Medications

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Medicating horses has become easy in an age where pharmaceuticals and nutraceuticals are abundant. But, unfortunately, their use circumvents two things.  The first is removing the cause of the medicated problem.  The second is not realizing the side effects of the medication.

I have written a lot about disease prevention in many of my blogs.  If we practiced prevention, we could stop using many medications.  For example, removing manure from where horses eat would remove the need for giving parasite control medications. Likewise, eliminating grain would improve gut health and remove the need for ulcer medications.

A more sinister result of giving medications has recently come to our attention.  The head of the Centers for Disease Control (CDC) here in the US has declared the number one issue confronting the health of humans today is antibiotic resistance.  He placed this higher than opioid addiction, obesity and heart disease. Random use of antibiotics is causing many bacteria resistant to medicines to continue to grow and breed a large resistant population.

A study done by Texas A&M vet school, presented at a meeting of veterinarians (AAEP), determined the normal bacterial population of the mouth.  Over 700 individual bacteria normally live within the mouth as determined by genetic testing of the bacteria washed from horses’ mouths.  The researchers gave one dose of a common nonsteroidal antiinflammatory.  With that one dose of medication, a family of bacteria (many species) was destroyed and eliminated. The importance of the normal bacterial colonization (microbiome) of the digestive tracts, which includes the mouth, is only recently being realized.  The ramifications of altering the microbiome are not yet completely understood, but all gut ulcerations have a disturbed microbial environment in humans.  An altered normal microbiome is called a dysbiosis, and if one dose of a common pain reliever can cause a dysbiosis, what other problems can arise from chronic use?

Medications are life-saving as well as provide comfort.  I have seen firsthand how removing pain with opioids, and the long-term use of antibiotics has saved lives.  However, if we do not address the root cause of disease and pain and make every effort to improve their prevention, then we may find ourselves, through good intentions, causing more harm in the long run. Or worse, our medications are no longer working.

The difference between a “Legend” drug, a “generic” drug, and a “compounded” drug needs to be understood.  Legend and generic drugs are good to use if needed because they adhere to a strict manufacturing standard actively monitored in the US by the Food and Drug Administration (FDA).  All manufacturing stops and batches are recalled if they find any improperly made or contaminated drugs.

A legend drug made by an original drug manufacturer has a patent protecting the manufacturer from any other manufacturer making it. In addition, the patent provides financial protection until the original manufacturer can recoup the money spent developing and testing the drug.  A generic drug made by another manufacturer is like the original drug after the patent has expired.  An example of this is Tylenol© which is the legend drug, and acetaminophen made by a pharmacy like Walgreens to the same manufacturing and testing standards of the legend drug.

A compounded drug is made by a compounding pharmacy using bulk ingredients to create a drug that is not available in a legend or a generic form. For example, compounding pharmacies cannot make acetaminophen because it is available as a legend and generic medication. Likewise, a compounding pharmacy cannot make the antiinflammatory drug “Bute” (phenylbutazone) in the horse world, but it can add flavoring to an FDA inspected phenylbutazone.  Doctors and veterinarians can compound medications any way they want. They can order a compounding pharmacy to make these drugs available whenever there is no legend or generic drug equivalent available.

Unfortunately, compounded medications are never independently tested, and therefore, they can make mistakes.  One vet had yohimbine compounded to reverse the sedatives he gave horses for routine dentistry even though a legend drug was available.  He cut costs, but the incorrectly compounded drug caused two horses to die.  Another vet ordered the compounding of a legend drug made in the US but was illegal to use in the US.  It causes an increased energy output from cells, making it a sport-enhancing drug thus, no accepted purpose for the drug other than cheating.  The compounding pharmacy was legal to make this drug but, unfortunately, added ten times the amount of one ingredient, which caused the death of 14 polo ponies in front of all the spectators.

Compounding medicines have caused the deaths of horses, humans and other animals. I will never administer any compounded drug internally to me or any animal I see. I will order skin creams but warn owners to watch for unexpected results after the first application.

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