What else can I do? Bute, Laminil and Metformin
Through this blog and many articles I have written, I have discussed in depth information regarding the different types and techniques of podiatry solutions for horses with laminitis. One area I have neglected in recent years is information describing the drugs and supplements used in the management of laminitis. This article aims to cover a number of aspects related to different medical therapies.
Imagine, your horse develops laminitis over night. They are showing the typical signs of laminitis; shifting weight from one leg to the other, they are reluctant to move or are laying down for extended periods, they have heat around their coronary band and hoof wall, as well as an increase intensity to the digital pulses. All of these signs are an indication of inflammation and pain.
The most common class of drug used for the management of pain in the horse with laminitis is known as non-steroidal anti-inflammatories (NSAID). There are a number of different types of NSAIDs on the market – phenylbutazone, flunixin megulmine and meloxicam. The most common type of NSAID used is phenylbutazone or Bute. Bute comes in 3 forms; injectable to be given intravenously, as a paste or granules to be given orally.
Bute can be a powerful anti-inflammatory and helpful in the management of laminitis cases. That being said, horses can develop gastro-intestinal ulceration and inflammation, particularly right dorsal colitis. When used in compromised patients or at high doses for extended periods of time, Bute can cause kidney damage. This means that before administering Bute to your horse, you should engage your veterinarian to ensure you are using the drug appropriately. It is also important to use a gastro-protectant in cases of long term Bute use.
New anti-inflammatory targeted at laminitis – Laminil
Laminil was developed to treat horses with an active episode of laminitis. Laminil works by stabilising inflammatory cells and reducing the release of inflammatory mediators. Inflammatory mediators are responsible for the pain and heat experienced by horses with laminitis. Excess inflammation in a laminitis case is thought to be detrimental, therefore changing the inflammatory profile is helpful. Laminil requires a veterinary prescription and comes in two forms; an IV perfusion and a transdermal topical cream. The IV perfusion must be administered by a veterinarian and typically injected into the palmar digital vein supplying the foot. The transdermal cream can be applied by the owner to the coronary band daily. For more information on supply, please contact us.
What caused the laminitic episode?
One of the crucial questions to answer when dealing with a case of laminitis is what caused the episode to occur. There are three categories for the causes of laminitis;
- Sepsis associated: this can occur in the horse that is clinically ill, such as a pneumonia, diarrhoea or retained foetal membranes
- Mechanical overload: occurs in the horse with a severe limb injury that overloads the supporting limb
- Hormone associated: horses that have an underlying metabolic condition such as Equine Metabolic Syndrome (EMS) or Pars Pituitary Intermedia Dysfunction (PPID or Cushings)
Which ever the cause, it is important to treat the underlying disease process. If it is a horse with sepsis associated laminitis it is important to treat the infection as efficiently and effectively as possible to reduce the likelihood of further lamellar damage. Similarly with the supporting limb laminitis case, it is important to resolve the pain arising from the injured limb so that the horse can bear weight evenly.
In the case of EMS or PPID, it is also important to manage these conditions. Before managing these hormone associated diseases, it is important to make a clear diagnosis. EMS is best diagnosed using an oral sugar test and monitoring the horses levels of blood glucose and insulin. Similarly, PPID can be diagnosed by monitoring blood ACTH.
Once a diagnosis of EMS or PPID is established, we can use two drugs to improve these conditions. Metformin is a human drug, used to treat type 2 diabetes. It works by sensitising insulin to glucose. This has been shown to work well in horses with EMS. Unfortunately, metformin is not registered for use in horses and needs to be purchased from a human pharmacy with a prescription from your vet. Pergolide is the treatment of choice for horses with PPID. It comes in two forms, a suspension and a tablet.
While the underlying cause of laminitis is being managed and the inflammatory phase controlled, we can use supplements to help improve hoof growth. There are many different hoof supplements on the market, each with a slightly different formula. The mainstay of any hoof supplement is Biotin. Biotin is thought to be essential in new, healthy hoof growth. Does this mean your horses hooves will grow quicker? Not necessarily, however studies have shown that horses that were supplemented with Biotin did have healthy new growth. New wall grows down from the coronary band, therefore if you are using a supplement, it needs to be continuously administered. If we stop using a supplement, the new growth won’t have the benefit of supplementation and wall quality can reduce. Ranvet’s Hoof Food has been on the market for many years and has a high concentration of Biotin.
This is a relatively short list of some of the medical therapies we use on a regular basis to treat horses with laminitis. If you have any questions, please don’t hesitate to reach out to us via the website, email or social media networks