Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses.
Authors: Flood Jordan, Stewart Allison J
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses Pain management remains a cornerstone of equine practice, yet the narrow safety margin of commonly prescribed NSAIDs—particularly phenylbutazone and flunixin—demands careful consideration of their risk-benefit profile across a range of conditions from colic to lameness. Flood and Stewart's 2022 literature review synthesised current evidence on NSAID efficacy and toxicity, focusing on the three principal adverse effects: gastroduodenal ulceration, right dorsal colitis (RDC), and renal papillary necrosis, which arise primarily from excessive or prolonged dosing. Whilst conventional NSAIDs inhibit both COX-1 and COX-2 enzymes, theoretically increasing toxicity risk, COX-2 selective inhibitors such as firocoxib offer a potentially safer alternative by preserving protective gastrointestinal and renal mechanisms. For equine professionals, this review underscores the importance of using the lowest effective dose for the shortest clinically necessary duration, monitoring high-risk patients for early signs of NSAID-related complications, and considering selective COX-2 inhibitors when extended analgesia is required. Understanding the current state of diagnostic and therapeutic approaches to NSAID toxicity enables more informed clinical decision-making and improved welfare outcomes in horses requiring pain management.
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Practical Takeaways
- •Monitor horses on prolonged NSAID therapy closely for signs of gastroduodenal ulceration, colitis, and renal complications, as these are the most common serious side effects
- •Consider using COX-2 selective NSAIDs like firocoxib when long-term pain management is needed, as they may offer a safer profile than traditional NSAIDs
- •Recognize that while NSAIDs are essential for equine pain management and welfare, their narrow safety margin requires careful dosing and duration protocols
Key Findings
- •NSAIDs (phenylbutazone and flunixin) are commonly used in equine medicine for pain management but have a narrow margin of safety
- •Three main toxicities associated with excessive or prolonged NSAID usage are gastroduodenal ulceration, right dorsal colitis, and renal papillary necrosis
- •Cyclooxygenase-2 selective NSAIDs such as firocoxib are theoretically safer alternatives to non-selective NSAIDs