# Banamine for Horses: Dosing, Uses, and Warnings Banamine is the brand name most horse owners use for flunixin meglumine, a prescription nonsteroidal anti-inflammatory drug (NSAID) that controls pain, fever, and inflammation in horses. It is given by a veterinarian or under veterinary direction, most often as an intravenous (IV) or intramuscular (IM) injection, and in some regions as an oral paste. Flunixin is one of the most effective pain relievers available for equine visceral pain, which is why it is a mainstay for colic and for inflammatory conditions such as endotoxemia [1]. It is also one of the drugs most likely to cause serious gastrointestinal and kidney harm when it is dosed too high, given too long, or combined with another NSAID [2][3]. This article covers what flunixin does, how it is dosed by each labeled route, how long it stays in the body, which horses should not receive it, and the warning signs that mean you need to call a veterinarian immediately. **This article is educational and is not a substitute for veterinary diagnosis or treatment.** ## At a Glance | Feature | Detail | |--|--| | Active ingredient | Flunixin meglumine | | Drug class | Nonsteroidal anti-inflammatory drug, nonselective cyclooxygenase (COX) inhibitor | | Species | Horses (also studied in donkeys) | | How it is given | Intravenous injection, intramuscular injection, oral paste in some regions | | Onset | Rapid after IV administration, with peak analgesic effect within hours | | Duration | Roughly 12 to 24 hours depending on dose and route, which is why label intervals are 12 or 24 hours | | Prescription status | Prescription only in the United States | | Maximum labeled duration | Do not exceed 5 days without veterinary direction | | Withdrawal times | Set by label and by country, and must be verified before any animal enters the food chain | ## What Banamine Is and What It Treats Flunixin meglumine is a nonselective COX inhibitor, which means it blocks both COX-1 and COX-2 enzymes [1]. COX-1 is involved in normal protective functions such as maintaining the stomach lining and kidney blood flow. COX-2 is induced during inflammation and generates prostaglandins that drive pain and fever. Because flunixin blocks both, it relieves pain very effectively but also removes some of the body's natural protection for the stomach and kidneys. That trade-off explains nearly every warning in this article. Flunixin is most frequently selected for equine systemic inflammatory response syndrome and endotoxemia, and it is widely used for visceral pain such as colic [1]. It is also used for musculoskeletal pain, ocular pain, and post-surgical pain. In a controlled study of horses with corneal wounds, flunixin produced the lowest ocular pain scores among the treatments compared, lower than phenylbutazone, acupuncture, or control [4]. In a study of horses undergoing castration, flunixin controlled post-operative limb rigidity and preputial edema better than firocoxib or meloxicam [5]. In a study of mild visceral post-operative pain after inguinal castration, flunixin, meloxicam, and ketoprofen all controlled pain without a significant difference between them, and pain scores fell after the second dose of flunixin [6]. Flunixin also has measurable effects on inflammatory markers. In horses challenged with lipopolysaccharide to mimic endotoxemia, flunixin reduced tumor necrosis factor alpha and cortisol more than meloxicam did [1]. In laboratory work on isolated equine neutrophils, flunixin significantly inhibited the rise in tumor necrosis factor alpha protein in a concentration-dependent manner [7]. In donkeys undergoing castration, flunixin reduced inflammatory markers including tumor necrosis factor alpha and fibrinogen [8]. ### What Banamine Does Not Cover Flunixin is not an antibiotic. It does not treat infection. It does not replace fluids, surgery, or specific therapy for the underlying cause of colic. It does not reverse endotoxemia, it blunts the inflammatory response to it. Flunixin is also not a substitute for diagnosing why a horse is painful. Masking pain can hide a worsening surgical or medical condition, which is why veterinarians use it alongside repeated examinations rather than instead of them. ## How Flunixin Works Flunixin inhibits cyclooxygenase enzymes, which convert arachidonic acid into prostaglandins and thromboxane. Blocking COX-1 and COX-2 reduces prostaglandin-driven pain, fever, and inflammation [1]. A transdermal pharmacokinetic study in horses confirmed that flunixin inhibits both COX-1 and COX-2 activity as well as 15-lipoxygenase activity, with anti-inflammatory effects measurable after administration [9]. The drug is metabolized in the liver. Research using equine liver microsomes and recombinant enzymes identified that flunixin is converted to its main metabolite, 5-OH flunixin, primarily by members of the equine CYP3A family and by CYP1A1 [10]. This matters because any drug or condition that changes CYP3A activity could change how quickly a horse clears flunixin. That is one reason veterinarians ask about every other medication a horse is receiving. ## Banamine Dosing for Horses Doses below reflect what published equine studies and label-based veterinary guidance describe. They are provided so you understand what your veterinarian is doing, not so you can dose your own horse. Flunixin is a prescription drug and the correct dose depends on the horse's weight, condition, hydration, kidney function, and the problem being treated. ### Dose Table by Route | Route | Label or study dose | Interval | Withdrawal | |--|--|--|--| | Intravenous (IV) | 1.1 mg/kg | Every 12 to 24 hours depending on the condition and label | Set by label and by country. Verify before any animal enters the food chain | | Intramuscular (IM) | 1.1 mg/kg | Once daily | Set by label and by country. Verify before any animal enters the food chain | | Oral paste | 1.1 mg/kg | Once daily | Set by label and by country. Verify before any animal enters the food chain | The 1.1 mg/kg figure appears repeatedly in the equine literature. It is the dose used in studies of gastric mucosal effects [11], in studies of lameness and endotoxemia [12][1], in studies of coagulation [13], in studies of post-operative pain [6][5], in studies of foot pain [14], and in the combination-NSAID study that documented a fatality [2]. The IM route at 1.1 mg/kg once daily for 5 days was used in a gastroscopy pilot study [11]. The IV route at 1.1 mg/kg every 24 hours was used in a 15-day study of lameness and gastric ulcer scores in Mongolian horses [12]. The IV route at 1.1 mg/kg every 12 hours for 5 days was used in studies of colonic wall thickness and coagulation [15][13]. A horse's weight must be measured, not estimated. A 500 kg horse and a 600 kg horse differ by 20 percent of the dose, and that difference is enough to change the safety margin. Many veterinarians use a weight tape or a scale before calculating a flunixin dose. ### Intravenous Use IV administration produces the most predictable blood levels and the fastest onset. It is the route used in most equine research on flunixin [12][1][13][6][14][2][4][5]. IV flunixin must be given slowly, and it must be given into a clean vein. Perivascular injection, meaning the drug leaks outside the vein, causes severe local tissue damage and swelling. If you are not trained to give IV injections, do not attempt it. Ask your veterinarian to administer the drug or to place a catheter. ### Intramuscular Use IM flunixin at 1.1 mg/kg once daily for 5 days was used in a pilot study of gastric mucosal health [11]. IM injection is generally reserved for horses without IV access. IM flunixin can cause local muscle inflammation and soreness at the injection site. It should never be given into a dirty or contaminated site, and it should not be given repeatedly into the same muscle. ### Oral Paste Some regions have an approved oral paste formulation of flunixin. Where it is labeled, it is dosed at 1.1 mg/kg once daily. Oral administration avoids injection-site problems but depends on the horse actually swallowing the full dose. A horse that spits out part of the paste receives a partial dose, which may be ineffective, or a full dose if the paste is re-administered, which risks overdose. Oral flunixin still carries the same gastrointestinal and kidney risks as the injectable form. ### Duration of Treatment Do not exceed 5 days of flunixin without direct veterinary supervision. The 5-day ceiling appears throughout the equine literature as the standard short course [11][15][13][2][5]. Longer courses increase the risk of gastric ulceration, kidney injury, and low blood protein. A 15-day study in Mongolian horses was conducted under research conditions with weekly gastroscopy and blood work, not as a template for home use [12]. ## How Fast It Works and How Long It Lasts After IV administration, flunixin produces measurable analgesia within hours. In a study of horses with lipopolysaccharide-induced inflammation, pain scores were significantly lower in the flunixin group than in the placebo group within the observation window of 60 minutes before to 420 minutes after the challenge [1]. In the foot-pain study, flunixin was compared against placebo and phenylbutazone at 30-minute intervals for 2 hours and then hourly to 12 hours, and flunixin did not separate from placebo in that specific reversible lameness model, while phenylbutazone did [14]. That result does not mean flunixin is ineffective for pain. It means flunixin's strength is visceral and inflammatory pain rather than every type of musculoskeletal pain. The elimination half-life of flunixin is long enough to require 12- to 24-hour dosing intervals. A transdermal pharmacokinetic study in horses reported a terminal half-life of 22.4 hours with a range of 18.3 to 42.5 hours [9]. A population pharmacokinetic meta-analysis across 65 horses from four countries estimated an irrelevant plasma concentration of 1.9 ng/mL and an irrelevant urine concentration of 70.2 ng/mL, with a typical urine-to-plasma ratio of 35.9 [16]. A separate population pharmacokinetic study using Monte Carlo simulation examined detection times after single and multiple 1.1 mg/kg IV doses [17]. These numbers matter for competition horses, because flunixin can be detected in plasma and urine for days after the last dose, and detection times lengthen after multiple doses [16]. ## Withdrawal Times and Regulatory Status Withdrawal times for flunixin vary by country and by formulation, and they must be verified against the specific product label before any horse, donkey, or mule could enter the food chain. In the United States, flunixin is not approved for use in horses intended for human consumption, and the label carries restrictions on food-animal use. In jurisdictions that do permit equine meat or milk to enter the food supply, the withdrawal period is set by the national regulator and printed on the approved label for that product. Do not rely on a withdrawal time you read online, heard from another owner, or used for a different product. Read the label of the exact product you have, confirm the current national requirement, and if there is any doubt, keep the animal out of the food chain. This is a legal and food-safety matter, not a judgment call. For competition horses, medication control rules are separate from food-safety withdrawal. The International Federation of Horseracing Authorities screening limits for flunixin are 1 ng/mL in plasma and 100 ng/mL in urine [16][17]. A meta-analysis of international flunixin pharmacokinetics found that detection times were longer in plasma than in urine under those limits, particularly after multiple doses, and suggested that raising the plasma screening limit from 1 to 3 ng/mL while keeping the urine limit at 100 ng/mL would better align plasma and urine detection times [16]. This is a regulatory science question, not something an owner should try to manage alone. If your horse competes under any medication-control jurisdiction, ask your veterinarian and your governing body before administering flunixin. ## Side Effects and Toxicity Red Flags Flunixin's adverse effects are well documented and are the reason the drug carries strong warnings. The gastrointestinal tract and the kidneys are the primary targets. ### Gastrointestinal Effects The glandular portion of the stomach is the area most severely affected by nonselective NSAIDs including flunixin [3]. In a study comparing phenylbutazone, flunixin, and ketoprofen at high repeated doses, the glandular stomach was the most severely affected region across all three drugs, and four horses in the flunixin and phenylbutazone groups developed lesions [3]. A pilot gastroscopy study of horses treated with label-dose flunixin at 1.1 mg/kg IM once daily for 5 days found no glandular disease and no progression of pre-existing squamous lesions, but the study was small and non-randomized, so it cannot be read as proof that label-dose flunixin is harmless to the stomach [11]. A separate 15-day study in Mongolian horses found that flunixin improved lameness scores but also affected gastric ulcer scores and gastric fluid pH [12]. A study of colonic wall thickness found that flunixin at 1.1 mg/kg IV every 12 hours for 5 days did not increase colon wall thickness, while firocoxib did [15]. The practical message is that flunixin can cause gastric ulcers, and the risk rises with dose, duration, dehydration, stress, and concurrent NSAID use. Melena, which is black tarry stool from digested blood, is a red flag for gastrointestinal bleeding. Colic signs during or after flunixin treatment are also a red flag, whether they represent the original problem worsening or a new drug-related lesion. ### Kidney Effects Flunixin reduces prostaglandin-mediated blood flow to the kidney. A horse that is dehydrated, in shock, or already has kidney compromise is at much higher risk of acute kidney injury. Reduced urine output, abnormal drinking behavior, and dull mentation after flunixin are reasons to call a veterinarian. Serum chemistry monitoring is standard when flunixin is used in a hospitalized horse. ### Low Blood Protein Flunixin and other NSAIDs can cause low total protein and low albumin. In a 12-day high-dose comparison study, phenylbutazone-treated horses had a significant decrease in serum total protein and albumin, while flunixin-treated horses did not show that specific change at the doses used [3]. In the Mongolian horse study, serum total protein and albumin were among the parameters monitored during flunixin treatment [12]. In a castration study, serum protein decreased after surgery in all NSAID groups [5]. Hypoproteinemia is a concern because it can signal protein loss through a damaged gut or kidney. If your veterinarian reports falling protein levels during flunixin treatment, that is a signal to reassess the drug. ### Oral Ulcers Oral ulcers, including ulcers on the tongue, gums, or cheeks, are a recognized NSAID toxicity sign. A horse that drools, quids food, refuses to eat, or shows pain when the mouth is examined should be evaluated promptly. Oral ulcers can also reflect gastric ulceration higher in the tract. ### Coagulation Short-term flunixin at 1.1 mg/kg IV every 12 hours for 5 days did not significantly alter viscoelastic coagulation profiles in healthy horses in one study [13]. The authors cautioned that coagulopathy is still possible with long-term use or in critically ill horses [13]. Unexplained bleeding, prolonged bleeding from a small wound, or new petechiae are reasons to stop the drug and call your veterinarian. ### Colic Signs During Treatment Colic signs during flunixin treatment deserve special emphasis. They can mean the original colic is worsening, a surgical lesion has developed, or the drug has caused a new gastrointestinal lesion. Any of those possibilities requires immediate veterinary assessment. Do not give another dose of flunixin to a horse that is showing colic signs while on flunixin. ### The Combination NSAID Warning Do not combine flunixin with another NSAID. This is one of the most important warnings in equine medicine. In a study of horses with naturally occurring lameness, phenylbutazone at 2.2 mg/kg orally every 12 hours for 5 days was compared with the same phenylbutazone regimen plus flunixin at 1.1 mg/kg IV every 12 hours for 5 days. The combination relieved lameness better than phenylbutazone alone, but one horse in the combination group died of acute necrotizing colitis during the study [2]. That single death is the reason combination NSAID therapy is avoided outside carefully monitored hospital settings. If your horse is already on phenylbutazone, firocoxib, meloxicam, ketoprofen, or any other NSAID, tell your veterinarian before flunixin is given. ## The Decision Path for a Painful Horse The flowchart below shows the main decision path when a horse is painful and flunixin is being considered. ```mermaid flowchart TD A[Painful horse] --> B[Call veterinarian] B --> C{Colic signs present} C -->|Yes| D[Do not give flunixin] C -->|No| E{Veterinarian authorizes flunixin} E -->|No| F[Use alternative plan] E -->|Yes| G[Confirm weight and dose] G --> H[Check for other NSAIDs] H --> I{Other NSAID in use} I -->|Yes| J[Do not combine] I -->|No| K[Give labeled route and interval] K --> L[Monitor appetite water manure] L --> M{Red flags appear} M -->|Yes| N[Stop drug and call veterinarian] M -->|No| O[Recheck at 5 days] ``` ## Who Should Not Receive Banamine Flunixin should not be given to a horse with any of the following, unless a veterinarian has specifically weighed the risk and is monitoring the horse closely. - Known hypersensitivity to flunixin or other NSAIDs - Active gastric or colonic ulceration - Dehydration, shock, or poor kidney perfusion - Known kidney disease - Concurrent use of another NSAID - Concurrent use of a corticosteroid, because the combined gastrointestinal risk is high - A horse already showing colic signs during flunixin treatment - A horse intended for human consumption in a jurisdiction where the drug is not permitted Flunixin has been studied in donkeys, including in castration and post-ovariectomy settings, but donkeys are not small horses. A retrospective study of ovariectomized jennies found that phenylbutazone treatment was associated with certain post-operative adverse events compared with flunixin, and the authors noted that conventional assumptions about which NSAID to use for which pain type are not supported by donkey-specific data [18]. If your equid is a donkey, mule, or hinny, tell your veterinarian so the plan reflects the right species. ## Drug Interactions Flunixin is metabolized by hepatic CYP enzymes, primarily CYP3A family members and CYP1A1 [10]. Any drug that induces or inhibits those enzymes can change flunixin clearance. The most clinically important interaction in horses is with other NSAIDs. The combination of phenylbutazone and flunixin has been associated with a fatal case of acute necrotizing colitis [2]. Corticosteroids, aminoglycoside antibiotics, and any nephrotoxic drug also increase the risk of kidney injury when combined with flunixin. Diuretics and any drug that reduces blood volume add to the same risk. Always give your veterinarian a complete list of everything your horse receives, including supplements, compounded products, and anything another owner or trainer has given. ## How Banamine Compares With Other NSAIDs Flunixin is a nonselective NSAID. The main alternatives in horses are phenylbutazone, ketoprofen, meloxicam, and firocoxib. Phenylbutazone is also nonselective and is often chosen for musculoskeletal pain. In a reversible foot-pain model, phenylbutazone reduced lameness scores significantly more than placebo or flunixin, while flunixin did not separate from placebo in that model [14]. In the high-dose 12-day toxicity comparison, phenylbutazone caused the most severe gastrointestinal lesions, including small intestinal edema and large colon erosions and ulcers, and it caused significant decreases in total protein and albumin [3]. Ketoprofen is nonselective. In the mild visceral post-operative pain study, ketoprofen, meloxicam, and flunixin all controlled pain without a significant difference between them [6]. In the 12-day toxicity comparison, ketoprofen affected the glandular stomach but did not produce the small intestinal and colonic lesions seen with phenylbutazone [3]. Meloxicam is COX-2 preferential. In the lipopolysaccharide endotoxemia model, meloxicam and flunixin produced similar pain scores and similar effects on body temperature, heart rate, respiratory rate, and leukocyte counts, but flunixin reduced tumor necrosis factor alpha and cortisol more than meloxicam [1]. In the castration study, flunixin controlled limb rigidity and preputial edema better than meloxicam or firocoxib [5]. Firocoxib is COX-2 selective. In the colonic wall thickness study, firocoxib increased colon wall thickness and produced subjectively more colonic edema than flunixin [15]. In the gastric mucosa pilot study, high-dose firocoxib was compared with label-dose flunixin, and the study was too small and too non-randomized to establish that firocoxib is safer for the stomach [11]. A veterinary clinical review asked whether firocoxib is as effective as flunixin for post-operative analgesia after colic surgery, which reflects the ongoing clinical question rather than a settled answer [19]. The choice among these drugs depends on the type of pain, the duration of treatment, the horse's hydration and kidney status, and the competition rules that apply. Flunixin's reputation for visceral pain control is well earned, and its gastrointestinal and renal risks are equally well documented. ## Questions to Ask Your Veterinarian Before flunixin is given, ask these questions. 1. What is my horse's measured weight, and what dose does that produce? 2. Which route are we using, and who will administer it? 3. How many days will we treat, and what is the plan if pain continues past 5 days? 4. Is my horse on any other NSAID, corticosteroid, or kidney-toxic drug? 5. Should we add a gastric protectant such as omeprazole during treatment? 6. What should I watch for at home, and what findings mean I should call immediately? 7. Does my horse compete under any medication-control rules, and what does that mean for this drug? 8. Does my horse's age, hydration, or kidney function change the plan? Omeprazole is sometimes co-administered with flunixin to reduce gastric ulcer risk. A study in Mongolian horses compared flunixin alone, flunixin plus omeprazole at 4 mg/kg orally every 24 hours, and placebo over 15 days, and measured lameness, gastric ulcer scores, gastric fluid pH, serum total protein, albumin, and oxidative stress markers [12]. Whether to add omeprazole is a decision your veterinarian makes based on the horse's ulcer history, treatment duration, and other risk factors. ## Limitations and When to Contact a Veterinarian Flunixin is a prescription drug and every case is different. The dose, route, duration, and monitoring plan depend on your individual horse, so this article cannot replace a veterinary examination. Contact a veterinarian immediately if any of the following occur during or shortly after flunixin treatment. - Colic signs, including pawing, rolling, flank watching, stretching, or lying down more than usual - Melena, which is black tarry manure, or any visible blood in the manure - Reduced or absent manure production - Refusal to eat or drink, or a sudden drop in water intake - Oral ulcers, drooling, quidding, or pain when eating - Reduced urine output, or a change in the color or smell of urine - Swelling, heat, or pain at an injection site - Unexplained bleeding, bruising, or prolonged bleeding from a small wound - Dull mentation, weakness, or collapse - Any new neurologic sign, including stumbling or head pressing - Worsening of the original problem despite treatment - Any suspicion that the horse received more than the intended dose Do not give another dose of flunixin while waiting for the veterinarian. Do not give a different NSAID to cover the pain. Bring the product label and the treatment record with you, including the dose, route, and time of every dose given. ## Frequently Asked Questions ### What is Banamine used for in horses? Banamine is used to control pain, fever, and inflammation in horses. It is most often selected for visceral pain such as colic and for inflammatory conditions such as endotoxemia, and it is also used for musculoskeletal, ocular, and post-surgical pain [1][4][5]. ### How is Banamine given to a horse? It is given by intravenous or intramuscular injection, and in some regions as an oral paste. The IV route produces the fastest and most predictable effect, and the IM route is used when IV access is not available [11][12]. ### What is the dose of Banamine for horses? The dose used throughout the equine literature is 1.1 mg/kg, given every 12 to 24 hours depending on the condition and the label. Your veterinarian calculates the exact dose from your horse's measured weight. ### How long can a horse stay on Banamine? Do not exceed 5 days without direct veterinary supervision. The 5-day course is the standard short treatment window in equine research, and longer use increases the risk of gastric ulcers, kidney injury, and low blood protein [11][15][13][2][5]. ### Can I give Banamine with bute or another NSAID? No. Combining flunixin with phenylbutazone or another NSAID raises the risk of severe gastrointestinal injury. In one study, a horse given phenylbutazone and flunixin together died of acute necrotizing colitis [2]. ### What are the warning signs of Banamine toxicity in horses? The main red flags are colic signs, melena or black tarry manure, oral ulcers, reduced urine output, low blood protein, and unexplained bleeding. Any of these means stop the drug and call a veterinarian immediately [12][3]. ### What is the withdrawal time for Banamine in horses? Withdrawal times vary by country and by product label, and they must be verified against the specific label before any horse could enter the food chain. In the United States, flunixin is not approved for use in horses intended for human consumption. ### Can Banamine be used in donkeys? Flunixin has been studied in donkeys, including in castration and post-ovariectomy settings, but donkeys are not small horses and the drug plan should be set by a veterinarian familiar with the species [8][18]. ## Related Articles - [Heatstroke in Dogs: Warning Signs and Prevention](/knowledge/veterinary-medicine/emergency-care/heatstroke-in-dogs) - [Why Is My Bird Tail Bobbing? Breathing Warning Signs](/knowledge/veterinary-medicine/pet-bird-care/bird-tail-bobbing-breathing) - [Can Dogs Eat Grapefruit? 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Oxalate Nephrotoxicity Warning](/knowledge/veterinary-medicine/toxicology-food-safety/can-dogs-eat-star-fruit-oxalate-nephrotoxicity-warning) - [Clonidine for Dogs: Uses, Dosing, and Safety](/knowledge/veterinary-medicine/pet-medication-guide/clonidine-for-dogs-uses-dosing-and-safety) - [Temaril-P for Dogs: Uses, Dosing, and Cautions](/knowledge/veterinary-medicine/pet-medication-guide/temaril-p-for-dogs-uses-dosing-and-cautions) - [Adequan for Dogs: Uses, Dosing, and Safety](/knowledge/veterinary-medicine/pet-medication-guide/adequan-for-dogs-uses-dosing-and-safety) ## Sources 1. [Oral Administration of Meloxicam and Flunixin Meglumine Have Similar Analgesic Effects After Lipopolysaccharide-Induced Inflammatory Response in Thoroughbred Horses.](https://pubmed.ncbi.nlm.nih.gov/36586521/) 2. 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