Carbon hemoperfusion markedly reduces serum meloxicam concentrations in dogs with meloxicam toxicosis.

Carbon hemoperfusion markedly reduces meloxicam half-life and should be considered for high-dose canine meloxicam toxicosis.

This retrospective case series evaluated the efficacy of synthetically derived activated carbon hemoperfusion (cHP) for treating meloxicam toxicosis in five dogs across three veterinary teaching hospitals. Dogs presented with meloxicam ingestion at a median dose of 16.7 mg/kg (range 1.4–168.8 mg/kg). Serum meloxicam concentrations were measured via ultra-performance liquid chromatography-tandem mass spectrometry. The first case utilized in-series cHP with hemodialysis; subsequent cases underwent standalone cHP based on initial findings. Median blood volume processed was 2 L/kg over approximately 2.2 hours. During cHP, meloxicam half-life was dramatically shortened to 0.4–1 hour compared to 5.1–16.6 hours post-procedure. Median clearance during cHP was 6.52 mL/kg/min versus 0.49 mL/kg/min post-cHP. The extracorporeal elimination constant was 13.8 times faster than the intrinsic elimination constant. A rebound phenomenon averaging 47.2% concentration increase was observed approximately 5 hours post-cHP in three dogs, suggesting redistribution from peripheral compartments. All five dogs were discharged within 72 hours. One dog developed IRIS Grade II acute kidney injury that resolved with supportive care. The authors conclude that cHP markedly and rapidly reduces serum meloxicam concentrations, substantially shortens drug half-life, and should be considered in dogs with high-dose meloxicam ingestion, with monitoring for the post-procedure rebound effect.

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