Use of Previcox

[ponybutler]

My pushing 30 pony mare was on vet grad(?) Bio-Iso-G Cortaflex for about 15 years, after developing mild arthritis in one ankle. Unfortunately, it became unavailable in Canada last year, and after speaking with several horse folk and a few vets, my choices seemed to be a small daily dose of Bute, or 1/4 Previcox pill.

I went with the Previcox; was instructed by main vet to give 5 days on/2 days off, which didn’t seem to jibe with the official dosing instructions. So, pony has been on daily Previcox for a couple of months. I’m wondering if a should give her a med vacay, or find an anti-ulcer med to pair with the Previcox?

(In the case of an Arabian who went a bit lame at 18, it took a while to diagnose her (in the early stage), and she was okay without a joint supplement for about 7 more years in retirement. Apparently one front knee was bone on bone arthritis, and the vet said bute was the only effective med.

Nevertheless I spent tons of $ trying various new joint products as they came to market, but nothing helped. In my mares last year or two (not in noticeable pain, but getting slower), my vet advised gram of bute in a.m., omeprazole noon, and gram bute p.m. This regimen worked, but was not designed for long term use.

Back to the pony, I’m wondering how other people have treated arthritis in older equines, and see if I need to consider any tweaks or ? Thanks for any advice or comments.

[Huntin_Pony]

I have a 29-year-old pony with arthritic knees and probably other arthritis as well. She has been on 1/2 Previcox daily for a couple of years now with no problems. It definitely helps keep her mobile and she has not shown any side effects at all. YMMV.

[walkinthewalk]

1. My 26 yr old IR/Cushings horse has a twice fractured sacrum, residual founder issues, and x-rays of the RF this spring revealed Low Ringbone.

2. I only feed him Previcox as needed but “as needed” is becoming more frequent. He also sees a vet/chiropractor monthly.

A chiro may be something to consider for your horse as dealing with arthritis makes them compensate in ways that can throw them out of alignment.

3. SmartEarth’s camelina oil (they are based in Canada) has worked miracles for this horse, in that it does wonders to help eliminate inflammation.

To reiterate because some people reading this will misinterpret —— Camelina oil helps to greatly reduce inflammation —- It does NOT get rid of the arthritis. But reducing inflammation reduces pain level and stress.

4. Succeed helps him with fore and hind gut issues. It’s a U.S. product, I recently put him back on it, more or less permanently —— it’s not cheap but nothing is that works:(

I don’t know how shipping is between the two countries since Covid is still an issue.

5. Cosequin ASU+ (Plus) also helps him.

I hope this is helpful. It is really tough watching them fight these horrid diseases- especially when they greet you every morning with nicker, ears forward, seeming to say “it’s ok, I can do this today”.

[McGurk]

I don’t think Previcoxx causes stomach issues in the same way other NSAIDS like bute do, and I have never heard of a dosing schedule that included days off.

I don’t remember the exact dosing schedule I was given for starting Previcoxx; but you start with a larger dose and then taper down to 1/4 pill a day. Also, is you stop the dose for any length of time, you have to start back with the loading dose.

I have had two senior citizens on Previcox, and the difference in the overall soundness and happiness is pronounced.

[beowulf]

Some vets advise 5 days on 2 days off, others suggest a few weeks to a month on, with a week or so off. Some others suggest 6 months on, 1 month off. It depends on vet and region. The reason for this is because one of Previcox’s side effects can be liver and/or kidney damage. I understand this is not followed in every region, but the best practice is running liver/kidney values first before Previcox administration and to do followups - I do them every fall.

There are still ulcer concerns with Previcox, as with any NSAID. It’s my NSAID of choice for maintenance in arthritic horses, though. Like others said, it helped manage comfort in a few geriatric horses who otherwise were stiff without it. I always try to pair it with full access to hay 24/7 (of course, one of them is toothless - ugh) to offset any stomach irritation, and 24/7 turnout for the oldies because the ‘motion is the lotion’ as the saying goes…

[lenapesadie]

I have an oldie with a semi truck load of health issues. As per my vet, I dose him with Bute as needed. At one point he was on 2 grams a day for almost two weeks. Out of concern for his tummy, I give him a dose of Purina’s Outlast with the Bute and at subsequent intervals as I am able to. He has 24/7 access to hay or grass (and most of his hay is alfalfa).

I’m not sure if Outlast is available in Canada, but if so you might check it out. It’s available in 40 lbs sacks (as pellets) and in treats. I’ve used both. It’s pretty affordable (relatively speaking). I have been pleased to note that my horse has not developed any signs of ulcers. I would not hesitate to use it on another horse in a similar situation (or any situation where my goal was to prevent ulcers from starting).

Please note this is a sample size of one and YMMV.

[cayuse]

My vet also suggest a day or two off the Previcox each week. I’ve had three aged ponies on it with varying success. It’s has not been a “magic bullet” for me and I sometimes wonder if ponies metabolize it a bit differently. One pony responds MUCH better to aspirin but vet doesn’t want him on it because of the ulcer possibilty.
I have had great results with Conquer HA joint supplement and use it on my minis. Makes a HUGE difference for them.

[JB]

@ponybutler

my choices seemed to be a small daily dose of Bute, or 1/4 Previcox pill.

I say this a lot but it’s important for those who don’t know:

Previcox pills come in 227mg and 57mg doses. Comments of “1/4 of a pill” are referring to the 227mg pill, to get a 57mg-ish dose. 227/4 is a bit less than 57mg, and it doesn’t necessarily split evenly.

Someone shouldn’t take their dog’s 57mg pill and split that into 1/4ths

@ponybutler

was instructed by main vet to give 5 days on/2 days off, which didn’t seem to jibe with the official dosing instructions.

NSAID use is very situational. Technically, the official dosing instructions also say not to use more than 14 days. It’s very common to use bute or firocoxib on a less than 7 day schedule, whether that’s 4 on 1 off, 5/2, a full dose once a day or divided into 2 1/2 doses (the latter often works better, keeping a more steady plasma level).

@ponybutler

I’m wondering if a should give her a med vacay, or find an anti-ulcer med to pair with the Previcox?

I would see how many days you can keep her off, and cycle that way. You’ll “mess up” and go a day too long at first, but then you’ll know that you can go 2 days but not 3, or it needs to be 4 on 1 off, or something. That’s the art side of this.

I don’t think it’s been studied with firocoxib, but it has been studied with bute, and using omeprazole with bute to help protect the stomach can actually backfire and cause hind gut issues. I REALLY wish we could still get ranitidine, though I’m not sure if it can still be compounded

You might have success with something like GUT-X

[Calvincrowe]

The large warmblood I board has multiple limb issues resulting in arthritis and general pain. He’s on one 57mg pill per day, and has been for nearly a year. I have seen no gut issues. Vet monitors his health. He is also on one Prascend for Cushings daily. There really does seem to be a lot of variety in dosing Previcox, much like dosing of NSAIDS in humans. I’d listen to my vet.

[IPEsq]

Previcox / Equioxx has a long half life compared to the other NSAIDs too so you reach peak serum concentration after a few days (how many depends on if you do a loading dose or not). Which means a day or two off won’t be enough to totally clear the drug. But I think the dosing that was studied was 2 or 3 weeks (?) and then off. So this is where some dosing recommendations vary. But at week 2 you have the same concentration of the drug in the body as you would at month 2, and it seems to be relatively safe for most, so that is why some vets prescribe it for continuous use for horses with chronic conditions. Benefit seems to outweigh the risks.

Certainly if you can get by using a bit less then that would reduce the potential risks further. The tricky part with the regime may be keeping track of the days.

[theresak]

My vet said it has a 36 hour half life, so they say minimum of 4 days off if you are coming up on an event where you need to switch to another NSAID. If you are trying to give the kidneys a rest, my vet recommends a week off every month. I don’t follow that protocol anymore and keep my horse on it full time but we do run kidney numbers once a year.

[McGurk]

Thanks for that info, beowulf.

[sascha]

@McGurk

I don’t think Previcoxx causes stomach issues in the same way other NSAIDS like bute do

I (and I know at least a few other CotHers would agree) have a horse who would beg to differ. It does take longer though. With Banamine and bute I need to start dosing Sucralfate immediately. With Previcox I have a 2 week window before mine will go off her feed and need Sucralfate. So, if I’m treating for something acute that’s likely to resolve quickly, I can get away with no belly meds. If it’s going to go on much past a week, I start dosing Sucralfate within the 2nd week.

That said, there are loads of people who have had the exact experience the literature tells them they will have - no gut issues at all.

[Huntin_Pony]

JB:

Thanks for the reminder about the 227mg tabs. In my case, when I said half a pill, I was referring to half a 57mg Equioxx pill. Just to clarify.

I appreciate the chance to be clear about the dosing regime that my pony is on.

[JB]

@McGurk

I don’t think Previcoxx causes stomach issues in the same way other NSAIDS like bute do,

Bute is a non-selective COX inhibitor, which means both COX-1 and COX-2 are inhibited. This can significantly degrade the stomach lining by reducing those prostaglandins.

Firocoxib is a selective COX-2 inhibitor, leaving C-1 alone. This has a significant reduction in the stomach lining degredation, but isn’t a no-risk situation. All NSAIDs have the risk of causing situations that allow ulcers to form. Some are lower risk than others.

[McGurk]

@JB and @sascha,

Thank you for relating your experiences and giving additional information. My experience =/= everyone’s experience!

My old guys also tolerate bute very well, though I never give it long term. They are also on 24/7 turnout with unlimited pasture or hay, which helps.

Any of them losing interest in feed would a definite danger signal!

@JB, thanks for the explanation about the difference in COX inhibitors.

[lenapesadie]

@McGurk

My old guys also tolerate bute very well, though I never give it long term. They are also on 24/7 turnout with unlimited pasture or hay, which helps.

My vet said he prefers Bute for horses that need help intermittently. I’m not sure if that’s bc it works more quickly or if it’s a bit stronger?

My horse tolerates his well. His weight, coat and manure quality have all continued to improve

[StormyDay]

I have two horses on it, one who is 21 and gets a full pill every day, and one who is 8 with a fusing hock who gets a pill every other day.
I give them a break from the meds whenever they get a break from riding for a few weeks. The 8 YO has had no gastrointestinal issues. The 21 YO displayed mild signs of ulcers about 2 years ago in the winter time, so I reduced the pills to every other day until the spring grass came in and the behavior stopped.

I truly think previcox is one of the best medications out there for horses. It helps with joint pain without covering up pain from other causes, and is very safe. It’s a great drug.

[Texarkana]

@lenapesadie

My vet said he prefers Bute for horses that need help intermittently. I’m not sure if that’s bc it works more quickly or if it’s a bit stronger?

Ironically, I was just having this conversation with a vet who is a fairly recent grad. She was saying the current thinking is the slightly diminished negative side effects of firocoxib aren’t worth it when the medication doesn’t provide the same level of relief/pain management.

That is the first I had heard anyone say that, so take it with a huge grain of salt.

[lenapesadie]

I’m fairly sure that lines up with what my vet said too.