Page 937 - Adams and Stashak's Lameness in Horses, 7th Edition

Principles of Therapy for Lameness 903

formulation labeled for one species to another (in other orally to provide or stimulate production of raw materi-
words, the canine formulation cannot be legally prescribed als or biochemical pathways required for normal bodily
VetBooks.ir ents nor pharmaceuticals, they are generally used in an
functions. Although these substances are neither nutri-
for horses just because it is cheaper).
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attempt to lower the dose of other drugs that are more
®
Carprofen (Zenecarp, Rimadyl )
problematic and provide medical benefits that prevent
Carprofen is a propionic acid NSAID approved in or treat disease. Included in this broad category of prod-
Europe for oral use in horses. Its mechanism of action in ucts are nutrients, dietary supplements, functional foods,
horses is still unclear; however, it is described as being a and phytochemicals (including herbs).
more effective analgesic than anti‐inflammatory agent. The FDA does not recognize nutraceuticals as foods
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Carprofen in horses was well tolerated when given at or drugs. However, based on the definition of nutraceu-
twice the oral dose for 14 consecutive days. The bene- ticals, the FDA perceives veterinary nutraceuticals as
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fit of using this NSAID in horses compared with other unapproved drugs even though they are not labeled or
available NSAIDs requires further investigation. marketed as drugs. The FDA does not regulate these
products unless they become unsafe or are associated
Vedaprofen (Quadrisol ) with labels that claim a drug use. The Center for
®
Veterinary Medicine (CVM) has allowed products to be
Vedaprofen is an arylpropionic acid NSAID with marketed as nutraceuticals provided that they do not
anti‐inflammatory, antipyretic, and analgesic properties. claim to treat, cure, or mitigate disease. Ultimately, there
Vedaprofen is approved in Europe for oral use in horses. is no requirement to prove safety or efficacy of a nutra-
It is recommended for musculoskeletal disorders and ceutical for its intended use. 12
soft tissue lesions. Side effects of this drug are those The Dietary Supplement Health and Education Act
associated with the use of NSAIDs in general. The main (DSHEA) allows manufacturers to make claims with
toxic effect is ulcer formation in the GI tract, making it regard to health, structure or function, and nutrient con-
contraindicated for use in foals under 6 months of age. tent of a nutraceutical and requires that the manufac-
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Use of this NSAID in horses compared with other avail- turer ensure that its product is safe before marketing.
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able NSAIDs requires further investigation. In general, the manufacturer must identify each dietary
ingredient contained in the product and adhere to state
licensing requirements. However, neither the DSHEA
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®
Meloxicam (Metacam )
nor FDA have set up a system to monitor manufactur-
Meloxicam is a relative COX‐2‐selective NSAID ers. There is no requirement for manufacturers to guar-
intended for the treatment of inflammatory orthopedic antee high quality and batch‐to‐batch consistency, and
problems, including chronic musculoskeletal and soft product safety is completely up to each individual man-
tissue disorders. 10,105 It is available for horses in Europe. ufacturer. In 2001, the National Animal Supplement
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Meloxicam was shown to be more effective than PBZ in Council (NASC), a nonprofit trade organization, was
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decreasing pain in an LPS synovitis model. It was also founded by animal supplement industry stakeholders to
shown to be effective in controlling swelling and lame- try to improve and standardize the industry. As part
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ness postoperatively after partial resections of fractured of this goal, the NASC developed the concept of a
splint bones compared with placebo controls. 154 “Quality Seal Program.” The idea was that the presence
Side effects seen with this drug are those routinely of the seal on a product indicates to the consumer that
associated with the use of NSAIDs. Oral doses of the company is reputable and has undergone some form
0.6 mg/kg were well tolerated when administered daily of quality control. To have a seal placed on their prod-
for 2 weeks 151 and 6 weeks, 109 but 1.8 and 3 mg/kg uct, the company must demonstrate compliance in four
demonstrated decreased protein and albumin concen- main areas to NASC investigators: a quality control
trations, GI and renal damage, or bone marrow dyscra- manual that demonstrates standard operating proce-
sia. Oral administration of three different doses (0.6, dures that are in place, an adverse event reporting sys-
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1.8, and 3 mg/kg q24) for 14 days demonstrated less tem to evaluate the ingredients within each product,
compromise to the gastric mucosa than oral administra- proper labeling guidelines, and inclusion of any warning
tion of decreasing doses of PBZ over the same time frame; and caution statements recommended by the FDA’s
however, there was no difference in ulceration between CVM for particular ingredients. A list of NASC compa-
the NSAIDs. Oral doses of 0.6 mg/kg for 3 weeks were nies that completed the quality audit can be found at
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well tolerated in 6‐week‐old foals, and interestingly, foals www.nasc.cc/members/.
demonstrated no adverse effects after 1.8 mg/kg was Nutraceuticals are often used by many owners or
administered BID for 7 days. Caution should be used trainers independent of their veterinarians. Products
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and close monitoring performed when using this drug on have become widely available in many formulations
horses treated concurrently with another NSAID, corti- including capsules, tablets, and powder, and they are
costeroid, or nephrotoxic medication. 148 incorporated within packaged feed. When using or rec-
ommending these products, documentation validating
the contents, purity, and quality control procedures
NUTRACEUTICALS should be requested from the manufacturer to examine
and understand the quality, efficacy, tolerance, and
The nutraceutical term has undergone many different safety of each individual nutraceutical. 142,159
definitions over time but is basically any substance that Several of the products in the equine market
is a food, or part of a food, that can be administered have considerable variability in purity, formulation, and