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Tiffani B
Jan. 7, 2009, 06:18 PM
I'm considering Adequan for my gelding, but don't understand the dosing. The Adequan website recommends 500mg every four days - how many cc's or mL is that? I'm curious how long the 5mL bottle will last.

Simkie
Jan. 7, 2009, 06:20 PM
A 5 mL bottle is one dose.

TheHunterKid90
Jan. 7, 2009, 06:23 PM
I would go with a bottle a week for 4 weeks (4 bottles) if you're looking to use it as a preventative thing...a bottle every 4 days for a month (7 bottles) if your horse already has joint issues or is in intensive training.

Tiffani B
Jan. 7, 2009, 06:35 PM
Then after the first month, how often is usually recommended?

I know my vet will tell me, but if I can't afford it I'm not going to bother with calling him.

Simkie
Jan. 7, 2009, 06:42 PM
I use Adequan monthly. My vet did not advise me to do the loading dose, but we did start with an IA injection of Adequan into the problem fetlock.

Mallard
Jan. 7, 2009, 06:46 PM
I'm considering Adequan for my gelding, but don't understand the dosing. The Adequan website recommends 500mg every four days - how many cc's or mL is that? I'm curious how long the 5mL bottle will last.

I think you are confusing 'mg' with 'ml'....they are not the same thing.

One Adequan vial contains 5 ml, and in this 5 ml vial is 500 mg of medication.

The recommended 'loading dose' is one vial every 4 days for a month.
Then one vial every month.

I treat my horse with 'IChON' and the recommended loading dose is one vial a week for 5 weeks, then once a month.

Simkie
Jan. 7, 2009, 06:51 PM
I treat my horse with 'IChON' and the recommended loading dose is one vial a week for 5 weeks, then once a month.

Ah, the people who MAKE IChON certainly don't recommend that. Kinetic (http://www.kineticvet.com/products/ichon.html) only recommends that it be used as a sterile lavage. Injecting it IM is considerably off label. Fine if you want to take that risk, but if something happens, you are seriously SOL.

Tiffani B
Jan. 7, 2009, 06:57 PM
I think you are confusing 'mg' with 'ml'....they are not the same thing.

One Adequan vial contains 5 ml, and in this 5 ml vial is 500 mg of medication.

No I am not confusing anything. The information is very clear on the Adequan website - 500mg is the recommended dose, yet it is sold by the milliliter. That is why I was asking how many doses were in a bottle, because milligrams is a WEIGHT while milliliters is a VOLUME and there is no direct conversion possible.

Anyways, my question was answered regarding how many doses are in a bottle.

Does anyone have an answer to my second question (what is the recommended dosing after the initial month of treatment)?

Simkie
Jan. 7, 2009, 06:59 PM
Does anyone have an answer to my second question (what is the recommended dosing after the initial month of treatment)?

Mallard answered this question for you.


The recommended 'loading dose' is one vial every 4 days for a month.
Then one vial every month.

Tiffani B
Jan. 7, 2009, 07:43 PM
Missed that, thanks!

MidlifeCrisis
Jan. 7, 2009, 08:08 PM
Actually, Lupitold has changed their recommendations. It is now 1 vial every four days for 28 days (or 7 vials). Then that course is repeated as necessary. The company no longer recommends the monthly shot.

mothermucker12
Jan. 7, 2009, 08:19 PM
Actually, Lupitold has changed their recommendations. It is now 1 vial every four days for 28 days (or 7 vials). Then that course is repeated as necessary. The company no longer recommends the monthly shot.

Now that's interesting!!

XHalt
Jan. 7, 2009, 08:35 PM
I don't think they have ever recommended one shot per month. Most people do the loading dose and then one shot per month (or as needed).

Mallard
Jan. 8, 2009, 05:58 PM
Ah, the people who MAKE IChON certainly don't recommend that. Kinetic (http://www.kineticvet.com/products/ichon.html) only recommends that it be used as a sterile lavage. Injecting it IM is considerably off label. Fine if you want to take that risk, but if something happens, you are seriously SOL.

Yes ... we know we're using it 'off label'
Thanks, anyway.

Simkie
Jan. 8, 2009, 07:18 PM
Yes ... we know we're using it 'off label'
Thanks, anyway.

I would be very careful throwing the word "recommended" around when you're using something off label. It's very easy to give them impression that the company producing the product is making that "recommendation."

Ritazza
Jan. 10, 2009, 07:03 PM
Actually, Lupitold has changed their recommendations. It is now 1 vial every four days for 28 days (or 7 vials). Then that course is repeated as necessary. The company no longer recommends the monthly shot.


I was actually just coming onto COTH right now to ask about this - my trainer said this same thing to me today, and I was very interested to hear about this, seeing as I did an initial loading dose and then have been doing the once monthly thing.

Does anyone know where I can find more information on this? "As necessary" worries me because I'd rather PREVENT the problem from flaring up in the first place... not feel the need to do injections when she's actually in pain.

HookedOnReefing
Feb. 5, 2009, 01:35 AM
The recommended 'loading dose' is one vial every 4 days for a month.
Then one vial every month.


"As necessary" worries me because I'd rather PREVENT the problem from flaring up in the first place... not feel the need to do injections when she's actually in pain.

While research has been done for Adequan in regards to the loading dose, no research has been done on the use of Adequan after giving the loading dose. After the loading dose (which some people modify as well), some people give Adequan once per month and others twice per month. Wether that is effective or not remains to be seen. In essence you are experimenting and using the drug off label. The FDA has not approved the drug other than for giving the loading dose.

Does that mean you shouldn't use it once per month after the loading dose? I don't know, there are plenty people on this forum that say it makes a difference...

You might want to use Adequan as recommended by the manufacturer and after the loading dose swith to Legend or something else.

dalpal
Feb. 5, 2009, 08:04 AM
Actually, Lupitold has changed their recommendations. It is now 1 vial every four days for 28 days (or 7 vials). Then that course is repeated as necessary. The company no longer recommends the monthly shot.

Yep....my vet said 7 doses over 28 days and then repeat this every four months.

JB
Feb. 5, 2009, 08:14 AM
While research has been done for Adequan in regards to the loading dose, no research has been done on the use of Adequan after giving the loading dose. After the loading dose (which some people modify as well), some people give Adequan once per month and others twice per month. Wether that is effective or not remains to be seen. In essence you are experimenting and using the drug off label. The FDA has not approved the drug other than for giving the loading dose.

Does that mean you shouldn't use it once per month after the loading dose? I don't know, there are plenty people on this forum that say it makes a difference...

You might want to use Adequan as recommended by the manufacturer and after the loading dose swith to Legend or something else.

I think that's a very liberal interpretation of "off label use" :confused:

It's been proven that the 4 days 7 vials protocol puts the most chemical in the cartilage, hence the recommendation. What has not been proven, and really *cannot* be proven, is the continued frequency of use. For many horses, once a month keeps them very happy. I've heard that some need every 3 weeks. Some people do the loading dose once a year and it works just dandy.

Off-label use generally means you are not covered by the manufacturer if something goes wrong.

According to the Luitpold website, the 4 days 7 vials dosage is "recommended".

It also says

there are no known contraindications for the intramuscular use of Adequan® i.m. No adverse effects were observed in clinical trials and toxicological studies in which Adequan® i.m. was administered intramuscularly at five times the recommended dose and for three times the recommended duration.

It seems like once a month is well within "recommendation" and safety margins.

JB
Feb. 5, 2009, 08:15 AM
Yep....my vet said 7 doses over 28 days and then repeat this every four months.

OMG, do another loading dose every 4 months? Are you providing his car payment? LOL

Why would you not do the loading dose, then 1 vial every 2-4 weeks? That would be cheaper, and keep a constant supply of Adequan coming in :confused:

HookedOnReefing
Feb. 5, 2009, 09:01 AM
Off-label use generally means you are not covered by the manufacturer if something goes wrong.

According to the Luitpold website, the 4 days 7 vials dosage is "recommended".

I'm not suggesting that using it as directed, which is indeed the loading dose which is 1 vial every 4 day's for a total of 7 vials in 28 day's is off label use.

After that initial loading dose use it is "as necessary". The question is what that means...? Luitpold is not recommending, and legally can not recommend, due to no FDA approval and thus would constitute off label use, once per month shots. As a matter of fact, if you read Luitpolds literature, they don't even mention to use it as needed/necessary after the inititial loading dose...

So, how about doing the loading dose once every 6 months for a total of 2 times per year? For example, in the case of a field hunter who is hunted hard 2 day's per week, give the loading dose a month before hunting season starts followed by another loading dose once the season is over. That way you use it as directed. It also comes down to the same total amount of money spend over a year vs monthly shots.

The use of Adequan has been researched and proven to work when using the loading dose. Once per month injections "as needed" has not been researched, at least the research ,if it has been done in the first place, has not been published. So the question is, do the once monthly injections work?

For virtually the same amount of money on a yearly basis, you could administer the loading dose of Adequan twice per year for a total of 14 shots vs 12 monthly shots. Would this work better?

HookedOnReefing
Feb. 5, 2009, 09:48 AM
I have emailed Luitpold regarding the once monthly "maintenance" injections vs the twice yearly loading dose. If I hear back from them, I'll post it here.

JB
Feb. 5, 2009, 09:54 AM
I'm not suggesting that using it as directed, which is indeed the loading dose which is 1 vial every 4 day's for a total of 7 vials in 28 day's is off label use.
Right, I understood that :) I knew you were talking about the once monthly, etc, usage.


The use of Adequan has been researched and proven to work when using the loading dose. Once per month injections "as needed" has not been researched, at least the research ,if it has been done in the first place, has not been published. So the question is, do the once monthly injections work?
I realize there hasn't been (published) research on 1x/month maintenance - wish there was! As for working? You have to ask the horses that. It's obvious it does work for some horses, obvious it doesn't work for others. In that regard, it's no different from a feed-through - some work for some horses in some cases, but not always. At least there's proof of what Adequan actually does :)


For virtually the same amount of money on a yearly basis, you could administer the loading dose of Adequan twice per year for a total of 14 shots vs 12 monthly shots. Would this work better?
Might be :) But that doesn't help the horses who start to deteriorate 3 weeks post-loading dose, but are just hunky dory with monthly injections. This is where the maintenance becomes an art :)


I have emailed Luitpold regarding the once monthly "maintenance" injections vs the twice yearly loading dose. If I hear back from them, I'll post it here.
That would be excellent!

WorthTheWait95
Feb. 5, 2009, 10:37 AM
I only do the loading the dose periodically throughout the year and skip the 'monthly maintenance' now. The montly shots don't seem to do much for my horses which isn't surprising. Isn't the drug only active for 4 days after administration?

Anyway, the would start getting stiff/unhappy again about 4-5 months after the initial loading dose with or without the monthly 'maintenance' so now I just do the loading dose 2-3 times a year. I buy and administer my own adequan, however, so it really isn't THAT expensive.

I know other people that say the monthly shots do wonder for their horses and they can tell when they're due for another so maybe it's just my horses but the last 4 I've owned haven't really responded to the monthly shots.

HookedOnReefing
Feb. 5, 2009, 11:11 AM
I emailed Luitpold this morning and already got an answer back from them!:cool: And as promised I have copied and pasted their reply to me below:


Dear Sir;
You are correct, the use of Adequan i.m. in any other protocol than one 500mg injection every fourth day for seven injections is off label. We cannot recommend any other protocol, and no studies have been conducted with monthly injections. The single monthly injection would achieve one positive result: the increase of viscosity of the synovial fluid is maximized at 48 hours. This is caused by stimulation of the synovial membrane to produce long chain hyaluronic acid.
Your suggestion of a series every six months is one followed by many, however, it is our experience that more individuals are using the veterinarian recommended monthly injections.
We do have studies with a regular protocol every other month for three prophylactic series on racing quarter horses and a weight based dose on thoroughbred foals from as young as six weeks of age to November of their yearling year. They are both off label due to the lack of disease diagnosed, but proved valuable as a preventative.
Thank you for your interest in Adequan, you have studied it well!

So even though vets recommend a monthly maintenance dose, it is not Luitpolds recommendation. And since the increase of viscosity of the synovial fluid is maximized at 48 hours you have to wonder how effective these monthly shots really are.

But by the same token, horse owners do know their animals well and if ridden regularly, might "feel" when a maintenance dose is necessary and probably also "feel", that once the monthly maintenance dose has been injected, a difference. And a once monthly maintenance dose is more cost effective as compared to a "feed through supplement".

Giving more Adequan than the recommended dose has been studied for toxicity and it was shown that it's not toxic to the horse. So it won't hurt your beast.

JB
Feb. 5, 2009, 12:04 PM
Isn't the drug only active for 4 days after administration?
It is my understanding that the drug is only "active" in the system, as in, you can detect its presence, until it is incorporated into the cartilage, which is the ultimate goal. RAyers or Ghazzu explained how all that worked in one of these threads.


Anyway, the would start getting stiff/unhappy again about 4-5 months after the initial loading dose with or without the monthly 'maintenance' so now I just do the loading dose 2-3 times a year. I buy and administer my own adequan, however, so it really isn't THAT expensive.
Cool, just another scenario that people can choose to try :)


I emailed Luitpold this morning and already got an answer back from them!:cool: And as promised I have copied and pasted their reply to me below:



So even though vets recommend a monthly maintenance dose, it is not Luitpolds recommendation. And since the increase of viscosity of the synovial fluid is maximized at 48 hours you have to wonder how effective these monthly shots really are.
Thanks!

As I mentioned above, it was my understanding that yes, while the synovial fluid is positively affected short-term, I thought it was the long-term help to the cartilage that was the ultimate goal, and becoming incorporated there was why it was no longer detected in the system :confused:


But by the same token, horse owners do know their animals well and if ridden regularly, might "feel" when a maintenance dose is necessary and probably also "feel", that once the monthly maintenance dose has been injected, a difference. And a once monthly maintenance dose is more cost effective as compared to a "feed through supplement".
It may be that for the horses who benefit from a 3-4 week maintenance dose are being helped in the inflammation department more than simply the short-term increase in synovial fluid viscosity, yes? Just a thought, I don't know for sure. If you can get some inflammation down, you can stop, at least for a while, a cycle of inflammation = more pain = more inflammation = ...


Giving more Adequan than the recommended dose has been studied for toxicity and it was shown that it's not toxic to the horse. So it won't hurt your beast.
Right :)

Thanks for e-mailing them!

HookedOnReefing
Feb. 5, 2009, 01:18 PM
As I mentioned above, it was my understanding that yes, while the synovial fluid is positively affected short-term, I thought it was the long-term help to the cartilage that was the ultimate goal, and becoming incorporated there was why it was no longer detected in the system

JB,
You are correct, that is the indeed the long term goal and is what happens when you do the loading dose. But when you do the once monthly "maintenance dose", the only positive effect is the increase of viscosity of the synovial fluid which maximized at 48 hours.

JB
Feb. 5, 2009, 01:41 PM
How is it possible (honest question :)) for 1 dose to not make it to the cartilage, but the 4/7 dosing does? I mean, doesn't 1 dose HAVE to make its way to the cartilage in some amount? :confused:

HookedOnReefing
Feb. 5, 2009, 01:47 PM
I honestly don't understand why it wouldn't get absorbed by the cartilage either JB, but that is what I gather from the response I received from Luitpold...:confused:

JB
Feb. 5, 2009, 01:50 PM
Ok, we're on the same page then :)

dalpal
Feb. 5, 2009, 02:44 PM
OMG, do another loading dose every 4 months? Are you providing his car payment? LOL

Why would you not do the loading dose, then 1 vial every 2-4 weeks? That would be cheaper, and keep a constant supply of Adequan coming in :confused:

I don't buy it from him. ;) He recommended the same thing for my dog. Loading dosage and then again in 4 to 6 months. My small animal vet seemed to have the same thought...she didn't want to give it to my dog monthly, only do the loading dosage again if needed. We ended up doing 2 loading doses 6 months apart and she hasn't needed it since.

I was just saying that was the protocal that my vet recommended. I am sure that many have their own thoughts on adequan.

dalpal
Feb. 5, 2009, 02:45 PM
I have emailed Luitpold regarding the once monthly "maintenance" injections vs the twice yearly loading dose. If I hear back from them, I'll post it here.

Well DAMN, they gave you an answer. When I called to ask about the protocal for my dog (loading dosage vs once a month) they refused to speak to me and told me that they would only discuss it with my vet.

SquishTheBunny
Feb. 5, 2009, 08:35 PM
Just Spoke to the rep and read about the PSGAG in the Plumb.

100mg per ml.
So, if it was 500mg you needed, that would be 5mL = 1 bottle.

ON label use of adequan direct from the VETERINARY DRUG HANDBOOK:
`For IM Injections: 500MG IM every 3-4 days for a minimum of 4 and preferably 7 treatments.

Also important:
- Some studies have indicated that PSGAGs (adequan/legend etc) are much less effective in joints where there has been acute trauma, but without the presence of degenerative enzymes. - ie. acute damage to joint, without "arthritis", is not likely to be helped by adequan.

Pharmacokinetics (how it works): PSGAG is deposited in all layers of articular cartilege and preferentially taken up by osteoarthritic cartilege. When administered IM, articular levels will with time exceed those found in the serum. Peak joint levels are reached 48 hours after IM injection and persist for 96 hours after injection.

There is a HUGE theraputic index. 5x overdose generated NO adverse reactions.

So, REP recommended 7 doses for a horse showing some signs of arthritis. Recommended 4 doses for a "preventive" treatment. There have been NO STUDIES to say monthly shots are beneficial, however the rep said it would not hurt the horse. Of course he is promoting the product so didnt think it would be a waste of money, but he did say that a LOADING DOSE is far more beneficial than monthly shots.

chism
Feb. 6, 2009, 11:11 AM
I'm considering Adequan for my 15 year old OTTB. He's had his hocks injected once a few years ago & he's starting to look a little sticky on his RH again. I can either just do the injections again or try the Adequan route first and see if I could forego injecting. Could anyone give me an idea as to ballpark cost (ie...what it costs you for the loading dose ..every 4 days for 28 days). TIA

Simkie
Feb. 6, 2009, 11:14 AM
I'm considering Adequan for my 15 year old OTTB. He's had his hocks injected once a few years ago & he's starting to look a little sticky on his RH again. I can either just do the injections again or try the Adequan route first and see if I could forego injecting. Could anyone give me an idea as to ballpark cost (ie...what it costs you for the loading dose ..every 4 days for 28 days). TIA

http://www.allivet.com/Adequan-Equine-p/10041-7.htm

Bogie
Feb. 6, 2009, 11:20 AM
Very interesting. I'd never read that the manufacturer does not recommend the monthly shots after the loading dose.

I used Chondroprotec (I know, off label), after my horse had his hocks injected. After the loading dose I tried 1 shot/month and it wasn't enough. Twice a month seemed to keep him comfortable.

Now I'm looking at my 11 year old TB and trying to determine the best course of action for him. I will take this into consideration.

spotmenow
Jul. 31, 2010, 07:52 AM
I did the loading dose and gave the last dose on July 12th....it did help. My vet recommended the monthly dose, so he's due for an injection August 12th, but now I'm wondering if I should bother or just do the loading dose as needed (probably once a year)??? What do people think?

JB
Jul. 31, 2010, 10:38 AM
What we think really doesn't matter LOL You'll have to listen to your horse as that's what it takes. See how things go between now and 8/12. If that day comes and he's just fine, see how he is the next week, and the next, etc.

It might help be more subjective if you take a video of him lunging both ways now, then on 8/12, then 2 weeks later, etc, as you might see subtle issues that you might not feel.