Long Term Use of Sedalin

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Kmmilner

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Hi My horse has been on box rest for I think 20 weeks (starting to lose count now!) for a pedal bone fracture which is proving difficult to get to heal due to him constantly box walking and getting himself up set tot he point of being dangerous. Following some more x-rays we ahve just been given another 4 weeks box rest for the last two eeks I ahve been giving him sedalin gel and while he is less angry and generally a nicer person when it wears off he is still creating havoc in his stable bucking etc! So the vet now has me giving him 7.5 mls on a morning and 5ml at night which seems to be keeping him calm and he always has another horse with him. But I am getting concern about long term side affect or doing him permanent damage, has anyone else had to do box rest sedated?
 
Gosh, how stressful for you!
A lot of laminitics are on ACP/Sedalin long term on veterinary advice, I've not heard of any side-effects and it looks as though your horse needs it to prevent further injury to himself and you.
I would give Oxyshot a try, it can work very well and it's drug free.
 
Kmmilner said:
Hi My horse has been on box rest for I think 20 weeks (starting to lose count now!) for a pedal bone fracture which is proving difficult to get to heal due to him constantly box walking and getting himself up set tot he point of being dangerous. Following some more x-rays we ahve just been given another 4 weeks box rest for the last two eeks I ahve been giving him sedalin gel and while he is less angry and generally a nicer person when it wears off he is still creating havoc in his stable bucking etc! So the vet now has me giving him 7.5 mls on a morning and 5ml at night which seems to be keeping him calm and he always has another horse with him. But I am getting concern about long term side affect or doing him permanent damage, has anyone else had to do box rest sedated?
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I have kept many horses on medium term box rest on ACP (tablets or gel) without problems. Having said that, I often recommended the use of Modecate (fluphenazine) injection. It is not licensed for use in the horse, but works very well as a one off injection lasting 4-6weeks whien using ACP at the same time. It potentiates the effect of ACP and so you can use a lower dose but cause the same effect, this seems beneficial at reducing worries about side-effects.

As Modecate isn't licensed for horses I use a test dose (0.2mls) at a 10th of the full dose (2mls) into muscle. If there are no reactions - hyperactivity or drowsiness (:confused:) then the full dose is give a few days later.

It might be worth a try, even if it just reduces the cost of acp - at 12.5mls per day your pocket is going to hurt!! :) Maybe ask you vet for tablets instead for cost - same effect, but a pain if the horse won't eat them. :rolleyes:

Good Luck
Imogen
 
I don't suppose it would be possible for him to go in a small paddock or yard with a mate? I personally can't see it being more of a risk if he is bucking etc. and very stressed in the stable anyway.

It's such a difficult one this isn't it, I really feel for you and your boy. Hope you both get through this ok. I'm a bit anti sedation especially long term but I do realize sometimes it's unavoidable. I do think we should all look at other options that are less stressful for the horse and the poor owners trying to care in these circumstances.

Modecate has a high risk of side effects in humans and has other actions apart from sedation. It is given to humans much less these days for good reason. Plus once it's injected that's it for a month, it's a slow release preperation so cannot be stopped once given.
http://www.rxmed.com/b.main/b2.phar...hs/CPS- (General Monographs- M)/MODECATE.html
 
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amandap said:
Modecate has a high risk of side effects in humans and has other actions apart from sedation. It is given to humans much less these days for good reason. Plus once it's injected that's it for a month, it's a slow release preperation so cannot be stopped once given.
http://www.rxmed.com/b.main/b2.phar...hs/CPS- (General Monographs- M)/MODECATE.html
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Yeah it does - which is why we use the test dose - I've had one horse that had a low grade sedation reaction to the modecate test dose....but none react to full dose.
 
I've tried Sedalin a few times with a horse that was difficult to shoe, clip etc... I always found it to be an unpredictable and dangerous thing - the horse was not sedated as such and would "come to" unpredictably and really over react.

The real problem is that you get no warning - there is just a "boom" - where an unsedated horse you can see it buikding up. For that reason I would tend to avoid Sedalin.

So if I have to clip this particular horse, I just use the vet to sedate - and he only takes less than a 0.2ml sniff of domo and he's away for an hour!

Ithink different breeds react diferently to it - a friend uses sedaline on her conemara for various things and it works a treat - he's totally chilled by it (I think she has the problem anyway, not him)

Really not a fan of sedation, but if it makes it safe....
 
i had my boy on ACP for months while trying to get him used to turnout after box rest as he was such a lunatic. the only side effect was to my pocket (luckily the insurance paid me back). It's almost impossible to get hold of horse strength ACP tabs now with the VMD deciding they're not licensed for horses so we have to use the licensed Sedalin but Sedalin is just sooooo expensive (even at cost price!)
 
ImogenBurrows said:
I have kept many horses on medium term box rest on ACP (tablets or gel) without problems. Having said that, I often recommended the use of Modecate (fluphenazine) injection. It is not licensed for use in the horse, but works very well as a one off injection lasting 4-6weeks whien using ACP at the same time. It potentiates the effect of ACP and so you can use a lower dose but cause the same effect, this seems beneficial at reducing worries about side-effects.

As Modecate isn't licensed for horses I use a test dose (0.2mls) at a 10th of the full dose (2mls) into muscle. If there are no reactions - hyperactivity or drowsiness (:confused:) then the full dose is give a few days later.
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Had no idea that Modecate was used for horses, learn something new everyday. Are there any reports on S/E in horses apart from what you mention ? There are certainly a few S/E in humans that can be very serious if not monitored carefully, even when apparently ok with a test dose, complications can arise later on, needing immediate medical attention.
 
horserider said:
Had no idea that Modecate was used for horses, learn something new everyday. Are there any reports on S/E in horses apart from what you mention ? There are certainly a few S/E in humans that can be very serious if not monitored carefully, even when apparently ok with a test dose, complications can arise later on, needing immediate medical attention.
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I was very shocked and disturbed when I read of it a few months ago! My personal opinion is that it is unacceptable and it's high time in this day and age that we rethought how we accomplish 'box rest'! It's no wonder some horses object and go frantic when they are allowed out for 'gentle' exercise.
Humans are rarely prescribed bed rest these days for all sorts of physical complications it causes but for a prey animal who relies on being able to see all around him and is built to move constantly with company it must be difficult and torment for some! Locked in a box with usually only one small view, no mates and inability to walk, wander and forage. The importance of mental attitude to healing is being recognised in humans...

I'll get off my soap box now!
 
We did small paddock rest for 6 weeks but after been in for 10 weeks the horse got board with small paddock rest and was getting dangerous to lead to the field and back each day. We would rear lunge forward buck out towards his handler and try and legit on 2 occasion he did manage to get away from me and gallop round the field flat out! Unfortunatly because of where his fracture is and the fact it goes right back to the coffin joint everytime he moves he pulls that end of the fracture apart and it is now wider at one end than the other so he is back in trying to minimise his movement. We considered cross tying him but I think that will just make him more angry so hence why we are trying sedation. Thank you all for your responses I now feel less worried about sadating him and have managed to reduce his sedalin to 5ml twice a day which seems to be working. We always keep another horse in with him so he is never alone. Thanks
 
Hi,

Got lazy so I've copy and pasted this from netdoctor:

"Modecate and Modecate concentrate injections both contain the active ingredient fluphenazine decanoate, which is a type of medicine called a phenothiazine antipsychotic. (NB. Fluphenazine is also available without a brand name, ie as the generic medicine.)
Fluphenazine is sometimes described as a neuroleptic or a 'major tranquilliser', though this last term is fairly misleading, as this type of medicine is not just a tranquilliser, and any tranquillising effect is not as important as its main mechanism of action in psychiatric illness.
Fluphenazine works by blocking dopamine receptors in the brain. Dopamine is a natural compound called a neurotransmitter, and is involved in transmitting messages between brain cells. Dopamine is a neurotransmitter known to be involved in regulating mood and behaviour, amongst other things.
Psychotic illness, and particularly schizophrenia, is thought to be caused by overactivity of dopamine in the brain. Fluphenazine blocks the receptors that dopamine acts on, and this prevents the overactivity of dopamine in the brain. This helps to control psychotic illness.
Fluphenazine improves disturbed thoughts, feelings and behaviour in psychotic illness such as schizophrenia. It produces a calming effect and controls aggression, delusions and hallucinations.
Modecate and Modecate concentrate injections are depot injections. The injection is administered into the muscle of the buttock, where it forms a reservoir of medicine that is slowly released into the bloodstream. This means that you don't need to remember to take a dose of the medicine every day. The injection is usually given every two to five weeks, depending on the dose required."

Obviously this is human stuff so not directly translatable!!

As far as side-effects go:

"These include Parkinsonian symptoms (including tremor); abnormal face and body movements (dystonia); restlessness (akathisia); rhythmic, involuntary movements of the tongue face and jaw (tardive dyskinesia). Most of these side effects, also recognised in horses, resolve after drug withdrawal; however tardive dyskinesia is of particular concern as it may be irreversible."

As I said before I have not ever seen any of these.
 
I would strongly advise against using modecate even if your vet is willing to administer it. I understand how stressful box resting a horse can be, particularly for that length of time, but I don't think that the risks of using modecate are acceptable. The possible neurological side effects are dramatic and distressing (there is a video on youtube I think), and are very difficult to control.

No safe dose rate has been established; most vets use 2ml but this is not based on anything scientific and I have seen horses respond adversely at this dose. Reactions can occur in horses that have shown a good response on previous occasions, so a trial dose is not a failsafe. The literature on the use of this drug in horses is limited to reports of adverse reactions, and I have never read or heard a recommendation for its use from a respected source.

Sedalin is much safer even over a prolonged period at a moderately high dose, and if it's working for him I'd stick with that. Hopefully the 4 weeks extra box rest will go quickly!
 
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GreedyGuts said:
I would strongly advise against using modecate even if your vet is willing to administer it. I understand how stressful box resting a horse can be, particularly for that length of time, but I don't think that the risks of using modecate are acceptable. The possible neurological side effects are dramatic and distressing (there is a video on youtube I think), and are very difficult to control.

No safe dose rate has been established; most vets use 2ml but this is not based on anything scientific and I have seen horses respond adversely at this dose. Reactions can occur in horses that have shown a good response on previous occasions, so a trial dose is not a failsafe. The literature on the use of this drug in horses is limited to reports of adverse reactions, and I have never read or heard a recommendation for its use from a respected source.
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Interesting as a number of "well respected vets" have used this...

Side effects are possible but rare IME as with any drug, I'd be interested to know how many horses you've seen react and how many you've seen injected over all....did the reacting horses have a trial dose. And while I agree it's not failsafe I don't have experience of any that had no reaction at the low dose that have then reacted at the full dose.

Sedalin is much safer even over a prolonged period at a moderately high dose, and if it's working for him I'd stick with that. Hopefully the 4 weeks extra box rest will go quickly!
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Sedalin is licensed so you do have comeback in side-effects, should they occur and interestingly both acepromazine and fluphenazine are phenothiazines, i.e. the same drug family so aren't vastly dissimilar anyway.

It's interesting that it's provoked such as strong reaction from some... :rolleyes:. Bear in mind I have lost a horse from a profound and rare vaccination reaction....if you want horror stories they can be around everything. ;)
 
ImogenBurrows said:
It's interesting that it's provoked such as strong reaction from some... :rolleyes:. Bear in mind I have lost a horse from a profound and rare vaccination reaction....if you want horror stories they can be around everything. ;)
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I find this remark very 'interesting'! lol Are you implying something here? Of course there are horror stories about every aspect of our life with horses. I'm asking myself everyday why?

For me this is an ethical issue. I've outlined part of my objections to sedation in general for box rest with the caveat that of course there are times when there is no alternative. However I seriously question the frequency of the box rest prescription on the grounds of how detrimental it can be for the horse both physically and emotionally and I feel vets and owners need to be thinking 'outside the box' much more often and asking is BR really necessary?

Modecate is an old fashioned neuroleptic drug with severe side effects well documented in humans. Horses are unable to speak and communicate how they are responding to us so do we really have the right to enforce a very powerful drug on them to make life easier for us as vets and owners? Come on, we are supposed to be the intelligent animal species, we impose our ideas and values onto horses in every aspect of their lives, often with little regard for how they have evolved to live, can't we at least give them the courtesy of coming up with some new management ideas or splints etc. rather than giving them strong chemicals where for us to notice any side effects the horse would probably be having a severe reaction!
If neuroleptics are going to be used for horses, why can't they be given in a daily dose form rather than this long acting preparation?

The cynical side of me wonders if the chemical industry sees a new market for this drug now it's used so much less in humans.
 
I did not post to start an argument, just felt that your advocacy of fluphenazine should be tempered by another point of view. There is no evidence base for its use in horses, but significant evidence that adverse reactions are severe and difficult to manage. In many ways the fact that it is anecdotally of use, yet no-one has ever conducted or published a clinical trial speaks for itself.
 
OP, thanks for posting about Sedalin, im going through similar & having to sedate almost daily atm. I was worrying about it but am not anymore. Very best of luck with your horse.
 
I really, really sympathise as my normal quiet doppy horse turned into a dangerous nightmare after a couple of months box rest, and I could graze him in hand every day so it wasn't as if he never got out at all.

Sedalin did sort of work, but its effects wore off after a couple of weeks, and at £5.00 a tube it was getting pricey. To cut a log story short I took him to a livery yard for rehap and after one frightening expereince they got hold of the vet for something better.


They used BROMIDE, which apparently they give to young TB colts and it worked well, except the first day the poor livery owner thought she had given him colic as he wouldn't eat, the effect of the bromide was to slow down his digestion. Rang vet "Oh yes that can happen sometimes." So the poor YO was out at 11.00 at night walking a dopey horse round trying to get him to eat SOMETHING to get his insides working again.

He was on the bromide for the rest of his stay there, but by the time he came home he was on a tiny dose, about 1/2 a teaspoon a day and since he came home he reverted to his usual quiet self.

Just an idea.
 
amandap said:
I find this remark very 'interesting'! lol Are you implying something here? Of course there are horror stories about every aspect of our life with horses. I'm asking myself everyday why?
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;) I was merely suggesting that "googling" side effects are likely to bring up a whole spectrum of stuff....the more extreme ends are rare. It's not that bad stuff doesn't happen, it's just it doesn't happen as often as alledged in most cases.

For me this is an ethical issue. I've outlined part of my objections to sedation in general for box rest with the caveat that of course there are times when there is no alternative. However I seriously question the frequency of the box rest prescription on the grounds of how detrimental it can be for the horse both physically and emotionally and I feel vets and owners need to be thinking 'outside the box' much more often and asking is BR really necessary?
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I quite agree with this...the trouble is, it is often very helpful for the underlying condition, but trying to get the horse to understand that BR is "in it's best interest" is quite another story. Personally where possible I try and use the term "box-sized area" rest. I'm quite happy if they are calm out in a tiny area of paddock penned off - this works very well in a lot of cases. Problem is ask a child, or anyone for that matter, if they are ok with bed rest for 6 weeks....of course not. We'd go doolally. At least we can understand though.

Modecate is an old fashioned neuroleptic drug with severe side effects well documented in humans. Horses are unable to speak and communicate how they are responding to us so do we really have the right to enforce a very powerful drug on them to make life easier for us as vets and owners? Come on, we are supposed to be the intelligent animal species, we impose our ideas and values onto horses in every aspect of their lives, often with little regard for how they have evolved to live, can't we at least give them the courtesy of coming up with some new management ideas or splints etc. rather than giving them strong chemicals where for us to notice any side effects the horse would probably be having a severe reaction!
If neuroleptics are going to be used for horses, why can't they be given in a daily dose form rather than this long acting preparation?
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They are given in daily dosing - ACP is the same drug family...a conveniently forgotten fact here! ;)
It's a great idea to try and develop splints etc, impractical for the upper limb when they do more harm than good, and sadly pressure sores often create a far was set of problems in long time casting/bandaging or splinting, however well it's done. It's not a perfect world. :(

The cynical side of me wonders if the chemical industry sees a new market for this drug now it's used so much less in humans.
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I'm sure you may well be right....but it's not widely used, or widely advocated. It's IME used as a last resort, I certainly don't mean to give the impression it's doled out like sweeties. I doubt it'll ever hit the market in a big way - something will superceed it...and besides, as is evident on this thread, there would need to be far more research done. I don't see it talking off - fortunately :p

GreedyGuts said:
I did not post to start an argument, just felt that your advocacy of fluphenazine should be tempered by another point of view.
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Quite right too - a good discussion needs two sides ;)

There is no evidence base for its use in horses, but significant evidence that adverse reactions are severe and difficult to manage.
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I'm not sure I agree with the first part...evidence based it has been tried and does work in a good number of cases....and while I'm sure part two is true to some extent, the same has been said for morphine in the horse for years. When I qualified, it was contraindicated now it's routine. Why? Because we kept trying it in different cases, for different reasons, at different doses and given by different routes. Many people don't like the idea that trial and error work occurs....but it happens all the time. That's the only way we can learn and advance. Side effects of morphine are horrid in the wrong case/dose...same, same but different.

In many ways the fact that it is anecdotally of use, yet no-one has ever conducted or published a clinical trial speaks for itself.
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I suspect there hasn't been the case demand to require the enormous drug companies have to incur to obtain manufacturing licensing. Call me a cynic, but I suspect it boils down to financial reasons and no more. That's why we have so few drug licensed for the horse anyway.

Look for the record, I agree the side effects are pretty horrid. I've used it as a last resort in a few cases a year, and IME have had no issues. One colleague of mine, had a horse that got a little depressed on the test dose. I don't know anyone else directly that's seen a reaction. That's why I'd include it as an option. But it is just an option.:o

I'm not trying to be argumentative or awkward - but a good debate is healthy and we can all learn stuff - I certainly can and do everyday!

I wonder how many horses in the US where it has allegedly been used pretty commonly in illegal doping for competition have suffered side effects? It hardly bears thinking about. :(

Good job most cases respond to ACP!:D

All the best
Imogen
 
ImogenBurrows said:
;) I was merely suggesting that "googling" side effects are likely to bring up a whole spectrum of stuff....the more extreme ends are rare. It's not that bad stuff doesn't happen, it's just it doesn't happen as often as alledged in most cases.
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Fair enough. Tardive dyskinesia and other neurological side effects were very common in humans and drugs to combat these effects were often given routinely in the past if my memory serves me right.


ImogenBurrows said:
I quite agree with this...the trouble is, it is often very helpful for the underlying condition, but trying to get the horse to understand that BR is "in it's best interest" is quite another story. Personally where possible I try and use the term "box-sized area" rest. I'm quite happy if they are calm out in a tiny area of paddock penned off - this works very well in a lot of cases. Problem is ask a child, or anyone for that matter, if they are ok with bed rest for 6 weeks....of course not. We'd go doolally. At least we can understand though.
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I agree with what you say here, that is my point, horses do not understand why we need to box them sometimes and due to the nature of the distress for some horses and carers perhaps more thinking should be put into this whole area, not accept the current options and thinking. I don't mean you personally here btw, I mean all of us involved with horses. Is a box sized area really required in some even many cases? I'm not a vet as you are but I would have thought constant low level movement was less stressful for bones and ligaments than tense, stressful turning round and round etc. in a stable.


ImogenBurrows said:
They are given in daily dosing - ACP is the same drug family...a conveniently forgotten fact here! ;)
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Actually I hadn't forgotton this I didn't know until I've just looked it up and found the drug to be Acepromazine so I've learned more today thankyou.

ImogenBurrows said:
It's a great idea to try and develop splints etc, impractical for the upper limb when they do more harm than good, and sadly pressure sores often create a far was set of problems in long time casting/bandaging or splinting, however well it's done. It's not a perfect world. :(
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I know it's not a perfect world but if we don't question and try and find 'better' ways, things will never improve.
Look at the work Vet Noel Gallagher is doing with small animals. Contentious for some I know but at least he is giving other species similar chances as we humans get. His work may well benefit 'us' too I believe.

ImogenBurrows said:
I'm not trying to be argumentative or awkward - but a good debate is healthy and we can all learn stuff - I certainly can and do everyday!
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Good debate is very healthy and questioning is vital I think.


Thankyou for replying to my points.
 
amandap said:
Fair enough. Tardive dyskinesia and other neurological side effects were very common in humans and drugs to combat these effects were often given routinely in the past if my memory serves me right.
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It seems as though the side effects in humans were far more common that IME with horses....Horrid stuff :eek:

I agree with what you say here, that is my point, horses do not understand why we need to box them sometimes and due to the nature of the distress for some horses and carers perhaps more thinking should be put into this whole area, not accept the current options and thinking. I don't mean you personally here btw, I mean all of us involved with horses. Is a box sized area really required in some even many cases? I'm not a vet as you are but I would have thought constant low level movement was less stressful for bones and ligaments than tense, stressful turning round and round etc. in a stable.
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I think this is often debated and I guess we still don't know. I don't like the idea of short, sharp, repetitive movement e.g. box walking. I frequently believe that restricted paddock/pen rest is better that box walking in the stable stressed to high heaven. How can it not be??

Actually I hadn't forgotton this I didn't know until I've just looked it up and found the drug to be Acepromazine so I've learned more today thankyou.
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No problem - I'm learning lots more about the side-effects and will probably be more descriptive when talking to owners before using Modecate in future...I learn too!!:D


I know it's not a perfect world but if we don't question and try and find 'better' ways, things will never improve.
Look at the work Vet Noel Gallagher is doing with small animals. Contentious for some I know but at least he is giving other species similar chances as we humans get. His work may well benefit 'us' too I believe.
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I'm unfamiliar with this work....will investigate:o

Good debate is very healthy and questioning is vital I think.

Thankyou for replying to my points.
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I thoroughly agree!! No thanks required. ;)
ATB
Imogen
 
ImogenBurrows said:
I'm unfamiliar with this work....will investigate:o
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What a numpty I am! Living in my own Oasis it seems! The Vet I meant was of course Noel Fitzpatrick NOT Noel Gallagher as I put earlier. He's TV's bionic vet, have a feeling you will have heard of Noel Fitzpatrick.

*Wanders through the desert back to my little oasis!* lol
 
amandap said:
What a numpty I am! Living in my own Oasis it seems! The Vet I meant was of course Noel Fitzpatrick NOT Noel Gallagher as I put earlier. He's TV's bionic vet, have a feeling you will have heard of Noel Fitzpatrick.

*Wanders through the desert back to my little oasis!* lol
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I was humming some Oasis....:D

Ah yes - that sounds more familiar...controversial is about right :D But advances start somewhere...
I did work with a farrier who'd been out in the states working with a vet who treated equine amputees...he wasn't so positive about that - the focal weight bearing was too much resulting in big pressure necrosis problems...small animals more possible....
Food for thought:
images
 
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Very interesting debate, I am very familiar with the side effects of Modecate in humans having worked in psychiatry for many years. Many of the drugs in use for horses are not licensed for equines, purely because of the cost of trials.
I personally would be very reluctant to allow modecate to be prescribed for a horse of mine until I'd seen clinical trials done on horses that gave satisfactory results. Even then,I'm not sure I'd go with it on an animal that was unable to communicate its distress, or have that distress blamed on being stabled and restless. TD or OGC (Oculargyric Crisis ) are extremely distressing side effects, not uncommon in people with out correct monitoring and drugs to relive these symptoms. I'd hate to think of a horse going through that unnoticed, as even with people it sometimes takes skilled observation to correctly diagnose and treat rapidly.
 
horserider said:
Very interesting debate, I am very familiar with the side effects of Modecate in humans having worked in psychiatry for many years. Many of the drugs in use for horses are not licensed for equines, purely because of the cost of trials.
I personally would be very reluctant to allow modecate to be prescribed for a horse of mine until I'd seen clinical trials done on horses that gave satisfactory results. Even then,I'm not sure I'd go with it on an animal that was unable to communicate its distress, or have that distress blamed on being stabled and restless. TD or OGC (Oculargyric Crisis ) are extremely distressing side effects, not uncommon in people with out correct monitoring and drugs to relive these symptoms. I'd hate to think of a horse going through that unnoticed, as even with people it sometimes takes skilled observation to correctly diagnose and treat rapidly.
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Very well thought out discussion in my book....sounds very fair. I've learnt a lot about the extremes of the human side-effects and certainly while I don't think they are as profound in the horse, it is hard to monitor - it has made me think more about what to discuss before using it in future for sure!! Thanks everyone. :)
 
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