Cats and Chronic NSAIDs

Renata Pinho, DVM, MSc, PhD

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to provide analgesia and reduce inflammation in veterinary patients. NSAIDs are used for both acute and chronic pain management. Specifically to cats, NSAIDs are well established for acute postoperative pain, but their chronic prescription is debatable.

Cats are prone to chronic pain, particularly as they age and develop conditions such as degenerative joint disease (DJD), osteoarthritis (OA), periodontal disease, oncologic pain, and persistent postoperative pain. Chronic NSAID therapy can be beneficial for these patients by reducing inflammation and providing analgesia, which increases mobility, improves appetite, and enhances overall welfare.

Cat presenting chronic back pain. Image courtesy of Dr. Nadia Crosignani

The primary indication for the chronic use of NSAIDs in cats is chronic pain, especially when inflammation is a contributing factor. The choice of NSAID should be based on available evidence for chronic use. In cats, the literature supports the chronic use of meloxicam for 6 months (Gunew et al., 2008) and robenacoxib for 3 months (King et al., 2021).

Before considering a patient eligible for long-term NSAID treatment, a thorough assessment is critical. This includes owner’s evaluation using validated scales to assess chronic pain in cats, a  physical examination by a veterinarian, and blood pressure measurement. Blood tests should include a complete blood count and a chemistry profile to ensure normal renal and liver functions. More specific tests, such as SDMA (symmetric dimethylarginine) and UPC (urine protein:creatinine ratio), are recommended to identify early stages of kidney disease (Taylor et al., 2024).

Cats with chronic kidney disease (CKD) may be eligible for long-term NSAID use if their disease is at IRIS (International Renal Interest Society) stage 1, 2, or 3 and is currently stable. However, owners should be aware of potential risks, including signs of dehydration, vomiting, and diarrhea, and the selected patients should be subjected to frequent and close veterinary monitoring (KuKanich et al., 2021).

Contraindications for long-term NSAID use in cats include unstable CKD or IRIS stage 4, systemic conditions that predispose them to dehydration, anemia, gastrointestinal conditions, hepatic disorders, concurrent treatment with antihypertensive drugs and drugs that affect renal function, and a history of NSAID sensitivity (Taylor et al., 2024).

For patients who are approved for the long-term treatment after screening, the protocol typically involves an initial full dose followed by a maintenance dose for long-term management. For meloxicam, the initial dose is 0.1 mg/kg in the first day, followed by a daily maintenance dose of 0.01-0.05 mg/kg orally (Guillot et al., 2013; Gunew et al., 2008). For Robenacoxib, both the initial and the daily doses are 1-2.4 mg/kg orally (King et al., 2021).

Continuous pain assessment using the validated scales and regular follow-ups after initiating the protocol are essential to monitor the patient's response and to adjust the treatment plan accordingly (i.e., doses should be reduced to the lowest effective level). For example, the short-form of the Feline Musculoskeletal Pain Index (FMPI-sf) is considered an easy and reliable tool to assess pain in cats with DJD (Enomoto et al., 2022). 

Regular weighing is necessary to adjust doses appropriately and to monitor body condition. Behavioral video updates can be useful for assessing improvement over time. Laboratory tests reassessment should be conducted at least every six months in healthy cats that do not present any clinical signs of adverse effects, and this interval should be shorter for CKD cats and patients presenting any behavioural or health concerns (Taylor et al., 2024).

Veterinarians and owners should weigh the benefits against the risks of NSAID long-term treatment in cats. Owners should be alert to any signs of side effects that may require treatment interruption and a veterinary consultation such as anorexia or reduced appetite, vomiting, diarrhea, and behavioral changes. Close communication between the owner and the veterinarian will ensure the long-term welfare of the patient while minimizing potential adverse effects associated with chronic NSAID use.

References

Enomoto, M., Lascelles, B. D. X., Robertson, J. B., & Gruen, M. E. (2022). Refinement of the Feline Musculoskeletal Pain Index (FMPI) and development of the short-form FMPI. Journal of Feline Medicine and Surgery, 24(2), 142–151. https://doi.org/10.1177/1098612X211011984

Guillot, M., Moreau, M., Heit, M., Martel-Pelletier, J., Pelletier, J.-P., & Troncy, E. (2013). Characterization of osteoarthritis in cats and meloxicam efficacy using objective chronic pain evaluation tools. The Veterinary Journal, 196(3), 360–367. https://doi.org/10.1016/j.tvjl.2013.01.009

Gunew, M. N., Menrath, V. H., & Marshall, R. D. (2008). Long-term safety, efficacy and palatability of oral meloxicam at 0.01–0.03 mg/kg for treatment of osteoarthritic pain in cats. Journal of Feline Medicine and Surgery, 10(3), 235–241. https://doi.org/10.1016/j.jfms.2007.10.007

King, J. N., Seewald, W., Forster, S., Friton, G., Adrian, D. E., & Lascelles, B. D. X. (2021). Clinical safety of robenacoxib in cats with chronic musculoskeletal disease. Journal of Veterinary Internal Medicine, 35(5), 2384–2394. https://doi.org/10.1111/jvim.16148

KuKanich, K., George, C., Roush, J. K., Sharp, S., Farace, G., Yerramilli, M., Peterson, S., & Grauer, G. F. (2021). Effects of low-dose meloxicam in cats with chronic kidney disease. Journal of Feline Medicine and Surgery, 23(2), 138–148. https://doi.org/10.1177/1098612X20935750

Taylor, S., Gruen, M., KuKanich, K., X Lascelles, B. D., Monteiro, B. P., Sampietro, L. R., Robertson, S., & Steagall, P. V. (2024). 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats. Journal of Feline Medicine and Surgery, 26(4), 1098612X241241951. https://doi.org/10.1177/1098612X241241951