Managing Pain

PhenylbutazoneIt is a difficult decision – you can see your horse is suffering discomfort and you want to help; as fortune would have it, the vet left quite a number of sachets of painkillers behind after his last visit, and they haven’t been finished off. With the idea of being helpful, caring and cautious,  and possibly thinking if it doesn’t help, it won’t harm, why not put them to use.

Probably the most popular painkillers for horses is Equipalazone; but this innocent sounding medication is far from innocent. This is one of the many brandnames for phenylbutazone. Here is a list of many more products that are phenylbutazone or medicines containing phenylbutazone:

  • Akrofen
    Nufarindo, Indonesia
  • Ambene
    Merckle Recordati, Germany
  • Antipyranal (veterinary use)
    Alfasan, Netherlands
  • Arthrisel (veterinary use)
    Selecta, Germany
  • Beautamav (veterinary use)
    Mavlab, Australia
  • Berlison
    Berlico Mulia Farma, Indonesia
  • Bizolin (veterinary use)
    Boehringer Ingelheim Vetmedica, United States
  • Butadion
    Gedeon Richter, Georgia; Gedeon Richter, Lithuania
  • Butalone (veterinary use)
    Apex Laboratories, Australia
  • Butapirazol
    GlaxoSmithKline, Poland
  • Butasan (veterinary use)
    Vetochas, Germany; Vetoquinol, Switzerland
  • Butasyl (Phenylbutazone and Salicylic Acid (veterinary use))
    Novartis Animal Health Australasia, Australia
  • Butatron (veterinary use)
    Cross Vetpharm Group, United States
  • Butazolidin
    Fagron, Netherlands
  • Butazolidin (veterinary use)
    Schering-Plough Animal Health, United States
  • Butazolidina
    Novartis, Brazil
  • Bute (veterinary use)
    Acme, Italy; Ranvet, Australia
  • Butequine (veterinary use)
    Bioniche Animal Health, United States
  • Butin (veterinary use)
    International Animal Health, Australia; Parnell, New Zealand
  • Companazone (veterinary use)
    Arnolds, United Kingdom
  • Deltazone (veterinary use)
    Ceva Delvet, Australia
  • Dextrarine Phénylbutazone (Phenylbutazone and Dextran)
    Sanofi-Aventis, France
  • Diflamix (Phenylbutazone and Triamcinolone (veterinary use))
    Omega Pharma France vet., France
  • Enkapyrin (Phenylbutazone and Propyphenazone)
    Kimia Farma, Indonesia
  • Equibutazone (veterinary use)
    Virbac, Australia
  • EquiBute (veterinary use)
    Fort Dodge Animale Health, United States
  • Equipalazone (veterinary use)
    Bomac, New Zealand; Dechra, United Kingdom; Dechra Veterinary Products, France; Selecta, Germany; Veterinaria, Switzerland; Vétoquinol, United States
  • Equiphen (veterinary use)
    Luitpold, United States
  • Equizone (veterinary use)
    A&G Pharmaceuticals, United States; Bomac, New Zealand
  • Esanfrix (Phenylbutazone and Methyl Salicylate)
    Farmac. Esan, Chile
  • exrheudon OPT
    Optimed, Germany
  • Fenilbutazona Andromaco
    Andromaco, Chile
  • Fenilbutazona Mintlab
    Mintlab, Chile
  • Fenilbutazonã MK
    Fiterman, Romania
  • Fenilbutazona Sanitas
    Sanitas, Chile
  • Fenilbutazonã
    Antibiotice, Romania; Gedeon Richter, Romania; Ozone Laboratories, Romania; Sintofarm, Romania
  • Fenilbutazone (veterinary use)
    Ati, Italy; Equality, Italy
  • Fenylbutazon Oba
    OBA, Denmark
  • Fenylbutazon (veterinary use)
    Dechra, Sweden; Kombivet, Netherlands; V.M.D, Belgium
  • Fenylbutazone (veterinary use)
    Virbac, South Africa
  • Hippopalazon (veterinary use)
    Aristvet, Germany
  • Inflazone
    Aspen Pharmacare, South Africa
  • Irgapan
    Dexa Medica, Indonesia
  • Irtonpyson
    Newai Chem, Taiwan
  • Kadol
    Teofarma, Italy
  • Myoton (veterinary use)
    Jurox, Australia; Jurox, New Zealand
  • Oralject (veterinary use)
    Bomac, New Zealand
  • P Butazone (veterinary use)
    Vetsearch International, Australia
  • P-Butazone (veterinary use)
    Vetsearch International, Australia
  • Phen Buta (veterinary use)
    Cross Vetpharm Group, United States
  • Phen-Pred (Phenylbutazone and Prednisolone (veterinary use))
    Stricker, Switzerland; Alvetra u. Werfft, Austria; CPPharma, Germany
  • Phenylarthrite (veterinary use)
    Bayer Animal Health, South Africa; Vétoquinol S.A., Australia
  • Phenylbutariem (veterinary use)
    Ecuphar, Germany
  • Phenylbutazon
    Gedeon Richter, Hungary
  • Phenylbutazon (veterinary use)
    Aristvet, Germany; CPPharma, Germany; Eurovet, Netherlands; Riemser Animal, Germany; Selecta, Germany
  • Phenylbutazone Molex Ayus
    Molex Ayus, Indonesia
  • Phenylbutazone with Sodium Salicylate (Phenylbutazone and Salicylic Acid (veterinary use))
    Pfizer Animal Health, Australia
  • Phenylbutazone (veterinary use)
    Ayrton Saunders, United Kingdom; Cross Vetpharm Group, United States; IVX, United States; Pegasus, United States; Sparhawk, United States; West-Ward, United States
  • Phenylbute (veterinary use)
    Caledonian Holdings, New Zealand; IVX, United States; Schering-Plough Animal Health, United States
  • Phenylzone (Phenylbutazone and Lidocaine (veterinary use))
    Ilium Veterinary Products, Australia
  • Phenylzone (veterinary use)
    Schering-Plough Animal Health, United States
  • Predni-Butadion (Phenylbutazone and Prednisolone (veterinary use))
    Streuli Vet, Switzerland
  • Pributazone (veterinary use)
    First Priority, United States
  • Pro Dynam (veterinary use)
    Dechra, United Kingdom
  • Robizone V (veterinary use)
    Fort Dodge Animale Health, United States
  • Salbute (Phenylbutazone and Salicylic Acid (veterinary use))
    Nature Vet, Australia
  • Sigma-Elmedal
    Thiemann, Ethiopia
  • Superiorbut (veterinary use)
    Superior, United States
  • Tevcodyne (veterinary use)
    IVX, United States
  • Therazone (veterinary use)
    First Priority, United States
  • Arthri Dog (Phenylbutazone and Prednisolone (veterinary use))
    Vetoquinol, France
  • Butazona Calcica
    Boehringer Ingelheim, Brazil
  • Fenilbutazona
    Neo Quimica, Brazil
  • New Skelan (Phenylbutazone and Carisoprodol)
    Medifarma, Indonesia; UAP, Indonesia
  • Ticinil Calcico
    Boehringer Ingelheim, Venezuela
  • Afibutazone (veterinary use)
    AFI, Italy
  • Ambene
    Merckle Recordati, Germany
  • Bute (veterinary use)
    Acme, Italy
  • Fenilbutazone (veterinary use)
    Intervet, Italy
  • Nabudone (Phenylbutazone and Cinchocaine (veterinary use))
    Ilium Veterinary Products, Australia
  • Nabudone (veterinary use)
    Ilium Veterinary Products, Australia
  • Phenylbutazon (veterinary use)
    Vetochas, Germany
  • Phenytoin
    Union, Taiwan
  • Ramidex (Phenylbutazone and Ramifenazone, + Dexamethasone (veterinary use))
    Ranvet, Australia

This list is by no means complete but it does give a good indication of how much of this product is floating around albeit under some fancy name or other. Not all products are available in every country but certainly most of those produced in or for your part of the world, will be. The key is always check the labels because there you will find the name phenylbutazone clearly listed – or at least a variation thereof – whenever this is a constituent. Do also be aware of the foreign variations: phenylbutazon (German), phénylbutazone (French), fenilbutazona (Spanish) or even phenylbutazonum (Latin).

But why is it so bad?

To start with, pain is not simply a symptom, it is also a warning. Pain tells the body that there is something wrong and that avoidance is possibly a good idea. By giving painkillers, this pain is removed, or reduced, and the animal will possibly cause itself yet more harm because the tolerance level for pain has been shifted.

Phenylbutazone is intended for treating musculo-skeletal syndromes such as arthritis, tendinitis and (somewhat questionably) laminitis/founder. Pain relief is as a result of treating primary and secondary inflammation, thus it is not a remedy for puncture wounds nor for stiff muscles, for instance. The key is musculo-skeletal; if there is no muscle or bone involved, then phenylbutazone is the wrong thing to be using. And yet it is prescribed by vets for all manner of problems and dealt out with relative impunity.

But phenylbutazone has yet another side. In most countries, it has been banned for use as a humane medicine – in some countries for more than forty years. The contraindications can be extremely serious – the combination with paracetalmol, for instance, can see the very rapid onset of severe, irreversible, liver damage with an almost as rapid death following. For this reason, phenylbutazone can only be prescribed by veterinary surgeons and every horse that has been treated with phenylbutazone must have it noted in its passport; this note is to ensure that the horse is not presented to an abattoir allowing its meat to end up in the human food chain.

The human contraindications are just as applicable to the horse. It is often stated the phenylbutazone is one of the safest medicines we can give to a horse but is it very  important to know exactly with what it is being combined. And for this reason alone, it is little short of lunacy to give a horse phenylbutazone unprescribed. Another reason is toxicity. Not all horses are so affected but just as with many medicines – and certainly with NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen (aspirin is also an NSAID but enjoys something of a special status because in general there are less contraindications and many more usable applications) -toxins are released into the body which can cause contraction of the capillary blood vessels. When this happens in hoofs, we are talking potential laminitis/founder; and then we are a big step in the wrong direction.

So, be sensible:

  • only give phenylbutazone to the horse for which it is prescribed;
  • only give the prescribed dose and do not experiment with higher doses;
  • if the problem has gone away and there are still packs of phenylbutazone over, give them back to the vet;
  • if you are unsure just what your vet is prescribing, ask him;
  • if you don’t want to give your horse phenylbutazone, tell your vet and refuse the medication – and don’t pay for it either.

 

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