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NSAIDS:Friend or Foe?

Non-Steroidal Anti-inflammatory Drugs are a group of drugs commonly used in both human as well as equine medicine. Drugs such as Phenylbutazone (Bute), Banamine, Ketoprofen, Carprofen, and Naproxen, have been relied upon to help our equine athletes with all types of ailments. These drugs are as the name says anti-inflammatory, but they are also analgesic (moderate or control pain) in their operation and so the list of uses is quite long. Some of the most common uses for these drugs are aids in healing orthopedic conditions, controlling colic, and controlling fevers. Just as in human medicine, veterinarians vary in the amount they use these drugs, since like many good things in life, excess can have its drawbacks. In the case of NSAIDS for horses, these drawbacks or toxicities have, due to their nature, meant that these drugs are sold as prescription only. The side effects of these compounds include gastric irritation and ulceration, colonic irritation and ulceration, and renal (kidney) toxicity. Horses vary in their ability to tolerate these drugs without the deleterious side effects, and although there are some that can take repetitive full doses of these compounds for extended periods of time, the average horse cannot. On the other end of the sensitivity spectrum there are horses that even one or two small doses of these drugs will cause toxicity and possibly even clinical signs of discomfort or pain from the toxicity. There are also some conditions that will exacerbate the toxicity issues any horse experiences. Pre-existing gastric or colonic irritation or ulceration can be especially concerning when using non-steroidal drugs, as these drugs inhibit the protective mechanisms of the stomach and colonic lining and the condition will usually worsen. Dehydrated horses or horses with pre-existing renal disease will be much more sensitive to the toxic effects of this class of drugs and special cautions should be taken to limit the dose and the number of doses administered in these situations.

So, are NSAIDS a friend or foe? The question as much of life is perspective, as an equine practitioner, working to improve the lives of horses; there is no question in my mind that these drugs are my friends. I can't imagine how frustrated I would be if I could no longer use NSAIDS in my practice. Furthermore, my patients would be limited by medical conditions that there was no other reasonable therapy for. This brings up the question of fear of using non-steroidals; no, I am not afraid of using this class of drugs. But yes, having seen the side effects and the toxicity issues, I do have a healthy respect for these drugs and try to prescribe a reasonable dose for a reasonable period of time, to effectively bring about improvement in the medical condition I am treating. In addition to moderating my dosing of these drugs, I also recommend alternatives to the drugs and or "protectants" from the toxicity issues where appropriate. Some of the common alternatives I will employ to limit use of the drugs include rest, ice therapy, massage, intra-articular injections, acupuncture, chiropractics, and injectable as well as oral joint therapy compounds. When it comes to the issue of renal toxicity and or dehydration, I will either employ re-hydration tactics prior to use of the drugs or avoid them completely. When it comes to protective strategies, I have historically used gastro-protectants such as omeprazole (Gastro-guard), ranitidine (Zantac), cimetidine (Tagmet), calcium carbonate, and magnesium and aluminum salts. The first three represent drugs that not only can treat minor symptoms, but when used properly can affect a cure to gastric ulcers. The second three compounds are used for minor conditions, or as a strategy for maintenance for a horse that has had major problems with gastric ulceration, and I want to use a product for control of the ulcers and prevention of recurrence after treatment with one of the first three products. When it comes to colonic irritation and ulceration, these drugs do not seem to help. There is another gastro-protectant drug on the market called Sucralfate, which is suspected to help with issues in the hindgut or colon, but results with this therapy have been mixed. This strategy is usually employed in hospitalized horses, or horses with a severe problem. Over the past few years my work in developing The Assure System®, and the Assure® product line has been to help with the issue of colonic irritation and ulceration, and the company's research as well as clinical case load has shown this to be an effective strategy. Most recently we have developed a product know as Assure® Guard, that combines the effectiveness of the original Assure® product with the powerful antacid calcium carbonate (found in Rolaids and Tums).