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Trichlormethiazide and Dexamethasone (Tri Dex) combination is an oral product that was licensed and marketed under the brand name of Naquasone as a treatment for udder edema in the cow. Many veterinarians use this drug combination in horses to reduce mild swellings particularly of the legs.
Trichlormethiazide is a diuretic that works at the level of the proximal tubules of the kidneys to decrease the re-absorption of sodium. It has little effect on potassium excretion. Dexamethasone is a corticosteroid. A full discussion of the anti-inflammatory effects and side effects associated with dexamethasone are discussed in the Dexamethasone monograph.
One of the benefits to using a combination product is that
each component works by a different mechanism. This may allow a smaller dose
of the individual drugs than might be used if the drug were given individually.
Tri Dex has been used by equine practitioners to treat
mild swellings of the distal limbs. Because of the relatively small dose of
the individual drugs it is generally thought to be a safe product for bumps,
bruises, non-specific edema or stocking up. It is sometimes used in conjunction
with antibiotics in leg wounds where there is both a bacterial component and
inflammation or contusion. Tri Dex does not cure the underlying cause of the
swelling or edema and should not be used without appropriate diagnostic evaluation.
• Dexamethasone is a corticosteroid. All of the potential
side effects of corticosteroids should be reviewed and considered. Of particular
importance in the horse are considerations regarding laminitis and immune-suppression.
• Trichlormethiazide is a diuretic and causes the loss of water and sodium
chloride. Free access to water and salt are important at all times.
• Tri Dex can mask the signs of infection because
of the corticosteroid's anti-inflammatory action.
• Tri Dex should not be used in any horse that is prone to laminitis
due to the Dexamethasone. Pony breeds may be more susceptible to some side
effects of corticosteroids, particularly laminitis.
• Drugs containing corticosteroids are generally not recommended in pregnant
animals because in some species, corticosteroids may cause premature labor
and birth defects. The drugs contained in Tri Dex are excreted in milk therefore
it should not be used in pregnant or lactating mare unless the benefits outweigh
the risks.
• Tri Dex would rarely be used in foals due to possible immune suppression
from corticosteroids.
• Tri Dex should not be used in horses with pituitary pars intermedia
dysfunction (equine Cushing's syndrome, or pituitary hypertrophy/adenoma).
• Tri Dex should not be used at the same time as other corticosteroids
or diuretics.
• Dexamethasone: Short-term administration is unlikely to cause serious
harmful systemic effects due to adrenal suppression but laminitis is always
an area of concern with an overdose of corticosteroids.
• Trichlormethiazide: Electrolyte depletion and dehydration are possible
with prolonged use or overdose of diuretics.
Dr.
Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania.
She has a master's degree in animal science from the University of Delaware
and graduated from the University of Pennsylvania School of Veterinary Medicine
in 1982.
She began to develop her interest in client education and medical writing 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
You can purchase books by Dr. Forney at www.exclusivelyequine.com
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