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| aCUTe PaIN IN CaTS: TreaTmeNT wITh NSaIDS 28 Today's Veterinary Practice May/June 2014 tvpjournal.com • The 2010 Consensus Guidelines: Long-Term Use of NSAIDs in Cats (available at www.catvets.com/ guidelines/practice-guidelines/nsaids-in-cats) pro- vides recommendations from the International Soci- ety of Feline Medicine (ISFM) and American Acade- my of Feline Practitioners (A AFP) for long-term daily dosing of meloxicam oral suspension in cats. 16 • In addition to standard dosing protocols (Table 2), meloxicam has also been recommended at lower doses, such as 0.02 mg/kg/daily. 18 At this dose, it is well tolerated, but there is currently no informa- tion on whether it is efficacious. 19 However, a recent masked, placebo-controlled clinical study found a dose of 0.035 mg/kg to be efficacious over a 3-week period. 15 In the U.S., the FDA issued a black box warning for meloxicam in 2010 (see Management of Chronic Pain in Cats, November/December 2012, at tvpjournal.com), indicating that repeated use of meloxicam in cats has been associated with acute renal failure and death. It is most likely that the combination of the higher periop- erative dose and then follow-up dosing was responsible for these adverse events, but no details are available in the public domain. n aaFP = american academy of Feline Practitioners; COX = cyclooxygenase; GI = gastrointestinal; ISFM = International Society of Feline medicine; NSaID = nonsteroidal anti-inflammatory drug References 1. Lees P, taylor Pm. Pharmacodynamics and pharmacokinetics of flunixin in the cat. Br Vet J 1991; 147:298-305. 2. taylor Pm, Delatour P, Landoni Fm, et al. Pharmacodynamics and enantioselective pharmacokinetics of carprofen in the cat. Res Vet Sci 1996; 60:144-151. 3. Parton K, Balmer tv, Boyle J, et al. the pharmacokinetics and effects of intravenously administered carprofen and salicylate on gastrointestinal mucosa and selected biochemical measurements in healthy cats. J Vet Pharmacol Ther 2000; 23:73-79. 4. marino cL, Lascelles BD, vaden sL, et al. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cats recruited for degenerative joint disease studies. J Feline Med Surg 2013; epub ahead of print. 5. robertson sA. managing pain in feline patients. Vet Clin North Am Small Anim Pract 2008; 38:1267-1290. 6. King s, roberts es, roycroft Lm, et al. evaluation of oral robenacoxib for the treatment of postoperative pain and inflammation in cats: results of a randomized clinical trial. SRN Vet Sci 2012; doi: 10.5402/2012/794148. 7. carroll GL, howe LB, Peterson KD. Analgesic efficacy of preoperative administration of meloxicam or butorphanol in onychectomized cats. JAVMA 2005; 226:913-919. 8. warner tD, mitchell JA. cyclooxygenases: new forms, new inhibitors, and lessons from the clinic. FASEB J 2004; 18:790-804. 9. Lees P, Landoni mF, Giraudel J, et al. Pharmacodynamics and pharmacokinetics of nonsteroidal anti-inflammatory drugs in species of veterinary interest. J Vet Pharmacol Ther 2004; 27:479-490. 10. marino c, Lascelles BD, vaden s, et al. the prevalence and classification of chronic kidney disease in a randomly selected group of cats and in cats with degenerative joint disease. J Feline Med Surg 2013; epub ahead of print. 11. hsiang Kw, chen ts, Lin hY, et al. incidence and possible risk factors for clinical upper gastrointestinal events in patients taking selective cyclooxygenase-2 inhibitors: A prospective, observational, cohort study in taiwan. Clin Ther 2010; 32:1294-1303. 12. eisenach Jc, curry r, rauck r, et al. role of spinal cyclooxygenase in human postoperative and chronic pain. Anesthesiology 2010; 112:1225-1233. 13. Brune K, Furst De. combining enzyme specificity and tissue selectivity of cyclooxygenase inhibitors: towards better tolerability? Rheumatology (Oxford) 2007; 46:911-919. 14. Brune K. Persistence of nsAiDs at effect sites and rapid disappearance from side-effect compartments contributes to tolerability. Curr Med Res Opin 2007; 23:2985-2995. 15. Gruen me, Griffith e, thomson A, et al. Detection of clinically relevant pain relief in cats with degenerative joint disease associated pain. J Vet Intern Med 2014; 28:346-350. 16. sparkes Ah, heiene r, Lascelles BD, et al. isFm and AAFP consensus guidelines: Long-term use of nsAiDs in cats. J Feline Med Surg 2010; 12:521-538. 17. Pelligand L, King Jn, toutain PL, et al. Pharmacokinetic/ pharmacodynamic modelling of robenacoxib in a feline tissue cage model of inflammation. J Vet Pharmacol Ther 2012; 35:19-32. 18. Gowan rA, Lingard Ae, Johnston L, et al. retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease. J Feline Med Surg 2011; 13:752-761. 19. Lascelles BD, henderson AJ, hackett iJ. evaluation of the clinical efficacy of meloxicam in cats with painful locomotor disorders. J Small Anim Pract 2001; 42:587-593. B. Duncan X. Lascelles, BSc, BVSc, CertVA, PhD, MRCVS, DSAS (ST), Diplomate ECVS & DACVS, is a professor in small animal surgery at North Carolina State University. He is director of the Comparative Pain Research Laboratory. His work on pre- emptive analgesia, opioid use in cats, perioperative NSAIDs, and outcome measures in canine osteo- arthritis and feline degenerative joint disease has impacted veterinary medicine practice. SAFE NSAID USE FOR CHRONIC PAIN with respect to chronic administration of NSAIDs, there is an urgent need for more safety data in older cats that: 1. Suffer from painful conditions requiring long-term pain management and 2. Have concurrent diseases, such as renal impairment, hyperthyroidism, and liver disease. TVP_2014-0506_FelinePainMgmt (Part 2).indd 28 5/23/2014 11:23:10 AM