Bute, Banamine, or Equioxx? Using NSAIDs Safely

Last updated: September 27, 2026

By: Miles HenryFact Checked

If your horse has arthritis, you may already have Bute in the tack room. You may also have used Banamine when your vet was treating a different kind of pain. You want to keep him comfortable, but you’ve also heard these drugs can cause ulcers, kidney trouble, and colon problems.

This guide explains how NSAIDs work, how the three common ones differ, the side effects to catch early, the basic rules for using them safely, what changes for senior horses, and how medication fits into a bigger arthritis plan.

How NSAIDs Relieve Pain, and Why They Can Cause Problems

NSAIDs (non-steroidal anti-inflammatory drugs) reduce inflammation by blocking COX enzymes involved in producing pain and swelling. That’s why a stiff, sore horse often moves better on them.

I’ve owned and managed horses long enough to see how useful these medications can be—and how quickly a helpful tool can become a problem when it’s used without a plan.

The reason NSAIDs work so well is also why they require caution. Some of the same processes involved in inflammation also help protect the gut lining and maintain normal kidney function. Bute and Banamine are non-selective NSAIDs, meaning they affect both COX-1 and COX-2 pathways. Equioxx is more selective for COX-2, which is more closely tied to inflammation. That may reduce some risks for some horses, but it doesn’t make Equioxx risk-free.

Bute vs. Banamine vs. Equioxx

These are the three NSAIDs most horse owners run into, and they aren’t interchangeable.

Bute is the medication most horse owners know. It can be useful for acute musculoskeletal pain and arthritis flare-ups, but the mistake I see is treating it like a maintenance supplement instead of a medication that needs watching. A 2026 overview in The Horse calls it a cornerstone of osteoarthritis treatment, but notes that chronic use is strongly associated with gastric ulcers, right dorsal colitis, and kidney damage. A horse that needs it day after day needs a plan built with your vet.

Banamine is used most often for colic and other internal pain, not as the usual first choice for arthritis. Leave the injectable form to your vet. Banamine injected into a muscle has been associated with serious clostridial muscle infections, and an injection that accidentally goes into an artery can trigger a severe reaction.

Equioxx is FDA-approved for the control of pain and inflammation associated with osteoarthritis in horses. Because it is more selective for COX-2, it may be a useful option for some arthritic horses, but it still has real risks and needs veterinary oversight. According to the FDA-approved label, Equioxx tablets are given once daily for up to 14 days, and the manufacturer warns against using it with other NSAIDs or corticosteroids. If your horse needs relief longer than that, that’s your vet’s decision to make and monitor.

NSAID Side Effects: When to Call Your Vet

Most NSAID trouble starts the same few ways: too high a dose, too long a course, a dehydrated horse, or two NSAIDs given together. These are the problems to watch for.

Gut injury and ulcers. Watch for a horse that gets picky about feed, turns cinchy at the girth, seems dull or irritable, shows mild colic that keeps coming back, or loses weight. The UC Davis Center for Equine Health lists NSAID use among the risk factors for ulcers.

Kidney problems. A horse that’s dehydrated or already has kidney disease is at higher risk. Watch for changes in how much he drinks or urinates, and keep clean water available at all times.

Right dorsal colitis. This is inflammation of part of the large colon, most often linked to Bute. It can build quietly, with loose manure or diarrhea, fever, dullness, poor appetite, or mild colic. See my guide to diarrhea in horses for more.

A hidden problem getting worse. Pain relief can mask a worsening joint or a soft tissue injury. A horse that looks sound on NSAIDs still needs regular soundness checks.

If a horse on daily NSAIDs suddenly gets cinchy, goes off his feed, or seems dull at feeding time, I don’t assume it’s nothing. Those changes can have several causes, but they’re enough for me to call the vet and review the medication plan before a small problem turns into a bigger one.

Rules for Using NSAIDs Safely

This article explains general safety considerations, not a treatment plan. If your horse is already on an NSAID or showing possible side effects, talk with your vet before changing anything.

• Follow the dose and schedule your vet sets. More medicine doesn’t mean more relief. It mostly means more risk.
• Never give two NSAIDs together unless your vet specifically tells you to.
• Keep water available at all times, and be cautious with a horse that isn’t drinking well.
• Don’t use human pain relievers like ibuprofen or naproxen unless your vet prescribes them.
• Watch your horse every day: appetite, water intake, manure, attitude, and how he moves.
• Ask about follow-up checks for a horse on longer-term treatment, including bloodwork when your vet recommends it.
• Know the rules if you compete or race. NSAID rules, testing thresholds, and withdrawal guidance vary by organization, medication, dose, route, and jurisdiction. In Thoroughbred racing, check the current HISA rules and get case-specific guidance from your vet before a start. For other competition, check that organization’s rulebook rather than a general withdrawal chart.

For help spotting pain early, see my guide to subtle signs of pain in horses.

NSAIDs in Senior Horses

Older horses are more likely to need ongoing pain management, and some also have health issues that change the risk, especially existing kidney disease, a history of gut problems, dehydration, poor appetite, or several medications at once. That’s why seniors often need closer monitoring and more frequent vet check-ins than younger horses.

For a senior, an NSAID should be one part of a broader arthritis plan and reviewed regularly with your vet. Regular, gentle movement helps too. See my senior horse exercise guide.

Arthritis Management Beyond NSAIDs

NSAIDs work best as one part of a larger plan. Joint injections are another tool, but they solve a different problem, treating a specific joint rather than the whole horse. Whether a horse needs one, the other, or neither depends on the diagnosis, the joints involved, his workload, and your vet’s exam. My guide to horse joint injections explains what to expect.

• Controlled exercise and turnout: Keeping an arthritic horse moving is one of the most useful things you can do.
• Weight management: Less weight means less load on sore joints.
• Farrier work: Good trimming and shoeing can reduce the strain on arthritic joints.
• Joint supplements: Results vary from horse to horse. My joint supplement guide covers what the evidence says.
• Bodywork and stretching: Some horses seem more comfortable when muscle tension is addressed. Use a qualified practitioner and treat it as supportive care, not a replacement for a diagnosis or arthritis plan.
• Specialist options: Depending on the joint, diagnosis, and horse’s job, your vet may discuss options like regenerative therapies or shockwave treatment. The evidence, cost, and expected benefit vary, so these are decided case by case.

NSAIDs for Horses FAQ

NSAIDs are one of the most useful tools in the barn when they’re used well, and one of the easiest to misuse. Let your vet pick the drug and the dose, watch your horse closely while he’s on it, and keep working on the rest of his program so he needs as little of it as possible.