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Doses of Common Drugs
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Table of Contents
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 | Puff = Delivery of one metered dose (inhalations) |
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 |
|
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- | Bactericidal, Gram +, Anaerobic coverage. Recommended against Streptococci(Strangles, Pneumonia) |
|
Procaine Penicillin G |
| 22 000 IU/kg q12h | IM or SC |
|
| Anaerobic coverage |
|
Cephalosporins | |||||||
Ceftiofur | 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, |
Excenel® (Pfizer) | 2 mg/kg q12h in neonate foals (2-7 days old) | IM | |||||
Aminoglycosides | |||||||
Gentamicin |
| 6.6 mg/kg q24h | IV | Does not cross blood/brain barrier | Nephrotoxicity |
| [3] |
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 | ||
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, |
Trimethoprim-Sulfonamide | Borgal® Duoprim® | 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, |
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, |
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, |
Glycopyrrolate | Robinul-V® | 0.007 mg/kg single dose | IV | Does not cross blood/brain barrier | Bradyarrhythmias, excitement, gut stasis |
|
|
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, | |
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, |
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, |
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, |
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, |
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, |
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] |
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- |
| 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, |
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- | |
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, |
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, |
2.2 mg/kg q24h | PO | Well absorbed by gastro-intestinal system |
| [41] | |||
Fluticasone | Flovent® (Glaxo- | 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, |
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- |
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 |
|
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 |
|
|
|
|
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- |
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, |
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- |
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, |
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) |
|
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 |
|
|
|
|
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, |
Miconazole |
| 10 mg/kg in 250 ml of saline q24h | Topical |
|
| Indicated for treatment of guttural pouch mycosis | [9, |
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, |
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, |
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, |
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- | ||
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- |
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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- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
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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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Department of Physiology and Sport Medicine, Faculty of Veterinary Medicine, University of Liège, Sart-Tilman, Liège, Belgium.
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