Pentosan, Legend or Adequan ???

[nhwr]

Back story;
Large, old style, 21 year old Han mare, used as a jumper til age 8 then became a dressage horse. Currently schooling 4th/PSG-ish. Not lame but has some filling in left hind from previous injury as well as stiffness in right shoulder and neck. Recently, right lead has been a little sticky to get unless I focus on setting her shoulder up perfectly. This mare has a super attitude and tries hard but ,as I keep reminding myself, she is 21.

I had the vet out for regular check up and asked if he had any recommendations for maintenance. He suggested pentosan. On different horses I have used Adequan before (good results) and Legend (no improvement).

Anyone have any results with pentosan and older horse? How does it compare to Adequan and Legend, if you have any experience with them?

Thanks.

[deltawave]

Love Pentosan. Wish it had been around when I was using Adequan (which was OK but 5x the price) on my old creaky event mare. Have never used Legend.

[katyb]

My mare that is on Pentosan is like brand new. We started in December. I’m not 100% sure that is what made the difference, but I’m sure as heck not stopping it.

[Dr_Doolittle]

[QUOTE=deltawave;6957115]
Love Pentosan. Wish it had been around when I was using Adequan (which was OK but 5x the price) on my old creaky event mare. Have never used Legend.[/QUOTE]

This ^^. AND (for some reason), Adequan is on back-order in many places??? I have used all 3 of these on my horses, and IMO Pento provides the best “bang for your buck”, and I have recommended it to ALL of my students (to the point where I feel like I should get a kickback! :-p) Good stuff, and though some vets are reluctant to prescribe it because it’s a compounded drug, the side effects are minimal, and it has been proven to be reliably effective.

Legend (HA) is a potent anti-inflammatory; I have seen it literally make windpuffs disappear–among other things–and it has a complementary effect to Adequan (or Pentosan.) I have had good results with all 3, but the Pentosan is definitely the best bargain

Good on ya for having a horse this age still in work, sound, and doing her job! I think it’s high time she had some support (I have a student with a 25 year old mare who is still riding her semi-regularly, and she looks great–but I am continually having to assure her that YES, this mare MUST have some DJD and arthritis at her age :sigh:, and am trying to, ahem, gently coax her into giving the mare some kind of injectable joint support if she is going to continue to ride her. She has paid for the ocassional Legend shot in the past–when she was competing her–but now she’s not on anything, and is stiff in the right hock.)

Good luck with your mare, I’m sure she will be greatly appreciative of your efforts to make her more comfortable!

(At 56, I only WISH that they prescribed Pentosan for humans in this country. Don’t get me started :mad:)

[deltawave]

I’m a fan, but certainly not willing to give it to a horse that is not clearly having some arthritic issues. My one mare who really does seem to benefit from it (mild hock arthritis, a big, chunky mare who does not move lightly on the earth) but am withholding it at the moment as I’m planning to breed her next month. Safety unknown in breeding animals–I’m not taking chances.

And it has a LOT of hoops to jump through before it has a snowball’s chance of being approved for humans. It is NOT completely risk free. For one thing, there is a moderate anticoagulant effect that may not be an issue in many individuals but can certainly be VERY undesirable in others.

I do hope the research is done, but I wouldn’t hold my breath.

[Laurierace]

My old guy is a new man on Pentosan. He was never lame but definitely slow to warm up in his hind end especially. It will be three years this May since the last time his hocks were injected. This was yesterday at Fair Hill. He is 25!

[Alibhai_s_Alibar]

I started my 17yo on Pentosan this spring- I’ve never used Adequan or Legend. I have not seen quite as dramatic results as some other people have seen, but I definitely feel a difference. The biggest improvement is in his lateral work- he is more willing and flexible now. I give it two thumbs up, especially for the price. Pentosan gave better results than any supplement I’ve ever tried.

[Dr_Doolittle]

[QUOTE=deltawave;6957200]
I’m a fan, but certainly not willing to give it to a horse that is not clearly having some arthritic issues. My one mare who really does seem to benefit from it (mild hock arthritis, a big, chunky mare who does not move lightly on the earth) but am withholding it at the moment as I’m planning to breed her next month. Safety unknown in breeding animals–I’m not taking chances.

And it has a LOT of hoops to jump through before it has a snowball’s chance of being approved for humans. It is NOT completely risk free. For one thing, there is a moderate anticoagulant effect that may not be an issue in many individuals but can certainly be VERY undesirable in others.

I do hope the research is done, but I wouldn’t hold my breath. :)[/QUOTE]

:sigh:

:rolleyes:

Personally I am NOT a bleeder (or on any medication, other than alcohol :lol:), so would willingly take the risk. I am on Glucosamine/Chondroiten/MSM and fish oil/Flax supplements–and I have noticed an improvement in my arthritis as a result–but it’s not as potent as an injectable would be.)

I was at the Marion Dupont-Scott center (at Morven Park) http://www.vetmed.vt.edu/emc/ with one of my students today; Dr. Adams was evaluating her mare and doing lameness diagnostics–she suddenly became “off”, and appeared stiff in the hind end about 3-4 weeks ago (looked like hocks, based on observation and the lameness eval and flexions by her usual vet a few weeks ago); at the time, I nagged the vet to give them a script for Pentosan rather than Adequan–they were reluctant to recommend it, and wanted to push the Adequan–but caved. The mare just got the 3rd shot (of a loading dose), and is markedly better, to the point where the vets were barely able to find any noticeable lameness after repeated flexions, blocks, and jogs on small circles. (I told my student that she just needed to “wait a little longer, rest the mare, and be patient”, but since mare wasn’t yet 100%, her mom wanted to get her diagnosed–the mom is going out of town for 10 days next week and is reluctant to “just leave things hanging.”)

Bottom line, x-rays were CLEAN, as was U/S (and negative to hoof testers all around), but the vet suspected mild bone inflammation; the only explanation for her being off (originally a “2” after flexions!) Next diagnostic, bone scan? VERY pricey, so we will try tincture of time, maintenance dose of Pento, and rest (she is out 24/7.)

This vet (highly respected) actually said that he “recommends that working horses in competition” go on a loading and maintenance dose of Pentosan, as a prophylactic and for soundness maintenance and joint support. (Since it first became available, this is what I have done with my own mare and what I have suggested to my students, but it’s the first time I had heard this from a vet, so I was, um, rather surprised!)

Bottom line seems to be that it can’t hurt and is likely to help, and it seems like the positives overwhelmingly outweigh the negatives (are there any negatives?) My student asked this vet about supplementing the mare with Cosequin (recommended by their regular vet), and when he raised his eyebrow, I said: “redundant?”, and he said “yes, exactly.”

[deltawave]

You may not be a bleeder, but many of my patients very definitely are. Usually my doing–my job description could very easily be described as “battling blood clots”. :lol: And guess who are on the majority of blood thinners? The same demographic that has the majority of arthritis.

I have to very politely disagree with the “can’t hurt” premise. It is not possible to say that about ANY drug, most particularly one with heparin-like properties that is being given frequently by injection.

Sorry if that warrants a :sigh: and a :rolleyes: I use it, like it very well, but would never think of it as without risk. That’s NUTS, with all due respect to your vets.

Putting on my “devil’s advocate” hat as a USER AND FAN OF PENTOSAN:

Summary Pentosan polysulphate is a low molecular weight heparinoid that is used as an anticoagulant. Because the drug also has antineoplastic properties, it has been used experimentally at the National Institutes of Health to treat metastatic malignancies. We present the case of a patient who developed thrombocytopenia resembling Type II heparin-induced thrombocytopenia (HIT) during the course of pentosan therapy. The patient’s plasma demonstrated platelet reactivity both by aggregometry and 14Cserotonin release in the presence of pentosan. Heparin and other polyanions could substitute for pentosan in aggregation studies. The aggregating activity co-purified with the patient’s IgG and was inhibited by pre-incubation with monoclonal antibody (MoAb) to the platelet Fc receptor. To elucidate the relationship between the platelet, the polyanion and the antibody, we measured the binding of 3H-heparin to platelets in the presence of the patient’s IgG and found that it was increased 6-fold over binding in the presence of control IgG. Heparin binding was not reduced by MoAb against the Fc receptor. Taken together, these data support a model in which polyanion-antibody complexes attach to the platelet surface by the polyanion and secondarily stimulate the platelet via their Fc termini.

Pentosan polysulfate sodium (Elmiron; Alza Pharmaceuticals, Mountain View, Calif) is an oral preparation of pentosan polysulfate used in the symptomatic management of interstitial cystitis. While pentosan polysulfate has a known heparin-like effect in its parenteral form, there have been no previous reports of coagulopathy with oral use. We present an interesting case of inadvertent systemic anticoagulation resulting in serious bleeding complications in a young woman taking oral pentosan polysulfate for interstitial cystitis.

Pentosan polysulfate sodium has weak anticoagulant effects. Prolonged bleeding time may occur. Pentosan polysulfate sodium should be used with caution, if at all, in patients with additional factors predisposing them to bleeding. The incidence of rectal hemorrhage in patients who were administered high doses (900 mg/day) of pentosan polysulfate sodium was more than double the incidence reported in patients taking the recommended daily dose of 300 mg/day. Bleeding complications of ecchymosis, epistaxis, and gum hemorrhage have been observed. Patients undergoing invasive procedures or having signs/symptoms of underlying coagulopathy or other increased risk of bleeding should be evaluated for hemorrhage. Patients with diseases such as aneurysms, thrombocytopenia, hemophilia, gastrointestinal ulcerations, polyps, or diverticula should be carefully evaluated before starting pentosan polysulfate sodium therapy.
A similar drug that was given subcutaneously, sublingually, or intramuscularly (and not initially metabolized by the liver) is associated with delayed immune-allergic thrombocytopenia with symptoms of thrombosis and hemorrhage. Pentosan polysulfate sodium should be used with caution in patients with a history of heparin induced thrombocytopenia.

I very definitely agree that in most cases benefit >>> risk. But to say this drug has no risks? I repeat: NUTS.

[nhwr]

Thanks for the feedback everybody.
It is hard to remember my mare’s age sometimes. She just loves her job and as long as she wants to keep doing it, I’ll support her. But I want her to be comfortable.

It’s great to see and hear about everyone’s senior citizens doing so well.

First dose of pentosan tomorrow
I’ll try to remember to follow up in a few weeks.

[BoyleHeightsKid]

[QUOTE=Laurierace;6957218]
My old guy is a new man on Pentosan. He was never lame but definitely slow to warm up in his hind end especially. It will be three years this May since the last time his hocks were injected. This was yesterday at Fair Hill. He is 25![/QUOTE]

Laurie, I hope my Boy is going that well at 25! Awesome!

I’m also a fan of Pentosan. Much more bang for your buck. The biggest result I saw in Boy was his canter. No more fussing and trying to pull me out of the tack when I ask for the left lead. It’s great stuff!

[Samantha37]

I really like Pentosan. Definitely helped straighten out some lingering hind end “wonkiness” in my gimp! I can tell when it is time for his next dose and he feels like a million bucks right after a dose. AND it’s cheaper than Adequan! Woo!!

[Dr_Doolittle]

[QUOTE=deltawave;6957353]
You may not be a bleeder, but many of my patients very definitely are. Usually my doing–my job description could very easily be described as “battling blood clots”. :lol: And guess who are on the majority of blood thinners? The same demographic that has the majority of arthritis.

I have to very politely disagree with the “can’t hurt” premise. It is not possible to say that about ANY drug, most particularly one with heparin-like properties that is being given frequently by injection.

Sorry if that warrants a :sigh: and a :rolleyes: I use it, like it very well, but would never think of it as without risk. That’s NUTS, with all due respect to your vets.

Putting on my “devil’s advocate” hat as a USER AND FAN OF PENTOSAN:

I very definitely agree that in most cases benefit >>> risk. But to say this drug has no risks? I repeat: NUTS.[/QUOTE]

:lol: Yes, I can see the ironic conundrum with the arthritis and the blood thinners=the same group of patients.

I’m not on blood thinners–yet! One would think that a responsible Dr. would evaluate the individual patient BEFORE prescribing ANY drug (my elderly mother has been in and out of the hospital for the better part of a year; she is is on a myriad of meds, and my elderly father has to be her advocate and keep track of everything in a notebook, he is excruciatingly conscientious. Too often the doctors don’t pay close attention to the side-effects, the redundancy, the actual NEED for particular meds–which changes from week to week–and the possible drug interactions. Oy!)

Anyway, I would be interested in hearing about any bleeding problems experienced by horses receiving Pentosan?, since I haven’t heard of any cases–but that doesn’t mean there haven’t been problems! The vets “mention this in passing” as (the only) possible side-effect, but they seem pretty cavalier about it. Are they too cavalier?

Does the small risk outweigh the (often) significant benefit?

Of course I’m in the “does the risk outweigh the possible improvement to quality of life?” camp, since I live with a lovely variety of chronic pain issues :(, so maintaining my own “quality of life” is often a struggle. I might take a chance on something with a small risk factor if it kept me functional and hopeful.

[Dr_Doolittle]

[QUOTE=deltawave;6957353]
You may not be a bleeder, but many of my patients very definitely are. Usually my doing–my job description could very easily be described as “battling blood clots”. :lol: And guess who are on the majority of blood thinners? The same demographic that has the majority of arthritis.

I have to very politely disagree with the “can’t hurt” premise. It is not possible to say that about ANY drug, most particularly one with heparin-like properties that is being given frequently by injection.

Sorry if that warrants a :sigh: and a :rolleyes: I use it, like it very well, but would never think of it as without risk. That’s NUTS, with all due respect to your vets.

Putting on my “devil’s advocate” hat as a USER AND FAN OF PENTOSAN:

I very definitely agree that in most cases benefit >>> risk. But to say this drug has no risks? I repeat: NUTS.[/QUOTE]

:lol: Yes, I can see the ironic conundrum with the arthritis and the blood thinners=the same group of patients.

I’m not on blood thinners–yet! One would think that a responsible Dr. would evaluate the individual patient BEFORE prescribing ANY drug (my elderly mother has been in and out of the hospital for the better part of a year; she is is on a myriad of meds, and my elderly father has to be her advocate and keep track of everything in a notebook, he is excruciatingly conscientious. Too often the doctors don’t pay close attention to the side-effects, the redundancy, the actual NEED for particular meds–which changes from week to week–and the possible drug interactions. Oy!)

Anyway, I would be interested in hearing about any bleeding problems experienced by horses receiving Pentosan?, since I haven’t heard of any cases–but that doesn’t mean there haven’t been problems! The vets “mention this in passing” as (the only) possible side-effect, but they seem pretty cavalier about it. Are they too cavalier?

Does the small risk outweigh the (often) significant benefit?

Of course I’m in the “does the risk outweigh the possible improvement to quality of life?” camp, since I live with a lovely variety of chronic pain issues :(, so maintaining my own “quality of life” is often a struggle. I might take a chance on something with a small risk factor if it kept me functional and hopeful.

Best of luck to the OP, I hope the Pento helps your boy become more comfortable, and please keep us posted!

[Dr_Doolittle]

[QUOTE=deltawave;6957353]
You may not be a bleeder, but many of my patients very definitely are. Usually my doing–my job description could very easily be described as “battling blood clots”. :lol: And guess who are on the majority of blood thinners? The same demographic that has the majority of arthritis.

I have to very politely disagree with the “can’t hurt” premise. It is not possible to say that about ANY drug, most particularly one with heparin-like properties that is being given frequently by injection.

Sorry if that warrants a :sigh: and a :rolleyes: I use it, like it very well, but would never think of it as without risk. That’s NUTS, with all due respect to your vets.

Putting on my “devil’s advocate” hat as a USER AND FAN OF PENTOSAN:

I very definitely agree that in most cases benefit >>> risk. But to say this drug has no risks? I repeat: NUTS.[/QUOTE]

:lol: Yes, I can see the ironic conundrum with the arthritis and the blood thinners=the same group of patients.

I’m not on blood thinners–yet! One would think that a responsible Dr. would evaluate the individual patient BEFORE prescribing ANY drug (my elderly mother has been in and out of the hospital for the better part of a year; she is is on a myriad of meds, and my elderly father has to be her advocate and keep track of everything in a notebook, he is excruciatingly conscientious. Too often the doctors don’t pay close attention to the side-effects, the redundancy, the actual NEED for particular meds–which changes from week to week–and the possible drug interactions. Oy!)

Anyway, I would be interested in hearing about any bleeding problems experienced by horses receiving Pentosan?, since I haven’t heard of any cases–but that doesn’t mean there haven’t been problems! The vets “mention this in passing” as (the only) possible side-effect, but they seem pretty cavalier about it. Are they too cavalier?

Does the small risk outweigh the (often) significant benefit?

Of course I’m in the “does the risk outweigh the possible improvement to quality of life?” camp, since I live with a lovely variety of chronic pain issues :(, so maintaining my own “quality of life” is often a struggle. I might take a chance on something with a small risk factor if it kept me functional and hopeful.

OP–best of luck with your horse, I hope the Pento makes her more comfortable, and extends her “working lifetime”.

[wendy]

And it has a LOT of hoops to jump through before it has a snowball’s chance of being approved for humans.

it’s already approved for use in humans- it’s sold as Elmiron, labeled for treatment of some bladder conditions.
Once something has been approved for use in humans, doctors can freely choose to prescribe it for other uses- “off label” prescribing.

I doubt the risk of bleeding from a shot once a week or so is very high; humans taking Elmiron take it orally every day, and they do have a risk of bleeding from that high, steady dosing.

Many older folks take anti-coagulants to reduce their risk of stroke/heart attacks; you’d think they’d be better off skipping the warfarin and instead taking a drug that both reduced the risk of clots AND improved their arthritis, wouldn’t you?

plus it appears to be absorbed well via the gut (at least in people) so they wouldn’t even have to get shots- just take a pill.

[Laurierace]

[QUOTE=BoyleHeightsKid;6957490]
Laurie, I hope my Boy is going that well at 25! Awesome!

I’m also a fan of Pentosan. Much more bang for your buck. The biggest result I saw in Boy was his canter. No more fussing and trying to pull me out of the tack when I ask for the left lead. It’s great stuff![/QUOTE]

Thank you! I can’t take much credit for his longevity although I do micromanage him a bit. I do that with all my horses though. I think the real secret is to keep going. He needs to be ridden every other day or so to make sure he lifts his back and uses his hind end. If we give him more than a week off he is very hard to get going again. I adopted him 9 years ago and was hoping I would get three years of use from him. I don’t know how long it will last but I sure am enjoying the ride!

[deltawave]

Yes, correct, I meant approved for parenteral use in human arthritis. We use drugs off label all the time, but nobody I know would make this kind of a leap.

Many older folks take anti-coagulants to reduce their risk of stroke/heart attacks; you’d think they’d be better off skipping the warfarin and instead taking a drug that both reduced the risk of clots AND improved their arthritis, wouldn’t you?

You’d think, but you’d better be pretty darn certain. :).

plus it appears to be absorbed well via the gut (at least in people) so they wouldn’t even have to get shots- just take a pill.

If only “you’d think” and “it appears” are enough to make decisions.

Are they too cavalier?

Ever heard of a doctor being “not cavalier enough”?

[SuckerForHorses]

What is the average/typical/usual cost of pentosan, and is there a loading dose?

I’m considering it for my mare who has hock arthritis, and wanted to get an idea of my “start up” costs, so to speak!

[nhwr]

$60/dose given IV, no farm call thankfully.
Loading protocol 1 dose/week x 4weeks. Once a month after that.

Vet mentioned that there may be some benefit to giving a dose immediately before a demanding performance situation because it seems to increase red cell PCV.
Which leads me to another question;

Any restrictions for competition while using it?
(Yes I know I can look it up and I will if we are headed for the competition ring. Just wondering )

Laurierace, if I can keep my mare going like your handsome fellow, I’ll be happy indeed.