This review aims to analyse recent literature that discuss the effectiveness of meloxicam. Meloxicam, also known as Metacam, is a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain and inflammation in acute and chronic musculoskeletal disorders such as osteoarthritis (OA) in dogs (NOAH, 2017).
The efficacy of meloxicam administered preoperatively and postoperative to cats undergoing surgical fracture repair was investigated in one study (Murison, et al., 2010). The results showed a reduction in pain (Murison, et al., 2010). However, a recent study presented that NSAIDs had no effect on postoperative respiratory and heart rate (Höglund, et al., 2017). This would suggest that meloxicam has no effect on pain relief. The study presented limitations in a lack of base line data and pain scoring (Höglund, et al., 2017).
Several studies showed evidence that Meloxicam causes gastrointestinal mucosal damage, among other side-effects (Monteiro-Steagall, Steagall, & Lascelles, 2014) (Waring, 2014). However there is evidence that meloxicam had no harmful effects on the gastric mucosa (Guillot, et al., 2013) (Eskafian, Tabrizi, & Lari, 2017) (Waring, 2014).
A number of studies demonstrated that meloxicam affects haemostasis (Monteiro-Steagall, Steagall, & Lascelles, 2014) (Zanuzzo, Teixeira-Neto, & et al, 2015). Walton 2014 contradicted this statement finding that meloxicam caused no significant changes to blood biochemistry. In addition Guillot et al., 2013 found that no clinical side effects were observed. However data was discarded as a sensor stopped recording motor activity in the majority of cats.
A considerable amount of literature has been published on managing osteoarthritis with meloxicam (Waring, 2014) (Monteiro-Steagall, Steagall, & Lascelles, 2014) (Walton, 2014) (Guillot, et al., 2013) (Waring, 2014). These studies conclude that meloxicam provides significant pain relief in both cats and dogs.
The studies reviewed provide conflicting conclusions of how effective meloxicam is at pain relief and the potential harmful side effects. Some of the studies reached conclusions without the use of a baseline. This brings into question the validity of their claims if they had no baseline data to compare pain scores to. Another study discarded a portion of data after a recording sensor malfunctioned. By reducing the overall data available the study cannot accurately make conclusions.
More independent research is needed. The studies will benefit from larger sample groups, the inclusion of geriatric patients and double blind conditions. These criteria will help to reliably investigate both the side effects and effectiveness of pain relief of meloxicam.
Under the 2013 Veterinary Medicines Regulations, medication such as Metacam oral suspension is classified as a POM-V (prescription only medication- veterinarian). Metacam is obtained only by prescription from a veterinary surgeon following a clinical assessment (The Veterinary Medicines Regulations 2013, 2013) (NOAH, 2017). Meloxicam is not a scheduled drug (The Misuse of Drugs Regulations 2001, 2001). There are multiple ways a client may obtain meloxicam; from a Suitably Qualified Person (SQP), veterinary practice and online pharmacies. Each method has there advantages and disadvantages.
A POM-V means that the client is charged for every repeat prescription written (BSAVA, Authorization and classification, 2018). In addition to the high cost, the patient has to attend the practice; causing additional stresses (Lind, Hydbring-Sandbery, Forkman, & Keeling, 2016).
The Veterinary Medicines Regulations 2013 states that POM-V medicines cannot be prescribed by SQP. However, if a client requests a repeat prescription a vet can authorise a competent SQP to dispense (Mosedale, 2016) (BSAVA, Suitably qualified person, 2018).
Buying medicines from a veterinary practice is convenient. Treatment can start immediately rather than waiting for delivery, particularly important for emergency medications (BVA, 2017). The veterinarian can also discuss the side effects, how to identify them and what to do (BVA, 2017).
The prescribing veterinarian can administer Metacam or supply a written prescription. The prescription allows the purchase of Metacam from another veterinary surgeon or registered pharmacist (BSAVA, Authorization and classification, 2018). This is beneficial to owners who do not stay in one location.
Online pharmacies offer clients the simplicity of home delivery, wider variety of drugs and lower prices than veterinary practices (Henderson, 2014). Online pharmacies buy larger quantities unlike individual veterinary practices. The expenses are more easily absorbed by the business, resulting in a reduced cost versus competitors (BVA, 2017).
It is not a legal requirement that POM-V medicines are special/recorded delivery (Crown, 2014). This could lead to items getting lost in the post, resulting in the patient being without medication.
Disadvantages are; the danger of counterfeit medication, incorrect storage outside of predetermined ranges, expired or near expiration and damaged or improper packaging reducing effectiveness and safety (Dr. Mike Paul, 2014). Additionally there is a risk of unofficial online pharmacy. However the Veterinary Medicines Directorate (VMD) recognizes UK-based retailers that meet AIRS (Accredited internet retailer scheme) criteria (Crown, 2014). Buying NSAIDs online without a prescription adds risk. The pet has no blood test, thorough physical examination or regular check-ups during the course (Karen A. Moriello, n.d.).
All suppliers of veterinary medicines should safeguard all personal information given in accordance with the Data Protection Act 1998 to protect their customers.
Metacam should be labelled correctly to ensure the dose is accurate and clear to the client (BSAVA, Prescribing, supplying, dispensing and labelling procedures, 2018).
When dispensing Metacam the prescriber must advise the customer on how to administer safely and make them aware of side effects (BSAVA, Prescribing, supplying, dispensing and labelling procedures, 2018). Metacam should be shaken well before use, given with food or directly into the mouth for easy administration (Ingelheim, 2015).
Once open, Metacam should be used within 6 months (Ramsey, 2017). The product will not be safe past this due to changes in chemical composition or a decrease in strength (FDA, 2016).
Special precautions are noted in NOAH data sheet. Contact should be avoided by the person administering Metacam, if they have a known hypersensitivity to NSAIDs in case of accidental ingestion. Washing hands after handling can prevent this (NOAH, 2017).
In conclusion, each method of obtaining meloxicam has its own benefits and drawbacks. There are far more drawbacks to buying medication through online pharmacies then veterinary practices. The risks are much more significant when buying medication online (Dr. Mike Paul, 2014). Although clients may end up paying more when buying their pets medication for the vet, they can trust that what they are giving to their pet is given under the correct guidelines (BVA, 2017).
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