Is Dex a no-no for an IR horse?

[ljc]

I've begun wading through the tremendous info on the Equine Cushings group. Frankly, it's overwhelming,partly because the basic approach seems to be extreme caution about everything, which is wise at first, I understand. According to one file I read there, nearly everything I use occasionally or regularly should be avoided, from certain wormers to various drugs.

Again, I'm not doubting the wisdom of total avoidance but wondering just how critical some of those really are. Of course, each horse will be different. And a horse far along on the spectrum with Cushings, laminitis and so forth would be an extreme case.

In my particular example, dex. Now, I'm not talking about a life-threatening situation such as a major allergic reaction or snake bite where it's essential to give dex. I'm talking about something far less severe - a skin problem that I normally wouldn't even think twice about treating with dex for a few days.

Now, however, I'm paranoid about giving anything and everything. That same file on the Cushings board said even bute could be problematic. And ace. (Just two more examples).

So, my question is, should I not give dex to an IR horse? (My vet is out of town until tomorrow; otherwise I would obviously ask him).

Thanks. I'm still learning about IR so I appreciate any or all advice!

[Auventera Two]

Dexamethasone treatment is contraindicated in IR horses because it creates a state of heightened insulin in the body. For a horse that is already insulin challenged, the horse may become acutely laminitic, or suffer laminar failure and rotation. Insulin is highly inflammatory and insulin injections alone has produced acute laminitis in at least one study that I know of. So further increasing the insulin load on a horse that already has increased levels is playing with fire. Personally I would never use it on a known IR horse.

Also, there are tons of no-no's listed on that Yahoo group, but every horse is different. Some horses can handle certain things that others can't. Some of the guidelines over there are aimed at creating the BEST diet and state of health for the horse. So that means avoiding or adding certain things that might not be absolutely "crucial" but that are optimal.

[Katy Watts]

Again, I'm not doubting the wisdom of total avoidance but wondering just how critical some of those really are.

Good heavens! Someone who might actually care about credentials or critical thinking? I am not alone in the universe after all.

Actually, there some fairly good evidence from highly credentialed people discussing risk of laminitis from steroids. Here is a full text article, written by vets with active licenses and who do research on real live horse I found it by going to www.scholar.google.com and searching 'laminitis insulin dexamethasone'. It is a better source of credible information than Yahoo.groups, or Wipedia.

http://www.compendiumequine.com/Media/PublicationsArticle/PV_26_07_547.pdf

http://avmajournals.avma.org/doi/abs/10.2460/javma.231.9.1365

[deltawave]

Steroids are always, ALWAYS a double-edged sword, to be used with a lot of thought and caution. Always. IR or no, there is never a situation where the "cons" shouldn't be stacked up against the "pros". This is true for any drug, but even more so with steroids. If there is an alternative that gets the job done, it's usually a better choice. But sometimes there isn't.

The pendulum seems to have swung the other way, which is probably a good thing, regarding steroids. I recall not so very long ago how "dex" or "azium" were flung around like so much water, with no regard whatsoever to what they actually did, could do, or didn't do. As with most things, the true wisdom lies somewhere in the middle. :)

[EqTrainer]

Steroids are always, ALWAYS a double-edged sword, to be used with a lot of thought and caution. Always. IR or no, there is never a situation where the "cons" shouldn't be stacked up against the "pros". This is true for any drug, but even more so with steroids. If there is an alternative that gets the job done, it's usually a better choice. But sometimes there isn't.

The pendulum seems to have swung the other way, which is probably a good thing, regarding steroids. I recall not so very long ago how "dex" or "azium" were flung around like so much water, with no regard whatsoever to what they actually did, could do, or didn't do. As with most things, the true wisdom lies somewhere in the middle. :)

Amen. And I'm not even religious :lol:

In regards to an IR horse, dex is a no-no. Bute and Ace? Well, still, things you don't want to just whip out at any instance but I have had no particular issues w/them and IR horses.

[deltawave]

EqT, you remind me of an old professor from school, who was fond of saying "All no-no's are relative". :)

[Ghazzu]

EqT, you remind me of an old professor from school, who was fond of saying "All no-no's are relative". :)

Or my cardiology professor, whose favorite answer to any given question was "it depends".

[coriander]

...
Actually, there some fairly good evidence from highly credentialed people discussing risk of laminitis from steroids. Here is a full text article, written by vets with active licenses and who do research on real live horse I found it by going to www.scholar.google.com and searching 'laminitis insulin dexamethasone'. It is a better source of credible information than Yahoo.groups, or Wipedia. ...


Thank you for pointing out that some sources are more credible than others!

[deltawave]

Or my cardiology professor, whose favorite answer to any given question was "it depends".

They teach you that 3rd month of fellowship. :lol:

[pharmgirl]

I thought the laminitis risk w/ dex is there for all horses, and assume that is why whenever my vet has given it (usually for something severe enough that he wants inflammation down PRONTO), he also has them concurrently on banamine the entire time to help keep that potential issue in check.

[EqTrainer]

I thought the laminitis risk w/ dex is there for all horses, and assume that is why whenever my vet has given it (usually for something severe enough that he wants inflammation down PRONTO), he also has them concurrently on banamine the entire time to help keep that potential issue in check.

Unless I'm really missing something here (and that could be true!) Banamine won't stop a horse from becoming laminitic from dex if that is what is going to happen. It might mask that it is happening and that's about it.

There is not a laminitic risk for all horses w/Dex.. what the issue is sometimes, is that people don't know that their horse has a potential sensitivity to corticosteroids.

[deltawave]

I think you could safely say that ANY horse, under the right circumstances, could be made to develop laminitis if given steroids in a high enough dose. What defines "the right circumstances", though is the big unknown. Which is why steroids (IMO) should be classified right in the same category as narcotics: huge abuse potential, never to be used casually, but really really helpful when needed.

I wouldn't think NSAIDs would do diddly squat to prevent the development of laminitis. Might make an ulcer a bit more likely, though. :(

[EqTrainer]

I think you could safely say that ANY horse, under the right circumstances, could be made to develop laminitis if given steroids in a high enough dose. What defines "the right circumstances", though is the big unknown. Which is why steroids (IMO) should be classified right in the same category as narcotics: huge abuse potential, never to be used casually, but really really helpful when needed.

I wouldn't think NSAIDs would do diddly squat to prevent the development of laminitis. Might make an ulcer a bit more likely, though. :(


I was thinking the NSAID use on top of it would make an ulcer more likely, too, but I am not sure how big a role *Dex* versus another steroid would play in that. Maybe Ghazzu knows. FWIW, we give my horse Ulcerguard beginning 2 days before he gets his hocks injected w/Vetalog and for a few days afterwards.

Yup, given the mechanism of laminitis, I don't think Banamine would make any difference.

[hoopoe]

OP talk to your vet today about alternatives for itchy skin issues.

My horse often blows a hot spot and typically diphenhydramine ( benadryl) and some topical hydrocortisone cream for 2 days works. I also add Aveeno oatmeal soak ( sponge on and leave to dry) works very well when the outbreak is generalized.

[Dalemma]

Well Dex my be a no no but sometimes unavoidable.......my boarders horse who was an extremely easy keeper........broke out in sores/hives all under her belly with edema 6" thick......oozing thick yellow puss.......back legs were stocked up as well.........she was put on dex symptoms went away.....she was weaned off they came back worse......at this point she was moved to my barn as they thought allergy at the new barn she just moved to.........she eventually went to the clinic for testing and ended up coming down with hypergammagobulin anemia.......again back on dex........last summer we had her weaned down to 1 cc from 4cc and then in Sept she blew back up again.....so back up to 4cc....been like that all winter.......she is now 1 day on 2 days off...........she had allergy testing and has had all the shots but without much success............she now appears to have cushings but are not sure at this point whether it is dex induced or a tumor on the pituatary.......vet feels it might be a tumor as she has curly hair on her legs and is not shedding and her spine sticks out from lose of muscling...........which is more typical of a tumor then from the dex itself.....my vet has never seen dex induced cushings..........I am now wondering if it has been cushings all along.........as skin inflammation can be a symptom......but does not usually present as the first sypmtom.......she is now on one mg of pergolide for two months and we wait and see if she starts to drop her coat.

Dalemma