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Doses of Common Drugs

Author(s):

van Erck E. and

Lekeux P.

In: Equine Respiratory Diseases by Lekeux P.

Updated:

MAR 02, 2005

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Preliminary Remarks
Glossary
Antibiotics
Bronchodilators
Corticosteroids
NSAID
Mucolytic Agents
Immunomodulators
Mast Cell Stabilizing Drugs
Anthelmintics
Antifungal Agents
Others
Local Anesthetics

Important Preliminary Remarks!

The list of drugs and directions for use and dosage have been compiled on the basis of information provided in the scientific literature. As such, some drugs have not been validated according to quality, safety, and effectiveness criteria necessary for drug approval and commercialization. This list of drugs does not take into account national or community laws, regulations or policies regarding the use and commercialization of a series of substances and some drugs cited have not received legal approval (for instance, the substances listed in the annex IV of the European regulation 2377/90 EC, the use of metronidazole is forbidden in all horses according to the European directive 2004/28 EC). Local doping rules and restrictions as well as minimum withdrawal periods should also be checked.

The authors decline all responsibility in the event of an incident. The veterinary practitioner engages his full responsibility.

Treatments are listed by category of action.
Inhalation treatments generally require a metered-dose inhalant system. Aerosol delivery systems can significantly affect both topical and systemic activity of inhaled drugs: Commercially available devices adapted to the equine species are:

The Equine Aeromask tm that has a facial mask and built-in spacer: Studies have shown that with a chlorofluorocarbon (CFC) propellant, 6% of actuated drug is effectively and homogeneously distributed to the lungs, and 14% of actuated drug if an hydrofluoroalkane (HFA) propellant is used;
The Equine Aerosol Drug Delivery System (EADDS; 3M Animal Care Products, St Paul, MN, USA) is a hand-held device composed of a spacer morphologically adapted to the left nostril: 23 - 46% of the drug is uniformly distributed to the lower airway tract. The canister is encased in the device and to this day, only albuterol sulfate canisters are commercialized (Torpex® Boehringer Ingelheim, Ingelheim, Germany);
The Equine Haler (Equine Healthcare, APS, Hillerod, Denmark) is a spacer device with a nasal mask adapted to the left nostril: 8.2 ± 5.2% of actuated dose is effectively delivered uniformly to the lung.

Aerosol deposition also depends on correct patency of airways and in cases of severe airway obstruction (e.g., heaves), adequate aerosol distribution to the lower airways is compromised.

For further information, see Aerosol Therapy, P. Lekeux and D.H. Duvivier. In: Equine Respiratory Diseases, Lekeux P. (Ed.) International Veterinary Information Service, Ithaca NY (www.ivis.org), 2001; B0331.1101.

Glossary
PO = Per os (oral) administration SC = Subcutaneous administration IM = Intramuscular administration IV = Intravenous administration q24h = Administration every 24 hours (once daily) q12h = Administration every 12 hours (twice daily) q8h = Administration every 8 hours (three times daily) q6h = Administration every 6 hours (four times daily)	Puff = Delivery of one metered dose (inhalations) AHSA = American Horse Shows Association BALF = Bronchoalveolar Lavage Fluid DPI = Dry Powder Inhalation EIPH = Exercise Induced Pulmonary Hemorrhage FEI = Fédération Equestre Internationale IAD = Inflammatory Airway Disease MIC = Minimum Inhibitory Concentration

Antibiotics
Drug	Trade Name	Dose	Route	Pharmaco- kinetics	Side Effects	Comments	Ref
Penicillin Compounds
Ampicillin		6.6 mg/kg q12h	IM			Efficient against S. zooepidemicus
Ampicillin		11 mg/kg q8h	IM
Ampicillin				Well absorbed PO by neonate foals	Can alter intestinal flora
Amoxycillin		20 - 30 mg/kg	PO	Serum concentrations maintained for 5 - 6 hours	Can alter intestinal flora and induce diarrhea in foals
Amoxicillin + Clavulanate
Penicillin sodium		22 000 IU/kg q6h	IV, IM or SC		Salts can have cardio- depressant effects	Bactericidal, Gram +, Anaerobic coverage. Recommended against Streptococci(Strangles, Pneumonia)
Procaine Penicillin G		22 000 IU/kg q12h	IM or SC			Anaerobic coverage
Cephalosporins
Ceftiofur (third-generation cephalosporin)	Naxcel® (Pfizer)	2 mg/kg q24h	IM	Needs to be refrigerated when reconstituted as its loss of potency is attained after 12 hours at room temperature	Possible local reactions	Efficient against S. zooepidemicus, Pasteurella sp., Actinobacillus. Doses can be increased if bacteria have a high MIC (Pseudomonas, Klebsiella, Enterobacter)	[1, 2]
Ceftiofur (third-generation cephalosporin)	Excenel® (Pfizer)	2 mg/kg q12h in neonate foals (2-7 days old)	IM		Possible local reactions		[1, 2]
Aminoglycosides
Gentamicin		6.6 mg/kg q24h	IV	Does not cross blood/brain barrier	Nephrotoxicity		[3]
Gentamicin	Gentocin® (Schering Plough)	50 mg/ml	Nebuli- zation	12 times greater concentration in BALF with aerosol delivery than with IV administration	Mild inflammatory cell response in BALF	Bactericidal Concentration-dependent antimicrobial activity	[3]
Kanamycin		7.5 mg/kg q8h	IV or IM		More expensive than gentamicin
Amikacin		4.4 - 6.6 mg/kg q8-12h or 21 mg/kg q24h	IV or IM		Less nephrotoxic than gentamicin	Less resistance of gram- strains in comparison to gentamicin	[4, 5]
Trimethoprim-Sulfonamide	Borgal® (Intervet) Duoprim® (Schering Plough) Tribrissen® Oral Paste (Schering Plough) Tribrissen 48% (Schering-Plough) Duphatroxim® (Fort Dodge) Trisuprime® (Bayer)	12.5 - 30 mg/g q12h. Often dosed 5/1 Sulfa/trimethoprim	PO IM IV SC	Should be administered 30 minutes prior to feeding (best absorbed)	Can cause diarrhea	Bactericidal Certain strains of S. zooepidemicus are resistant
Macrolides
Erythromycin		25 mg/kg q12h Treatment duration: 4 - 6 weeks in cases of R. equi	PO		Can cause diarrhea	Used to treat Rhodococcus equi. Can be used in association with rifampin	[6]
Rifampin		3 - 5 mg/kg q12h	PO		Should not be used alone as microbial resistance can develop rapidly
Metronidazole		15 mg/kg q6 - 8h	PO		Effects on CNS (depression, circling, head tilting)	Anaerobic coverage. Cannot be used in food animals	[7]
Chloramphenicol		55 mg/kg q6h	PO	Half life is too brief to allow effective plasma concentrations when administered IV	IM injections cause pain and are contra-indicated in horses	Gram + and - anaerobic coverage. Should be manipulated with care as cases of fatal aplastic anemia have been reported in man. Cannot be used in food animals	[8, 9]
Tetracyclines
Oxytetracycline		6.6 mg/kg q12 - 24h	IV
Doxycycline		10 mg/kg q12h	PO		IV administration reported to cause fatal diarrhea		[10]
Fluoroquinolones
Enrofloxacin	Baytril® (Bayer)	2.5 - 5 mg/kg q12h	PO or IV		Reports of arthropathy and possible cartilage damage in young horses (< 4 years)	Has not been approved for use in equine species	[11, 12]
Marbofloxacin	Marbocyl® (Vetoquinol)	2 mg/kg q24h	IV, SC or PO	Concentration-dependent anti-Gram - activity Time-dependent anti-Gram + activity	~100% bioavailability by SC administration, 62% by oral administration	Should be given prior to feeding	[13]

Bronchodilators
Drug	Trade Name	Dose	Route	Pharmaco- kinetics	Side Effects	Comments	Ref
Anticholinergic Agents
Atropine		0.01 - 0.02 mg/kg single dose	IV		Bradyarrhythmias, excitement, gut stasis	Single dose induces bronchodilation within 15 mins in heavey horses	[14, 15]
Glycopyrrolate	Robinul-V®	0.007 mg/kg single dose	IV	Does not cross blood/brain barrier	Bradyarrhythmias, excitement, gut stasis
Glycopyrrolate	Robinul-V®	1 - 1.5 mg/horse q12h	inhalation	Effects on respiratory mechanics 15 minutes after inhalation. Effect lasts at least 60 minutes	None reported. Absence of tachycardia in treated horses		[16]
Ipratropium bromide	Atrovent®	100 - 360 ug q6h (5 - 18 puffs)	Inhalation		None reported	Must be delivered using a metered-dose inhalant system
		2 - 3 ug/kg	Nebulization	Effect lasts 4 - 6 hours		Dose dependent effect	[17]
		2.5 - 5 ug/kg	DPI	Onset of effect within 15 minutes		Delivered with a DPI mask	[18, 19]
Beta 2-Adrenergic Agonists
Albuterol sulfate	Torpex® (+3M device)	360 - 720 ug q 6h	Inhalation	Onset of effect: 5 minutes Effect lasts 30 minutes to 3 hours			[20, 21]
Clenbuterol	Ventipulmin® (Boehringer Ingelheim)	0.7 - 0.8 ug/kg q12h	PO	Increase dose by 25% if no response after 3 days. Maximal dose: 0.32 ug/kg	Low intensity sweating, muscle tremor, and/or nervousness at higher doses. Effects on cardiac contraction. Can cause abortion in pregnant mares.	Differences in individual response according to severity of clinical signs.	[22, 23]
Clenbuterol	Ventipulmin® (Boehringer Ingelheim)	0.7 - 0.8 ug/kg q12h	IV, IM, Nebulization		Excitement, tachycardia, sweating, muscle tremors after IV injection.	Improves mucociliary clearance	[24]
Fenoterol	Berotec®	0.9 - 2 mg	Inhalation	Rapid onset of effect (< 5 mins)		Improves respiratory mechanical parameters	[25, 26]
Terbutaline	Brethine®	2 - 4 mg (10 - 20 puffs)	Inhalation Nebulization	Low bioavailability if given PO (100 ug/kg)	Causes tachycardia, CNS stimulation, hyperventilation and lethargy after IV injection (10 ug/kg)		[27, 28]
Isoproterenol		0.1 - 0.2 mg/ horse (until heart rate doubles)	IV				[15]
Pirbuterol	Maxair®	1.2 - 2.4 ug/kg	Inhalation	Onset of effect: 5 minutes Effect lasts at least 7 hours	Causes agitation, tremors sweating and tachycardia, at doses exceeding 6 ug/kg		[29, 30]
Salmeterol	Serevent®	0.5 - 1 ug/kg	Inhalation	Onset of effect: 5 minutes Duration of effect: 6 - 8 hours Maximal effect: 30 - 60 minutes			[31]
Phosphodiesterase Inhibitors (Methylxanthine Derivatives)
Theophylline		1 - 5 mg/ kg q12h	PO	Narrow therapeutic margin	Toxic interaction with erythromycin	Causes tachycardia, increase in lactatemia and hyperoxia	[32]
Theophylline		20 mg/kg then 15 mg/kg q24h	PO	Narrow therapeutic margin	Toxic interaction with erythromycin		[33]
Aminophylline	(Soluble salt of theophylline)	9 - 15 mg/kg diluted in 1L of fluids delivered over 20 - 60 mins q12h or q8h	IV	Narrow therapeutic margin	Toxic interaction with erythromycin	Dose-related tachycardia, polypnoea and nervous symptoms (tactile, visual and auditory hypersensitivity, muscle tremor, sweating)	[15], [34- 36]
Aminophylline		5 mg/kg q12h	PO				[37]
Pentoxifylline		16 g per horse (~36 mg/kg) q12h	PO	Poor absorption by gastro-intestinal tract	None reported	14 days administration improved respiratory mechanics at day 8, but had effect on BALF cytology	[38]
Alpha 2-Adrenergic Agonist
Xylazine hydrochloride		0.5 mg/kg single dose	IV		Bronchodilating effects are offset by an increase in respiratory resistance due to upper airway relaxation	Other alpha-2 adrenergic agonists have similar effects	[39]

Corticosteroids
Drug	Trade Name	Dose	Route	Pharmaco- kinetics	Side Effects	Comments	Ref
Dexamethasone		0.08 - 0.164 mg/kg q24h	PO	50% biodisponibility when given PO. Effective within 6 hours, peak effect at 24 hours		Longer effect when given PO in comparison to IV. Feeding decreases bioavailability	[40, 41]
Dexamethasone	Azium® (Schering-Plough)	0.04 - 0.1 mg/kg q24h	IM, IV	Improvement of lung function at 2 hours (IV), with a peak effect at 4 - 6 hours. Dose should be gradually decreased to minimum necessary		Improves clinical signs, airway function and BALF cytology in heaves-affected horses in 3 - 7 days.	[41- 44]
Dexamethasone-21-isonicotinate	Voren® (Boehringer Ingelheim)	0.04 - 0.06 mg/kg, q3 days	IM	Long acting form of dexamethasone		Improves clinical signs and airway function in heaves-affected horses in 3 - 7 days. After 10 days of treatment, BALF cytology is not improved.	[41, 42]
Prednisone		1 mg/kg q12h for 1 week, decrease by 25% each week	PO	Very low biodisponibility		Ineffective for the treatment of pulmonary inflammation	[41, 42, 45- 47]
Prednisone		2.2 mg/kg q24h	PO	Well absorbed by gastro-intestinal system			[41]
Fluticasone	Flovent® (Glaxo- Wellcome)	2 - 4 ug/kg q12h or 2 mg/horse q12h	Inhalation	Serum cortisol concentrations return to pretreatment values within a 2 day wash-out period.		Must be delivered using a metered-dose inhalant system. A 21 days treatment improves clinical signs, airway function and BALF cytology in heaves-affected horses in 3 - 7 days.	[41, 48- 50]
Beclomethasone		1.32 - 5 mg/horse q12h during 7 to 14 days	Inhalation	Adrenal suppression occurs at a dose of 528 ug/horse q12h but is restored after a 2 day wash-out period.	None reported although systemic absorption occurs through respiratory and gastro-intestinal tracts.	Improvement not detected before 24 - 72 h. Less effective than PO dexamethasone. Must be delivered using a metered-dose inhalant system	[51- 54]
	Beclovent®	1 - 3 ug/kg (12 - 15 puffs) q12h	Inhalation (EADDS®)			Must be delivered using a metered-dose inhalant system	[49]
	Vanceril® (Schering-Plough)		Inhalation			Must be delivered using a metered-dose inhalant system	[41]
	Beclazone 250 inhaler®	500 ug/horse q12h	Inhalation			Treatment of SPAOD in a laminitis-prone horse. Must be delivered using a metered-dose inhalant system	[55]
Triamcinolone	Vetalog®	0.04 - 0,09 mg/kg single dose	IM	Adrenal suppression maintained after 3 weeks of administration	Laminitis	A single dose improves heaves symptoms for up to 3 weeks	[56]
Budesonide	Pulmicort®	800 ug q12h					[57]
Flunisolide						Safety and efficacy has not been evaluated in horses

Non-Steroidal Anti-Inflammatory Drugs (NSAID). Indicated for symptomatic treatment of fever and pain in diseases such as respiratory viral diseases, strangles, etc.
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Phenylbutazone		3 - 4.4 mg/kg q12 - 24h	IV, PO			Inefficient against heaves or IAD
Flunixine Meglumine	Banamine® Binixine®	1.1 mg/kg q12 - 24h	IM, PO			Inefficient against heaves or IAD
Flunixine Meglumine	Banamine® Binixine®	1.1 mg/kg q12h	IV
Ketoprofen	Ketofen® Anaphen®	2.2 mg/ kg q12h	IV, IM
Dimethyl sulfoxide (DMSO)		100 ml mixed with 200 ml glycerin and 200 ml propylene glycol	Topical			Local treatment of upper airway inflammatory conditions (pharyngitis, epiglottic ulceration,…)	[58]
Sodium hyaluronate	Hyonate® (Bayer)	40 mg/ horse, two injections at 7 days interval	IV			Decreases BALF neutrophils in horses in remission from RAO. Possible antioxidant properties	[59]

Mucolytic Agents
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Acetylcysteine		2 g q12h	PO
Acetylcysteine	Mucomyst® (Bristol)	20 - 60 ml of a 20% solution	Topical			Guttural pouch lavage in cases of empyema	[60]
Dembrexine	Sputolysin® Sputolosin® (Boehringer Ingelheim)	0.33 mg/kg q12h	PO			Antitussive properties. Cannot be used in food animals	[61]
Bromhexine	Bisolvon®	60 mg/kg	PO				[62]

Immunomodulators
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Propionibacterium acnes	Eqstim® (Immunovet Inc.)	3 doses administered every 2 to 3 days	IV		Fever, anorexia, lethargy within 12 - 24 hours after first doses	Increases peripheral WBC. Decreases BALF cytologic counts including lymphocyte and macrophage populations	[63- 65]
Purified mycobacterial cell wall extract	Equimune® IV, Vetripharm Inc.	1.5 ml repeated in 1 to 3 weeks	IV		Pulmonary lesions reported in 5 horses (granulomatous pulmonary fibrosis pneumonitis, bronchiolitis)		[66, 67]
Inactivated parapoxvirus	Baypamune®, Bayer	460 IU q8h at 48 h interval	IM			Delivery according to the predicted delay of highest infectious pressure. 1 week= IM injections at Day 0, Day 2 and Day 4 2 weeks= IM injections at Day 0, Day 2 and Day 9
Interferon alpha						Recommended for the treatment of IAD. No effect on severity of clinical signs or duration of viral shedding in experimentally induced EHV-1 infection	[68- 71]
Interferon Alpha 2a recombinant	Roferon-A®	50 - 150 IU q24h for 5 days	PO			Recombinant is less effective than the natural interferon
Interferon Alpha n3 recombinant	Alferone®	50 - 150 IU q24h for 5 days	PO
Interferon Alpha 26 recombinant	Intron A®	50 - 150 IU q24h for 5 days	PO

Mast Cell Stabilizing Drugs
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Cromolyn sodium	Intal® (Rhone-Poulenc-Rorer)	200 mg q12h	Nebulization			Prophylactic effect only on mast cell degranulation	[72, 73]
Disodium cromoglycate	Intal®	80 mg q12h 1st week, then q24h	Nebulization	Delayed action		Prophylactic effect only on mast cell degranulation
Nedocromil	Tilade®	80 mg q12h 1st week, then q24h	Nebulization			Prophylactic effect only on mast cell degranulation

Anthelmintics
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Mebendazole		10 mg/kg q24h	PO			Efficient against P. equorum(adults) and S. vulgaris(adults)
Mebendazole		20 mg/kg q24h for 5 days	PO			Efficient against D. arnfieldi
Fenbendazole	Panacur® (Hoechst-Roussel)	10 mg/kg q24h for 5 days	PO			Efficient against adults and larvae of P. equorum and S. vulgaris
Thiabendazole		88 mg/kg	PO			Efficient against P. equorum
Albendazole		25 mg/kg q12h for 5 days or 50 mg/kg q12h for 2 days	PO
Albendazole		4 - 8 mg/kg q12h for 1 month	PO			Treatment of hydatid cysts caused by Echinococcus granulosus
Ivermectin	Eqvalan®	200 ug/kg	PO			Efficient against P. equorum(adults) and S. vulgaris(adults and larvae) and D. arnfieldi

Antifungal Agents
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Potassium iodide		10 - 15 g q24h for a 450 kg horse 5 - 10 g q24h for a pony for 30 - 60 day	PO		Treatment should be stopped with signs of iodism (lacrimation, coughing, scurfy coat with hair loss). Contraindicated in pregnant mares and in very young foals.
Enilconazole		33.3 mg/ml solution	Topical			Indicated for treatment of guttural pouch mycosis	[9, 74]
Miconazole		10 mg/kg in 250 ml of saline q24h	Topical			Indicated for treatment of guttural pouch mycosis	[9, 74]
Itraconazole		5 mg/kg q24h	PO			Reported as systemic therapy of guttural pouch mycosis	[74]
Nystatin			Topical			Treats mycotic rhinitis (Aspergillosis) or guttural pouch mycosis	[75, 76]
Natamycin			Topical			Treats mycotic rhinitis (Aspergillosis)	[76]
Amphotericin B		0.3 mg/kg day 1, dose increased by 0.1 mg/kg on each subsequent day, for at least 21 - 35 days	IV		Very nephrotoxic	Mycotic rhinitis, fungal pneumonia	[77, 78]

Others
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Furosemide(diuretic)	Lasix®	1.0 mg/kg	Inhalation, IV		Kaliuresis	Bronchodilator Reduces acute pulmonary edema	[9, 79]
Furosemide(diuretic)	Lasix®	0.5 mg/kg 30 minutes to 4 hours prior to racing	IV			Used to prevent or reduce severity of EIPH. Prohibited by FEI, the AHSA and most non-American racing rules	[80- 83]
Nasal strips	Flair® Equine Nasal strips					Reduces EIPH severity	[83]
Respiratory Analeptics
Doxapram		0.3 - 1 mg/kg	IV	Half life: 2 - 3 hours	Increases heart rate and cardiac output	Causes transient hyperventilation (approximately 5 minutes)	[84- 87]
Topical lavage solution		0.05% to 5% povidone-iodine solution q12 - 24h for 5 - 10 days	Topical			Sinus, guttural pouch lavage

Local Anesthetics
Drug	Trade Name	Dose	Route	Pharmacokinetics	Side Effects	Comments	Ref
Lidocaine		15 - 20 ml of a 4% solution	Topical			Local pharyngeal, tracheal or bronchial anesthesia, for instance during endoscopic examination
Xylazine		5% solution	Topical			Local pharyngeal, tracheal or bronchial anesthesia, for instance during endoscopic examination

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References

1. Meyer JC, Brown MP, Gronwall RR, et al. Pharmacokinetics of ceftiofur sodium in neonatal foals after intramuscular injection. Equine Vet J 1992; 24(6): 485-486.

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How to reference this publication (Harvard system)?

van Erck, E. and Lekeux, P. (2005) “Doses of Common Drugs”, Equine Respiratory Diseases. Available at: https://www.ivis.org/library/equine-respiratory-diseases/doses-of-common-drugs (Accessed: 01 October 2023).

Affiliation of the authors at the time of publication

Department of Physiology and Sport Medicine, Faculty of Veterinary Medicine, University of Liège, Sart-Tilman, Liège, Belgium.

Author(s)

van Erck E.

Veterinarian

DVM PhD Dipl ECEIM

ESMP - Equine Sports Medicine Practice,

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Lekeux P.

Professor

DVM PhD Dipl ECVPT

Department of Physiology and Sport Medicine, Faculty of Veterinary Medicine, University of Liège

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Doses of Common Drugs

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Important Preliminary Remarks!

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