Is Meloxicam safe for dogs and cats?

Meloxicam (Metacam) is FDA-approved for dogs for the control of pain and inflammation associated with osteoarthritis. It is a preferential COX-2 inhibitor that provides anti-inflammatory efficacy with a somewhat lower GI ulceration risk than traditional non-selective NSAIDs, though GI risks remain present. The primary long-term concerns are GI hemorrhage (especially in dogs with pre-existing GI disease or concurrent corticosteroid use), renal papillary necrosis with prolonged use in renally compromised dogs, and rare hepatotoxicity. Concurrent NSAID and corticosteroid use is contraindicated. Standard monitoring recommendations include baseline renal and hepatic function before initiating long-term therapy. Overdose causes vomiting, diarrhea, melena, and renal failure. Meloxicam is generally considered one of the better-tolerated long-term NSAIDs in dogs at the approved dose.

Meloxicam (Metacam) is FDA-approved in cats only as a single subcutaneous injection for perioperative pain control. Repeated oral dosing of meloxicam in cats has caused acute renal failure and death in multiple documented cases, leading FDA in 2014 to issue a black-box warning on the oral liquid formulation (Metacam Oral Solution) stating it is for dogs only — not for cats — with the explicit statement that repeated use in cats may cause acute renal failure and death. Cats are more susceptible to NSAID-induced nephrotoxicity than dogs because: (1) cats have a higher baseline dependence on prostaglandin-mediated renal afferent arteriole tone, (2) they have lower renal reserve capacity, and (3) they have limited COX-2-selective benefit from meloxicam relative to the degree of COX-1 inhibition at therapeutic doses. The European Medicines Agency approved low-dose oral meloxicam (0.05 mg/kg every other day) for long-term feline osteoarthritis pain, but this indication is not FDA-approved in the US. The contrast between the European approval (with careful dose titration and monitoring) and the US black-box warning reflects differences in regulatory risk tolerance and available post-market data. Cats with CKD, hypertension, or cardiovascular disease are at extreme risk.