Equioxx--why do vets prescribe long term instead of recommended 14 days.

[pony_baloney]

My horse started Equioxx almost two months ago and vet recommended keeping him on it from now on. He’s 32 and has severe arthritis with fused hocks. The drug was first prescribed for an injured hock.

Why are vets keeping horses on it long term instead of the recommended 14 days as stated on the bottle? Do we know of any future side effects? (Besides kidney issues) Or for some horses, it’s quality of quantity of life? Or Merial covering their *ss?

On another forum I saw it mentioned that it stays effective in their system for 36 hours. This person was giving a pill in the morning, then next day in the evening, then skipping dose next day, then restarting in the morning again. Anyone do this? Since it’s so much more expensive than Previcox, it would save quite a bit of money if it works just as well that way.

[Laurierace]

Generally speaking horses that need NSAIDS daily have nothing left to lose as the next step is euthanasia.

[Gainer]

I had my very old mare on Equioxx daily for more than 5 years. We started when it first came on the market, in paste form. It was a game changer for her.

She never had any issues or side effects from it.

I believe she was one of the first horses to go on it long term. We had a lot of discussions with the drug company about its long-term use. The only reason they said 14 days at that time was because they hadn’t done testing for long-term use.

I have another elderly gelding that’s been on Equioxx/Previcox for almost 10 years now with no issues.

It’s definitely improved the quality of life for several of my old horses. I just wish it wasn’t so darn expensive!

[quietann]

@Laurierace

Generally speaking horses that need NSAIDS daily have nothing left to lose as the next step is euthanasia.

I wouldn’t say that! I know many horses who are on it long-term, and it’s basically the same as people taking Naproxen or something else daily to help with arthritic pain. Most of these horses (including mine) have been on it for years and are still being ridden.

This is not to ignore the possible side effects, and I know there are risks – but it’s been very helpful for my horse, who’s been on Previcox, or now Equioxx, daily for about 5 years.

[JB]

The Equioxx site itself says the drug stays in the system for 24 hours (not 36). That doesn’t mean all horses who need it must have it every 24 hours to be effective. There are situations where it’s not necessary to control the inflammation to that level. Many horses, for example, will get bute for 2-3 days on, then 1-2 days off, and still have their arthritis controlled (as well as it can be). So it is very conceivable that a given horse can have Equioxx every 36 hours and be perfectly managed.

Why do vets prescribe it long-term instead of 14 days? NSAIDs don’t cure arthritis. They only manage the symptoms. The reference to 14 days I found on the Equioxx site is that it’s the only NSAID approved for use for 14 successive days by the USEF and AQHA

From the label:
“The recommended dosage of EQUIOXX (firocoxib) for oral administration in horses is 0.045 mg/lb (0.1 mg/kg) of body weight once daily for up to 14 days. In target animal safety studies, toxicity was seen at the recommended dose when the duration of treatment exceeded 30 days.”

Many drugs are not studied for use long-term, and only get approved for the duration for which there were no, or some acceptable level of issues. Without searching for that 30 day toxicity issue, for all I know it could be really minor.

The 30 day comment doesn’t bother me. ALL NSAIDs have risks long-term. Firocoxib has fewer risks than bute. So if the horse needs it, firocoxib is the better choice than bute, as long as it gets the job done. Some horses have better results with bute.

[JB]

@quietann

I wouldn’t say that! I know many horses who are on it long-term, and it’s basically the same as people taking Naproxen or something else daily to help with arthritic pain. Most of these horses (including mine) have been on it for years and are still being ridden.

I think you mis-read Laurie’s post. The point of long-term NSAID use is that there isn’t much left after that, so you either use it daily/long term, or the horse either lives his days in too much pain, or you PTS. So even though the label may say “up to 14 days”, daily for the rest of the horse’s life is a common off-label use because there are no more options.

[betsyk]

There are a lot of older school horses and therapy horses that get daily previcox to stay comfortable in their jobs and safe for their riders. Sometimes you have to weigh the benefits - keeping an old guy happy and working in some form vs retirement or euthanasia. Retirement/euthanasia certainly is the right choice for some but it’s nice to have a choice to make.

[walktrot]

I’ve had my now 22 y.o gelding on it a couple of times for a soft tissue injury, 1/4 of the big dog pill every other day. He was on it for quite a while and I saw no problems with it. He doesn’t need it now and is on vitamin E as an anti-inflammatory.

There’s been tons written on this site about Previcox/Equioxx. While the manufacturer didn’t do any long-term usage studies, there is plenty anecdotal evidence in thousands of horses like mine that it can be used long-term and definitely is a better option that bute for most horses. I suspect that Merial knows precisely what has been going on with this drug. Why else would they have decided to finally market a pill approved for horses?

[quietann]

@JB

I think you mis-read Laurie’s post. The point of long-term NSAID use is that there isn’t much left after that, so you either use it daily/long term, or the horse either lives his days in too much pain, or you PTS. So even though the label may say “up to 14 days”, daily for the rest of the horse’s life is a common off-label use because there are no more options.

I think you are right; I probably skimmed it.

I do know that when my mare is retired, while I won’t do so much as I do now to keep her riding sound, she will continue to get her daily Equioxx.

[keysfins]

My senior horse gets it daily. It keeps him comfortable in work and day to day living. Most vets and pros feel that keeping a horse in work, if sound to do so, can help manage age related arthritis and any discomfort. I have seen the difference in my own horse, and have seen no ill effects. He is 24 this year.

YMMV.

[Renn_aissance]

@Laurierace

Generally speaking horses that need NSAIDS daily have nothing left to lose as the next step is euthanasia.

While I understand where you’re coming from with that, in that horses who need daily symptom management are often beyond other treatment options, I think the phrasing here is a bit extreme.

My 22-year-old horse is on a daily Previcox and has been for the past year. In that time, he had some metabolic changes, an injury, some nutritional need changes, and through it all, lousy circulation. He started on it to help with the circulation and the physical soreness that went along with reduced exercise on rehab, and stayed on it while ramping up fitness. Now that he’s doing better all over, we’re at a good place to do a trial run of a week or two without it to see how much of his current physical condition is due to good health and fitness, and how much of it is better living through chemistry. If it’s the former, he doesn’t need it. If it’s the latter, my vet and I agreed that his current activity level is doing him physical good, and that it’s worth keeping him on Previcox long-term to facilitate that rather than take him off it and reduce his exercise.

I first heard the saying “motion is lotion” on this board- Laurie, I feel like that might have been you?- and I really like it. If it’s a choice between discomfort or an NSAID to get the older horses over the physical hump to be comfortable in exercise that benefits their physical well being, after a lot of thinking about the ethics of medicating a horse so the horse can be ridden, if there are no other health contraindications, I come down on the side of facilitating an appropriate activity.

[Laurierace]

Maybe I was a little simplistic, I apologize. Bottom line to me, you do what you have to do to keep them comfortable until you can’t anymore then you let them go. And yes motion is lotion, not sure if I can take credit for that or not but definitely one of my closest held beliefs.

[pony_baloney]

Thanks everyone. I don’t know where a poster on another forum got the info about the 36 hour effectiveness; I didn’t see it anywhere on the drug’s information. My guy will probably be on it indefinitely. He’s not nearly ready to retire yet and if it makes him comfortable enough to just walk around and explore, that’s fine with me. Although he was trotting up a storm today in his paddock (WEEEEE!! I LOVE drugs!) I won’t push him. The more regular activity he gets, the better he’ll feel.

walktrot, how much vitamin E are you giving for inflammation?

[beau159]

@pony baloney

My horse started Equioxx almost two months ago and vet recommended keeping him on it from now on. He’s 32 and has severe arthritis with fused hocks. The drug was first prescribed for an injured hock.

Why are vets keeping horses on it long term instead of the recommended 14 days as stated on the bottle?

You answered your own question.

You have a 32 yo horse with severe arthritis. The horse needs pain management. Do what the horse needs.

[findeight]

We’ll, with many seniors there’s no “hump to get over”. Their advanced arthritis isn’t going away nor will the damage it’s done to the joints. My 28yo in 6th year of full retirement, gets two pills a week in summer, three in winter, eases difficulty gettting up and down plus generally improves comfort. Prior to retirement, horse was getting three a week…guessing been on it pushing 10 years, since it first started creeping into the available choices for long term pain relief. No hint of any negative side effects, doesn’t seem to be building resistance or requiring increasing dosage. Not sure you need to dose daily with it though, see a noticeable improvement every other day.

[walktrot]

Pony, I’m giving him Vitamin E with selenium from Horsetech.com which they call Selen. It’s 1250 IU per serving and natural E. They use stabilized milled flaxseed, and he also gets their Bioflax 20 for his feet. He is turning 23 soon, and the vet said he looks the best ever, and he’s been our vet since 2001.

[DressageLin]

It’s my understanding that this works similar to a cox-2 inhibitor (like celebrex), which basically need to build up in the system for best efficacy. A family member is a rheumatologist, so this is from dinner chatter about equioxx and what human drug it may be similar, too.

I have been keeping my teenage PSG horse on it every day for the last year with great results.

[JB]

Firocoxib is a COX-2 inhibitor, as opposed to bute which inhibits COX-1 and 2.

[Renn_aissance]

@findeight

We’ll, with many seniors there’s no “hump to get over”. Their advanced arthritis isn’t going away nor will the damage it’s done to the joints. My 28yo in 6th year of full retirement, gets two pills a week in summer, three in winter, eases difficulty gettting up and down plus generally improves comfort.

That general comfort is the hump I’m talking about- ease of exercise, definitely not the physical damage to the joint. My fellow has about 10-15 minutes at the start of his exercise where his body is tight and his joints are stiff. Once his body loosens up through that, he has the capacity to feel like a 10-year-old. That stiffness at start of exercise is “the hump.” If an NSAID or anti-inflammatory of other types eases the stretches and facilitates those first sticky steps of joint articulation and helps a horse who is physically capable of loose, correct, comfortable movement to get to that point of looseness, and the level of activity is appropriate to the horse’s physical condition, I am on board with it. The alternative is to sour the horse and make him afraid or resistant to his exercise because he is prepared for it to hurt. (Or, of course, to step down the exercise or retire the horse- which is where “activity appropriate to the horse’s physical condition” comes in.)

[chism]

I fully agree with what LaurieRace posted. My 23 year year old OTTB has cervical arthritis. He has been on daily Previcox (now Equiox) since the onset of his neuro symptoms about a year and a half ago. It keeps him comfortable and stable. If it was not for the Previcox, he wouldn’t be with us now. I have bloodwork done every few months to make sure there are no negative side effects…