Plasma concentrations of flunixin in the horse: its relationship to thromboxane B2 production

Medication control of flunixin in racing horses: Possible detection times using Monte Carlo simulations

Background

For medication control in several jurisdictions, withdrawal time is the period of refrain from racing after drug administration. It is set by adding a safety period to an experimental detection time. However, there are no reports of statistical analyses of detection time for the determination of withdrawal time in flunixin meglumine‐treated horses.

Objective

To analyse the population pharmacokinetics of flunixin in horses through the generation of a dataset for detection time statistical analysis and predictions via Monte Carlo simulation.

Study design

Experimental study.

Methods

Drug plasma and urine concentrations following single intravenous administration of flunixin 1.1 mg/kg bodyweight (BW) in 10 horses and multiple administration of q 24 hours for 5 days in 10 horses were measured using liquid chromatography with tandem mass spectrometry (LC‐MS/MS). Data were modelled using a nonlinear mixed effect model followed by Monte Carlo simulation. Irrelevant plasma concentration (IPC) and irrelevant urine concentration (IUC) were calculated using the Toutain approach. Detection times were obtained considering the time after the last administration for selected quantiles of 5000 hypothetical horses under the international screening limit (ISL) proposed by the International Federation of Horseracing Authorities (plasma: 1 ng/mL, urine; 100 ng/mL).

Results

For a regimen of 1.1 mg/kg BW q 24 hours, the IPC and IUC values were 2.0 and 73.0 ng/mL respectively. Detection times in plasma above the ISL for 90% of simulated horses were estimated as 74 hours after a single 1.1 mg/kg dose administration, 149 and 199 hours after multiple doses over 5 days at either 24‐ or 12‐hour intervals respectively. Corresponding detection times in urine were 46, 68 and 104 hours respectively.

Main limitation

Only female horses were investigated.

Conclusions

Statistical detection times for different flunixin meglumine regimens indicated a delay of detection time in plasma after multiple administrations under ISL.

Pharmacokinetics of transdermal flunixin meglumine and effects on biomarkers of inflammation in horses

Flunixin meglumine is a highly efficacious nonsteroidal anti-inflammatory drug commonly used in equine medicine and especially in performance horses. Recently, a new transdermal flunixin meglumine product has been approved for use in cattle. Although not currently approved for use in the horse, the convenience of this product may prove appealing for use in horses, warranting study. Six horses were administered a single transdermal dose of 500 mg and blood and urine samples collected for up to 96 h post-administration. Serum for determination of thromboxane concentrations and whole blood samples was collected at various time and challenged with lipopolysaccharide, calcium ionophore, or methanol to induce ex vivo synthesis of eicosanoids. Concentrations of flunixin, 5-OH flunixin, and eicosanoids were measured using LC-MS/MS and non-compartmental pharmacokinetic analysis performed on concentration data. Serum concentrations of flunixin and 5-OH flunixin were above the limit of quantitation at 96 h post-administration in both serum and urine. The mean (range) for C_max , T_max and the terminal half-life were 515.6 (369.7-714.0) ng/ml, 8.67 (8.0 12.0) h, and 22.4 (18.3-42.5) h, respectively. Following transdermal administration, based on effects on eicosanoid synthesis, flunixin meglumine inhibited cyclooxygenase 1 and 2 and 15-lipooxygenase activity, with anti-inflammatory effects lasting for 24-72 h.

Effects of flunixin on cardiorespiratory, plasma lactate and stride length responses to intense treadmill exercise in Standardbred trotters

REASONS FOR PERFORMING STUDY

Since nonsteroidal anti-inflammatory drugs, such as flunixin, on account of their anti-inflammatory and analgesic properties, are used in both racing and equestrian sport horses, the question has been raised as to whether these drugs affect the physiological responses to exercise and thus performance potential.

OBJECTIVES

The aims of this investigation were to study the effects of flunixin on cardiorespiratory, metabolic and locomotor parameters in horses during intense treadmill exercise.

METHODS

Six Standardbred trotters underwent an incremental treadmill exercise test to fatigue, without drug and then after administration of flunixin meglumine (1.1 mg/kg bwt i.m.). Heart rate (HR), oxygen uptake and stride length were measured and venous blood samples drawn repeatedly during the test.

RESULTS

Heart rates were found to be significantly higher at submaximal speeds, while the velocity causing a HR of 200 beats/min was significantly decreased after treatment with flunixin. Maximal HR and plasma lactate concentration 5 min after exercise were unchanged after medication. Flunixin caused higher plasma lactate concentrations at all speeds and the lactate threshold was decreased, compared with baseline values. Oxygen uptake levelled off at the highest velocities and did not change after flunixin treatment. Stride length was increased after treatment, although not at the highest velocities.

CONCLUSION

The increased HR and lactate responses to exercise after flunixin treatment indicate that it does influence physiological responses, but does not improve the performance potential of clinically healthy horses. However, the lengthened stride during submaximal exercise after medication could imply undetected subclinical lameness, masked in some of the horses, i.e. they have performed with a longer stride at the cost of a higher heart rate and an increased lactate concentration.

Quantification and confirmation of flunixin in equine plasma by liquid chromatography–quadrupole time-of-flight tandem mass spectrometry

The method describes quantification and confirmation of flunixin in equine plasma by liquid chromatography-quadrupole time-of-flight mass spectrometry (LC/Q-TOF/MS/MS). Samples were screened by enzyme-linked immunosorbent assay (ELISA) and only those samples presumptively declared positive were subjected to quantification and confirmation for the presence of flunixin by this method. The method is also readily adaptable to instrumental screening for the analyte. Flunixin was recovered from plasma by liquid-liquid extraction (LLE). The sample was diluted with 2 ml saturated phosphate buffer (pH 3.10) prior to LLE. The dried extract was reconstituted in acetonitrile:water:formic acid (50:50:0.1, v/v/v) and subsequently analyzed on a Q-TOF tandem mass spectrometer (Micromass) operated under electrospray ionization positive ion mode. The concentration of flunixin was determined by the internal standard (IS) calibration method using the peak area ratio with clonixin as the IS. The limits of detection (LOD) and quantification (LOQ) for flunixin in equine plasma were 0.1 and 1 ng/ml, respectively, whereas the limit of confirmation (LOC) was 2.5 ng/ml. The qualifying ions for the identification of flunixin were m/z 297 [M+H](+), 279 (BP), 264, 259, 239 and those for clonixin (IS) were m/z 263 [M+H](+), 245 (BP) and 210. The measurement uncertainty about the result was 8.7%. The method is simple, sensitive, robust and reliably fast in the quantification and confirmation of flunixin in equine plasma. Application of this method will assist racing authorities in the enforcement of tolerance plasma concentration of flunixin in the racehorse on race day.

Review of furosemide in horse racing: its effects and regulation

Furosemide has been used empirically and has been legally approved for many years by the US racing industry for the control of exercise-induced pulmonary haemorrhage (EIPH) or bleeding. Its use in horses for this purpose is highly controversial and has been criticized by organizations outside and inside of the racing industry. This review concentrates on its renal and extra-renal actions and the possible relationship of these actions to the modification of EIPH and changes in performance of horses. The existing literature references suggest that furosemide has the potential of increasing performance in horses without significantly changing the bleeding status. The pulmonary capillary transmural pressure in the exercising horse is estimated to be over 100 mmHg. The pressure reduction produced by the administration of furosemide is not of sufficient magnitude to reduce transmural pressures within the capillaries to a level where pressures resulting in rupture of the capillaries, and thus haemorrhage, would be completely prevented. This is substantiated by clinical observations that the administration of furosemide to horses with EIPH may reduce haemorrhage but does not completely stop it. The unanswered question is whether the improvement of racing times which have been shown in a number of studies are due to the reduction in bleeding or to other actions of furosemide. This review also discusses the difficulties encountered in furosemide regulation, in view of its diuretic actions and potential for the reduction in the ability of forensic laboratories to detect drugs and medications administered to a horse within days or hours before a race. Interactions between nonsteroidal anti-inflammatory drugs (NSAIDs) and furosemide have also been examined, and the results suggest that the effects of prior administration of NSAID may partially mitigate the renal and extra-renal effects which may contribute to the effects of furosemide on EIPH.

Pharmacokinetic considerations in the camel (Camelus dromedarius): a review

In this article the pharmacokinetic profile of several antibacterial, antiparasitic and antiinflammatory agents in camels has been reviewed. The effect of dehydration on the kinetics of these drugs has also been discussed.

Protein binding and in vitro serum thromboxane B2 inhibition by flunixin meglumine and meclofenamic acid in dog, goat and horse blood

Flunixin was highly protein bound in the serum of dogs (92.2 per cent), goats (84.8 per cent) and horses (86.9 per cent). Meclofenamic acid was also highly protein bound, although there were larger differences between the extent of the binding in dogs (90.3 per cent), goats (84.7 per cent) and horses (99.8 per cent). Both flunixin and meclofenamic acid were potent inhibitors of the in vitro generation of thromboxane (Tx) B2 in blood. Flunixin inhibited the generation of TxB2 by 50 per cent of the maximum response (IC50) in dog, goat and horse blood at concentrations of 0.10, 0.02 and 0.04 microM respectively and by 100 per cent (Imax) at 2.07, 0.14 and 2.07 microM respectively. The IC50 values of meclofenamic acid in dogs, goats and horses were 0.77, 0.80 and 0.30 microM respectively and the Imax values were 3.93, 3.63 and 3.56 microM respectively. When the concentrations of flunixin were corrected for protein binding, it was estimated that the IC50 of the unbound fractions in dogs, goats and horses were 0.008, 0.003 and 0.005 microM, respectively. Similarly corrected values for meclofenamic acid were 0.075, 0.122 and 0.001 microM respectively.

Nonsteroidal anti-inflammatory drugs

NSAIDs' mechanism of action by inhibiting the synthesis of prostanoids accounts for both their therapeutic and toxic effects. They are commonly used in acute and chronic musculoskeletal and soft-tissue conditions. Adverse reactions include gastrointestinal disturbances and hypoproteinemia. Their pharmacologic effect seems to have a longer duration than their plasma concentrations indicate. This gives implications on current regulations for competing horses and the relevance of permitted levels has been questioned. The NSAIDs do not appear to enhance performance, but rather allow the horse to run up to its potential by reducing pain and lameness. There is concern over the possible hazards to the horse by this kind of therapeutic use. In conclusion, NSAIDs have well justifiable therapeutic uses in equine practice. They should, however, be used when there is a clear clinical indication, in safe dose rates and without jeopardizing the welfare of the performance horse.