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  Discussion on Etodolac
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Posted on Thursday, Jan 3, 2002 - 2:17 pm:

I noticed the drug etodolac in conjunction with Cox-2 inhibition, and wondered since this has been used in horses (it's referenced in one of your articles on colic surgery) and is used for arthritis in dogs if this would be safer than bute or meclofenamate for chronic arthritis treatment. I don't see it mentioned in the NSAID article, is it "experimental" or worth reading up on?
Thanks,
Melissa

Posted on Friday, Jan 4, 2002 - 12:37 pm:

Hello Melissa,
I think the cost is difficult to justify for long term use, even when compared to meclofenamate. There is very little work on dosages and behavior in the horses system.

If you are looking for what might be the next great NSAID in horses look at the dosage information in the NSAID section on naproxen.

There has been quite a hubbub over this drug at the meetings in the last 6 months and I have just uploaded an article on this medication. See Equine Medications and Nutriceuticals: Anti-inflammatories, Steroids, and Arthritis Treatment: Use of Nonsteroidal Anti-inflammatory Drugs: Naproxen.
DrO

Posted on Friday, Jan 4, 2002 - 1:21 pm:

Thank you, DrO.

Cost was actually one of the reasons I asked about it, because actually it's alot cheaper than the $2.50/g I'm paying for meclofenamate. Drugstore.com charges $115 for 180 500mg tabs, or $1.28/g. Also, it comes in higher strength tablets which would be easier to handle than the little capsules of meclo I currently fumble with.

But: naproxen is only $42 at Drugstore.com for the same amount of drug, so looks like we'll switch! btw, is naproxen a cox-2 inhibitor too?

Thanks again!
Melissa
PS - Costs assume 1g of meclo = 1g of naproxen = 1g of whatever dosage-wise. Is this actually the caes?

Posted on Friday, Jan 4, 2002 - 1:42 pm:

Thank you for the article on naproxen! I just finished reading it, and it sounds like a great thing for my horse.

Further to my question above on dosages, I notice the dosage for naproxen is 5-10g/day for a horse the size of mine (1250lb). If I'm doing the math correctly, this compares with 1-2g/day bute, or 1-2g/day meclofenamate for equivalent therapeutic effect?

Right now, I'm giving my horse 1g/day of meclofenamate, but it's not always enough to make him really comfortable, so I think 1.5 would probably be better. That's $3.75 a day.

If I'll need say 8g/day of naproxen to accomplish the same amount of pain relief, that'll cost about the same per day.

Let me know if I'm calculating dosage and cost correctly. Though it would be great to save money, the lower toxicity of the naproxen is reason enough to celebrate!

Thanks again!
Melissa

Posted on Saturday, Jan 5, 2002 - 9:24 am:

As you have found, no they are not equivalent on a mg for mg basis. I know to put a dog on the animal approved product EtoGesic is expensive and suspect for a horse it would be prohibitive in the long run. Looking at dog doses, if this is scaled up to a horse it would take 5 to 7 grams daily. However not knowing the pharmokinetics in horses perhaps you can use less? Perhaps human products are cheaper? It is always good to remember that NSAIDs in the wrong specie can be very dangerous, I know very little about etodolac in horses.

Yes your math looks right but you ought to look at the over the counter product Aleve. The bottle I have for myself would contain about 8 doses for your horse and I know I don't pay that much for it.
DrO

Posted on Saturday, Jan 5, 2002 - 10:43 am:

Oh, thank you! I completely missed the point that it's the same as Aleve. Duh!

The Aleve package says a caplet is 220mg of naproxen sodium, and also says a caplet has 20mg sodium. Does that mean there would be 200mg naproxen in each caplet? For 200 caplets at $12.99, that would be 40g of drug for $12.99, or about $.33/gram, but then we need about 8g/day so that's maybe $2.60/day. (No problem with giving him the 20mgx8=160mg sodium I assume, right?) Maybe he'll go well on less, we'll certainly look for the minimum dosage.

Also, one of the drug info sites stresses "do not crush or chew" the extended release version of the drug. So if I need to syringe it to get it into him, how do I tell what's the extended release version? The Aleve package says "All Day", but nothing about extended release. Any reason I should go back to syringing twice a day to keep the doses smaller?

It costs less than the current medication, and the caplets would be easy to grind up in the coffee grinder, and I wouldn't need a prescription, so it's a lot easier to obtain. And fewer side effects! If it's not a bitter drug, my horse will be as happy as I will be.

We'll give it a try and report back.
Melissa

Posted on Sunday, Jan 6, 2002 - 9:11 am:

No I don't think the regular product is exctnded release unless so marked. By didviding the dose twice daily any NSAID is less toxic and perhaps more effective whether it is neccesary depends on the particular drug follow the instructions given with each medication. One thing I can assure you is that naproxen is a bad tasting drug, maybe as bad as bute. Let us know how he does with it.

You ask for a final assurance that this is going to work OK. Be sure you understand where we are with this drug. Early short time studies indicate that it is less toxic than bute at recommended dosages. However, we have a lot less experience with this drug used long term than we do with bute or even meclofenamic acid. We may find there are some long term effects that the earlier testing has not shown up. Also individuals differ in there sensitivity to the different NSAIDs, I cannot say if your horse will not have some unusual reaction. I think its long term use should be reserved for when cheaper or better tested drugs are no longer controlling a disease that greatly decreases the quality of life of the horse at dosages that are considered safe or affordable. And it should be done under the approval and supervision of your attendig veterinarian.
DrO

Posted on Sunday, Jan 6, 2002 - 12:49 pm:

Thank you for the caveats. Maybe it's better to continue with the meclofenamate for a while longer, since he's doing well, and consider the naproxen as an alternative if the meclo stops being effective. It's good to know there's an alternative if/when.

On a positive note, he seems pretty comfortable on a daily dose of 1-1.5g, and is going very well for dressage. I'm optimistic we'll be able to build him back up muscle-wise, given the amount of work he seems to be up to now. We're continuing the monthly Adequan, and doing the occasional Legend shot to hopefully slow down the progression of his arthritis.

Thanks again for all of your wonderful help and information!
Melissa
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