like a swarm of bees. This type of excessive inflammation can occur with wear-and-tear osteoarthritis, and with elbow or hip dysplasia.

Understanding prostaglandins and the COX enzymes that produce them allows us to understand how NSAIDs work. NSAIDs either target COX 1 enzymes and the PG they produce, COX 2 enzymes and the PG they produce, or both COX 1 and COX 2.

How do NSAIDs target prostaglandins?

NSAIDs are medications designed to target the COX enzymes that produce prostaglandins. Some of the newer NSAIDs are somewhat selective (Deramaxx (Rx)) and target COX 2 more than COX 1. An NSAID that targets COX 2 helps stop inflammation.

The older NSAIDs (aspirin and Rimadyl (Rx)) are less selective, targeting both COX 1 and COX 2, so they decrease beneficial stomach mucus at the same time that they decrease inflammation.

In actuality, no NSAID is completely selective for COX 1 or COX 2. This may be good because the latest research suggests the best pain relief may come from products that affect both COX 1 and COX 2.

What are potential side effects from NSAIDs?
About 1% of pets taking NSAIDs have a problem or side effect because of the drug. A common NSAID side effect is gastric ulcer. The pet may refuse to eat, vomit, and pass dark, tarry stool. Another side effect is kidney damage, causing the pet to drink more and urinate more, a condition called PUPD, or polydipsia, polyuria. Pets may become anemic with pale gums, or they may have yellow (icteric) gums. It is also common for NSAIDs to damage the liver. Fortunately, for most pets the organs return to normal when the NSAID is withdrawn.

In humans, some COX 2 inhibitors affected prostaglandins that protected the heart so that some people taking these drugs suffered heart attacks. Pets don't have the same predisposition to heart attack as humans do, but research has not clarified the full effect COX 2-inhibiting NSAIDs will have on pet hearts.

Vet Tip: Prevention
As with most things in nature, any medicine that can do so much good, has the potential to do harm. To prevent harm, most NSAIDs require a veterinarian's prescription. Some NSAID side effects warrant the veterinarian requesting blood tests to confirm that the NSAIDs have not damaged the stomach, liver, or kidneys. Some veterinarians recommend using Omega 3 Fatty Acids, such as those found in Lipiderm, 3V Caps, and Derm Caps to protect the kidneys, and using Denosyl to protect the liver. In addition, many veterinarians recommend using chondroprotectives, such as Adequan (Rx), Legend (Rx), Glyco-Flex, and 1-800-PetMeds Super Joint Enhancer to decrease the pet's need for NSAIDs.


Can I use human NSAID for my pet?

Medications for people, including NSAIDs, don't necessarily act the same in pets as they do in people. It is never wise to use them without specific veterinary instruction.

Can I use human aspirin for my pet?

Medications for people, including aspirin, don't necessarily act the same in pets as they do in people. Humans often take enteric-coated aspirin, but it is unwise to use these tablets in pets. Enteric coating prevents aspirin from dissolving easily so that it can sit in the pet's stomach for a long time. It's possible for aspirin to "collect" in the stomach, exposing the pet to a toxic dose. It's better to use aspirin, like Vetrin, specifically developed for pets, or to use a powdery, uncoated aspirin that dissolves easily. It's never wise to use aspirin without specific veterinary instruction. For cats, aspirin is usually not a wise choice because they metabolize it so slowly it can only be given twice a week. This isn't sufficient to help them with pain. Your veterinarian can recommend more effective analgesics.



What do we know about Rimadyl and the liver? Rimadyl has caused liver problems in some dogs—usually Labrador retrievers. They become lethargic, don't eat, vomit, and develop diarrhea. These side effects occur to about 1 in 5000 dogs receiving Rimadyl.



Veterinarians diagnose the liver toxicity with blood tests, and they find that the majority of these dogs make a full recovery after stopping the medication. Some dogs, however, can die or need to be euthanized because of liver damage. To protect a Labrador retriever, or any breed dog, from needing NSAIDs for arthritis pain, keep its weight down, and start it on cartilage-protecting supplements when it's young. We recommend Adequan (Rx), Legend (Rx), Glyco-Flex, 1-800-PetMeds Super Joint Enhancer and Missing Link with glucosamine.

What Do We Know About Piroxicam (Feldene) And Cancer?

A new use for the NSAID piroxicam is treating cancer of the mouth (squamous cell carcinoma) and of the bladder (transitional cell carcinoma).

[Miranda_D]

I'm a vet, and some colleagues are seeing great results in arthritis cases using stem cell therapy. Basically, fat is taken from the dog's abdomen and the stem cells are extracted, and injected into the sore joint. Dogs can be feeling better within 30 days. Obviously some dogs respond better than others, and it's not cheap, but it's free from side effects. Worth keeping in mind as an option.

[CorkyMax]

This was written by a person with DVM after their name!
And please remember where the word carprofen is that it is another word for RIMADYL!!!



Meloxicam (Metacam)

Brand name: Metacam, Mobic, Mobicox

Available in 7.5 & 15 mg tablets (human formulations) & two strengths of oral suspension (veterinary formulations)

Background

Meloxicam is a member of the class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), the same class as such common over-the-counter pain remedies as Advil (ibuprofen), Aleve (naproxen), Orudis (ketoprofen), and aspirin. Most NSAIDs cannot be used in pets due to the following unacceptable side effects:


Stomach ulceration - even perforation and rupture of the stomach can occur. This is not only painful but life-threatening.
Platelet deactivation - platelets are the cells controlling the ability to clot blood and, as a general rule, it is preferable not to promote bleeding. We would prefer platelets to remain active and able to function should we need them.
Decreased blood supply to the kidney - this could tip a borderline patient into kidney failure.
The veterinary profession has been in need of an NSAID that could effectively relieve pain without the above risks. The key appears to lie with the enzyme responsible for many inflammatory mediators: cyclo-oxygenase-2 (or COX–2). A different but related enzyme, cyclo-oxygenase-1 (COX-1), is responsible for producing important biochemicals needed to maintain normal blood supply to the kidneys and GI tract. It had been previously impossible to inhibit cyclo-oxygenase-2 without also inhibiting cyclo-oxygenase-1, hence the side effects of previous NSAIDS.

In 1997, Pfizer Animal Health released carprofenfor dogs in the U.S. as the answer to this need. Carprofen is what is called a preferential cyclo-oxygenase-2 inhibitor. Carprofen does inhibit cyclo-oxygenase-1 slightly but, for the first time, it became possible to exert a different effect on each of these two enzymes. Meloxicam is a similar type of NSAID, preferentially inhibiting COX-2 over COX-1. This new ability to inhibit only the inflammatory COX proved to be revolutionary for pain management not only for pets but for humans as well. The introduction of COX-2 preferential NSAIDs has reduced stomach and intestinal side effects by 50% in humans and has made FDA approval of NSAIDs possible for pets. Meloxicam has only been approved in the U.S. for canine use since 2003 but has been available in Canada and Europe for years before. Meloxicam has been available in the U.S. for human use for many years.

Meloxicam offers another unique feature that other veterinary NSAIDs do not: feline use. As much as having COX preferential NSAIDs has been a boon to canine practice, these same drugs did not offer pet cats any sort of safe relief. Cats are even more sensitive to NSAID side effects as a general rule and the quest for a feline NSAID is still on-going; still, meloxicam has been approved by the FDA for use in cats for surgical pain so long as only one dose is given. Longer term feline protocols have been developed (though not approved by the FDA at this time) and are in wide though cautious use in needful cats.

Another use of COX preferential NSAIDs bears mentioning. There are many forms of cancer, in particular certain types of carcinomas (transitional cell carcinoma , possibly squamous cell carcinoma , and more) seem to exhibit COX-2 activity. This implies that these types of NSAIDs have anti-tumor effects separate from their anti-inflammatory effects and their use in the treatment of inoperable cancers is currently being explored.

How this Medication Is Used

Meloxicam is generally given to control arthritis pain in dogs though can be given for many other painful conditions such as injuries, cancer, surgery, dental infections, and more. In dogs, it is typically given as a once a day as a pleasantly flavored liquid. The veterinary approved product comes with a special dosing syringe marked to show how much to give for the pet's weight (rather than in milliliters as most syringes are marked).

Meloxicam can be used in cats but with caution. The original oral solution of meloxicam was commonly dosed in drops from the bottle. Since the wrong dose of meloxicam can be very dangerous for cats, it is important not to drop the drops directly into the cat's mouth from the bottle as squeezing too strongly could easily deliver an overdose. There is currently a newer formulation at one third the strength of the original, which can be dosed more accurately with the included syringe. In cats. this product is given either as a single one time injection in association with surgery (its FDA approved use) or long term 2 to 3 times per week.

Patients being considered for long term meloxicam use should be evaluated with a complete physical examination and initial screening blood test to identify any factors, such as liver or kidney disease, that might preclude the use of this or any other NSAID.

Side Effects

The side effects of concern are the same with all NSAIDs: stomach ulceration, loss of kidney function, and inappropriate bleeding. These are dependent on the dose of medication used and on risk factors of the host (for example: an aged pet may not efficiently clear a dose of medication from its body leading to stronger and longer activity of the drug). There is also a particular idiosyncratic reaction for NSAIDs that has received a great deal of press. An idiosyncratic reaction is one that is neither dose-dependent nor predictable by any apparent host factor; it simply happens out of the blue. This particular idiosyncratic reaction is a liver toxicity that is rare enough that it did not show up in any of the initial 400 carprofen test subjects, nor in the U.K., and was not recognized until carprofen was used in over a million dogs in the U.S. after its release as the first NSAID. This reaction is reviewed below. While originally it was carprofen use that led to the recognition of this reaction, it is now felt that all veterinary NSAIDs have potential to cause this reaction.

The most common side effects of meloxicam are nausea, appetite loss, vomiting or diarrhea. If any of the above are noted, meloxicam should be discontinued and the pet brought in for a liver enzyme and renal parameter blood test. In most cases, the reaction is minor and resolves with symptomatic relief, but it is important to rule out whether or not the patient has more than just a routine upset stomach.
If a patient has borderline kidney function, NSAIDs should not be used as they reduce blood flow through the kidneys. It is also important that NSAIDS not be given to dehydrated patients because of this potential side effect. This is particularly true in cats. The hepatopathy side effect (usually occurs within the first 3 weeks of use).
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[CorkyMax]

A carprofen reaction that has received special attention is hepatopathy, a type of liver disease. Symptoms include nausea, appetite loss, and/or diarrhea as well as marked elevations (3-4 times higher than the normal range) in liver enzymes measured in the blood. The question of whether other veterinary NSAIDs share this reaction has arisen. At this time, it is generally felt that the hepatopathy idiosyncratic reaction is not unique to carprofen and should be of concern with any veterinary NSAID and this includes meloxicam. This reaction seems to be a canine issue only.

Dogs with hepatopathy show improvement with support 5 to 10 days after discontinuing medication. It is important that the NSAID be discontinued and the patient evaluated in the event of upset stomach signs in case of this syndrome. Even though this is a rare syndrome (one in 5000), it can become life-threatening if ignored. Appetite loss or other intestinal signs do not necessarily indicate a hepatopathy but since they might, it is important not to ignore these signs should they occur. There is no way to predict which dogs will experience this side effect.

The hepatopathy reaction usually occurs in the first 3 weeks after starting carprofen but could theoretically occur later.

All NSAIDs are removed from the body by the liver. If the patient’s liver is not working normally due to another disease or if the patient is taking other drugs that are also removed by the liver, it is possible to “over work” the liver and exacerbate pre-existing liver disease. If there is any question about a patient’s liver function, another class of pain reliever should be selected.
It is important to realize that COX-selectivity is not the sole factor in safety. In humans, the incidence of kidney function-related side effects was unchanged by the development of COX-2 preferential NSAIDs, such as meloxicam, and we expect the same is true with dogs. Still, these drugs have an excellent track record for safety. The important issue is to recognize risk factors for adverse reactions and take preventive steps (see the Concerns and Cautions section below).

One might wonder how this is possible given the COX-2 selectivity and the answer is complex. While it is easy to think of COX-2 as the “bad” enzyme, COX-1 as the “good” enzyme, and COX selectivity as seeing that only the "bad" enzyme is suppressed, this kind of thinking would be a drastic over-simplification. In fact, COX-2 is important in activities involving the healing of stomach ulcers and other important processes. There is also a COX-3, of which very little is known, and studies show there may very well be a COX-4. Further, at higher doses, meloxicam and other COX-2 selective NSAIDs will lose their COX-2 selectivity and significantly inhibit COX-1 as well.

As with all veterinary NSAIDs, periodic monitoring tests are important to check liver enzymes and kidney function, and to generally screen the patient's health. Typically a schedule of every 6 months is recommended for dogs. There is no general consensus on what is appropriate for cats but because of feline sensitivity towards NSAIDs, feline monitoring is especially important. If you are using this product in a cat, be sure you understand what monitoring schedule your veterinarian is recommending for your specific pet.

Interactions with Other Drugs

Drugs of the NSAID class should not be used concurrently as the potential for the aforementioned side effects increases. For similar reasons, NSAIDS should not be used in conjunction with corticosteroid hormones such as prednisone, dexamethasone, etc. Pfizer recommends a 5 to 7 day rest period when changing from one NSAID to another. Aspirinposes an exception due to its strong platelet inactivating abilities so 10 to 14 days is recommended when switching to another veterinary NSAID from aspirin. Allow at least one week between prednisone and meloxicam.

If meloxicam is used concurrently with phenobarbital, it is especially important that appropriate liver monitoring be performed. These two drugs interact such that neither may work well if they are used together.

ACE inhibitors such as enalapril, benazepril, or captopril may not be as effective in the presence of meloxicam. (ACE inhibitors are used in the treatment of hypertension or heart failure.) This is because ACE inhibitors depend on the dilation of blood vessels in the kidneys and such dilation can be interfered with by NSAIDs).

Concerns and Cautions

Meloxicam works as well when given on an empty stomach as when given on a full stomach. If a patient has had some upset stomach issues with meloxicam, these can often be minimized by administering the drug on a full stomach.

Maximum effect is seen approximately 8 hours after administration. When beginning a trial course of meloxicam, a response may take 3 or 4 days to show. If no response is seen in 10 days, meloxicam has failed and a different pain medication should be tried. If one NSAID fails, another may well work.

The veterinary formulations of meloxicam are oral liquids (either 1.5mg/ml or 0.5 mg/ml). It is important to compare these sizes to the human tablets which are available in much higher strengths. In general, human strength pills will be too strong except in very large dogs. It is important not to use human medications on pets unless your veterinarian has provided detailed dosing instructions.

Meloxicam should not be used in pregnancy or in lactation.

Meloxicam should not be used in puppies under 6 months of age (safety has not been proven).

Meloxicam should be avoided, if possible, in patients with impaired function of the liver, kidney or heart. It should also be avoided in dehydrated patients and patients with known GI ulcers.

ALWAYS SHAKE THE BOTTLE OF MELOXICAM BEFORE DRAWING UP THE DOSE

For More Information

The manufacturer of veterinary meloxicam, Boehringer Ingelheim, offers more information.

See information on veterinary non-steroidal anti-inflammatory drugs from the Food and Drug Administration (FDA).

It is our policy not to give dosing information over the Internet.

Date Published: 11/1/2004 10:46:00 AM
Date Reviewed/Revised: 11/12/2007


Again--Carprofen is another name for the killer Rimadyl!!!

[Yogi]

understood, but it is not another name for Metacam (Meloxicam). Though they are all in one class does not mean they are the same or work the same in addition will they share necessarily the same adverse effects, meaning while one will have distinct or could have distinct adverse effects the other (s) may only have adverse effects depending on the host. I have no problems with Metacam and would if needed have no problems using it again. Rimadyl on the other hand, I have never had to use.