NSAIDs for Horses with Arthritis: Benefits, Risks, and Responsible Use

Published on: May 5, 2025

By: Miles HenryFact Checked

Disclosure: This article is for informational purposes only and does not substitute for professional veterinary advice. Always consult your veterinarian regarding treatment decisions.

If your horse is showing stiffness, lameness, or reluctance to move, especially after work or in the cold, you’re likely dealing with the challenges of arthritis — and the right pain management can make all the difference.

As a lifelong equestrian, I’ve seen firsthand how debilitating joint pain can be for even the most willing horses. Finding safe and effective ways to improve their comfort and mobility is paramount. Understanding how NSAIDs work — and how to use them safely — is now a crucial part of responsible horse ownership.

In this guide, you’ll learn how to confidently manage your horse’s arthritis pain with NSAIDs, grounded in veterinary best practices and equine science, including recommendations from the American Association of Equine Practitioners (AAEP), UC Davis Center for Equine Health, and insights from peer-reviewed veterinary journals. Whether your goal is short-term pain relief, managing chronic discomfort, understanding potential side effects, or comparing NSAIDs to other therapies, we’ll walk through the key considerations.

Understanding Equine Arthritis and How NSAIDs Help

Arthritis causes joint pain, swelling, and stiffness, making even routine movement painful for horses. NSAIDs—non-steroidal anti-inflammatory drugs—are commonly prescribed to relieve this discomfort by reducing inflammation and pain at the source. But how does this occur?

NSAIDs block cyclooxygenase (COX) enzymes that produce prostaglandins—compounds that trigger inflammation, pain, and fever. Most equine NSAIDs inhibit COX-1 (which protects the stomach and kidneys) and COX-2 (involved in inflammation). By reducing prostaglandin production, these drugs help alleviate joint pain, decrease inflammation, and improve mobility in horses with arthritis. Source: Update on the Use of COX-2 Selective NSAIDs in Horses – JAVMA

A 2023 clinical review in Animals emphasizes the importance of selecting the appropriate NSAID based on the horse’s health status and the drug’s COX-selectivity.

What Are the Best NSAIDs for Horses with Arthritis?

The best NSAID for a horse with arthritis depends on several factors: the horse’s age, severity of joint damage, existing health conditions, and response to medication. In general:

• Firocoxib (Equioxx) is often preferred for long-term use. It is COX-2 selective, reducing inflammation while minimizing gastrointestinal side effects.
  The FDA’s Freedom of Information summary for Equioxx supports its long-term tolerability when administered at approved dosages.
  Kentucky Equine Research also reported horses tolerated firocoxib well over a 42-day trial with no significant adverse effects.
• Phenylbutazone (Bute) is a widely used short-term NSAID effective for acute musculoskeletal pain. However, long-term use increases the risk of gastric ulcers and kidney damage, particularly at higher doses or in older horses. An early clinical review in the Equine Veterinary Journal highlighted these risks, and current guidelines continue to support limiting Bute use to short, controlled periods under veterinary oversight. For competitors, be aware that Bute typically requires a 72-hour withdrawal period before most sanctioned competitions, though regulations can vary.
• Flunixin Meglumine (Banamine) is primarily used for colic and visceral pain but may be prescribed off-label for joint discomfort. Due to increased risk of side effects like tissue necrosis from intramuscular injection, it’s generally reserved for short-term or adjunctive use. A 2020 study by Knych et al. warns of additive risks when Banamine is used in combination with other NSAIDs. Similarly, Banamine generally requires a 72-hour withdrawal window for competition, so always double-check specific requirements.

Ultimately, the “best” NSAID balances pain relief with long-term safety, always under veterinary supervision. In many cases, combining NSAIDs with other therapies like joint injections or equine supplements yields the best results.

Quick Comparison: Common NSAIDs for Horses

NSAID	Typical Use	GI Risk	Kidney Risk	Withdrawal Time	Best For
Firocoxib (Equioxx)	Long-term use	Low (COX-2 selective)	Lower	14 days (FEI), consult vet	Daily control of arthritis pain
Phenylbutazone (Bute)	Short-term pain	High	Moderate–High	~72 hours (USEF)	Acute musculoskeletal pain
Flunixin (Banamine)	Colic/short-term use	Moderate	Moderate–High	~72 hours (USEF)	Visceral pain, occasional joint use

Benefits of NSAID Use in Arthritic Horses

NSAIDs don’t just relieve pain — when used appropriately, they can support your horse’s long-term soundness and daily comfort. Benefits include:

• Pain Reduction: Eases discomfort, making movement more comfortable and improving overall demeanor. According to a review in Veterinary Clinics of North America: Equine Practice, NSAIDs effectively manage acute and chronic musculoskeletal pain, leading to improved ease of movement and performance.
• Inflammation Control: Helps limit further joint degeneration by suppressing the body’s inflammatory response.
• Improved Mobility: Encourages voluntary movement, turnout activity, and willingness to work, especially in horses previously reluctant to move due to discomfort.
• Enhanced Quality of Life: Allows horses with chronic conditions to remain active and content, maintaining mental and physical health. To better recognize subtle signs of pain in horses, explore our guide: Signs of Pain in Horses.

Risks and Side Effects of NSAIDs in Horses

Despite their benefits, NSAIDs carry potential risks, especially with long-term use or improper dosing:

Gastrointestinal Ulcers

NSAIDs can reduce the protective prostaglandins that line the stomach and intestines, increasing the risk of gastric ulcers. Watch for signs like:

• Decreased appetite
• Behavioral changes
• Mild colic
• Weight loss

Note: COX-2 selective NSAIDs like firocoxib (Equioxx) are designed to reduce inflammation while sparing the gastrointestinal lining, making them less likely to cause ulcers than non-selective drugs like phenylbutazone.

A UC Davis Center for Equine Health article explains that prolonged NSAID use—particularly phenylbutazone—significantly increases the risk of gastric ulceration in horses.

Kidney Damage

Horses that are dehydrated or have pre-existing kidney conditions are more susceptible to NSAID-related kidney stress. Regular bloodwork is recommended for horses on long-term NSAIDs to monitor renal and liver function.

The Kansas State University Veterinary College emphasizes the importance of hydration and lab monitoring to minimize kidney risks in horses receiving NSAIDs.

Right Dorsal Colitis (RDC)

RDC is a serious but less common NSAID-related inflammatory condition of the colon, often linked to long-term phenylbutazone use. Symptoms include:

• Diarrhea
• Fever
• Lethargy
• Abdominal discomfort

Learn more about diarrhea in horses →

The 2022 review in Animals (above) also identifies RDC as a known complication of chronic NSAID exposure in horses.

Masking Underlying Conditions

NSAIDs can mask pain, making it harder to detect worsening joint disease, soft tissue injuries, or subtle lameness. This may delay proper diagnosis and lead to overuse injuries.

Veterinarians often recommend re-evaluating horses on NSAIDs regularly to catch underlying issues that may be progressing.

Key NSAID Safety Tips for Horse Owners

To support safe, effective use of NSAIDs in horses:

• Always consult your veterinarian before starting or changing treatment.
• Use the lowest effective dose for the shortest necessary duration.
• Never combine NSAIDs unless specifically instructed by your vet.
• Monitor hydration status, especially during hot weather or trailering.
• Schedule routine bloodwork every 2–3 months for long-term use.
• Watch for early warning signs like appetite loss, diarrhea, or behavior changes.
• Avoid NSAIDs before competition unless cleared — withdrawal times apply.
  Learn more →

🧬 Reference: Kansas State University NSAID Owner Guide

While NSAIDs can significantly improve your horse’s comfort, understanding and managing their risks is key to long-term success, and it starts with informed, responsible use under veterinary guidance.

Many owners wonder about maintaining their bond with an arthritic horse through riding. This helpful video addresses the question of whether it’s still possible and provides key considerations

How Much Bute Is Safe for a Horse?

Phenylbutazone (“Bute”) is one of the most commonly used NSAIDs in equine medicine. While effective for managing pain and inflammation, its dosage must be carefully managed to avoid side effects like gastric ulcers and kidney damage.

• Typical dose: 2–4 grams per 1,000 lb horse per day
• Safer limit for long-term use: ≤ 2 grams/day
• Important: Always administer under veterinary guidance and avoid exceeding the recommended dosage duration

According to the FDA-approved label for phenylbutazone on DailyMed, the typical dosage is 2–4 grams per 1,000 lb horse per day, usually administered as a single daily dose unless your veterinarian instructs otherwise.

NSAIDs vs Joint Injections in Horses

NSAIDs and joint injections are both commonly used to manage arthritis in horses, but they serve different purposes. Understanding how they vary in scope, frequency, and risk can help you and your veterinarian choose the most effective treatment approach based on your horse’s specific needs.

Feature	NSAIDs	Joint Injections
Scope	Systemic — affects the whole body	Localized — targets specific joint(s)
Frequency	Daily or during flare-ups	Every 1–6 months, depending on severity
Risks	GI ulcers, kidney stress, right dorsal colitis	Joint infection, injection site trauma
Best For	Managing widespread or systemic pain; multiple mild to moderate arthritic joints	Providing targeted, longer-lasting relief for specific joints with moderate to advanced degeneration

Joint injections are often used alongside NSAID therapy, particularly in performance horses or those with localized joint issues. However, because injections carry a risk of joint infection or irritation, they must be administered by a veterinarian under sterile conditions. 👉 Read more: Horse Joint Injections – What You Need to Know.

How to Safely Use NSAIDs in Horses with Arthritis

While NSAIDs are powerful tools for managing equine arthritis, their benefits must be balanced against potential risks. This section breaks down general best practices and critical safety warnings to help horse owners use these medications responsibly and effectively.

General Guidelines for NSAID Use

• Always involve your veterinarian before starting or changing treatment.
• Use the lowest effective dose for the shortest necessary duration.
• Schedule regular checkups, including bloodwork, every 2–3 months for long-term use. UC Davis Center for Equine Health – NSAID Use in Horses
• Monitor for side effects like lethargy, appetite loss, colic-like symptoms, drooling, or changes in manure.
• Ensure proper hydration, especially in hot weather, during trailering, or for horses on prolonged treatment.

Tip: For help spotting subtle signs of pain, see our guide to recognizing discomfort in horses.

Critical NSAID Warnings

• Never combine NSAIDs unless specifically directed by your vet — doing so dramatically increases the risk of gastrointestinal ulcers, kidney injury, and right dorsal colitis. This warning aligns with veterinary safety guidelines published by the American Association of Equine Practitioners (AAEP) and leading equine pharmacology references such as Plumb’s Veterinary Drug Handbook.
• Avoid NSAIDs before competition unless cleared by your veterinarian. Most equine regulatory bodies require a minimum 72-hour withdrawal period.

👉 See the 2022 USEF Equine Drugs & Medications Guidelines (PDF)

Striking the right balance between effective pain relief and long-term safety is possible — and begins with informed, cautious use of NSAIDs tailored to your horse’s needs.

Alternatives to NSAIDs for Arthritis Relief

While NSAIDs are often the first line of defense for managing equine arthritis pain, several other treatments can complement or reduce the need for daily medication. These alternatives may be especially useful for horses with sensitivities to NSAIDs or for long-term management.

Joint Injections

To reduce inflammation and pain, veterinarians can deliver corticosteroids or hyaluronic acid directly into an affected joint. This targeted approach is often used for moderate to advanced arthritis and may be combined with other therapies for maximum effect.
👉 Learn more about joint injections in horses

Oral Joint Supplements

Nutraceuticals may help support joint function and cartilage health, especially when used alongside exercise and proper nutrition. Common ingredients include:

• Glucosamine
• Chondroitin sulfate
• Hyaluronic acid
• Omega-3 fatty acids

Note: The effectiveness of joint supplements can vary between horses. Always consult your veterinarian to determine whether nutraceuticals are appropriate for your horse’s specific needs and condition.

👉 See our Equine Joint Supplement Guide

Physical Therapy and Management

Holistic and physical management strategies can support long-term joint health and reduce reliance on pharmaceutical treatments:

• Controlled exercise to maintain strength and flexibility
• Weight management to reduce pressure on joints
  👉 See our horse conditioning guide
• Therapeutic shoeing to improve alignment and reduce mechanical strain
• Massage and stretching to relieve tension and increase range of motion
  👉 Explore holistic horse therapies

Emerging Therapies Worth Discussing with Your Vet

For horses with chronic or advanced arthritis, cutting-edge options like platelet-rich plasma (PRP), stem cell therapy (used to promote joint repair), or shockwave treatment (which stimulates healing through sound waves) may be considered. These therapies are typically administered at specialty clinics and should be evaluated case-by-case in consultation with your veterinarian.

FAQs: NSAIDs for Horses with Arthritis

Curious about how to use NSAIDs for horses with arthritis more effectively? These frequently asked questions address common concerns about safety, alternatives, and long-term use.

Final Thoughts

NSAIDs can be transformative for horses with arthritis when used wisely. While they offer powerful relief, they’re not without risks, especially if overused or administered without veterinary oversight. With informed decision-making, regular monitoring, and supportive therapies, horse owners can help manage arthritis pain safely and improve their horse’s quality of life. Remember that a comprehensive approach, including appropriate feed, especially for senior horses, contributes to their overall comfort and well-being.

Share Your Experience

Have experience managing arthritis in your horse? We’d love to hear what’s worked for you — whether it’s NSAIDs, joint injections, or alternative therapies — and how it’s helped your horse’s comfort and mobility.

Please remember: always consult your veterinarian before making treatment decisions. Reader stories are valuable, but they’re not a substitute for professional advice.