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  Discussion on Equioxx/ previcox dosage - help!
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Member:
rosieint

Posted on Tuesday, Jul 8, 2014 - 6:53 pm:

Hello,

I would be so grateful for some advice. My horse is 21 and has severe low and high ringbone in his left foreleg. Otherwise he is healthy and full of life and a really determined spirit who I love with all my life and want to help as much as possible. We have been through the wars together. Here is our history...

I bought him 6 years ago and although on flexion he was uncomfortable on his left fore this went away in exercise and he passed the vetting as it was thought his foot balance was out. After getting him home, almost immediately I knew there was a problem. He had very low grade intermident lameness and after doing X-rays and an MRI showing an old collateral ligament strain, v low grade navicular change not consistent with navicular disease, the vets thought simply the foot balance was out and the best course of action was to inject a steroid into his left fore coffin joint to make him comfortable and work on the foot balance.

Immediately after the steroid injection he was horribly lame and a week later was admitted for a coffin joint flush under general anesthetic with suspected sepsis. Although in the flushing there were no visible signs of sepsis His prognosis was guarded. Despite trying all manner of things including shock wave and adequate and box rest he never returned to being sound but was a hapoy pasture sound horse who has become my dear friend and companion.

Five years on from surgery, and what was last summer, I thought that maybe barefoot would help him and we under went that transition. He went through mild torture with long toes and thin soles and being foot sore and quite lame and after xraying and seeing severe high and low ringbone in the left foot that had surgery, the vet advised shoeing. I sought advice from the remedial hospital farrier and he was immediately more comfortable in natural balance shoes.

We have been comfortable like this since last summer in natural balance shoes and in and off 2x bute, and in the spring he looked sound in trot in 2x bute. We tried over a week to reduce the bute to 1x a day and he was not comfortable. We put back the bute to 2x a day and tried acupuncture to see if that would help. He was not tolerant to acupuncture at all.

Two weeks after trying the acupuncture and what was now a month ago and at the beginning of June, he went down hill with pain in his left fore in the severe ringbone leg. He was quite visibly horribly lame at walk. A week later and in the first week of June we took him off bute and put him on 1x previcox. It helped a little more than bute but not significantly.

Two weeks later, the last week of June we tried putting a pad on his foot and he was much less lame and the farrier came out early as his feet had grown quite quickly. The vet wanted a pad put on his foot but the farrier didn't agree it would help and after doing a leverage test found he was more comfortable with his heel raised and suspected he had tweaked a ligament and put a wedge pad on his arthritic left fore. He has put his other fore foot in a pad a he was a bit foot sore though.

The vet sadly disagreed with the farrier and thinks the arthritic foot should be in a pad. I don't know who to believe in this regard. We are seeing the farrier again on sat and he wants to reduce the wedge but us still nit keen in the pad. Gieven the farriers experience and reputation I am loathe to burn bridges with him but I can't ignore the fact he looked better in a pad and the vet recommends a pad to be out on.

A week ago, and a week post the farrier shoeing, the new shoes are not making a significant difference. We upped the previcox to 3.5 x per day with the vet advice as we are clutching at straws as to what to do to make him comfortable and quite frankly take him away from the verge if pts the thought if which is just horrific for me. The increased dose made a significant difference although he is stil lame and approx 2/10 at walk and 5/10 at trot but this is much better than he was the previous week. Another vet visited today a week after the increased dose (to give him his third injection of catrophen) and said that this level of 3.5x per day previcox is dangerous and could cause his stomach to rupture. I am trying to be quite logical and sensible about all of this although I have never cried so much or hard in my life as over all of this. I know this is a post about drug medication but I thought the full history would be helpful so you guys could help me with the below questions. Please move this thread if it is in the wrong place.

- what is a safe level of previcox to give? I read a study from me rill but wonder if there is anything new on this?;
- any other advice on shoeing for ringbone eg pad or rock n roll shoe etc; and
- also how lame a horse should be before it is unkind to keep them going? I know this is a very personal decision. It having never suffered with arthritis and knowing that humans have more meds avail I don't know how to assess his pain. He still canters and trots down the field to see friends. Still plays with friends and rears and bucks. But he points his foot whilst grazing and no longer wants to go on walks with me around the farm and I would estimate is 2-4/10 lame at walk and 5-7/10 lame at trot.

I would do anything to keep him going but I don't want to do the wrong thing by him.

Thank you in advance for your thoughts. I do hope this is not too much of a ramble!
Member:
gramsey1

Posted on Tuesday, Jul 8, 2014 - 8:43 pm:

We have been giving 1/4 pill of 227mg Previcox to our 1200 lb arthritic horse every other day for years. When we see evidence of inflammation we may increase to daily for a few days.
I suggest that if this level of treatment is not effective, perhaps the drug is not capable of producing the desired effect.
Each case must be considered, in part, as an isolated case. Our horse was, and is better barefoot.
Good Luck with your Guy
Member:
rosieint

Posted on Wednesday, Jul 9, 2014 - 4:05 am:

Thanks for sharing your experience. The drug does work slightly for my horse at 1x previcox a day but by increasing it to 3.5x per day he is significantly more comfortable. However, i am concerned whether this is a dangerous level to dose.

I have read the merill study submitted for the dug licence application and it suggests that from tests that levels as low as 2.5 x per day have had renal effects. I don't know how many of the horses in this trial were effected though and whether it was a significant number. Here Is a link to the study and the pertinent info is at page 13 onwards https://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussio n/veterinary/000142/WC500065936.pdf

It is very difficult with it access to the exact results of the trials to weigh up the risks of over dosing against the benefits of keeping a horse more comfortable when all else has been tried.

Thank you for your thoughts to all that are reading this. I really would be grateful for any replies.
Member:
mysi

Posted on Wednesday, Jul 9, 2014 - 7:02 am:

Oh I have been there. I recently lost my horse because he could no longer get up because of his very advanced ring bone. He was about 1800lbs and my vet said no more than 2-57mg tabs of previcoxx daily- EVER. It worked for a few months but stopped. I returned to bute which actually had better pain relief than the previcoxx. I only went to previcoxx because of the lesser risk factors. I think 3.5 is a lot. But I completely understand you pain and need for help. Every horses pain tolerance is so different and their response to meds are too. Moose was very stoic and the vets were shocked he was so sound considering how advanced his ringbone was. I retired him and He remained comfortable for another 7 years after that. I feel like a certain level of Lame is ok as far as being pasture sound. I don't know your situation but If he's happy and eating and walking around the pasture, I would medicate on the lowest dose possible to keep him happy. Heck, I limp from an ankle injury almost daily after being on my feet all day... But I'm ok :-)))). Best of luck to you!
Member:
rosieint

Posted on Wednesday, Jul 9, 2014 - 7:39 am:

Hey Melissa,

Thank you so much for replying to my post. I read your posts on previcox which made me cry so much yesterday to hear that you had your horse put to sleep in the end. It makes me tearful just thinking about it. I do hope that you are doing ok and that time is healing your pain.

I have exactly the same relationship with my boy in that I would do anything to take away the pain. It is breaking my heart seeing him struggle but I don't want to lose him at all or cut his life short before the "right" time, but I don't want to be selfish and hold onto him if the right thing is to let him go.

Of course it is all so subjective and some people wouldn't see their horse in pain for a day with a chronic problem as they dobn't want them to struggle or if they are not in the rosettes. I see it much more like you do in that I believe there is still quality and enjoyment in life even if you are in pain, even though it is hard to see pain in someone you love. Someone described how they wouldn't put their horse to sleep for lameness issues unless if they were a human they would be putting them in a wheel chair and on a drip. I thought that was a good way to look at it but I still am worrying that I am being too selfish.

I am so grateful for you passing on the advice you have had from your vet about dosage levels. My vet is going to have a good read of the studies for me and see if she can give any guidance on acceptable levels.
Member:
mysi

Posted on Wednesday, Jul 9, 2014 - 8:10 pm:

I still struggle on a daily and sometimes hourly basis after losing my boy. It has definitely been a devastating experience even though I knew it was time. I know it's always said, but you do know when they have had enough especially when you have that incredible bond with them. Really you see it in their eyes... That's how they tell you. It doesn't sound like your boy is there, and do not feel bad if he's gimpy if he seems happy and eats well and is otherwise healthy. I feel like if they can no longer get up or are unwilling to walk around is when you start to evaluate it. As far as the meds hurting... It seems like every horse is so different and so many tolerate them well with no ill effects. I hope you are able to find the right balance. I also feel like 24/7 turnout is idea for those aches and pains, I'm not sure of your routine but Moose always did better when he was out and about. His worse times were the heat of the summer when he stood under the fans in the barn refusing to go out and get bit by horse flies! I tried every cream, injections, IM adequan, supplements... Looking back bute and turnout were his best friends.
Member:
rosieint

Posted on Monday, Jul 14, 2014 - 9:05 am:

Update! there have been a few studies carried out which my vet read to me. They weren't large number of horses in each study which means they are not as reliable as they could be. However, the long and short of it was that a dosage of 3.5 tablet for a 550kg horse, effected the horses with some signs of lesions in the mouth and gums which my vet said was indicative that there may have been something else going on inside like the guts leaking etc. My vet said that she wouldn't be giving anymore than 2.5 tablets a day based on the effects. I have tried to find the study but for some reason I can't - sorry!

Anyway, thank goodness for some reason my horse is a lot lot better! We have cut his tablets and simultaneously he is much more comfortable - go figure! We suspect that the arthritis was not the problem and in fact it was a tweak in the field and a soft tissue problem, which combined with the arthritis was making him very sore. The farrier and vet and all the support have been unbelievable. Thank you.
Member:
rosieint

Posted on Monday, Jul 14, 2014 - 9:10 am:

Melissa, I had to write you a separate post. Your posts have really touched me. They were there for me when I was at my darkest hour, knowing that there were other people like you that had gone through what I was going through. Your advice on when to call it a day will stay with me forever and I am so grateful. I wish I could take away your pain and bring your horse back. It is so desparately sad. You sound like an incredibly kind person. I bet he had the best home a horse could have with you. I do think that is better to have loved and lost than never to have loved at all. I do wish we could keep them going forever.
Moderator:
DrO

Posted on Thursday, Jul 17, 2014 - 6:27 am:

Hello RosieP,
Somehow I missed your post last week. The questions you have on firocoxib are addressed in the article associated with this discussion area. I suspect you have read it since to post this you had to get to the bottom. You may not have seen the Search Pubmed button in the article. It will bring up the lateest research published on this drug.

Concerning your questions on Ringbone check out HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Lower Limb » Ringbone. It discusses the issues you raise on treatment and shoeing.
DrO
Member:
rosieint

Posted on Monday, Jul 21, 2014 - 9:21 am:

Thanks for the info. I had a good look on the page and couldn't see the link that you are referring to. Could you post a link here?
Moderator:
DrO

Posted on Tuesday, Jul 22, 2014 - 10:11 am:

It is under the More Information Topic at the bottom of the article and before you get to the Add a Discussion button.
DrO
Member:
paul303

Posted on Thursday, Aug 7, 2014 - 10:38 pm:

I had my QH on medication from the late 1980's until her death last year at 33 years old. We bred her for reining and foaled her in 1980. Due to the long toe low heel trimming in those days, and her bulldog build and ballerina legs and feet, we soon ran head-on into navicular. By the time she was six, she was cripple. She was pulled out of the show arena and corrective shoeing began. Her heels were lifted, her toes rolled. We stopped showing her in the early nineties. From the late eighties, she was on bute. We had good times and bad times with her all those years. In the late nineties, we moved her to an all sand...soft environment where she was very comfortable...and she got so sound and belligerent, that she bowed a tendon at 21 years old...cavorting through the sand. She also developed Cushings at that age, and we made the choice to medicate her to the point at which she would be comfortable, and to let her go when the medications got too rough, or she gave out due to other complications. When Previcox came along, we switched...to hopefully give her stomach a break. She was horrendously healthy until a heat streak in the low 100's last year. At 33, her kidneys gave out, and despite desperate treatment, we lost her. But she lived in comfort, with her drugs, until then. We made a choice, to drug her to a comfort level, and to let her go when she, or the drugs failed.
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