Metacam Oral Suspension
Boehringer Ingelheim - Label Information

Description:
Meloxicam 1.5 mg/ml oral suspension (equivalent to 0.05 mg per drop).
Non-steroidal anti-inflammatory drug for oral use in dogs only.

Meloxicam is a non-steroidal anti-inflammatory (NSAID) drug of the oxicam class. Each milliliter of Metacam Oral Suspension contains meloxicam equivalent to 1.5 milligrams and sodium benzoate (1.5 milligrams) as a preservative. The chemical name for Meloxicam is 4-Hydroxy-2-methyl-N-(5-methyl-2-thiazolyl)-2H-1,2-benzothiazine-3-carboxamide-1,1-dioxide. The formulation is a yellowish viscous suspension with the odor of honey.

Clinical Pharmacology:
Meloxicam has nearly 100% bioavailability when administered orally with food. The terminal elimination half life after a single dose is estimated to be approximately 24 hours (� 30%) regardless of route of administration. There is no evidence of statistically significant gender differences in drug pharmacokinetics. Drug bioavailibility, volume of distribution, and total systemic clearance remain constant up to 5 times the recommended dose for use in dogs. However, there is some evidence of enhanced drug accumulation and terminal elimination half-life prolongation when dogs are dosed for 45 days or longer.

Peak drug concentrations can be expected to occur within about 7.5 hours after oral administration. Corresponding peak concentration is approximately 0.464 mcg/ml following a 0.2 mg/kg oral dose. The drug is 97% bound to canine plasma proteins.

Indications:
Metacam Oral Suspension is indicated for the control of pain and inflammation associated with osteoarthritis in dogs.

Dosage and Administration:
Metacam Oral Suspension should be administered initially at 0.2 mg/kg body weight only on the first day of treatment. For all treatments after day 1, Metacam Oral Suspension should be administered once daily at a dose of 0.1 mg/kb body weight.

Directions For Administration:
Dogs Under 10 pounds (4.5 kg): Shake well before use, then remove cap. Particular care should be given with regard to the accuracy of dosing. To prevent accidental overdosing of small dogs, administer drops on food only, never directly into the mouth. Carefully measure suspension onto food to assure that the correct dose is given before presentation of the food to the dog. The syringe provided with the meloxicam concentration of 1.5 mg/ml cannot be used to measure doses for dogs weighing less than 5 lbs (2.3 kg).

For dogs less than 5 lbs (2.3 kg), Metacam Oral Suspension can be given using the dropper bottle: one drop for each pound of weight for the 1.5 mg/ml concentration (2 drops for each kilogram of body weight) dropped directly onto the food.

For dogs between 5-10 lbs, Metacam Oral Suspension can be given by drops or by using the measuring syringe provided in the package. The syringe fits onto the bottle and has a scale beginning at 5 lbs, designed to deliver the daily maintenance dose (0.05 mg/lb or 0.1 mg/kg). When using the syringe, the dog�s weight should be rounded down to the nearest 5 pound increment. Replace and tighten cap after use.

Dogs Over 10 Pounds (4.5 kg): Shake well before use, then remove cap. Metacam Oral Suspension may be either mixed with food or placed directly in the mouth. Particular care should be given with regard to the accuracy of dosing. Metacam Oral Suspension can be given using the measuring syringe provided in the package. The syringe fits onto the bottle and has a scale beginning at 5 lbs, designed to deliver the daily maintenance dose (0.05 mg/lb or 0.1 mg/kg). When using the syringe, the dog�s weight should be rounded down to the nearest 5 pound increment. Alternatively, Metacam Oral Suspension can be given using the dropper bottle: one drop for each pound of body weight for the mg/ml concentration (2 drops for each kilogram of body weight). Replace and tighten cap after use.

Dosing Procedure:
1. Shake bottle well. Push down and unscrew bottle top. Attach the dosing syringe to the bottle by gently pushing the end onto the top of the bottle.

2. Turn the bottle/syringe upside down. Pull the plunger out until the black line on the plunger corresponds to the dog�s weight in pounds.

3. Turn the bottle right way up and with a twisting movement separate the dosing syringe from the bottle.

4. Push the plunger to empty the contents of the syringe.

Contraindications:
Dogs with known hypersensitivity to meloxicam should not receive Metacam Oral Suspension.

Warnings:
Not for use in humans. Keep this and all medications out of reach of children. Consult a physician in case of accidental ingestion by humans. For oral use in dogs only.

As with any NSAID all dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum biochemical baseline data is recommended prior to and periodically during administration.

For technical assistance or to report suspected adverse reactions, call 1-866-METACAM (1-866-638-2226).

Precautions:
The safe use of Metacam Oral Suspension in dogs younger than 6 months of age, dogs used for breeding, or in pregnant or lactating dogs has not been evaluated.

As a class, cyclo-oxygenase inhibitory NSAIDs may be associated with gastrointestinal and renal toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Patients at greatest risk for renal toxicity are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Since many NSAIDs possess the potential to produce gastrointestinal ulceration, concomitant use of Metacam Oral Suspension with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided or closely monitored. The use of concomitantly protein-bound drugs with Metacam Oral Suspension has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant and behavioral medications. The influence of concomitant drugs that may inhibit metabolism of Metacam Oral Suspension has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy.

Adverse Reactions:
Field safety was evaluated in 306 dogs. based on the results of the two studies, GI abnormalities (vomiting, soft stools, diarrhea, and inappetance) were the most common adverse reactions associated with the administration of meloxicam. The following table lists adverse reactions and the numbers of dogs that experienced them during the studies. Dogs may have experienced more than one incidence of the adverse reaction during the study.

Adverse Reactions Observed During Two Field Studies:

In foreign suspected adverse drug reaction (SADR) reporting over a 9 year period, incidences of adverse reactions related to meloxicam administration included: auto-immune hemolytic anemia (1 dog), thrombocytopenia (1 dog), polyarthritis (1 dog), nursing puppy lethargy (1 dog), and pyoderma (1 dog).

Effectiveness:
The effectiveness of meloxicam was demonstrated in two field studies involving a total of 277 doge representing various breeds, between six months and sixteen years of age, all diagnosed with osteoarthritis. Both of the placebo-controlled, masked studies were conducted for 14 days. All dogs received 0.2 mg/kg on day 1. All dogs were maintained on 0.1 mg/kg oral meloxicam from days 2 through 14 of both studies. Parameters evaluated by veterinarians included lameness, weight-bearing, pain on palpation, and overall improvement. Parameters assessed by owners included mobility, ability to rise, limping, and overall improvement.

In the first field study (n=109), dogs showed clinical improvement with statistical significance after 14 days of meloxicam treatment for all parameters. In the second field study (n=48), dogs receiving meloxicam showed a clinical improvement after 14 days of therapy; however, statistical significance was demonstrated only for the overall investigator evaluation on day 7, and for the owner evaluation on day 14.

Palatability:
Metacam Oral Suspension was accepted by 100% of the dogs when veterinarians administered the initial dose into the mouth. Metacam Oral Suspension was accepted by 90% of the dogs (123/136) when administered by owners. Problems associated with administration included refusal of food, resistance to swallowing and salivation.

Safety:
Six Week Study: In a six week target animal safety study, meloxicam was administered orally at 1, 3, and 5X the recommended dose with no significant clinical adverse reactions. Animals in all dose groups (control, 1, 3, and 5X the recommended dose) exhibited some gastrointestinal distress (diarrhea and vomiting). No treatment-related changes were observed in hematological, blood chemistry, urinalysis, clotting time, or buccal mucosal bleeding times.

Necropsy results included stomach mucosal petechiae in one control dog, two dogs at the 3X and one dog at the 5X dose. Other macrosopic changes included areas of congestion or depression of the mucosal of the jejunum or ilieum in three dogs at the 1X dose and in two dogs at the 5X dose. Similar changes were also seen in two dogs in the control group. There were no macroscopic small intestinal lesions observed in dogs receiving the 3X dose. Renal enlargement was reported during the necropsy of two dogs receiving the 3X and two receiving the 5X dose.

Microscopic examination of the kidneys revealed minimal degeneration or slight necrosis at the tip of the papilla in three dogs at the 5X dose. Microscopic examination of the stomach showed inflammatory mucosal lesions, epithelial regenerative hyperplasia or atrophy, and submucosal gland inflammation in two dogs at the recommended dose, three dogs at the 3X and four dogs at the 5X dose. Small intestinal microscopic changes included minimal focal mucosal erosion affecting the villi, and were sometimes associated with mucosal congestion. These lesions were observed in the ileum of one control dog and in the jejunum of one dog at the recommended dose and two dogs at the 5X dose.

Six Month Study: In a six month target animal safety study, meloxicam was administered orally at 1, 3 and 5X the recommended dose with no significant clinical adverse reactions. All animals in all dose groups (controls, 1, 3, and 5X the recommended dose) exhibited some gastrointestinal distress (diarrhea and vomiting). Treatment-related changes seen in hematology and chemistry included decreased red blood cell counts in seven of 24 dogs (four 3X and three 5X dogs), decreased hematocrit in 18 of 24 dogs (including 3 control dogs), dose-related neutrophilia in one 1X, two 3X and three 5X dogs, evidence of regenerative anemia in two 3X and one 5X dog. Also noted were increased BUN in two 5X dogs and decreased albumin in one 5X dog.

Endoscopic changes consisted of reddening of the gastric mucosal surface covering less than 25% of the surface area. This was seen in three dogs at the recommended dose, three dogs at the 3X dose and two dogs at the 5X dose. Two control dogs exhibited reddening in conjunction with ulceration of the mucosal covering less than 25% of the surface area.

Gross gastrointestinal necropsy results observed included mild discoloration of the stomach or duodenum in one dog at the 3X and in one dog at the 5X dose. Multifocal pinpoint red foci were observed in the gastric fundic mucosal in one dog at the recommended dose, and in one dog at the 5X dose. No macroscopic or microscopic renal changes were observed in any dogs receiving meloxicam in this six month study.

Microscopic gastrointestinal findings were limited to one dog at the recommended dose, and two dogs at the 3X dose. Mild inflammatory mucosal infiltrate was observed in the duodenum of one dog at the recommended dose. Mild congestion of the fundic mucosal and mild myositis of the outer musculature of the stomach were observed in two dogs receiving the 3X dose.

How Supplied:
Metacam Oral Suspension 1.5 mg/ml: 10, 32 and 100 ml dropper bottles with measuring syringe.

Storage:
Store at controlled room temperature 59-86�F (15-30�C).