 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||
|
|||||||||||
at time of writing, Gastroenterology Fellow University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma now, Gastroenterologist Adult Gastroenterology Associates 3174 East 38th Place Tulsa, Oklahoma 74105 fax 918/615-3401 mmblanken{at}yahoo.com
Resident Department of Medicine University of Oklahoma Health Sciences Center
Professor of Medicine University of Oklahoma Health Sciences Center
Published Online, February 26, 2008. www.theannals.com, DOI 10.1345/aph.1K492
Flunixin is an injectable NSAID indicated for alleviation of musculoskeletal pain and colic in horses and cattle. It is formulated as 50 mg of flunixin meglumine per milliliter of sterile solution. The recommended dose is 1.1-2.2 mg/kg once daily for no more than 5 days.2 Like other NSAIDs, flunixin achieves its antiinflammatory effects through inhibition of the cyclooxygenase-2 (COX-2) enzymes and subsequent prostaglandin inhibition. Flunixin is a nonselective COX-2 inhibitor and is known to be potentially ulcerogenic in animals.3,4 We report a case of severe peptic ulcer disease resulting from illicit use of flunixin by a human. We are unaware of any previous reports describing this association.
Case Report. A 53-year-old paraplegic man who suffered from chronic lower back pain presented to the emergency department with a 3 week history of abdominal discomfort and melena. His only reported medication was a "horse pill" for pain relief. He had no other medical problems, and he denied alcohol use. His hemoglobin was 5.5 g/dL. He was hospitalized and, after correction of anemia, an upper gastrointestinal endoscopy was performed. This revealed a superficial lower esophageal ulcer, a large hiatal hernia, a 15 mm cratered ulcer at the hiatus, and a larger than 20 mm cratered ulcer at the duodenal apex. No other sources of gastrointestinal bleeding were noted, and Helicobacter pylori serology was negative.
The patient was questioned further about his use of the "horse pill," which was in fact flunixin. He reported that it was very effective in alleviating his lower back pain. He had ingested 1.5 mL (75 mg) of flunixin solution in an empty gel capsule once daily for 3 months. The patient, who weighed 60 kg, exceeded the recommended equine and bovine duration of use. He had been told about flunixin by an acquaintance who had taken it for pain due to broken ribs. The patient had obtained the drug at minimal cost from his acquaintance, who had access to a ready supply. We contacted our patient's acquaintance, a horse trainer, who reported taking 1 mL (50 mg) of the solution mixed with juice twice daily for 6 weeks. She denied ill effects. She had learned of flunixin from some rodeo workers, and she was also aware of a veterinarian who had attempted to treat his wife's headaches with flunixin.
Our patient discontinued use of flunixin and was discharged in good condition. No further adverse events were reported. Use of the Naranjo probability scale indicated a probable relationship between peptic ulcer disease and flunixin in this patient.5
Discussion. Although we uncovered anecdotal evidence of more widespread illicit use of flunixin in humans, the prevalence of such use is unknown. Further study of relevant groups in the veterinary, horse racing, and rodeo communities would be helpful in determining the full extent of this practice. Education about the potential, serious adverse effects of flunixin and similar veterinary agents (eg, phenylbutazone or "bute") when used by humans would be a prudent activity of professional veterinary organizations.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
