Using Bute long term

[Ann Powell]

Using Bute

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I am thinking of changing from No Bute to Bute. Long Term. My horse has been on No Bute for over a year every alternative day. To try to ease the pain from an old injury that she got on her hock. Plus
as she is 27 years old she has arthritis ( she is a retired thoroughbred and is still very loopy). I would be interested to here of anyone that has used Bute over a long period of time and if there were many side effects.

Thanks

Ann

[Jakes Mum]

Can't help you with the bute side effects, sorry, but have you considered Danilon ?

It is an alternative to 'bute', but is safer and slightly more effective and is less likely to cause stomach ulcers and damage to the liver.

[Vicki&Milo]

A horse (actually maybe two) were on bute long time at my old RS, there didn't seem to be any ill effects but I'm afraid I would know enough about how often/much they were on to tell you much.
Vicki xx

[eventerbabe]

My pony was on and off bute for a period of about 5 and a half years. daily dosages varied from 1/2 a sachet to 3 sachets. when she was on the higher dosage, the vet was in weekly to check her just to make sure she wasn't suffering any side effects. We had no problems at the time and *touch wood* are having no problems now she's been off the bute for about 18 months.

[horsemad]

I haven't had personal experience of using Bute long term, but my vet did say that older horses don't tend to suffer as much from side-effects as younger horses.

[Big Ears]

I know of a horse who was diagnosed with navicular aged 8 and was on bute for most of the rest of his life till he was pts aged 24.

[prudence]

This is an article from 'Horse and Rider'. Hope it helps.



Phenylbutazone – 'bute is the commonly-used shortened term for it – is a potent pain-relieving, anti-pyretic (temperature reducing) and anti-inflammatory drug for horses.

There are two types of anti-inflammatory drugs, steroidal and non-steroidal, and 'bute falls into the latter category. Vets most commonly use 'bute for horses with lameness resulting from soft tissue and muscle soreness, and problems associated with bones and joints.

How does it work?

'Bute works by suppressing the body's production of prostaglandin and other inflammatory agents in the body. It can be given by intravenous injection or by mouth. Orally, it comes in powder form which is mixed in with the horse's normal feed, or in an oral paste that can be squeezed on to the tongue. If given orally, pain relief and fever reduction usually starts within one to two hours. If administered intravenously, it is effective in 20 minutes.

Why use it?

'Bute is a relatively inexpensive drug, and is well-tolerated by most horses (but see 'Watch points,' p100). It is highly effective in reducing pain in inflamed joints and tissues, and provides a comfortable, mobile life for many horses – reports of the adverse side-effect of long-term use are unfounded.

Getting the right dose

The recommended dose rates are 2.2 to 4.4mg of 'bute per kg of horse, once or twice daily. The lower end of this range equates to 1g of bute for a 500kg horse (one sachet of powdered 'bute).

Recent research (carried out by a group of vets in Oklahoma) has shown that increasing the dose rate doesn't increase the level of pain relief, but prolongs the action of the 'bute, ie it stays in the system for longer. However, they found that if the level administered is increased above the optimum dose rate, it is unlikely to produce any greater clinical improvement.

Long-term 'bute

There has been much discussion about the risks of using 'bute over a long period. However, research carried out in the US showed that previous reports on the safety risks are unfounded, as long as it is administered at the correct dose and according to instructions.

So providing a definitive diagnosis is established, there are no problems in using 'bute as a long-term painkiller or anti-inflammatory. In all cases under our care at Liphook, we carefully monitor the horse every few months. Periodically, it is better to stop or reduce the dose of 'bute to establish if the horse's condition has improved, and therefore no longer needs the drug, or deteriorated, so further investigation may be necessary.

Watch points

Care should be taken when giving 'bute to foals, small ponies, debilitated and dehydrated horses, as these equines are more likely to experience adverse side-effects. The side-effects might include gastric (stomach) ulceration, and less commonly, kidney damage, bleeding disorders and protein loss. An alternative non-steroidal anti-inflammatory drug, such as Finadyne or Arquel, could be used with small ponies, though these are more expensive.

Premature foals, septicaemic foals and foals with diarrhoea require careful monitoring, would be more likely to suffer side effects from being on 'bute, so at Liphook, we use alternative non-steroidal, anti-inflammatory drugs in these cases. If 'bute was used, some of the side effects could be reduced with the use of anti-ulcer drugs.

Occasionally, 'bute administered by injection can cause site reactions. This may occur if blood leaks back from the entry site under the skin, as it is irritating to tissue.

Buyer beware

As a good painkiller, 'bute masks underlying injuries or degenerative conditions, which is not useful if you are purchasing a horse.

At all five-stage pre-purchase vettings, unless the owner requests that a test is not taken (which should be regarded with caution), we obtain a blood sample, which is signed and witnessed by both the vendor and the purchaser. If there is a strong suspicion that the horse may have been drugged, the blood can be analysed prior to completion of the purchase. However, most commonly the blood is stored for three months and only analysed for 'bute if the horse shows signs of lameness, after the purchase.

To ensure lame horses are not used in competition, 'bute is a banned substance under FEI rules. To ensure the horse's system is clear of the drug, the manufacturers recommend the horse is taken off 'bute at least eight days prior to competition. Owners can have horses blood tested for analysis before a competition to ensure they are clear, but this is expensive.

Passports safe-guard use of 'bute

There were some concerns a few years ago that the use of 'bute would be banned by the EU, as some horses in Europe enter the human food chain. Our current understanding is that if the owner has signed the declaration that the horse is not intended for human consumption, then they can be given 'bute without the vet having to record it.

[hedgehunter]

heya.

When 1 of the horses we own went lame due to a fall, injured his suspensery tendon. We had him on bute for about a year and a half. The only side effects that the vet did tell me was that they " can " get liver damage. Abit like humans if we take to maney pain killers. But he is fine, it hasnt effected him in any way possible. :) Lots of people are butting there horses on bute for along term.

xx

[lynnholgate]

I had an old pony who was on 1/2 a sachet of Bute every day for 7 years. This kept her arthritic knee ticking over nicely. I found this to be more beneficial than my vets recommendation of 1 every other day. She lived for a very happy 35 years. I have used a product called 'Nil-Bute' with some success on another old arthritic pony. As well as having Devils Claw in it, it also has MSM. It did seem to have a beneficial effect.

LYNN

[purrrfect]

my 24yr old is on 1 bute a day coz of the arthritus in his hock. at first i wasnt sure about this but he's been on it for about 2 years now n it keeps him comfortable

[artemis]

Bute is a "nsaid" ie non steroidal anti inflamitory. Main side effect from long term use is stomach ulcers. I gave it to a horse long term some years ago with no ill effect.

[Lindsey_S]

This is an email from a friend that I kept:

All,

As most of you know I lost my beloved buckskin Durango this past June to a case of right dorsal colitis (RDC). He became ill after a trail riding accident in which he sustained a deep puncture wound to the inner thigh. The treatment for the wound was a combination of SMZ's (penicillin) and Bute 2x/day. He began to be off his feed and water on the second day of treatment, but after consulting with the vet, the feeling was that the wound was substantial enough to warrant such behavior. The third day he was still not eating or drinking - bran mash and beet pulp made apperances to try and stimulate the appetite. The fourth day he was very dehydrated and the vet was called again - the decision was to check his water consumption when I stopped at the barn after work then make decision about taking him to OSU to be looked at. The afternoon, he had eaten and drank about 2 gallons of water. We felt he had turned the corner and was going to be OK. The next morning he was turned out and happily munched on grass in the field. I tried to bring him in that afternoon, he would not come to the gate, he just stood in the field. I went to him and he was shaking and burning up with fever. The vet gave a preliminary diagnoses of RDC. We cooled him off, got an IV in him and loaded him in the trailer to go to OSU. He died 3 hours after I found him in the field, 50 miles from OSU Veterinary Hospital.

Based on the treatment outlined by my vet to the OSU veterinary staff, the preliminary cause of death was RDC brought on by acute primary NSAID toxicity.

Since he died, I have often thought about what we could have done differently to achieve a better outcome. I did a lot of research relating to his symptoms and treatment and had come across several discussions on horseadvice.com relating NSAID toxicity. After reading this article last week, I am further convinced that it was a sensitivity to NSAID's and a horrible set of circumstances that took Durango from us.

Please read this article if you have a moment and take care in the long term treatment of your horse with Bute.

Katie

Article to follow (It was too long for me to post together)

[Lindsey_S]

First half:

Bute: How Much is Too Much?
by: Marcia King
The Horse
January 2006 Article # 6408

Phenylbutazone (PBZ), commonly known as Bute, can be the horse owner's (and horse's) best friend. This popular and economical non-steroidal anti-inflammatory (NSAID) blocks pain, reduces swelling and inflammation, and lowers fever, making it an effective choice for treating injuries, infections, and musculoskeletal disorders such as laminitis, navicular disease, arthritis, and degenerative joint disease. Plus, Bute can deliver the goods for more than 24 hours.

But there is a downside: Generally a safe product when used as directed for most horses, Bute does have a narrow safety margin and, in certain individuals, can cause serious and even fatal side effects, warns Patricia Dowling, DVM, MS, Dipl. ACVIM, ACVP (pharmacology), professor of veterinary clinical pharmacology at the Western College of Veterinary Medicine (University of Saskatchewan) and director of Western Centre Canadian GFARAD (Global Food Animal Residue Avoidance Databank).

Although underlying causes of Bute sensitivity in some individuals go undetermined or undiagnosed, horses at most risk are foals, performance horses that travel, ponies, aged horses, dehydrated horses, and those with hypoproteinemia (low protein blood levels), liver or kidney disorders, or rhabdomyolysis (tying-up).

The most common side effects of Bute toxicity, Dowling says, are oral ulcers (open sores or lesions in the mouth) and right dorsal colitis (a life-threatening, ulcerative inflammatory condition of the colon). Bute toxicity can also cause ulcers or hemorrhages in the esophagus and gastrointestinal tract, diarrhea, low white blood cell count, anemia, and intestinal, kidney, and liver disease. "The kidney effects are usually clinically silent, unless you look for it with ultrasound," Dowling says. "With high doses of Bute in really dehydrated horses, you can see outright kidney failure."

The incidence of Bute toxicity is unknown, but it might be fairly common, says Rebecca S. McConnico, DVM, PhD, Dipl. ACVIM, assistant professor of equine medicine in Louisiana State University's Equine Health Studies Program. "Here at our teaching hospital, we may see one or two horses a month where there is concern that the horse is presented with signs consistent with Bute (or other NSAID) toxicity," she says. "Furthermore, there are likely many unidentified (subclinical) cases of Bute toxicity."

How Bute Works

Phenylbutazone is absorbed well from the stomach, but most of the dose of Bute remains in the blood and does not cross biological membranes well, Dowling explains. "The highest concentrations are in the liver, heart, kidney, lungs, and plasma, with low levels in normal tissues and joint fluid," she says. However, when tissues or joints are damaged, increased blood flow and the leaking of blood fluids from damaged blood vessels allow Bute levels to increase to therapeutic levels at these damaged sites.

"Phenylbutazone is converted by the liver to oxyphenbutazone (OPBZ), a metabolite with the same action as Bute, but that is removed slower from the body than Bute, so the therapeutic effect of Bute lasts for more than 24 hours," Dowling continues. "Less than 2% of the original dose of Bute is excreted in the urine as an unchanged drug, so liver function is very important in the elimination of this drug; the capacity of the liver to process Bute becomes overwhelmed at relatively low drug doses. Therefore, increasing doses of Bute can easily result in toxicity."

Bute is available in many intravenous and oral formulations (powder, paste, gel, tablets). "The injectable formulation must be given by careful intravenous injection, otherwise it causes severe tissue damage if given intramuscularly or subcutaneously," Dowling states. "Orally administered Bute is well absorbed, but the time it takes to reach peak blood levels is delayed by feeding the horse, as the Bute sticks to feed particles in the horse's gut."

Dosage varies somewhat depending on severity of pain or inflammation. "Routine lame horses (average horse weighing about 1,000 pounds or 450 kilograms) usually receive a dose of about 1 gram twice a day (2.2 mg/kg) initially over a five- to 10-day period," McConnico says. "However, it is not unusual for a horse to receive twice that daily dose. In fact, many veterinary textbooks and acceptable dosage recommendations are as high as 4.4 mg/kg twice a day, which is 4 grams a day."

While Bute is labeled for use at up to 4 grams per 1,000 pounds of body weight per day (for which many give 2 grams every 12 hours), Dowling recommends once daily dosing of 2 grams/1,000 pounds to allow as much Bute and OPBZ as possible to be eliminated before giving more. "As soon as possible, I get them on every-other-day therapy. For chronic use, I try to give it every three or four days," she says. "If the horse's condition is so painful that a higher dose would be needed, then I recommend using a different NSAID with a higher safety margin."

Bute Gone Wrong

NSAIDs like Bute reduce pain and inflammation by blocking chemicals known as prostaglandins that are released by damaged tissues. While controlling these inflammatory prostaglandins is a beneficial effect, unfortunately there are other prostaglandins that are produced by normal tissues. These "good" prostaglandins have normal housekeeping functions in the body: They regulate blood flow to the kidneys and lining of the gastrointestinal tract, and mucus production in the stomach. Toxicity from Bute and other NSAIDs occurs when these "good" prostaglandins are blocked along with the inflammatory prostaglandins.

"Bute is more toxic than other NSAIDs because most of the drug stays in the blood after administration," Dowling explains. "Therefore, it easily blocks the 'good' prostaglandins, resulting in reduced blood flow to the kidneys and GI tract and decreased mucus production in the stomach. This causes the kidney damage and the ulcers throughout the GI tract.

"Dehydration makes the toxicity problem worse," she adds. "As most of the Bute is in the bloodstream, when the horse is dehydrated, the Bute concentration will be higher. So a 'normal' dose to a dehydrated horse can be a 'toxic' dose."

The severity of gastrointestinal ulcers appears to be dose-dependent, and some horses might have an increased sensitivity to standard dosing, reports McConnico. "The incidence of right dorsal colitis subsequent to NSAID treatment is unknown, but probably occurs in varying degrees in most horses treated for longer than 48 hours (intravenous route) or 72 hours (oral route) at a dose of 8.8 mg/kg per day."

High doses of Bute can be directly toxic to the liver, and the liver damage can further decrease the horse's ability to metabolize and eliminate Bute and OPBZ, compounding the systemic toxicity.

Side effects from Bute toxicity can show up as early as a couple of days after starting therapy, or signs might not become apparent for several days to several weeks. "The onset of signs may be slow, then a sudden onset of diarrhea, weight loss, or colic may occur," McConnico says. Other clinical signs include inappetence, lethargy, and pitting edema (fluid swelling) on the underside of the abdomen. "Side effects may be long-lasting," McConnico continues. "Probably the most common long-term side effect is chronic colic due to chronic colonic ulceration, intestinal scarring (stricture formation), or adhesions."

What To Do?

If a horse shows adverse side effects after going on Bute, discontinue the Bute and consult with a veterinarian immediately. "The horse should be examined (including blood work) to determine if toxicity is a possibility," McConnico states.

Treatment will most likely include supportive care in the form of intravenous fluids with additional therapies based on how the Bute toxicity manifests itself.

"Treatment of NSAID gastrointestinal toxicity is intensive and mainly symptomatic," says Dowling. "The hypoproteinemia that results from loss of plasma proteins into the ulcerated gastrointestinal tract can be corrected with intravenous infusions of plasma. The fluid and electrolyte losses that accompany diarrhea are managed with commercially available intravenous fluids. Broad-spectrum antibiotics are indicated when there is evidence of bacterial septicemia."

"Since gastric ulceration is commonly associated with Bute toxicity, appropriate oral anti-ulcer medication is indicated," McConnico says. "The most effective medication for treatment is omeprazole (GastroGard from Merial, 4.4 mg/kg once daily). A lower dose of omeprazole has been recommended for preventative therapy."

"Surgical removal of damaged sections of stomach or the right dorsal colon may be necessary in some cases," notes Dowling. "Recovery is usually slow, and in severe cases the prognosis is guarded."

If pain management is needed, another form of analgesia such as butorphanol (an opioid) or xylazine (Rompun, a tranquilizer with some analgesic effects) will be necessary, McConnico states. More NSAIDs should not be given because, comprising the same drug class as Bute, they could irritate rather than alleviate toxicity reactions.

Dietary management is also important for recovery from Bute toxicity. Dowling recommends a diet high in alfalfa and corn oil. Studies show that the calcium content in alfalfa hays acts like a buffer and helps raise the stomach's pH (making it less acidic), while corn oil contains anti-ulcer properties.

A horse that has a Bute reaction once could have an adverse reaction again, if all the contributing factors are in place again, Dowling says. Therefore, future administration of Bute and other NSAIDs should be closely monitored in horses that have had problems with Bute.

[Lindsey_S]

Second half-

Avoid Problems

To minimize the risk of a Bute reaction, have your horse examined by a veterinarian prior to using the drug, suggests McConnico, so the normal appearance, heart rate, temperature, and breathing rate of the horse is known. Monitor the horse's attitude, appetite, manure production, and overall appearance daily when you start administration; if you notice any changes, don't delay in notifying your veterinarian. Horses treated long-term with Bute (or another NSAID) should receive a veterinary exam every seven to 14 days with blood samples drawn for albumin, total plasma protein, and renal (kidney) function, McConnico says.

Dose with the lowest effective amount and longest possible dosing interval, Dowling recommends. "The practice of giving a gram a couple of times a week to the mature horse with arthritis is fine and unlikely to cause toxicity," she says.

Always provide a well-balanced, palatable, easily digestible feed ration since nutritional support of the intestinal lining and the overall health status is critical, says McConnico. Make sure your horse has plenty of water to prevent dehydration.

Don't use Bute in situations where the horse is--or could become--dehydrated, such as during an endurance race, three-day event, long trailer ride, etc., Dowling says. "I ride endurance horses, and they always have a degree of dehydration after a race. I never use Bute after a competition."

Consider other pain relievers. "The other available NSAIDs are all less toxic than Bute and can be used judiciously when the horse has recovered," Dowling says. "Flunixin meglumine (Banamine), ketoprofen (Ketofen), and vedoprofen (Quadrisol 100, available in Canada, but not the U.S.) all stay in the bloodstream a much shorter time than Bute. However, they all accumulate at sites of inflammation, giving you effective therapy for 24 hours for musculoskeletal pain. Because there is less drug in the blood, there is less drug affecting the kidneys and GI tract. They don't accumulate to high levels because of saturation of the elimination mechanisms. The other benefit is that these drugs are all cleared faster and are less likely to result in positive drug tests--very important for someone in a 'no drug' sport."

If overdosed, these other NSAIDs can cause the same toxic reactions as Bute, but one doesn't see many problems with them in routine clinical use.

Take-Home Message

"The only reason to use Bute instead of another NSAID is that it is cheap," concludes Dowling. "Here in Canada, Bute costs 17 cents for a 1-gram tablet, while Banamine costs about $17 a dose. My horses are worth the extra expense for the extra safety margin. The only place I'd use Bute is in chronic conditions like laminitis or navicular disease, where therapy is for months or years; as long as it's low dose and every two or three days, it's very safe. But for serious pain like colic, rhabdomyolysis, etc., it's just not worth it to go cheap and use Bute instead of flunixin, ketoprofen, or vedoprofen."

Whichever NSAID you choose, make sure it is chosen with the input of your veterinarian. And to minimize the long-term effects of NSAID use, work with your veterinarian to quickly recognize and treat any toxicity problems that might arise.

Sorry, the hyperlink for the site would not work anymore...had to post the actual article. hope it helps some.

[atillathefun]

My Dads horse has one sachet of bute a day he has been going like this for about a year and will be for the rest of his life.
For me I think quality of life is better than quantity and if it makes him comfy then its worth the risk. We have seen a great imrpvement in him since he has been on it (his behaviour has got worse but thats good because thats what his like and before he went on it he was very quiet) He is 23 but thinks he is 5
Regarding side effects touchwood, fingers crossed etc etc I dont even want to write it but you know what I mean :D

[Ann Powell]

Thanks Lindsey S for the effort you put into replying about the Bute Long term/ I found the information really helpfull and I am nearly swayed to the idea of giving her a sachet of bute every other day. The only other worry is that Kelly is very hyper and dramatic. I hope that she will not start to feel so good that she injures herself again in the field.

Thanks again Ann

[Ann Powell]

Thanks Prudence for your reply, I found this information very helpfull, it has given me a better understanding of Bute. I would like to thank everyone else how took the time and effort to reply, very much appreciated.

[Ann Powell]

Lindsey, I was so sorry to read about your friends horse Durango. It seems that it was a combination of circumstances and a re-action to NSAID's.I wonder if he had ever been given Bute before his accident.

Ann