# Bute/Danilon



## Achinghips (8 April 2011)

What's the difference please? From what I've read Danilon is kinder on the kidneys and more palatable. Anything else?


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## alsiola (8 April 2011)

Bute contains phenylbutazone.  Danilon contains suxibuzone, which is metabolised by the horse's liver into (mostly) phenylbutazone.  In the end up, an equivalent level of phenylbutazone is circulating in the bloodstream regardless of which product is used.  This means that side effects on liver and kidney are identical between both products (no liver side effects, extremely uncommon kidney side effects).

There was a theory that as Danilon had already passed through the stomach before being activated into phenylbutazone, it would have fewer side effects in terms of gastric ulcers than bute.  However, the mechanism of action of equine gastric damage with phenylbutazone involves the drug in the bloodstream, not in the stomach itself.  This means that there will be no difference in ulcer formation between the two drugs.  There was a published trial showing Danilon to be associated with less ulcer formation than phenylbutazone, but the trial used Danilon at a standard dose, and phenylbutazone at a double dose.  The results are therefore pretty meaningless - the study has now been retracted, and Danilon cannot be legally advertised as safer for gastric health.

Neither bute nor danilon at commonly given doses cause gastric ulcers - this is a common misconception but there is absolutely no evidence that this is true.

The side effects of non-steroidal drugs (e.g. bute, Danilon, Finadyne, Metacam) are as follows:
Large colon ulceration (Right Dorsal Colitis) - uncommon at normal doses but does happen
Renal tubular damage - extremely uncommon
Caecal Impaction - incredibly uncommon

In short these are extremely safe and effective drugs when used at recommended doses.  The only advantage of Danilon over bute is that it tastes nicer, and I would only recommend its use for a horse that refused to eat normal bute.


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## Ladylina83 (8 April 2011)

Alsiola what a cracking response ! read with much interest - thank you


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## Britestar (8 April 2011)

Can't even being to make a response like above, but - tried my old girl with Danilon, she refused to touch it and then refused to eat any hard food for 7 days after. Tried to syringe bute inwater into her - I wore most of it. 

Finally had success (bute) with the ever reliable golden syrup sandwich!


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## Ladylina83 (8 April 2011)

Britestar said:



			Can't even being to make a response like above, but - tried my old girl with Danilon, she refused to touch it and then refused to eat any hard food for 7 days after. Tried to syringe bute inwater into her - I wore most of it. 

Finally had success (bute) with the ever reliable golden syrup sandwich!
		
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Funny for years i struggled if I ever needed to use bute - she worlfs down Danilon though


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## Achinghips (8 April 2011)

Thanks everyone for the responses, esp alsiona for such a long well thought out and thorough answer. 
My girl doesn't like the taste of bute


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## now_loves_mares (9 April 2011)

alsiola said:



			Bute contains phenylbutazone.  Danilon contains suxibuzone, which is metabolised by the horse's liver into (mostly) phenylbutazone.  In the end up, an equivalent level of phenylbutazone is circulating in the bloodstream regardless of which product is used.  This means that side effects on liver and kidney are identical between both products (no liver side effects, extremely uncommon kidney side effects).

There was a theory that as Danilon had already passed through the stomach before being activated into phenylbutazone, it would have fewer side effects in terms of gastric ulcers than bute.  However, the mechanism of action of equine gastric damage with phenylbutazone involves the drug in the bloodstream, not in the stomach itself.  This means that there will be no difference in ulcer formation between the two drugs.  There was a published trial showing Danilon to be associated with less ulcer formation than phenylbutazone, but the trial used Danilon at a standard dose, and phenylbutazone at a double dose.  The results are therefore pretty meaningless - the study has now been retracted, and Danilon cannot be legally advertised as safer for gastric health.

Neither bute nor danilon at commonly given doses cause gastric ulcers - this is a common misconception but there is absolutely no evidence that this is true.

The side effects of non-steroidal drugs (e.g. bute, Danilon, Finadyne, Metacam) are as follows:
Large colon ulceration (Right Dorsal Colitis) - uncommon at normal doses but does happen
Renal tubular damage - extremely uncommon
Caecal Impaction - incredibly uncommon

In short these are extremely safe and effective drugs when used at recommended doses.  The only advantage of Danilon over bute is that it tastes nicer, and I would only recommend its use for a horse that refused to eat normal bute.
		
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I just wanted to reply to say that my mare is currently recuperating from Right Dorsal Colitis, Caecal impaction, recurring colic and Gastric ulcers. She was on 4 Danilon a day for 3 days before she started going off her food, so a very very acute onslaught. So although uncommon, it does indeed happen. I am about 98% certain she didn't have the gastric ulcers before (and 100% sure there was no RDC/Impaction/Colic), but it is possible she got them via the starvation as a result of the colitis rather than directly from the Danilon - but it was related. She has wracked up over £5k in vets fees, spent 4 weeks in hospital, and is now on a no-hay, all soaked diet, meaning I am feeding her every 2 hours, plus getting up in the middle of the night.

My subsequent research since shows that the only reason to use bute/danilon is because it's cheap. The more modern NSAIDs don't target the Cox-1 receptors, and are therefore not only more targeted to the site of pain, but also far less likely to have gastric complications. I'll never use Bute/Danilon for short-term use on any of my horses ever again. We've considered having her PTS several times over the last few weeks. I'd go for Metacam or Equioxx (the newest, therefore most advanced) instead. 

This explains the cox1-cox2.
http://www.equioxx.com/about.asp

If you do use either Bute/Danilon, make sure your horse isn't dehydrated, as the likelihood of complications is much higher. Also try to ensure your horse has eaten a full haynet before you give the dosage. And use the absolute least dosage you can get of with (IIRC the size of the Danilon pack is bigger than a bute sachet). Of course lots of horses do perfectly well on Bute, and cost-wise it's probably still the best option for long-term low-dosage. But if you have a short-term need, there are better and safer options.

I'll get off my soapbox now, but as you can tell I've experienced the downsides rather seriously


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## alsiola (9 April 2011)

Sorry to hear about your mare, and all my best wishes for her speedy and complete recovery.



now_loves_mares said:



			I just wanted to reply to say that my mare is currently recuperating from Right Dorsal Colitis, Caecal impaction, recurring colic and Gastric ulcers. She was on 4 Danilon a day for 3 days before she started going off her food, so a very very acute onslaught. So although uncommon, it does indeed happen. I am about 98% certain she didn't have the gastric ulcers before (and 100% sure there was no RDC/Impaction/Colic), but it is possible she got them via the starvation as a result of the colitis rather than directly from the Danilon - but it was related. She has wracked up over £5k in vets fees, spent 4 weeks in hospital, and is now on a no-hay, all soaked diet, meaning I am feeding her every 2 hours, plus getting up in the middle of the night.
		
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4 danilon a day for 3 days is a fairly chunky dose rate - depending on the size of your mare.  Having said this I have personally used up to 8 in a day (for a 1 ton shire), so depending on the level of pain relief required may not have been inappropriate.  I would say that of the RDC cases I have seen, around half have been due to overdose, around half due to an individual horse's sensitivity to a reasonable dose.
In terms of how common complications are... In the last 6 months I have treated probably 200-300 horses with bute/danilon.  I have seen no complications.  In the practice I work in, probably 5 times this number treated, and one case of RDC seen.  So uncommon, but in a 5 vet practice we will see 2 or 3 a year on average.  Kidney problems I have never seen.  Caecal impaction I have seen once, while I was a student.  Within a university hospital, there were several residents who had not heard of this complication - that's how uncommon it is.



now_loves_mares said:



			My subsequent research since shows that the only reason to use bute/danilon is because it's cheap. The more modern NSAIDs don't target the Cox-1 receptors, and are therefore not only more targeted to the site of pain, but also far less likely to have gastric complications. I'll never use Bute/Danilon for short-term use on any of my horses ever again. We've considered having her PTS several times over the last few weeks. I'd go for Metacam or Equioxx (the newest, therefore most advanced) instead.

This explains the cox1-cox2.
http://www.equioxx.com/about.asp

Click to expand...

Unfortunately the cox-1/2 debate is far far far from resolved.  There is considerable evidence from human medicine that cox-1 sparing inhibitors have more side effects than balanced non-selective inhibitors.  So although it would seem that a cox-1 sparing NSAID would be better, there is no evidence that this is the case.
This is illustrated wonderfully in your link, the most important part of the whole page being:



			* Clinical relevance has not been determined.
		
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I.e. there is no proven advantage of Equioxx over Bute.  The same is true for Metacam.  Drug companies are great at making claims without real evidence.  Last time I spoke to a Boehringer-Ingelheim (make Metacam) rep, they harped on about how Metacam is better for laminitis because of its MMP inhibition, and cox-1 sparing properties.  However, they could not provide evidence that outcomes for horses treated with Metacam are better than horses treated with Bute. There is a similar paucity of evidence showing less side effects with Metacam/Equioxx vs Danilon/Bute.  
Given that 10 days of Metacam is approx £80, and 10 days of Bute is approx £20, then I think there should really be some evidence that the £80 is better than the £20 one.  The bottom line is that this evidence does not exist.

Pain relief is difficult in horses due to the lack of options available.  The only licensed oral products are all non-steroidal anti-inflammatories (bute, danilon, metacam etc.), and so the first approach to uncontrolled pain tends to be increasing the dose of these.  In other species, where there are more easily available, and financially viable oral drugs then different drugs are used in conjunction with NSAIDs, rather than higher doses of NSAIDs. (this is multi-modal analgesia)
Other possible drugs are either extremely expensive or impractical.  For example, the opioid Morphine is very effective and not too expensive, but needs dosing by injection every 8 hours.  OK for a hospitalised horse, but I won't be leaving horse sized doses of morphine for owners to inject.  Other opioids available e.g. butorphanol - nowhere near as effective as morphine, and needs injecting every 4-6 hours, but at least its safe to leave with an owner.  However, at around £240 per day it becomes difficult.  Both morphine and butorphanol can have significant side effects with all but v. short term use as well.
The only other oral analgesic that is close to practical is Gabapentin, but this is very much unproven in horses, and is probably only useful in chronic pain states, e.g. chronic laminitis.

I would personally love to see some drug company attention toward analgesia in horses - not directed toward "better" NSAIDs, but toward different classes of drug that could be used alongside NSAIDs more easily.  This would keep doses of, and therefore risks of, NSAIDs to a minimum.


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