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What is your Off Label Adequan Protocol?

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  • What is your Off Label Adequan Protocol?

    and why?

    Here's my situation: I have a nine year old warmblood dressage training PSG/I1, and also pi and pa. Has never had any soundness issues. She is on cortaflex a.m. and p.m. and one ounce of Flex Force H.A. and 10 grams MSM. Recently, we moved barns and during the adjustment period of getting used to a new neighbor (stall with run) the horse, a mare, had a kicking fit and got a bone bruise and also made her hock slightly sore on that leg. So as a precaution, I gave her her first ever treatment series of Adequan (7 shots, every four days). She gets the last shot Monday.

    My last horse was older and maintained on a monthly shot of legend and adequan (after the initial treatment series). I never knew how much these things were working until after I retired him and took him off the injectables. He got pretty stiff and lame. So I know that the maintenance dose is useful. My last trainer told me that her international horses get an adequan shot every other week and weekly during the competition season. (She used to also give Legend, but stopped). I know lots of people who do the adequan monthly, and some who do it weekly. I am contemplating reducing the oral supplements and starting a maintenance protocol with the adequan, but since it would be an off label use, I'm not exactly sure how often to give it, or whether to continue the orals as well.

    One friend says that the adequan series only works for about a month. She does it three times a year for her horses and doesn't give any oral supplements. Instead, both of her horses get annual joint injections.

    Another friend does Legend instead, monthly. Since my mare doesn't really have any evidence of arthritis yet, I'm not sure that the Legend is necessary yet, but I would like to step up what I'm doing since she's doing harder work.

    Anyway, would love to hear what you do, why you do it (i.e. how old is your horse, what type of work does it do, did you start doing it because of an injury, etc.). Vets vary widely on their opinions on what works and what doesn't. I find the whole subject confusing.

  • #2
    Well mine isn't off label but all of my horses (retired or currently showing) get the adequan series as needed. My retired horses average about one/year and my working horses usually end up getting the full series 2-3 times per year. I've never had any lucky whatsoever with the once/month shots and see them as a waste of money personally. Others seem to have had a different experience then me though.


    • #3
      I used to give Gwen one dose on the Tuesday before a Horse Trial. Seemed to help her to be a little more loose at shows--she competed until she was 20.

      It is confusing, and there are absolutely no data on various regimens other than the traditional one. Confounding that is the up and down nature of arthritis in general and the fact that horses can't give us a pain scale.
      Click here before you buy.


      • #4
        AND.....even the company won't give a specific recommendation.

        One equine vet said..."loading dose", then monthly.....One equine vet said loading dose, don't use again for four months, then do loading dose again.

        The small animal vet agreed with the second equine vet (was using it for a dog)

        So I called the company and explained to them that I was confused, which method was recommended by the company. I was told that they really didn't have a recommendation and that they couldn't speak to me personally about it, that my veterinarian would have to call and ask.


        • #5
          Originally posted by dalpal View Post
          AND.....even the company won't give a specific recommendation.

          One equine vet said..."loading dose", then monthly.....One equine vet said loading dose, don't use again for four months, then do loading dose again.

          The small animal vet agreed with the second equine vet (was using it for a dog)

          So I called the company and explained to them that I was confused, which method was recommended by the company. I was told that they really didn't have a recommendation and that they couldn't speak to me personally about it, that my veterinarian would have to call and ask.
          The company legally can't give you any more info/advice on dosing than what is approved on the label (and I believe the mfr got a nastygram from the FDA on this awhile back). I believe it is approved for treatment only, so any kind of maintenance regimen would be off label and something they cannot officially comment on.

          I would also assume that because it is a prescription product, they can only have certain discussions with the prescribing vet but I'm not positive on that one.


          • #6
            I gave the loading then monthly. I tried once to go a little longer on my arthritic old guy just to see if it made a difference or not....6 weeks was too long. Then I ended up having to kind of do another loading dose. I think the amount each horse needs might vary and you can play around with it a bit. But if you end up with a sore horse from waiting too long, the therapeutic level may have fallen too low and you may have to load again somewhat.
            A good horseman doesn't have to tell anyone...the horse already knows.

            Might be a reason, never an excuse...


            • #7
              i did the "old" regimen - 4 weekly shots, then moved to monthly, but I started right after he had his hocks injected, so I figured that was enough $$ out of my pocket.

              When I was regularly competing, I gave a monthly shot of legend, then adequan, each 2 weeks apart. My horse thought that was quite nice. Right now I'm giving just monthly adequan shots and I think he'd be happier every 3 weeks rather than 4, but for now he's going to have to livew ith monthly shots.

              Now that the new multi-dose bottle is out (in 6 more days!), I may go to every 3 weeks, that's a bit cheaper than per bottle.
              Your crazy is showing. You might want to tuck that back in.


              • #8
                Didn't read through all of the aboves posts but here's what my vet recommended

                1 shot every 7 days (total of 3 shots over 3 weeks) followed by
                1 shot every 3 weeks until

                There is nothing wrong with my horse. He's a young (6.5) WB jumping in heavy work and vet said to do it preventative. I think he was treating my peace of mind more than anything wrong with the horse. I had asked him to do lameness because the horse won't get clean lead changes, he found nothing wrong (told me to "ride better"). I have felt that he moves a bit more extravagantly and he is jumping really hard, wether that is the Adequan or the cold weather (he is not fresh at all) I cannot say. There are several horses at my barn on the same protocol.


                • Original Poster

                  I just spoke to Mountain Vet about the new multidose vial. They think they might have it in by the end of the month and that it will be comparably priced or cheaper than the 7 pack. The multidose vial is ten shots, so that makes it about $25 per shot, give or take. I think an every other week protocol, as my prior trainer did, would make financial sense if I replace my daily orals with it (except MSM, which I would continue to give).

                  There is alot of conflicting information about how and when to give the shots. That is why I wanted a thread just on what people are doing and why. My old horse had degenerative arthritis in his carpus, hocks and stifles from a traumatic injury (he fell off a cliff). The monthly adequan/legend (a shot every other week) kept him sound for many years. He had injections of the knees twice, but never in his hocks or stifle. At the end, when he was a 2/5 lame through the adequan/legend, the vet felt that he'd need injections of all those joints every other month to be sound, so I just retired him, but he was 24 years old at that point. I took him off the shots, pulled his shoes, but kept him on a quadriple dose of corta-flx (a double dose of Corta Rx HA), 2 grams of MSM, and an ounce of Flex Force HA. He was still pretty lame, so I had him on Buteless as well. The monthly shots probably improved his lameness levels a grade at least, maybe two.

                  Also, some say the effects of adequan take two months to appear; others say the shot only has a four day lifespan, so how could a maintenance shot do anything? That is where I have problems figuring out what to do. But since adequan has the ability to reverse cartilage damage and prolong joint health, I think it's a good thing to do with my mare before she develops any arthritis.

                  If the cost is similar to the orals, which, with the multidose vial it would be, then I think it makes sense to replace the orals with the injectible.

                  Anyone else have a protocol? My vets says seven shots and then repeat as necessary.


                  • Original Poster

                    I also wanted to say that I had a long conversation with a Luitpold vet prior to retiring my old guy a little over a year ago. I tried a 7 shot adequan series on him, instead of the multiple every other month joint injections the vet wanted to do, and my old geezer came sound on it. SO I called Luitpold to see where to go next with it. They told me that there is a very powerful anti-inflammatory effect with the serious and to give it 30-60 days and if the horse went lame again, then adequan wasn't really going to help him that much.

                    This made me wonder whether my friend, who told me that an adequan series only works for thirty days, needs to do something else with her horses. Although I kind of which I had tapered down with my old guy--to a weekly shot then a bimonthly shots etc., to see if it could still help him. But I kind of think by that point he was bone on bone.

                    The Luitpold vet told me, of course, that they had only done clinical trials for adequan as a treatment regimen and not a maintanance or prevention regimen. That you should repeat the treatment regimen as needed, normally once to three times a year. If it gets more frequent than that, the horse probably needs joint injections instead. He also told me that Adequan peaks at 48 hours, so if you want to do it as a pre-event booster, do it two days before the event. FWIW.

                    Most of the off label protocols are anecdotal, just like oral supplements are.


                    • #11
                      Originally posted by Cowgirl View Post
                      Most of the off label protocols are anecdotal, just like oral supplements are.
                      True dat, but people who ride their horses every day and are attuned to their performance abilities often can work wonders with anecdotal evidence. Case in point, I didn't need no stinkin' Luitpold to tell me adequan peaks 48 hours out. I figured that out for myself years ago. Legend: 24 hours out, adequan 48 hours out. Been there, done that, got the t-shirt.

                      So those of who have played around with "off label" frequency might have figured out what works for our horse. The fatal flaw in anecdotal evidence is to try and apply it to a larger population and expect the same results, but its not necessarily incorrect for the individual. It's also worth remembering that if the company didn't do the clinical trials for monthly, that doesn't mean they don't have a benefit, it just means the company didn't spend the mega bucks to do the research. It wouldn't have improved their marketing position one iota to do that research (they had proven the benefit on the existing trial, so I don't fault them one bit). There's more strategy to clinical trials than just uncovering every last treatment protocol.
                      Your crazy is showing. You might want to tuck that back in.


                      • #12
                        Originally posted by pharmgirl View Post
                        The company legally can't give you any more info/advice on dosing than what is approved on the label (and I believe the mfr got a nastygram from the FDA on this awhile back). I believe it is approved for treatment only, so any kind of maintenance regimen would be off label and something they cannot officially comment on.

                        I would also assume that because it is a prescription product, they can only have certain discussions with the prescribing vet but I'm not positive on that one.

                        I realize that teh company can't legally give me info...thus why they asked to speak to the vet.....I was just trying to give an informational post.


                        • #13
                          Having used both Adequan and Legend on several horses, I've found that for my gang, both products really need to be given weekly. The effects of Legend in particular no longer seem noticeable after a week. That said, my horses are older competition horses (h/j) with a lot of miles on them (and one younger guy with a cartilage problem). Your mileage may vary with a more fundamentally sound horse. At any rate, weekly Adequan for several horses would be cost prohibitive, so I am working my way through a vial of compounded glucosamine similar to Ichon and have been very pleased with the results, particularly considering the cost (I want to say it was $60 for 20 5 ml. doses). I do give it weekly. I tried bi-weekly and just didn't feel I got the same results. I also have a call into my vet's office regarding an alternative to Legend. I would really like to give weekly Legend to my late teens hunter, but just can't afford it. Mine all get oral joint supplements as well (I will do anything to keep my little herd happy doing their jobs - they are the bomb ).


                          • #14
                            I found every giving adequan every two weeks helped my lame arthritic gelding allot this summer. I had previously given it weekly for several months but could not tell because he was recovering from a collateral ligament injury.


                            • Original Poster

                              The every other week regime was told to me by a former trainer, who is an international competitor and represents her country in FEI competitions. She said this is what all of her team members do, and what her trainer, a medalist from Germany does: adequan every other week and Legend weekly during the competition season. She didn't get any result from Legend, so stopped using it, but she continued to do adequan every other week. She also uses oral supplements. Another trainer I know uses an every three week regime for her upper level horse, but I have seen drag marks in the arena, indicating that the three week protocol isn't enough--horse drags his hind legs. A friend of mine just gave a series, had her older schoolmaster's hocks done as well, and is now doing monthly adequan shots.

                              The other thing I've read is that when there is an issue precipitating a need for the adequan series, to do ten days of bute or equioxx to get inflammation under control to start. Same when you inject a joint. Inflammation causes arthritis, so this to me makes sense.

                              I started this thread to compile information on what people are doing based on their horse's age, workload, circumstance (i.e. injury or not) because while the evidence is anecdotal and you should be able to feel when your horse needs a little boost, I think there might be some commonalities. For those of us with horses that don't yet have issues, it would help to know what frequencies appear to be effective.


                              • #16
                                In small animal medicine, we recommend doing a loading series of 8 shots - twice a week for 4 weeks. Then we do maintenance as needed, ranging from every 3 or 4 months to every week. Once the loading series is completed, we never re-do it.
                                When I started my older TB mare on Adequan about 5 years ago, we simply did monthly injections. This time, with a different vet, on my TB gelding who is my hunter, I was told to do a loading series as one shot once weekly for 4 weeks, then to do them once a month/as needed - she recommends doing an extra injection during a hard show season, so I'll do them every 2 or 3 weeks during the height of show season.

                                In the dogs and cats we treat where I work, doing the monthly maintenance shot generally makes a HUGE difference, but different animals have different results. I have always liked the monthly shots in my horses as well.


                                • #17
                                  Adequan and Polyglycan here..

                                  I have a 15 year old friesian gelding.. doing 1st level work.. he is sound...but starts out kinda stiff and shuffely until he warms up. I started doing Adequan 1x/month as a preventitive about a year ago.. did not do a loading dose. I never saw any results.

                                  I recently decided to try Polyglycan and DID see a very noticeable result. I am going to try to do the loading dose of Adequan in January to see if it does anything for my guy. If it doesn't, I'll just stick with the Polyglycan and try to do that every couple of weeks. If the Adequan does do something, I'll do that 2x/year...and forget the monthly Adequan (just do Polyglycan). I will continue the Polyglycan regardless because of what it did for him... like riding on sneakers.. really amazing...regardless that it is not labeled for IV use... am thankful my vet is willing to prescribe it for us!

                                  I also have him on a custom horsetech product.. glanzen-lite w/ ASU and MSM and SmartPak's TLC (MSM and other anti-inflammatories). I took out the oral glucosamine and chondroitin as a cost reduction (money for injectibles must come from somewhere and only limited $$ to spend). I also have him on Conquer liquid.. but will likely have to discontinue it to afford more Polyglycan. I've never seen the results with any oral HA (Lubrisyn or Conquer) that I did with Polyglycan...so when deciding to spend $$ on either, Polyglycan wins...


                                  • #18
                                    20 year old Hanoverian mare, currently goofing off in the pasture while I attempt to finish college. She gets adequan every 6 weeks. I started with the loading dose, then every four weeks. After six months, the vet said that I could try six weeks and see how she did. When my work load isn't this heavy, I ride four times a week and jump up to 3 feet (once or twice a week). She was a fancy show horse, she injured her stifle -- about 8 years ago, and before I got her. She has some general arthritis and gets stiff if left in her stall for very long. She's been on adequan for three? four? years now. I definitely see a difference in her.


                                    • #19
                                      I give Adequan every three weeks, plus once-yearly hock injections and daily Force Flex (for giggles, it's cheap, why not). I also have Legend on hand for times when I think it might help. There is no rhyme or reason to that, just "when I want to."

                                      I, personally, would not give Adequan at intervals longer than four weeks and expect to get any "bang for my buck," but that's just me . . ..


                                      • #20
                                        Is Adequan ineffective if given without a loading dose?

                                        My gelding is BAD with shots so I tend to avoid them. I'm afraid he will break a needle jumping around.

                                        Whenever I have the vet around, I ask him to give an Adequan shot. He had one early December, another about two weeks later, and he'll get another early January. Am I just wasting my money?

                                        I did a loading dose on my mare and will give Adequan monthly for her, so I'm waiting to see how that works. Vet also recommended giving a Legend shot every 3 months, but from what I know about Legend, it makes more sense to me to give before shows or as needed.