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Discussion on Price of Equioxx (long...)

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Jeanette R
New Member
Username: jlaurits

Post Number: 1
Registered: 9-2002
Posted on Sunday, Aug 19, 2007 - 8:05 pm:   Edit PostPrint Post

In a previous thread, the observation was made that the cost of Equioxx at $12-15 a syringe (retail) was prohibitive. This gets really interesting when you compare the cost of Merial’s Equioxx to their canine formulation of firocoxib “Previcox.” I crunched some numbers:

--An oral syringe of Equioxx contains 6.93 grams of Equioxx PASTE (0.82% firocoxib) sufficient to treat a 1250 lb horse." (from dosing instructions found on http://www.entirelypets.com/equioxx.html among others, including Dr. Oglesby's article citing package instructions; also FDA document http://www.fda.gov/cvm/FOI/141-253123005.pdf ).

--The recommended dosage for horses is "0.045 mg/lb (0.1 mg/kg) of body weight once daily for up to 14 days." (Again, Oglesby's citation from the package instructions; also the FDA document.)

--At that rate of concentration (0.82% -- oh, yes, I checked the decimal point -- several times!), there's only 56.8 (round it to 57) mg of firocoxib in each tube, enough, the instructions say, for a 1200 lb horse. The cost: $12-15 PER SYRINGE.

Now, here's where it gets interesting! Prior to the availability of Equioxx, the box of ten 57 mg "chewable tablets," each about the size of a baby aspirin, of Previcox my vet dispensed for my gelding cost me $16. From the box, the dosing instructions read, "[administer] orally at a dose of 5 mg/kg body weight once daily." (Remember, this is for a DOG! The dosage to body weight is significantly higher than for horses. Dr. O, there’s undoubtedly a reasonable explanation that I don’t know: metabolism, sensitivities?)

For my 1100 lb horse, however, after a loading dose of 1/2 tablet (27 mg) a.m. and p.m. for the first day, I was giving only 1/2 tab ONCE a day. I've since lost Doc to unrelated causes, but when we put him on the Previcox version of firocoxib, he improved markedly within 48 hours.

And I had changed NOTHING else. (Even my non-horsey sister who was visiting at the time noticed improvement in his attitude and carriage!) The vet practice had had similar success with a number of other clients, so there’s no reason to think the improvement was merely coincidence in my small sample.

So, finally, trying to make cents (pun intended) of the numbers: a 20-day supply of Previcox (at the dosage levels above) cost about 80 CENTS a day. That's a far cry from the $12-15/day (at full dose) Equioxx will set the horse owner back, even figuring extra materials and packaging!

When I recently asked about trying Previcox with my arthritic mare, my vet tells me she’s been told that she can no longer prescribe Previcox for horses. I know there might be a bioavailability issue, but it's just hard for me to believe that there's much more than market economics at work here. I suspect the vets may be over a barrel re their prescribing practices. Even if you eliminate the profit motive (vets gotta eat, too), there's the issue of potential liability. It may be legal for them to prescribe "off-label," but if there's actually an equine version of the drug available, is it wise for them to do so vis-a-vis their potential liability exposure?

But, what an injustice this is to our equine companions! What seems to bring effective pain relief is for most of us essentiallly unavailable. Hmmm, just like for a lot of people, I guess. *#@%*&# !!
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19045
Registered: 1-1997
Posted on Monday, Aug 20, 2007 - 6:51 am:   Edit PostPrint Post

Excellent detective work Jeanette R and your numbers check out to me so far. I am going to check the small animal formulation and cost with my office this morning as my associate uses Previcox in small animals. If it does check out I will have more to add to this discussion.
DrO
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Jeanette R
New Member
Username: jlaurits

Post Number: 3
Registered: 9-2002
Posted on Friday, Aug 31, 2007 - 12:32 pm:   Edit PostPrint Post

DrO -- Just wondering whether you'd had a chance to check into the Equioxx/Previcox equation.

Jeanette
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19118
Registered: 1-1997
Posted on Monday, Sep 3, 2007 - 10:14 am:   Edit PostPrint Post

Thanks for joggling me on this, it had fallen to the bottom of a long list that has been hard to work through. We will be back in town tomorrow and I will put it at the top of the list.
DrO
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19137
Registered: 1-1997
Posted on Wednesday, Sep 5, 2007 - 12:40 pm:   Edit PostPrint Post

Jeanette your math works out and is consistent with the dosages, concentrations, and costs at our office. If I were prescribing firocoxib I would certainly consider using the tablets instead of the paste since it costs almost 1/10th as much! In fact at this price I may start using the product as I could not justify it under the paste costs. There are increased liability issues prescribing a off label drug when there is a labelled one available but if I explain the issue to the client and let them choose I consider this risk small at least with well known clients and well established client patient relationships. I do not think my state veterinary practice act forbids me from prescribing in the above described situation (see below for correction).
DrO
PS Since writing the above I have found out there is are federal rules in the Animal Medicinal Drug Use Clarification Act (AMDUCA) that states:
An animal drug may be used in an extralabel manner only if no approved animal drug containing the active ingredient needed is available in the required dosage form labeled for the indication.

Therefore my earlier statement need correction. It is against federal regulations for a veterinarian to prescribe or dispense the product Previcox®, labeled for use only in dogs, for use in horses because there is already a FDA-approved drug for use in horses (Equioxx®).

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Jeanette R
New Member
Username: jlaurits

Post Number: 4
Registered: 9-2002
Posted on Saturday, Sep 8, 2007 - 8:15 pm:   Edit PostPrint Post

Thanks, Dr. O, for the response. I've now run this by several others, and we've now batting a thousand as to the math for dosage and cost. ;-)

Your analysis of risk also makes sense to me in terms of "informed consent." I may try to make that case with the equine practice I've used for many, many years.

And, frankly, as to the form the drug is delivered in, I found stuffing a tablet -- even a liver-flavored tablet -- into a slice of apple and hand feeding it a much more pleasant experience for my horse and me than having to push a syringe full of paste into his mouth once a day.

Thanks, again.

Jeanette
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Sarah Smith
New Member
Username: digger89

Post Number: 1
Registered: 5-2007
Posted on Wednesday, Oct 31, 2007 - 7:43 pm:   Edit PostPrint Post

I was thrilled to read this post - I was advised today to try firocoxib on my horse with severe (MRI documented) navicular disease. I wondered if the canine formulation would be safe for horses, especially since I have a huge bottle left over from this summer when my dog was injured. The savings in using the canine pills will help pay for the MRI and special shoes! Thanks for your input about this topic. Sarah
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19458
Registered: 1-1997
Posted on Thursday, Nov 1, 2007 - 7:48 am:   Edit PostPrint Post

Welcome Sarah,
I am afraid all I know about this particular use is what you see above and my particular opinion on using it are stated above.

There is a risk with any drug use and while the generic ingredient was found safe enough to get approval in the paste formulation there has been no published safety testing with the small animal tablets.
DrO
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Sarah Smith
New Member
Username: digger89

Post Number: 2
Registered: 5-2007
Posted on Friday, Nov 2, 2007 - 4:42 pm:   Edit PostPrint Post

Dr. O - Thank you for your comments. I know that the canine version hasn't been approved for use in horses specifically. But, this horse is on 2 grams of bute per day, and it isn't keeping him comfortable. He has had a neurectomy plus all the injections, pads, shoes etc that the vets and farriers can come up with. This is probably his last chance to become more comfortable, and truthfully I could not afford $10-15 per day long term. My horse is still young and very beloved, but I am also trying to be realistic about his total well-being. I think the benefits outweigh the possible risks considering how few options we have left. The MRI report was very dismal but did show multiple signs of ongoing inflammation that bute hasn't helped. Maybe THis will make the difference.
Thank you again for your help. Sarah
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Martha E. Mitchell
Member
Username: mitma

Post Number: 154
Registered: 11-2006
Posted on Friday, Nov 2, 2007 - 10:14 pm:   Edit PostPrint Post

Sarah,
Is that really YOU??? So funny... Welcome to HA!!! And, how ironic, as I just saw Morris this week in Williamsburg and he mentioned the issue of navicular in your gelding... (I, too, have a navicular mare who is a 14 yo rescue... I'm now in the corrective "natural" trim phase of her therapy... so far, her lameness has improved quite a bit, but she's only in the round pen now at a walk/trot and has not yet been started under saddle... hopefully, she will make it to that point and be comfortable as a trail horse for someone...) We should definitely get together sometime this winter!
Martha
P.S., Sorry Jeanette and Dr. O for butting in to the Equioxx thread...
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19476
Registered: 1-1997
Posted on Saturday, Nov 3, 2007 - 8:21 am:   Edit PostPrint Post

Sarah, once you have tried the firocoxib for a while I would love for you to start a new post here describing the lesions found on the exam of your horse along with your experiences comparing the bute and the firocoxib. It will help many others.
DrO
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Sarah Smith
New Member
Username: digger89

Post Number: 3
Registered: 5-2007
Posted on Saturday, Nov 3, 2007 - 9:26 am:   Edit PostPrint Post

Ok, I will check in again in a few weeks to let you know how DJ is doing. Thanks for your help. Sarah
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Bunny Delgado
New Member
Username: annied

Post Number: 1
Registered: 12-2007
Posted on Saturday, Jan 24, 2009 - 5:27 pm:   Edit PostPrint Post

Just wanted to join the discussion about Equioxx, as I was ready to place an order and saw this discussion. Equioxx has been an actual life saver for our two horses. Our 12 yr old Paso Fino foundered last year 8/07 and blood test revealed Cushings. He foundered so severely that just a few years earlier we would have not been able to save him. Thanks to our wonderful vet and well educated farrier specializing in these cases, over the course of 8 months of stall rest and sometimes daily, or weekly trimmings and special shoeing, our boy is sound. During this extremely painful experience, Equioxx kept him comfortable enough to keep a good attitude and will to live.He was on one tube daily for months, yes, it cost a fortune, but he was worth it. Now, my 26 yr old Peruvian has been on 2 to 3 tabs of bute for quite some time, due to severe arthritis in rt front. He got diahreah and fearing it was the bute I took him off it, fearing how he would deal with the pain. I started him on 1 tube of Equioxx for a few days and then 1/2 tube daily which he has been on for aprox 1 month. This is affordable and an absolute blessing. He has been more comfortable than I can remember in the past few years.
Just wanted to suggest that possibly 1/2 tube or even 1/4 tube might be affordable for most horse owners out there.
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Andrea Robinson
New Member
Username: jetski53

Post Number: 3
Registered: 8-2010
Posted on Friday, Sep 10, 2010 - 9:19 pm:   Edit PostPrint Post

All - last post on this topic was from 2009 so I thought it worth while to add to it. I just left my vet hospital with both Equioxx and Previcox. He recommended I try the paste to see if I get results and if so then to move to the Previcox as a less expensive alternative for daily dosing. So I think this is catching on now within the vet and equine world.
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