Common Equine Medications Common Equine Medications and Their Effectsand Their Effects

Matt Kornatowski, DVMMatt Kornatowski, DVM

My PerspectiveMy Perspective

• Many questions about drugs

• Misconceptions

• Reasons for choosing

certain drugs

• Safety for you and your horse

OutlineOutline

• Sedatives• NSAIDs

(Non-steroidal Anti-inflammatories)

• Antibiotics• Gastroprotectants

• Topicals• Miscellaneous

Talking PointsTalking Points

• Appearance

• Uses

• Administration routes

• Side Effects

Non-Talking PointsNon-Talking Points

• Doses• Steroids (Too much)• Reproduction drugs

– Dr. Stanford’s talks

• Dewormers– A whole different talk!

• Supplements • Controlled drugs

AbbreviationsAbbreviations

• PO = Per Os = Orally

• IV = Intravascularly

• IM = Intramuscularly

• PR = Per rectum = enough said

SedativesSedatives

• Acepromazine

• Detomidine

• Romifidine

• Xylazine

• Use caution!

AcepromazineAcepromazine(Ace)(Ace)

• Affects dopamine receptors• Light yellow appearance

Oral tablets/paste• Used for mild calming effect

– Not strong analgesic/sedative

• Given PO, IM, IV• Lasts 3-4 hrs• Side effects: Sedation, ataxia, hypotension,

– persistent penile prolapse (paraphimosis)

DetomidineDetomidine(Dormosedan, Dorm)(Dormosedan, Dorm)

• Alpha 2 agonist• Clear in appearance• Used for heavy sedation, mild

analgesia– Dentals, wound repair, etc

• Given IM, IV• Lasts 45 min – 1 hr• Side effects: Ataxia, swaying, diuresis

– Occasional hyperresponsiveness– Rarely recumbency

• Reversal agents

RomifidineRomifidine(Sedivet)(Sedivet)

• Alpha 2 agonist• Clear in appearance• Used for moderate sedation

– Wound repairs, oral exams

• Given IM, IV• Lasts 1 – 1 ½ hrs• Side effects: Ataxia, sweating

– Rarely facial edema

XylazineXylazine(Rompun)(Rompun)

• Alpha 2 agonist

• Clear in color, shortest acting

• Used for mild sedation, mild analgesia

• Given IM, IV

• Lasts app. 30 min

• Effects: Sedation, mild analgesia– Occasional hyper-responsiveness

NSAIDsNSAIDs(Non-Steroidal Anti-Inflammatories)(Non-Steroidal Anti-Inflammatories)

• Phenylbutazone

• Banamine

• Firocoxib

• Aspirin

• Piroxicam

• Meloxicam

NSAIDsNSAIDs(Non-Steroidal Anti-Inflammatories)(Non-Steroidal Anti-Inflammatories)

PhenylbutazonePhenylbutazone(Bute)(Bute)

• Large white tablets, white paste, flavored powder• Used for musculoskeletal pain

– Mild anti-pyretic effect• Given PO, IV• Lasts 12-24 hrs• Side effects: GI ulceration (high dose)

– Renal papillary necrosis (dehydration)– Bone marrow suppression (anemia)

• Long term use– IM injections cause tissue necrosis (death)– Use caution in pregnant mares

• “Bute Babies”

Flunixin MeglumineFlunixin Meglumine(Banamine)(Banamine)

• White paste, clear liquid

• Used for GI pain, fever reduction

• Given PO, IV, (IM??)

• Lasts 12 hrs

• Side effects: GI ulceration – Renal ischemia (papillary necrosis)

AND….

Clostridial MyositisClostridial MyositisResult of IM injections

AspirinAspirin

• White powder

• Used for hypercoagulable states, Equine Recurrent Uveitis

• Given PO

• Side Effects: Same as above (less common), platelet inhibition,

tinnitus (overdose)

FirocoxibFirocoxib(Equioxx, Previcox)(Equioxx, Previcox)

• Cox 2 specific

• Used for musculoskeletal pain

• Given PO

• Lasts 24 hrs

• Side effects: Less common but similar to other NSAIDS– GI ulceration, renal injury, oral erosions

PiroxicamPiroxicam

• Cox 1

• Used for Squamous Cell Carcinoma

• Given PO, IV (less common)

• Side effects: Same as above

Meloxicam (Metacam)Meloxicam (Metacam)

• Cox 2 specific, considered quite safe

• Used in Europe

• Coming soon??

AntibioticsAntibiotics

• SMZs• Penicillin G• Gentamicin• Ceftiofur• Doxycycline• Metronidazole• Enrofloxacin• Chloramphenicol

ResistanceResistance

• When a microorganism has

the ability of withstanding the

effects of antibiotics– Genetic mutation within the

bacteria

• Due to overuse or improper use – underdosing

• Multi-drug resistant superbugs– MRSA (Methicillin Resistant Staph. Aureus)

SMZsSMZs

• Trimethaprim Sulfadiazine (Veterinary)– SMZs, Uniprim, Tucoprim

• Trimethoprim Sulfamethoxazole (Human)– Tribrissen

• 160 mg Trimethoprim• 800 mg Sulfa• Main difference:

– Urine concentration– Metabolization

SMZsSMZs

• Paste, powder, white tablets

• Given PO, IV (Rare)

• Used for variety of infections– Mainly skin, uterine, urinary

• Side effects: Colitis,

Anemia (long term)

Penicillin GPenicillin G

• “G” = Gold Standard• White liquid• Limited spectrum of activity• Used commonly for

Staphylococcus/Streptococcus- Skin, “strangles”

• Given IM only!– Other forms of penicillin can be given IV

• Side effects: Soft tissue reaction, Allergic reaction, anemia (long term use)

GentamicinGentamicin(Gentocin)(Gentocin)

• Clear liquid, ophthalmic

ointment• Synergistic with penicillin

– Gentomicin is poor against

Streptococcus

• Given IV, IM, Ocular• Side effects: Nephrotoxic (Kidneys)

– Rare ototoxicity (ears)– Neurotoxicity

CeftiofurCeftiofur(Naxcel, Excede)(Naxcel, Excede)

• White powder reconstituted

to yellow liquid• Excede is brown, thick liquid• Used for respiratory infections,

internal disease, surgery• Given IV, IM (Excede IM ONLY)• Side effects: Colitis & anemia (high doses)

DoxycyclineDoxycycline

• Small, orange tablets

• Used for various issues– Penetrates tissues very well

• Given PO– Oxytetracycline given IV

• Side effects: Congenital malformations

• GI disruption• Relatively safe

MetronidazoleMetronidazole(Flagyl)(Flagyl)

• Oblong white tablets

• Used for diarrhea, thrush,

canker (anaerobic infections)

• Given PO, PR, topically

• Side effects:– Neurotoxicity (rare)– Disruption of GI protozoa

EnrofloxacinEnrofloxacin(Baytril)(Baytril)

• Liquid or oral paste • Used for variety of infections

– Less resistance

• Given PO, IV• Side effects: Colitis

NeurotoxicityTissue irritation (Oral lesions) Cartilage damage in young

ChloramphenicolChloramphenicol

• Yellow pills, oral liquid, eye ointment• Used for variety of infections

– “Big gun” antibiotic

• Given PO, IV, Ocular• Side effects: Diarrhea, inappetance

bone marrow suppression

Relatively safe• Aplastic anemia in humans

– Wear gloves!

GastroprotectantsGastroprotectants

• Gastrogard

• Ulcergard

• Ranitidine

OmeprazoleOmeprazole(Gastrogard/Ulcergard)(Gastrogard/Ulcergard)

• Oral, white paste• Treat/prevent

gastric ulcers• Proton pump inhibitor

– Decreases acid secretion

• Given PO• Side Effects:

– No adverse effects listed

RanitidineRanitidine(Zantac)(Zantac)

• Small, circular yellow or white tablets

• Treat gastric ulcers

• Inhibits H2 receptors– Decreases acid secretion

• Given PO, IV

• Side effects: Very rare

TopicalsTopicals

• Triple Antibiotic Ointment

• Silver Sulfadiazine

• Furazone

• Surpass

• DMSO

Triple Antibiotic OintmentTriple Antibiotic Ointment(Neomycin, Polymyxin, Bacitracin)(Neomycin, Polymyxin, Bacitracin)

• Clear gel comprised of 3 antibiotics

• Topical antibiotic

• Used for variety of issues– Eye ulcers (Ophthalmic),

wounds, mild to moderate

skin infections

• Side effects: Contact dermatitis

Silver SulfadiazineSilver Sulfadiazine(SSD)(SSD)

• Thick, white cream

• Anti-bacterial, anti-fungal

• Used for burns, eye ulcers,

wounds

• Side Effects: Skin irritation

NitrofurazoneNitrofurazone(Furazone)(Furazone)

• Yellow gel– Can be mixed with DMSO

• Antibacterial

• Good for burns, skin infections– Scratches

• Side effects:– Contact dermatitis– Renal impairment

Diclofenac Diclofenac (Surpass)(Surpass)

• White gel

• Topical NSAID (Non-specific Cox 1 & 2)

• Control of joint pain & inflammation

• Side effects: – Well tolerated– Dermatitis (Let dry)– Possible weight loss,

gastric ulcers, diarrhea

DMSODMSO((DDi-i-MMethyl ethyl SSulf-ulf-OOxide)xide)

• Clear gel• “Topical application to reduce

acute swelling due to trauma”– Used in many other ways

• Topical carrier agent– Some anti-inflammatory

properties

• Side effects: “Burning” (erythema)– Garlic odor– Relatively safe– Teratogenic properties in humans (Gloves!)

Miscellaneus MedsMiscellaneus Meds

• Pergolide

• Isoxsuprine

• Marquis

PergolidePergolide

• Dopamine agonist– Decreases release of

certain proteins

• Used to treat

Cushing’s Disease

• Side effects: Few (Well tolerated)– In humans: Neuroses (hallucinations),

nausea, vomiting, rhinitis

IsoxsuprineIsoxsuprine

• White tablets

• Used for laminitis & navicular– Dilates blood vessels– Questionable efficacy

• Given PO

• Side effects: Unlikely– Tachycardia, hypotension – Hyperexcitability

PonazurilPonazuril(Marquis)(Marquis)

• Paste formulation• EPM treatment ONLY

– Equine Protozoal Myelitis– Anti-protozoal– Affects organelle specific to

protozoa!

• Given PO• Side effects:

– At 10x the dose, some soft manure– Very safe!

Key PointsKey Points

• Sedatives – Ataxia, sweating, urination

• NSAIDs– Gastric ulcers, kidney problems

• Antibiotics– Resistance– Potentially cause colitis

• Call your vet before administering any drugs!

Questions?Questions?