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Skill
Procedures that you should be able to competently and safely perform on a horse.

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How to use flunixin meglumine (Banamine®) to treat your horse

Summary

Flunixin meglumine (the familiar trade name is Banamine®) is the prescription pain and inflammation medication most commonly kept on hand by horse owners, mostly for the treatment of abdominal pain (colic). Used correctly and with veterinary guidance, it is an extremely useful drug. Used incorrectly, it can mask the signs of a worsening problem, delay diagnosis and treatment, and endanger your horse's life.

Flunixin requires a veterinary prescription. I dispense injectable flunixin or flunixin paste to clients I trust and with whom I have a valid VCPR (Veterinarian-Client-Patient Relationship), with the understanding that they will call me to discuss the situation BEFORE they give this drug to their horse. That call matters! Once the drug is on board, it can complicate your vet's interpretation of your horse's problem.

When we advise giving flunixin injectable solution orally, understand that this is an extra-label use of the drug. It is not intended to be used this way, but it works.

The route (IV, oral, or IM) determines how quickly the drug takes effect, and that timing is the heart of this skill. Given IV (by your veterinarian), flunixin acts within just a few minutes. Given orally (injectable solution given by mouth, or paste), expect 45 minutes before meaningful effect. Ideally, flunixin is not given in the muscle, as it can cause tissue irritation and potentially severe infections. If it is given in the muscle, the onset is by about 20 minutes.

These times set the clock for the most important judgment in colic: whether the drug worked, and what it means if it did not. A horse that has not returned to normal attitude and appetite within the expected window probably has a more serious problem, and your vet needs to know immediately. This skill covers giving the drug correctly, timing it, monitoring the response, and recognizing the moment when "wait and see" must end.

PROCEDURE

PROCEDURE
1. Call your vet. Describe your observations and your Whole Horse Exam findings, and agree on whether to give flunixin, the dose, and the route. Do not skip this step.

2. Halter and restrain your horse in a safe, calm area. If your horse is in violent colic pain, your priority is safety — see Handle Horse with Colic before attempting to medicate.

3. Prepare the dose exactly as your vet directed. Injectable solution can be given by mouth at the same dose — draw it into a clean syringe with no needle. Paste is dosed by the weight markings on the plunger.

4. Give the medication. For oral administration technique, see Give Oral Medication.

5. Record the time, dose, and route.

6. Remove all feed unless your vet has directed otherwise.

7. Start the clock for the route used: [DOUG: oral window / IV window]. Monitor your horse — attitude, appetite, pawing, lying down, manure — and repeat the Whole Horse Exam, paying particular attention to heart rate.

8. Decision point: if your horse has NOT returned to normal attitude and appetite within the expected window, call your vet back immediately. This is a Code Red. Do not give more medication while you wait.

9. If your horse improves, keep monitoring as the drug wears off. While you will see dosing frequency for this medication given as every 12 hours, in reality, abdominal pain recurs before then. You will see effects starting to decrease at about 7 hours and a horse with a significant pain level will begin again showing signs of pain. Pain that returns after a single appropriate dose means a more serious problem — the horse must be examined by a vet ASAP. Pain that does not ever improve signals a more serious or painful problem , and a vet should examine the horse ASAP also.
TIPS FOR SAFETY AND SUCCESS

Call your vet BEFORE you give flunixin, not after. The conversation is short, and it protects your horse.

Write down the exact time, dose, and route the moment you give the drug. Your vet will ask for all three.

When treating colic pain, remove all feed unless your vet directs otherwise. All the medication is doing is breaking the pain cycle. Pain may recur as the medication wears off, and a horse with feed in front of it can make an intestinal problem worse.

Do not give flunixin to a horse you believe is dehydrated except under direct veterinary guidance. In the dehydrated horse this drug can cause kidney and intestinal injury.

NEVER give a second dose without veterinary involvement. Additional doses do not necessarily improve pain relief and can cause dangerous side effects. If your horse is sick enough to require a second dose, it must be seen by a veterinarian.

Improvement after the drug is not the same as resolution of the problem. Flunixin masks pain. The question is never "did the drug fix the colic" — it is "did it stop the pain?" The next question is "does the pain return when the drug wears off."

I don't recommend intravenous injection unless you do it very frequently and are very confident doing it. The consequences of an incorrectly placed injection can be fatal.

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Author: Doug Thal DVM Dipl. ABVP