Proportion of nonsteroidal anti-inflammatory drug prescription in equine practice.
Authors: Duz M, Marshall J F, Parkin T D
Journal: Equine veterinary journal
Summary
# Editorial Summary: NSAID Prescription Patterns in Equine Practice Prescribing practices for equine NSAIDs vary considerably across the UK, USA and Canada, with a 2019 analysis of over 400,000 medical records revealing markedly higher usage rates in North America (42.4% in the USA and 34.2% in Canada) compared to the UK (28.6%). The researchers employed text-mining technology to extract NSAID prescription data from electronic records across 10 UK practices, 20 USA branches and 7 Canadian branches, then categorised drug selection according to clinical indication. Phenylbutazone and flunixin meglumine dominated prescribing in all three countries, though concerning discrepancies emerged: flunixin meglumine was appropriately favoured for colic cases across all regions, yet a notable proportion of colic patients received phenylbutazone despite its licensed restriction to musculoskeletal conditions; conversely, phenylbutazone remained first-line for orthopaedic disease, followed distantly by flunixin meglumine, whilst newer alternatives including meloxicam, ketoprofen and firocoxib saw minimal uptake. These findings highlight significant variations in clinical decision-making between countries and suggest that individual practitioner preference and practice-specific policies substantially influence NSAID selection, with important implications for drug licensing compliance and the underutilisation of licensed alternatives with potentially beneficial pharmacological profiles for specific conditions.
Read the full abstract on PubMed
Practical Takeaways
- •NSAID prescription patterns vary substantially by country, suggesting that individual practitioner preference and practice policy significantly influence drug choice rather than uniform evidence-based guidelines
- •Phenylbutazone and flunixin meglumine remain the default choices in equine practice; if considering alternatives, understand that adoption of other NSAIDs remains limited despite their availability
- •Off-label phenylbutazone use in colic cases occurs regularly despite licensing restrictions—discuss appropriate NSAID selection for each condition type with your veterinarian
Key Findings
- •NSAID prescription rates differ significantly between countries: USA 42.4%, Canada 34.2%, UK 28.6%
- •Phenylbutazone and flunixin meglumine dominate prescription practices across all three countries
- •Flunixin meglumine is most prescribed for colic cases, though some phenylbutazone is used despite being licensed only for musculoskeletal disease
- •Alternative NSAIDs (meloxicam, ketoprofen, firocoxib) remain rarely prescribed despite available efficacy data