Enya- First Ever Experience of Longterm Metacam Causing Problems

Enya is almost 8 and over the last 6+ months she has been on daily Metacam due to arthritic pain in her lower spine and hips. She has been on the middle dose range for her weight and it has been providing good pain control. However, at the beginning of this week she showed signs of reduced gut motility and on examination she had a very tender abdomen. She still had input and output, but her general demeanour indicated that there was something 'not right'.

C advised we stop the Metacam, give Ranitidine and Metoclopramide and to give low dose Tramadol for analgesic cover. After 5 days on this treatment Enya is improving and we are as sure as we can be that the cause of her GI tract problem was GI tract inflammation/ulceration due to the Metacam. This is the first time that I have ever encountered problems giving a Rabbit daily Metacam for managing a chronic pain condition. C said that having spoken with a few Exotics/Referral Vets they too are starting to see more Rabbits develop GI tract problems when on a moderate to high dose of Metacam over a protracted period of time.

I am NOT suggesting for one second that Metacam may not be as 'safe' as we think or that it should not be used at all. After all, I am in no way qualified to make such a statement. I just wanted to flag up what *might* be a potential issue for *some* Rabbits in *some* circumstances. It is an issue I will now always discuss with a Vet prescribing Metacam to use on a longterm basis.

In short, I wanted to post this just for consideration by anyone who's Rabbit may be prescribed Metacam on a longterm basis. This tread is not a statement claiming that 'JJ is the expert'..........which I aint and never will be !

I hope Enya is back to normal now. Whilst I am sorry that this has happened with Enya it is fortunate (sorry, can't think of a better word but hope you understand what I mean ) that between you and C this has come to light and you are able to pass this information on. Gabriel is on a mid dose for arthritis in his spine so will watch him even more closely.

Thanks for sharing Jane, I hope Enya does better on the alternative meds

It's interesting, as my bunnies had long term Metacam for their pain issues and stasis. Over time, they both worsened, and it was impossible to say whether it was just that the meds no longer helped the same (eg the pain had worsened), or whether the meds themselves made things worse.

My Bridge Bun Dylan was on long term metacam for arthritis and eventually tramadol too. He had occasional episodes where he stopped eating and had to be given metaclop. I continued with the metacam as it made a clear difference to his mobility. When the pain relief stopped working effectively, and on the advice of my vet, sadly I had him put to sleep as his quality of life was so poor.

I asked FHB about this as Scarlet has been on metacam constantly for around 18 months. She said at the dose she's on (2 to 3 drops twice daily) they don't routinely give ranitidine to protect the gut. Scarlet is also on it for her arthritis which has fused three vertebrae in her neck. Hope Enya is ok.

Hope Enya is okay. I've not much experience of Metacam use in rabbits.

However, I know with dogs/cats blood tests are done on a 6 monthly basis to monitor the kidney function as it has been linked to speed up potential kidney disease etc.

daphnephoebe said:

Hope Enya is okay. I've not much experience of Metacam use in rabbits.

However, I know with dogs/cats blood tests are done on a 6 monthly basis to monitor the kidney function as it has been linked to speed up potential kidney disease etc.

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Yes my cat who has kidney disease cannot have Metacam.

My Harry rabbit had long term Metacam for chronic ear infection and was very lucky not to have gut problems as for a short time he was on 2mls twice a day (smaller dose the rest of the time).Im glad you flagged this up though Jane as its useful information.
Hope Enya shows improvement.

Thank you - this is well worth knowing about. Our Pineapple (nethie cross), who will be 10 in March, has been on 0.4ml of Metacam daily since the summer for the arthritis/stiffness in one of her hips and part of her spine. She's also on half a capsule of Nutraquin+ (cat version) every other day to help "support" her joints and a weekly dose of Fibreplex. Obviously we expect her to be on Metacam long term/for the rest of her life.

Is the switch to Ranitidine and Metoclopramide permanent for Enya or just a respite to give her gut a chance to recover?

AnyBunny said:

Thank you - this is well worth knowing about. Our Pineapple (nethie cross), who will be 10 in March, has been on 0.4ml of Metacam daily since the summer for the arthritis/stiffness in one of her hips and part of her spine. She's also on half a capsule of Nutraquin+ (cat version) every other day to help "support" her joints and a weekly dose of Fibreplex. Obviously we expect her to be on Metacam long term/for the rest of her life.

Is the switch to Ranitidine and Metoclopramide permanent for Enya or just a respite to give her gut a chance to recover?

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No, the Metoclopramide was just to address the acute situation of a reduced gut motility. The Ranitidine to try to heal any GI tract ulceration- Ranitidine also has prokinetic properties. The Tramadol is for analgesic cover for her arthritic pain. All Metacam has been stopped.

She was on Metoclopramide for 4 days and she is remaining on Ranitidine for at least 2 weeks. During which time she will remain on Tramadol as analgesic cover (which appears to be working well). Then we will review.

As I have said, Enya is the first Rabbit I have ever had who has had problems on longterm Metacam. And I have had many, many Rabbits on it longterm over the years. I think Enya's situation may be the exception rather than the rule. But I thought it worth flagging up anyway

Silly question but how do you administer the tramadol? Fiver is on long term, low dose metacam but I am aware he may eventually need tramadol. I remember the trouble I had getting it into my dog because of it being a capsule, which she just spat out. We couldn't break the capsule as apparently the body wouldn't absorb the powder properly and it tasted awful.
Your thread has proved useful. Do you think if a rabbit was on a high dose of metacam long term that taking ranitidine would help protect the gut? I'm just wondering if Fiver's bouts of stasis may be caused by inflammation in the gut from the metacam. He was on ranitidine for a good few weeks and has since been ok. *Touch wood*.

this is an interesting (and worrying) thread. i've been wondering lately if bisc's high metacam for his spondylosis might be the cause of his tummy issues, mainly excess caecotrophs. he's now on 0.3ml of cisapride daily to keep them under control.

he's always had tummy issues though and needed gut meds every so often, but now i'm wondering if it's just how he is, or whether the metacam could have always been the cause. he's been on it since 2009 - originally for his snuffles/nose swelling, and now for his spondylosis.

unfortunately for bisc, it's taking a very high dose to keep his back under control. i wonder if lowering it and switching to tramadol might be better? can they even be given at the same time? i don't think it will be long before he needs something more but i don't think the metacam dose can really go any higher. it's a worry how much he needs already.

we've always been told that it's very unlikely to cause problems in the gut in terms of ulcers so he's never had anything else to protect the gut.

Vegan_Bunny said:

Silly question but how do you administer the tramadol? Fiver is on long term, low dose metacam but I am aware he may eventually need tramadol. I remember the trouble I had getting it into my dog because of it being a capsule, which she just spat out. We couldn't break the capsule as apparently the body wouldn't absorb the powder properly and it tasted awful.
Your thread has proved useful. Do you think if a rabbit was on a high dose of metacam long term that taking ranitidine would help protect the gut? I'm just wondering if Fiver's bouts of stasis may be caused by inflammation in the gut from the metacam. He was on ranitidine for a good few weeks and has since been ok. *Touch wood*.

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Tramadol comes in tablet form too. I crush the tablets up in a drop of apple juice.

There are some Vets who believe that Ranitidine should be given to a Rabbit on a medium/high dose of Metacam longterm. Other Vets think it to be un-necessary and may cause other problems. We are keeping Enya on just Tramadol now and no Metacam at all. The Tramadol is providing good pain control with no adverse sedation.

Jack's-Jane said:

Tramadol comes in tablet form too. I crush the tablets up in a drop of apple juice.

There are some Vets who believe that Ranitidine should be given to a Rabbit on a medium/high dose of Metacam longterm. Other Vets think it to be un-necessary and may cause other problems. We are keeping Enya on just Tramadol now and no Metacam at all. The Tramadol is providing good pain control with no adverse sedation.

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Thanks Jane. That's very helpful. I suppose it depends on the individual buns. Hope Enya continues to improve.

Mimzy has had metacam in increasing doses since he was three years old: he began with 0.1-0.2 mls dog strength and is now at 0.5 mls, twice a day. He is now eight and I worry that either the metacam isn't working well anymore (he's gotten crooked and more creaky) or he may be starting to have trouble with metabolizing it.

Right before he got head tilt he began taking ranitidine to see if it would help his stomach (we thought he was starting to brew an ulcer) and I still worry that the ranitidine stopped the absorption of the metacam long enough for his e.c. to manifest and cause his tilt. It was the only difference in his routine. But I think I asked you if that was possible, Jane, and you seemed to think it hadn't affected how the metacam was absorbed. My vet at the time couldn't say either if it was an issue, but if I ever had to give both meds again in future I'm of the opinion that I wouldn't give them at the same time, just to be sure they don't interfere with one another. (Might just be my OCD talking here though.)

I know dogs and cats have a harder time with metacam, hence why things like tramadol or rimadyl are more often prescribed. Our dog, Shadow, did not do well on metacam (really messed up his gut), and Jenna had one experience with it that she threw up after having it...but recently did much better with it. I think the amount was lowered that she was allowed and maybe that helped.

Thank you for the information, Jane. It is always good to know that there are sometimes cases where caution should be exercised. I do hope Enya will do better and better as each day passes. xxxxxxxxx

MimzMum said:

Mimzy has had metacam in increasing doses since he was three years old: he began with 0.1-0.2 mls dog strength and is now at 0.5 mls, twice a day. He is now eight and I worry that either the metacam isn't working well anymore (he's gotten crooked and more creaky) or he may be starting to have trouble with metabolizing it.

Right before he got head tilt he began taking ranitidine to see if it would help his stomach (we thought he was starting to brew an ulcer) and I still worry that the ranitidine stopped the absorption of the metacam long enough for his e.c. to manifest and cause his tilt. It was the only difference in his routine. But I think I asked you if that was possible, Jane, and you seemed to think it hadn't affected how the metacam was absorbed. My vet at the time couldn't say either if it was an issue, but if I ever had to give both meds again in future I'm of the opinion that I wouldn't give them at the same time, just to be sure they don't interfere with one another. (Might just be my OCD talking here though.)

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I don't think the absorption of metacam is any way affected by ranitidine. Doughnut is on ranitidine permanently and I add in metacam when she is poorly and Mark has never said the absorption is affected or they interact with each other, so please don't blame yourself. I've given her high doses such as 0.5ml 3 times a day at max and she's only a little bun at 1.2kg.

cpayne said:

I don't think the absorption of metacam is any way affected by ranitidine. Doughnut is on ranitidine permanently and I add in metacam when she is poorly and Mark has never said the absorption is affected or they interact with each other, so please don't blame yourself. I've given her high doses such as 0.5ml 3 times a day at max and she's only a little bun at 1.2kg.

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Thank you cpayne
I'm glad to hear that Doughnut has done so well with her medications. I do get a little miffed at the vet who doesn't want to raise Mimzy's metacam since I think he could likely do better with a little more, but his former vet (who was very attuned to him and his idiosyncrasies) was even thinking maybe we were looking at gabapentin for him if his pain became unmanageable before having to make a more serious decision.

Personally, I don't doubt that the temperature here is not agreeing with him at present. It is only the single digits above zero Fahrenheit and I know I'm aching, so he must be too. I just want him to be comfortable.

Sorry...not trying to hijack Jane's topic. xx

Sorry Jane I'm not either.

Doughnut was on gabapentin it made her very nervous and jumpy. That was when we thought she could still feel the scar in her throat, like a lost limb and it was still irritating her before we discovered she had acid reflux.

Yes I've been diagnosed with advanced arthritis. Had 16 injections over the course of 8 weeks to get it under control with my specialist!

My bridge bunny Daisy was on quite a high dose of metacam when her back legs gave way. The vet eventually cut it down because she was worried that some of the other problems she started having we're being caused by the medicine. Nothing was ever proven though.

Laura10101 said:

My bridge bunny Daisy was on quite a high dose of metacam when her back legs gave way. The vet eventually cut it down because she was worried that some of the other problems she started having we're being caused by the medicine. Nothing was ever proven though.

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do you mind me asking what dose she was on, and what problems she started to have? did the vet switch to another pain relief instead? thank you.