flunixin
{{Short description|NSAID analgesic veterinary drug}}
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| CAS_number = 38677-85-9
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Flunixin is a nonsteroidal anti-inflammatory drug (NSAID), analgesic, and antipyretic used in horses, cattle and pigs. It is often formulated as the meglumine salt. In the United States, it is regulated by the U.S. Food and Drug Administration (FDA), and may only be lawfully distributed by order of a licensed veterinarian. There are many trade names for the product.
Dosage and uses in horses
Flunixin is administered at a dose of 1.1 mg/kg.{{cite journal | vauthors = McIlwraith CW, Frisbie DD, Kawcak CE | title = Nonsteroidal Anti-Inflammatory Drugs | journal = Proc. AAEP | date = 2001 | volume = 47 | pages = 182–187 }} The full analgesic and antipyretic effects usually occur 1–2 hours following treatment, but there is often an effective analgesic effect within approximately 15 minutes. Despite its short plasma half life of 1.6–2.5 hours, effects can persist for up to 30 hours,{{cite book | vauthors = May SA, Lees P | chapter = Nonsteroidal anti-inflammatory drugs | veditors = McIlwraith CW, Trotter GW | title = Joint Disease in the Horse | location = Philadelphia | publisher = WB Saunders | date = 1996 | pages = 223–237 }} with maximal effects occurring between 2 and 16 hours. This is likely due to accumulation of the drug at inflammatory foci. Flunixin is primarily eliminated by the kidneys.{{cite journal | vauthors = Soma LR, Behrend E, Rudy J, Sweeney RW | title = Disposition and excretion of flunixin meglumine in horses | journal = American Journal of Veterinary Research | volume = 49 | issue = 11 | pages = 1894–8 | date = November 1988 | pmid = 3247913 }}
Because it targets the inflamed tissue, flunixin is mainly used for colic pain, musculoskeletal pain, and ocular pain.{{cite journal | vauthors = Foreman JH, Bergstrom BE, Golden KS, Roark JJ, Coren DS, Foreman CR, Schumacher SA | title = Dose titration of the clinical efficacy of intravenously administered flunixin meglumine in a reversible model of equine foot lameness | journal = Equine Veterinary Journal. Supplement | issue = 43 | pages = 17–20 | date = December 2012 | volume = 44 | pmid = 23447872 | doi = 10.1111/j.2042-3306.2012.00655.x | doi-access = free }}{{cite journal | vauthors = Jochle W, Moore JN, Brown J, Baker GJ, Lowe JE, Fubini S, Reeves MJ, Watkins JP, White NA | title = Comparison of detomidine, butorphanol, flunixin meglumine and xylazine in clinical cases of equine colic | journal = Equine Veterinary Journal. Supplement | issue = 7 | pages = 111–6 | date = June 1989 | volume = 21 | pmid = 9118091 | doi = 10.1111/j.2042-3306.1989.tb05668.x }}{{cite journal | vauthors = Hilton HG, Magdesian KG, Groth AD, Knych H, Stanley SD, Hollingsworth SR | title = Distribution of flunixin meglumine and firocoxib into aqueous humor of horses | journal = Journal of Veterinary Internal Medicine | volume = 25 | issue = 5 | pages = 1127–33 | date = 2011 | pmid = 21781166 | doi = 10.1111/j.1939-1676.2011.0763.x | doi-access = free }} It is also used as an antipyretic and to reduce the effects of endotoxemia.{{cite journal | vauthors = Bryant CE, Farnfield BA, Janicke HJ | title = Evaluation of the ability of carprofen and flunixin meglumine to inhibit activation of nuclear factor kappa B | journal = American Journal of Veterinary Research | volume = 64 | issue = 2 | pages = 211–5 | date = February 2003 | pmid = 12602591 | doi = 10.2460/ajvr.2003.64.211 | doi-access = free }}
Side effects and precautions
Flunixin is labeled for no more than 5 days of consecutive use and prolonged use increases the risk of toxicity. In horses, this includes gastric ulcers,{{cite journal | vauthors = Videla R, Andrews FM | title = New perspectives in equine gastric ulcer syndrome | journal = The Veterinary Clinics of North America. Equine Practice | volume = 25 | issue = 2 | pages = 283–301 | date = August 2009 | pmid = 19580940 | doi = 10.1016/j.cveq.2009.04.013 }} right dorsal colitis,{{cite journal | vauthors = McConnico RS, Morgan TW, Williams CC, Hubert JD, Moore RM | title = Pathophysiologic effects of phenylbutazone on the right dorsal colon in horses | journal = American Journal of Veterinary Research | volume = 69 | issue = 11 | pages = 1496–505 | date = November 2008 | pmid = 18980433 | doi = 10.2460/ajvr.69.11.1496 | doi-access = free }} and nephrotoxicity.{{cite journal | vauthors = Black HE | title = Renal toxicity of non-steroidal anti-inflammatory drugs | journal = Toxicologic Pathology | volume = 14 | issue = 1 | pages = 83–90 | date = 1986 | pmid = 3487106 | doi = 10.1177/019262338601400110 | s2cid = 28865193 }}
Flunixin is a prohibited substance under International Federation for Equestrian Sports rules,{{cite web|title=FEI Prohibited Substances List|date=28 October 2013 |url=http://www.fei.org/fei/cleansport/ad-h/prohibited-list|access-date=23 January 2016}} and its use is prohibited or restricted by many other equestrian organizations. At labeled dose (1.1 mg/kg) given IV, detection time was found to be 144 hours.{{cite web|title=FEI List of Detection Times|url=http://www.fei.org/system/files/FEI%20detection%20times%20lab%202015.pdf|access-date=23 January 2016}} However, drug recycling from bedding contamination by treated horses has been shown to potentially increase the clearance time.{{cite journal | vauthors = Popot MA, Garcia P, Bonnaire Y | title = Doping control in horses: housing conditions and oral recycling of flunixin by ingestion of contaminated straw | journal = Journal of Veterinary Pharmacology and Therapeutics | volume = 34 | issue = 6 | pages = 612–4 | date = December 2011 | pmid = 21995754 | doi = 10.1111/j.1365-2885.2011.01276.x }}
Administration
Flunixin may be given orally as a paste, as granules in feed, or intravenously(IV). It is strongly recommended that it not be administered intramuscularly (IM) as it is very irritating to tissue and IM administration has been associated with myonecrosis in horses,{{cite journal | vauthors = Peek SF, Semrad SD, Perkins GA | title = Clostridial myonecrosis in horses (37 cases 1985-2000) | journal = Equine Veterinary Journal | volume = 35 | issue = 1 | pages = 86–92 | date = January 2003 | pmid = 12553469 | doi = 10.2746/042516403775467513 }} so IV administration is preferred.
Administration of phenylbutazone to a horse also receiving flunixin has been shown to increase the risk of toxicity without improving analgesia.{{cite journal | vauthors = Foreman JH, Ruemmler R | title = Phenylbutazone and flunixin meglumine used singly or in combination in experimental lameness in horses | journal = Equine Veterinary Journal. Supplement | issue = 40 | pages = 12–7 | date = November 2011 | volume = 43 | pmid = 22082440 | doi = 10.1111/j.2042-3306.2011.00485.x | doi-access = free }}{{cite journal | vauthors = Reed SK, Messer NT, Tessman RK, Keegan KG | title = Effects of phenylbutazone alone or in combination with flunixin meglumine on blood protein concentrations in horses | journal = American Journal of Veterinary Research | volume = 67 | issue = 3 | pages = 398–402 | date = March 2006 | pmid = 16506899 | doi = 10.2460/ajvr.67.3.398 }} For this reason, concurrent administration with another NSAID is not recommended. Doubling the dose of flunixin produces no improvement in analgesia, while potentially increasing the risk of toxicity.
In the US, the only labeled route for flunixin administration in cattle is intravenous and pour-on. This is not the case in other countries; for example, in the UK, Allevenix is licensed for IV and intramuscular use,{{cite web|title=Allevinix 50 mg/ml solution for injection for cattle, pigs and horses|url=http://www.noahcompendium.co.uk/?id=-453339|website=NOAH Compendium|publisher=National Office of National Health|access-date=19 April 2017}} and a pour-on product also exists.{{cite web|title=Finadyne Transdermal 50 mg/ml pour-on solution for cattle|url=http://www.noahcompendium.co.uk/?id=-454763|website=NOAH Compendium|publisher=National Office of National Health|access-date=19 April 2017}}
In the US flunixin is not labelled for goat use, however, flunixin may be used in goats in an extra-label fashion under appropriate veterinary guidance. Flunixin administered subcutaneously to dairy goats may carry a milk withdraw recommendation of 36-60 hours.{{cite journal | vauthors = Smith JS, Marmulak TL, Angelos JA, Lin Z, Rowe JD, Carlson JL, Shelver WL, Lee EA, Tell LA | title = Pharmacokinetic Parameters and Estimated Milk Withdrawal Intervals for Domestic Goats (Capra Aegagrus Hircus) After Administration of Single and Multiple Intravenous and Subcutaneous Doses of Flunixin Meglumine | journal = Frontiers in Veterinary Science | volume = 7 | pages = 213 | date = 2020 | pmid = 32509803 | pmc = 7248982 | doi = 10.3389/fvets.2020.00213 | doi-access = free }} Interestingly, when given subcutaneously to goats in that study, tissue injury, such as seen in horses with intramuscular administration, was not observed.
See also
References
{{Reflist}}
External links
- [http://www.ivis.org/products/product.asp?BID=639 Flunixin meglumine] {{Webarchive|url=https://web.archive.org/web/20070927031717/http://www.ivis.org/products/product.asp?BID=639 |date=2007-09-27 }}
- [http://www.wedgewoodpharmacy.com/monographs/flunixin.asp Flunixin Meglumine For Veterinary Use]
- [http://www.norbrook.com/products/flunixin-injection/ Flunixin licensing in the UK provided by Norbrook]
{{Anti-inflammatory products}}
{{Prostanoidergics}}
Category:Nonsteroidal anti-inflammatory drugs