Editor’s note: On September 7, 2022, the American Association of Equine Practitioners (AAEP) sent the following letter to the National Reining Horse Association about the group’s addition of romifidine as an approved medication.
Mr. Rick Clark, President
National Reining Horse Association
3021 West Reno Avenue
Oklahoma City, OK 73107
Dear President Clark and NRHA Executive Committee,
The American Association of Equine Practitioners (AAEP) is a U.S.-based professional association of more than 9,000 equine veterinarians that is committed to ensuring the health and welfare of horses. We would like to share our concerns regarding recent changes to NRHA’s medications policy, specifically with regards to the addition of romifidine as an approved medication.
We applaud you for many of your policy changes; however, we wish to share our grave concerns regarding your allowance of compounded romifidine for sedative effects and its impact on the health and welfare of both horse and rider.
Romifidine is a sedative of the most common class used in horses, the α2-adrenergic receptor agonists. Unlike phenothiazine tranquilizers such as acepromazine, the α2-agonists produce significant analgesia (decreased pain perception) in addition to sedative effects, including ataxia (loss of coordination and balance). Much research has been conducted on horses receiving romifidine. These studies have demonstrated that at 30 minutes post-administration, 80% of horses still show signs of mild to moderate sedation, and signs of lameness are significantly decreased from a pre-administration baseline evaluation. Ataxia may still be present up to an hour after administration, and diminished response to painful stimuli and other signs of sedation may persist up to 2 hours in some horses.
Taken together, allowing a horse to enter a show ring at 30 minutes post-administration of romifidine presents a safety and welfare risk to both the horse and rider, including masking a lameness that could become worse with riding, or results in the horse tripping and injuring him/herself and the rider. The analgesic effects of this drug furthermore can be considered performance enhancing and an affront to the spirit of fair competition.
Also, as you are aware, there is no FDA-approved form of romifidine manufactured in the United States. Sedivet, previously manufactured in the U.S., is no longer available in the U.S. but is in Canada and Europe. Therefore, romifidine in any form in the U.S. can only be obtained from a compounding company.
As licensed veterinarians, our profession has strict guidelines that we must adhere to for the use of compounded medications, and administration for competitive purposes goes against these guidelines (see below). Secondly, compounding pharmacies are unregulated; as such, there can be variations in concentrations and quality of compounded preparations which has led to disastrous consequences even when there has been the best of intentions (e.g., polo pony deaths).
Legal drug compounding requires a valid Veterinary Client/Patient Relationship (VCPR). A compounded medication can only be used when there is not an equivalent FDA-approved medication available. Off label (extra label) medication is the use of an FDA-approved product for a non-equine species that is used (off label) in the horse. It should be noted that the use of compounded drugs in a highly regulated competitive environment should be discouraged due to the variability of therapeutic levels and detection times. The AAEP Guidelines for Drug Compounding are an excellent reference for the legal and ethical use of medications in horses. The AAEP also offers additional resources on compounding online here.
We note that the NRHA’s Animal Welfare Position Statement embraces the values of ensuring the highest standards of safety for both horse and rider and condemns the use of performance-altering substances in competition. For the safety of the discipline’s equine and human athletes, we urge NRHA members and leadership to reconsider this recent change allowing for the use of compounded romifidine. We do not believe it is in the best interest of the horse.
Thank you for your consideration of our concerns.
Emma Read, DVM, MVSc, DACVS
President – 2022
American Association of Equine Practitioners
cc: Gary Carpenter, NRHA Commissioner