stomach protector w/metacam

Question
QUESTION: my 11 year old boy has been on metacam for more than a few years for arthritis.
i read somewhere that people are giving bunnies a drug {can't remember the name ;( } to protect the stomach when using long term nsaids.
i did bring the name of the drug to my vet when i read it and he said "i've done many,many rabbit necropses and have not seen ulcers, i don't think we need to worry about that... i do not want to give him something else "
do you know what i;m talking about and if so,whats your opinion?
thanks
Jeanine

ANSWER: Dear Jeanine,

The drug that you are probably thinking of is famotidine, which is now available over the counter as Pepcid or generic brands.  It's an antacid, and we've used it occasionally, but only for our wild hares (who appear to ulcerate *very* easily!) and very stressed rabbits whose stress hormones might cause problems with the normal, protective enzymes that prevent stomach acids from harming the stomach (cyclo-oxygenases 1 and 2).

Metacam is a selective cyclooxygenase inhibitor (a.k.a., Cox-2 inhibitor), and is supposedly less rough on the intestines because it inhibits the activity of only *one* of the two protective enzymes (cyclo-oxygenase 2), and not both (as most other NSAIDS do).  

One of the reasons people have been using this, rather than Banamine, on rabbits is because of the putatively fewer intestinal side effects of metacam.

If your bunny has been on metacam for many years, I'd worry less about his stomach and intestines than his kidneys.  If you or your vet are interested, this article explains why:

http://content.karger.com/ProdukteDB/produkte.asp?Doi=20665

But congratulations on having a senior bunny!  :)  He's lucky to have such a caring mom!  

Hope this helps.

Dana

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

QUESTION: thanks for the great explanation...there is another part that may be equally important... my boy has mature cataracts and gets flurbiprofen: 1 drop/per day/each eye prophylactically. would that make a difference re: the gi issue?
i know that it takes a while for kidney issues to show up on a blood panel, but he does get blood tests every 3 months.
PS trying to also figure out a weird behavior: he spends alot of time licking his pellets {like 20 minutes at a time}...ever seen such a thing?
thanks again,
jeanine

Answer
Dear Jeanine,

Flurbiprofen is an NSAID, so it should not be used in conjunction with corticosteroids or other NSAIDS, if taken orally.  I am not really sure about using another NSAID if the fluriprofen is used only in a tiny dose, as an eye drop.  And I've never actually heard of this being used as an eye drop.

Please ask the vet about this, and whether there is another drop that would be appropriate for his cataracts (why does he have them?  Glaucoma?  If so, he may need drops for glaucoma--not inflammation--and it might be wise to consult a good veterinary ophthalmologist) so that other NSAIDs could be used for other pain.

Hope this helps!

Dana