Best Practices for Choosing an NSAID

There are a plethora of non-steroidal anti-inflammatory drugs for horses. Here’s how your vet decides what to use.
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One of the most important tools in an equine practitioner’s kit is his or her collection of anti-inflammatory medications to reduce pain, swelling, fever, and lameness. Non-steroidal anti-inflammatory drugs (NSAIDs) come in many forms, but usually as intravenous or oral (paste, powder, tablet) formulations. These medications are relatively inexpensive and can be very effective within hours of administration.

Alastair Cribb, DVM, PhD, dean and professor of Pharmacology at the University of Calgary, in Alberta, reviewed NSAID options for use in horses at the 2015 American Association of Equine Practitioner’s Convention, held Dec. 5-9 in Las Vegas.

He reviewed with veterinarians how NSAIDs work primarily through blocking cyclooxygenase (COX) enzymes—in a nutshell, the process responsible for inflammatory response. There are two forms of NSAIDs:

  • Those that are nonselective and inhibit production of all prostaglandins (hormone-like products the body produces), including COX-1, which is important for maintaining health of the intestinal lining and blood flow through the kidneys; and
  • The newer selective inhibitors, including firocoxib and meloxicam, which only target inflammation-causing COX-2 prostaglandins.

General Effects of NSAIDs

Cribb listed the NSAIDs currently approved for use in horses: flunixin meglumine (Banamine), phenylbutazone (PBZ, Bute), ketoprofen, firocoxib, aspirin, and topical diclofenac cream. He added meloxicam to his discussion because while it is currently not labeled for use in horses in North America, doctors use meloxicam to treat rheumatoid arthritis and osteoarthritis in people, and veterinarians have access for off-label use “only for cases in which there is insufficient response from other approved NSAID choices,” he said

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Written by:

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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