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the medical records of cats over 7 years of age treated for a minimum of 6 months with a daily maintenance dose of 0.02 mg/kg meloxicam and concluded that this dose does not hasten progression of renal disease in aged cats or aged cats with pre-existent stable IRIS stage 1-3 renal disease21,22.
In 2015, a paper reported on the safety of robenacoxib (1–2.4mg⁄kg) for daily, month long treatment of DJD in cats including 40 with chronic kidney disease IRIS stages 2-4. There was no evidence of increased risk in the frequency of reported adverse events, or in deterioration in renal variables in the subgroup of cats with concurrent CKD23. Despite being similar to meloxicam (class, mechanism of action), by September 2016 it was licensed only for short-term use.
Excretion and metabolism of meloxicam have been studied in cats. After oral administration, the major route of excretion is fecal and the main pathway of biotransformation is by oxidation, rather than by their limited glucuronidation pathway. Additionally, 21% of the recovered drug was eliminated in urine (2% as unchanged meloxicam, 19% as metabolites) and 79% in the feces (49% as unchanged meloxicam, 30% as metabolites)24.
A comprehensive review of the long-term use of NSAIDs in cats was published in 2010. This document may be accessed free-of-charge at: http://www.catvets.com/ guidelines/practice-guidelines/nsaids-in-cats in Spanish, French, German and Japanese25. In addition, an educational client brochure (Spanish, French) regarding the safe use of NSAIDs in cats is also available at the same web link. To minimize the risks of NSAIDs, it is important to:
• Select appropriate patients: individuals should maintain hydration and not be hypovolemic, hypotensive or in congestive heart failure.
• Obtain a complete list of medications the cat is receiving or has access to.
• Base the dose on lean body weight and consider titrating, once pain is controlled, to lowest daily dose that maintains comfort.
• Use a balanced approach: include nutritional, adjunctive and environmental components.
• Use gastroprotectants to treat or prevent gastric upset.
• Ensure communication with clients through verbal and written instructions.
• Recognize adverse reactions promptly and discontinue the NSAID.
• Monitor blood work q 2-4 months (high risk patients) or q6 months (low risk patients25.
• A washout period of 3-5 days should be used if transitioning from one NSAID to another; a longer washout period is indicated (7-10 days or longer) when switching to, or from, aspirin or a corticosteroid. Additional, alternate analgesic agent(s) should be used during the washout period.25,26
A suitable protocol for a cat with pain from musculoskeletal disease might be baseline NSAID with intermittent use of an opioid (such as burprenorphine) when “break-through” pain is evidenced by a decrease in appetite, mobility or social interaction. Gabapentin may be added for ongoing care.
Environmental modifications: Regular nail trimming helps by maintaining proper joint relationships. Ramps and steps to favourite sleeping spots are helpful. Warm, soft, padded sleeping places for stiff, painful, possibly bony joints should be considered. Raising food and water bowls may help the cat with cervical vertebral changes. Adding a litter tray to reduce the distance between boxes may reduce accidents as well as encourage regular voiding and defecation. The rim of the tray mustn’t be too high, nor the opening into the box too small. It should be scooped several times a day to encourage use.
Feeding a diet that is supplemented with eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) +/- green-lipped mussel (GLM) extract and glucosamine/chondroitin sulfate may be beneficial. Disease-modifying agents such as polysulfated glycosaminoglycan, glucosamine and chondroitin sulfate may improve joint health27. Additional modalities (therapeutic exercise, acupuncture, cold laser therapy) while no scientific studies have been done to support efficacy, may also play a role in providing comfort for a cat with musculoskeletal discomfort.
The author recommends that for chronic administration of NSAIDs in cats, it is good clinical practice to use
the lowest effective dose based on lean body weight, tapering to the lowest effective daily dose (off-label) and to avoiding use in, (or use lower initial doses) in cats with renal disease. Ensure that the patient is hydrated and give the NSAID with food. Individual patients respond differently to the same agent and dose. In most cases, NSAIDs are most effective when used in conjunction with other treatment modalities.
ANALGESIA FOR NEUROPATHIC PAIN
Neuropathic pain may be caused by inadequately alleviated traumatic or surgery-induced pain, such as onychectomy (declaw) or amputation28. Clients may remark that their cat doesn’t jump as high as before
the procedure or walks as if on glass or eggshells. Alternately, they may note decreased activity, increased aggression, inappetence starting months or even years after surgery. While the initiating event may be known,
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