arthritis in rabbits

Question
QUESTION: Hi Dana, i e-mailed a question last night but have found the answer regarding the dosage of Metacam for rabbits on one of your previous answers for tooth pain. my mini-rex is 11.5 years old and has arthritis. it has been progressively getting worse, so we are going to increase his Metacam from .2 ml to .3ml [he weighs 2.2 kg. and Metacam concentration is 1.5 mg/ml.]
Q1 - over what time period should I make this increase?
Q2 - what is your opinion for the best treatment of arthritis? i.e. if i you Metacam (long-term) should i put him on famotidine also?
Q3 - you mentioned tramadol, but we may not have it in Canada, is there an alternative to Metacam that would not have GI or liver side effects?
Q4 - i am also getting some supplement for joint health from Dr. McCluggage at Chaparral Animal Health Centre in Colorado. would that help to alleviate the side effects of Metacam?

ANSWER: Dear Patricia,

Q1 - over what time period should I make this increase?

You can increase it immediately, up to about 0.3mg/kg once per day. I'm not sure I'd go higher.

Q2 - what is your opinion for the best treatment of arthritis? i.e. if i you Metacam (long-term) should i put him on famotidine also?

Famotidine wouldn't hurt.  But ask the vet about adding tramadol.


Q3 - you mentioned tramadol, but we may not have it in Canada, is there an alternative to Metacam that would not have GI or liver side effects?

I'm pretty sure you can get tramadol in Canada.  It's a synthetic opioid.  If by some chance it's *not* available, then another opioid given in a very small dose might help.  Buprenorphine is one, but give very little, so he won't be gorky.  

Q4 - i am also getting some supplement for joint health from Dr. McCluggage at Chaparral Animal Health Centre in Colorado. would that help to alleviate the side effects of Metacam?

The joint supplement won't have any effect on the metacam side effects, but it can't hurt to try and see if it helps his joints.

Hope he feels better soon!

Dana

---------- FOLLOW-UP ----------

QUESTION: dear Dana,
thank you so much for your helpful answers. we decided to stick with Metacam and increased his dose so that it is in the middle range. We also started on Ranatidine? (similar to famotidine which my vet was of) - a liquid to prevent acid buildup at .25 ml (2x/day). After a day, i noticed that my rabbit's poop is darker, almost black instead of brown (usual color), but remaining about the same size. What is this an indication of? is there a need for concern, i.e. should he go off it? Otherwise, there are no other different symptoms so far.

Answer
Dear Patricia,

The ingredients in some antacids and intestinal soothing products can turn the stool very dark. (Ever taken Pepto Bismol?  That'll scare you if you're not forewarned!)

But blood in the intestine, once digested, can also turn the stool dark.  I doubt this is the problem, but it would be a good idea to mention this to the vet, in case she thinks the metacam is causing ulcerations.   I've never heard of this happening, and especially if he's on an antacid, this is unlikely.  But better safe than sorry!

Hope this helps.

Dana