The Horse

FEB 2018

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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Page 29 of 51

30 THE HORSE February 2018 "We presently use Equioxx on small intestinal colic cases and have shown good pain control (as good as Banamine) and reduced markers of sepsis," says Blikslager. "The ideal scenario would be to have Equioxx used in the field for a referral suspect, as it takes 24 to 48 hours to lose inhibition of COX-1 in horses that have had Banamine, and we believe that reduces gut repair." Flunixin meglumine's counterpart, phenylbutazone, is more potent than the COX-2-selective inhibitors and, therefore, better for treating acute musculoskel- etal pain. This includes injuries such as tendon or ligament tears, laminitis, bone bruising, or other orthopedic conditions. "For laminitis, in particular, it is typically required to shut down the COX pathways to have any effect on pain," says Blikslager. "The worst dilemma is a horse with laminitis and colitis. With these horses, it is best to start with NSAIDs but back off as soon as possible and hope other pain meds are helpful." For long-term anti-inflammatory use for osteoarthritis, chronic laminitis, or chronic stages of bone injuries, veterinar- ians typically reach for Equioxx. It might not be potent enough to provide relief during the acute stages of pain, but as a COX-2-selective inhibitor it limits the risk of side effects and is safer long-term. Fultz emphasizes the importance of maintaining communication with your veterinarian while giving your horses prescribed NSAIDs. He or she can help monitor for complications and manage any side effects as soon as possible. When Not to Use NSAIDs "It is best to avoid NSAIDs when there is any evidence of complications or in dehydrated patients prior to rehydration," says Blikslager. Fultz agrees, adding, "Toxicity with NSAIDs is increased in animals off- feed, dehydrated, critically ill, or with pre- existing gastrointestinal disease, so veterinarians know to use caution in these cases." Due to the threats of renal papillary ne- crosis, gastric ulceration, and right dorsal colitis, it is essential to rehydrate horses that will be receiving NSAIDs. "I recommend baseline bloodwork prior to starting a treatment plan involv- ing NSAIDs," says Fultz. Otherwise, "once anything out-of-character is noted, the horses may be more (adversely) affected than if caught early with bloodwork monitoring." In older horses veterinarians have historically used nonspecific COX inhibi- tors to treat chronic conditions such as osteoarthritis. "The 'old school' way of maintaining these horses is with Bute dai- ly," says Blikslager. "However, over time, that puts them at increased risk of GI and renal complications due to the length of time they are treated. This can be avoided by using a COX-2 inhibitor." Fultz recognizes that COX-2-selective NSAIDs have been shown to cause fewer side effects, particularly on intestinal tissues, in various studies, but points out an important detail: "Despite studying effects on numerous body systems up to three months, the manufacturer does not endorse Equioxx to be used for such long periods. If it will used for a prolonged period (beyond the recommended labeled duration) it is key to have a veterinar- ian be involved to help with monitoring beneficial outcomes and risks." Report any signs of the above compli- cations in horses receiving NSAIDs to your veterinarian immediately. He or she might tell you to discontinue NSAID use and provide an alternative treatment. Take-Home Message Non-steroidal anti-inflammatory drugs serve an important role in managing equine pain and inflammation. These medications allow veterinarians and owners to provide sick or injured horses an improved quality of life. Each horse responds to NSAIDs differently, however, and because of their inherent risks, these drugs should always be used with a vet- erinarian's advice. Knowing the signs as- sociated with complications can help you recognize side effects early and address them properly. As with most medications, NSAIDs are best used in moderation. h NSAIDs: Help or Harm? It is best to avoid NSAIDs when there is any evidence of compli- cations or in dehydrat- ed patients prior to rehydration." DR. ANTHONY BLIKSLAGER CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian. EQUIOXX® (firocoxib) is indicated for the control of pain and inflammation associated with osteoarthritis in horses. Firocoxib belongs to the coxib class of non-narcotic, non- steroidal anti-inflammatory drugs (NSAID). CONTRAINDICATIONS: Horses with hypersensitivity to firocoxib should not receive EQUIOXX. WARNINGS: EQUIOXX is for use in horses only. Do not use in horses intended for human consumption. Do not use in humans. Store EQUIOXX Tablets out of the reach of dogs, children, and other pets in a secured location in order to prevent accidental ingestion or overdose. Consult a physician in case of accidental human exposure. Horses should undergo a thorough history and physical examination before initiation of NSAID therapy. Appropriate laboratory tests should be conducted to establish hematological and serum biochemical baseline data before and periodically during administration of any NSAID. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Treatment with EQUIOXX should be terminated if signs such as inappetance, colic, abnormal feces, or lethargy are observed. As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal, and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Horses that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on diuretic therapy, or those with existing renal, cardiovascular, and/ or hepatic dysfunction. The majority of patients with drug-related adverse reactions recover when the signs are recognized, drug administration is stopped, and veterinary care is initiated. Concurrent administration of potentially nephrotoxic drugs should be carefully approached or avoided. Since many NSAIDs possess the potential to produce gastrointestinal ulcerations and/or gastrointestinal perforation, concomitant use of EQUIOXX with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein bound drugs with EQUIOXX has not been studied in horses. The influence of concomitant drugs that may inhibit the metabolism of EQUIOXX has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. The safe use of EQUIOXX in horses less than one year of age, horses used for breeding, or in pregnant or lactating mares has not been evaluated. Consider appropriate washout times when switching from one NSAID to another NSAID or corticosteroid. The Safety Data Sheet (SDS) contains more detailed occupational safety information. For technical assistance, to request an SDS, or to report suspected adverse events call 1-877-217-3543. For additional information about adverse event reporting for animal drugs, contact FDA at 1-888-FDA-VETS, or Rev 10/2016

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