Daily Bute for older horse. Am I nuts?

[PiasaBird]

I’ve got a 26 yr old WB cross. 16.2 hands. He has mild arthritic issues. I’ve found one gram of bute keeps him happy. He gets daily turnout and is ridden a couple times/week.

I needed to refill the bute Rx which entailed vet visit + exam. Vet and asst. remarked how great horse looks. I say, “He seems great as long as he gets 1 gm bute daily.” Well, you would have thought I’d grown 3 heads by the way they looked at me. The vet recommended I start horse on equioxx for a 2 week trial.

They start telling me how they’ve had horses who ate 1 gram of bute end up at the emergency vets. And you can’t feed bute daily because it will damage liver and hind gut, etc. etc.
I like bute because it’s easy to feed, cheap and seems to work. Horse has never had a bad reaction to it. I don’t have a problem taking breaks from it. Also I can increase the bute to 2 grams if necessary.

Long story short, I thought feeding a gram of bute to an older horse was not unusual. He does not get injections or anything else beyond standard care including dental work.

Now I’m wondering if I am wrong? I’ve had horse on Previcox in the past. Bute just seems to work better for him.
I want to do what is best for him.

[SuzieQNutter]

I do know that bute can cause ulcers.

[Guilherme]

If keeps the horse comfortable and there are no adverse side effects noted then “no harm, no foul.”

Bute long term can have adverse side effects but they are not inevitable, AFAIK.

G.

[Highflyer]

It absolutely can cause kidney and liver damage. Some horses get it in low doses long term and are fine, some horses have issues right away. Equioxx/ Previcox is safer but more expensive and (IME) often less effective. Sometimes with an older horse the risk is reasonable because there aren’t great alternatives.

[poltroon]

I am taking care of a horse that is 35 years old. He’s been getting a gram of bute daily for over 10 years.

We did try switching him to Previcox once in that time. IMHO, the switch was hard on him and we didn’t see positives. We ended up switching him back.

Earlier this year he seemed to have some issues and as a desperate and experimental move, we started giving him two grams, one AM one PM. It helped instantly. After a week I tried discontinuing the AM dose and I didn’t like what I saw. We have had him on the 2 grams ever since. Vet saw him recently and we agreed this is a good permanent plan for him.

In the last month I’ve seen this horse canter and buck and look pretty joyful… this is a horse who is clearly near the end but he’s enjoying what he has at the moment, so we’re just watching him and giving him scritches even though bending his legs is getting harder and he’s not as fat and shiny as we’d like.

Your horse is 26. One of the questions might be, would the emergency vet trip even be appropriate for him at this time.

I’m not against Previcox and indeed we use that for the other older horse that’s here who is not permanently retired. No question there are some concerns for long term bute. But if you already have seen that bute works better for your horse and you I would not feel badly about staying with it, and I would say it’s possible you see an actual real difference. The majority of horses on it for the long term do OK IMHO.

That said: This is an Rx and you will need a vet to sign off on your plan. If your vet is adamant, then you may have to consider next steps.

[2tempe]

I’ve also heard bute can be hard on stomach, but I know of other horses that have been on it LONG term. I’ve been personally satisfied w/ previcox for my retired16 yr old mare who has a history of intestinal issues and hind suspensory problems.
Seems to me you have a couple options: Use the previcox per vet’s suggestion; it will give stomach a break and then you can say to vet that it doesn’t work as well if that’s true again. OR stand firm with the bute and consider adding something to help keep ulcers at bay. The higher the dose of bute, the higher the risk, obviously

I know several vets, all of them have moved to previcox for long term meds.

[IPEsq]

1gm is not a high dose. Before there was Previcox/Equioxx, it wasn’t uncommon to use Bute in this way. There are always risks of side effects; neither of these are risk free. Some horses just don’t respond well enough to Previcox. I also kind of wonder if something like 1gm bute is really any worse than 1/2 tab Previcox, which some oldsters I know get (so, 2x the approved dose). You have to remember also that Previcox/Equioxx is approved for 2 week use at a time. So, when you are talking long term maintenance of age related aches and pains, none of these anti-inflammatories are being given according to label. And so do we really know that a horse on 1/2 (or even 1/4) tab Previcox will not have problems after 10 years? I don’t think it’s been around that long yet, right?

Of course, whatever pain management you do in this case requires a vet to sign off on it to give you the Rx, so there’s that. I do think that Previcox/Equioxx has become preferred by vets for this type of use.

[joiedevie99]

Previcox is the NSAID du jour. It has somewhat lower risk of GI issues (but not none). That said, some horses don’t seem to respond to it as well as they do to bute.

Only you can decide whether the risks/benefits of long-term bute are acceptable for you and your horse. Personally, once they are retired and hit a certain age - I’m more worried about making each day good than avoiding long-term issues that may never come.

[JB]

@Guilherme

If keeps the horse comfortable and there are no adverse side effects noted then “no harm, no foul.”

Bute long term can have adverse side effects but they are not inevitable, AFAIK.

G.

@Highflyer

It absolutely can cause kidney and liver damage. Some horses get it in low doses long term and are fine, some horses have issues right away. Equioxx/ Previcox is safer but more expensive and (IME) often less effective. Sometimes with an older horse the risk is reasonable because there aren’t great alternatives.

Both of these ^^

If it’s working for this guy, then while I would get some regular blood work done to check the kidney/liver functions, I would also not blink at keeping him on that low dose.

You COULD try a dose every other day and see if that keeps him as happy - you never know. As much as necessary, as little as possible

Many, MANY horses have been on 1gm/day for years and years and lived happily until the end.

[Critter]

My old mare (28) has been on daily bute for at least 2-3 years now. We tried Previcoxx but it really didn’t have much of a benefit to her. The 1g bute makes a difference. There was even a period she was on 1g morning, and 1 g in the afternoon 3 days a week. My vet supported the fact that quality is better than quantity at this point. She kept one of her old racehorses on daily bute for a few years as well. Yes, is there risk of kidney issues and ulcers…but this mare would not be able to get up without the bute. She otherwise looks great and no signs of ulcers/issues. Not that it will stay that way…but at 28, my goal is to keep her as comfy as possible and be thankful for the time I have.

[vxf111]

@joiedevie99

Personally, once they are retired and hit a certain age - I’m more worried about making each day good than avoiding long-term issues that may never come.

This. Once they get very elderly and need a lot of NSAIDs I stop worrying about long term issues and more about how to make the days they have left comfortable

[merrygoround]

There are some veterinary schools that act as if bute is the devil incarnate. I’m so glad my vet did not graduate from there. :applause: I’ve know horses on a low dose for years. Dose varying according to weight.

As with any medication. Monitor your horse. I’ve known horses on Previcox for years, no problem. Another horse went off feed after -6 days.

[findeight]

At this point in his life, side effects from long term use should not effect your decisions if he has been tolerating the bute well and is noticeably happier on it. You might try it every other day but if he’s more comfortable on it daily, so be it, it’s his golden years.

Your vet has a conflict of interest as you are buying it thru him and bute is considerably cheaper to start with and has a much lower mark up potential.

If we were talking about a younger horse looking at many years, conversation might be different. Despite internet beliefs most don’t make it past 30 and some that do should have been allowed to go.

[buck22]

Years ago, the real Buck was on 1g per day for about 5 years for stifle arthritis. Kept him happy, until one day it wasn’t enough. He went to 2g after a significant ride or show. Eventually turned into 2g per day. When he started needing more support than that, my vet had “the talk” with me about his quality of life. He was around 26 and had been on daily bute for almost 7 years. Didn’t seem to have any side effects on him at the time, and, at that time, it wasn’t at all unusual for older horses to be getting daily bute to stay comfortable.

He was stabled with limited turnout, and in hindsight, that was part of the problem.

By coincidence, I moved across the state that summer and took him with me. Retired him to a 24/7 pasture lifestyle and he bounced right back. Didn’t need bute any longer, and we actually got to ride a bit together again. When light riding made him sore, he was fully retired.

Fast forward a few years, he has an accident, vet comes out and prescribes bute for the pain and swelling. Within 24 hours of being given 2g of bute, he had a massive ulcer flare up. Laying down, unable to eat, pale faced, I thought I was going to lose him. He’d never given any indication that he had ulcer issues in the past. All we can surmise is that the long-term use did long-term damage, and he’s just stoic enough to hide it.

Buck is still bouncing around at age 38.

Old age brings aches and pains from time to time, but he can’t have bute ever again. Previcox tears him up as well. We have major battles with seasonal diarrhea, and he lives on psyllum year round. Any pain he has has to be dealt with topically, massage, adjustment in lifestyle, etc. Even injectables like Pentosan mess him up.

If I could go back and do it over again, I would have explored every lifestyle change possible and used bute as a very last resort. I too agree with “keep 'em happy to the end” but, I never expected my horse to live this long. : ) I’m sure glad he has though.

[trubandloki]

@joiedevie99

Previcox is the NSAID du jour. It has somewhat lower risk of GI issues (but not none). That said, some horses don’t seem to respond to it as well as they do to bute.

Only you can decide whether the risks/benefits of long-term bute are acceptable for you and your horse. Personally, once they are retired and hit a certain age - I’m more worried about making each day good than avoiding long-term issues that may never come.

This!

I have a senior horse that has been on one gram of bute daily for several years now.
The vet and I discussed changing him to something else and my vet’s theory is that this is working for this horse so why try to switch to something that will cost more and might not work.

[Bluey]

We had a horse with ringbone from an injury that was on a gram of bute, before any other was available.
After a year we had to go to two grams, which was ok for another year.
Then he started going downhill and back lame and cribbing, probably from ulcers.

Remember that one of the points of the AAEP guidelines for euthanasia is if a horse has to be kept on painkillers for a fair quality of life:

https://aaep.org/horsehealth/euthana…icult-decision

Let the horse guide you what is right, for that horse.

[NancyM]

If the bute is working for him and you are satisfied that it is the best plan, it is your choice as the owner what is best for your horse. Many horses have been on maintenance bute for many years without noticeable health issues resulting. If health issues do crop up, and become a terminal problem, then the end of the horse’s life is determined, and you as the owner have accepted that fact in advance. Bute may effect some horses in an obviously negative manner, and owners with those horses must search for a different solution. Vets are there to give advice, help you make decisions for your horse, make suggestions, not make decrees. You know your own horse better than anyone else does.

[GraceLikeRain]

For those who are saying they did years of daily bute with no ill effect, did you ever scope?

[beau159]

@PiasaBird

I’ve got a 26 yr old WB cross. 16.2 hands. He has mild arthritic issues. I’ve found one gram of bute keeps him happy. He gets daily turnout and is ridden a couple times/week.

I needed to refill the bute Rx which entailed vet visit + exam. Vet and asst. remarked how great horse looks. I say, “He seems great as long as he gets 1 gm bute daily.” Well, you would have thought I’d grown 3 heads by the way they looked at me. The vet recommended I start horse on equioxx for a 2 week trial.

They start telling me how they’ve had horses who ate 1 gram of bute end up at the emergency vets. And you can’t feed bute daily because it will damage liver and hind gut, etc. etc.
I like bute because it’s easy to feed, cheap and seems to work. Horse has never had a bad reaction to it. I don’t have a problem taking breaks from it. Also I can increase the bute to 2 grams if necessary.

Long story short, I thought feeding a gram of bute to an older horse was not unusual. He does not get injections or anything else beyond standard care including dental work.

Now I’m wondering if I am wrong? I’ve had horse on Previcox in the past. Bute just seems to work better for him.
I want to do what is best for him.

For long term use, I would much rather have a horse on Equioxx than bute.

They are both non-steriodal anti-inflammatory (NSAID) medications but they are different classes. Bute is a cox-1 inhibitor (cyclo-oxigenase). COX is what produces prostagladins, which are what cause inflammation. If you stop producing of the prostgladins, then you stop inflammation. However, prostaglandins do other things in the body too, and there are “good” prostaglandins that the body needs to function.

But with Cox-1 inhibitors like Bute, it’s going to inhibit pretty much ALL prostaglandins in the body. This is why bute and other cox-1 inhibitors can cause stomach problems such as ulcers, and can also affect kidney function. It’s also stopping the “good” prostaglandins that you need to function and live.

Equioxx is a cox-2 inhibitor and is selective. It usually leaves the prostagladins alone in the stomach/gut, which is why it’s much less common to have side effects with a cox-2 inhibitor. They can still happen, but much less likely.

If I were to keep a horse on bute, I would have them scoped for ulcers and most likely have them on something to prevent ulcers. He might look great from the outside, but you never know what that bute is doing to the inside of them.

In my experience, it takes about 1 week for the Equioxx to “kick in”. It is not fast acting like bute. It needs to be given every day (or almost every day) to keep a consistent theurapeutic level in the horse. I also always give a loading dose when starting, which is three 57 mg tabs on the first day. THen one 57 tab each day after.

[poltroon]

@GraceLikeRain

For those who are saying they did years of daily bute with no ill effect, did you ever scope?

The horse I am speaking of has not been scoped. He may well have ill effects from the long term bute. But he’s 35 and having a pretty nice day.