File this under “things I think way too much about.”
When is the use of bute appropriate? Not medically, I mean, but philosophically.
It’s an anti-inflammatory that is relatively benign as far as things go; it’ll upset a horse’s stomach, and in true longterm use can cause other things like kidney & liver issues. (It is, after all, an NSAID – and there is no such thing as a drug with zero side effects.)
I tend to think of it as the equivalent of a human taking an advil or tylenol pill: something that’s perfectly fine in direct application, but a bad idea to do every day for extended periods of time.
I will use bute for Tristan in a couple of circumstances. If he appears a touch off, I’m happy to do an evening + morning of bute after he is a bit lame, and then wait and see. If he’s worked excessively hard in a lesson and seems likely to have a bit of soreness, I’ll do the same. He often gets a dose after spring shots to help with that. The key for me is as an acute response to a specific situation – not a coverup.
Go beyond that, however, and it gets into gray areas. I’m sure we’ve all known a lesson horse or two that gets bute the morning before a long day of work, or before a schooling show. I’ve once or twice seen owners be very liberal with bute in response to any possible pain or inflammatory response. I’m sure there are people out there who just bute regularly as a matter of course, in a neverending cycle of overwork and stress. I think that we can all agree that bute as a masking technique to enable high-volume work is definitely on the misuse side of things.
Where’s the line between acute and chronic, though?
Consider that lesson pony, who has a lot to give still and may not mentally handle retirement well. Is it okay to do a little bit of bute if, say, the pony is going to do a small schooling show, to take the edge off a day of work that’s longer than usual?
What about an older horse turned out in spring for the first time, who’s likely to be a little bit of an idiot?
What about a horse who really needs to stay in very light work to keep healthy, but struggles through warmup – would making that warmup a bit more fluid be to his benefit, so he can get the physical therapy of a light ride?
In short, what about pre-emptive bute? Bute to pave the way to a goal, instead of as a reaction to a specific situation? How to define the guard rails there? Always, sometimes, never?
I don’t have a good answer. I’ve seen it done; I’ve never done it with Tris. I have no real plans to do it with him, but as he gets older, it seems likely to be something I’ll have to grapple with. So I wonder.
beljoeor.com 
I do it with Mocha. Given that she has known hock issues (hello, reining-bred QH, extreme sickle and cow hocks) there are times when it’s advised. Though I usually give it after a long day rather than before. Or I use Equioxx. She is already on Equioxx for the farrier–1-2 days before the appointment, depending on whether it’s winter and forefeet only or if it’s the rest of the year with shoes on all fores.
But. She also has very thin soles and late summer here means that fields are baked hard. This past winter with minimal snow until late and hard-frozen ground illustrated the problem–all the horses were hurting on the frozen fields, not just the oldies like Mocha. This summer when we get into the hard ground issue, farrier and I have decided to use pour-in pads.
A daily usage of Bute would have me looking at Equioxx or another alternative, and now that I have Equioxx as an option, if I’m seeing something that’s likely to be more than a one-off, I’ll use the Equioxx.
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I know it doesn’t directly answer your question but we have better medications, better nsaids, to help take that edge off and get everything moving a bit more smoothly so that senior horses can get even more movement to help their bodies. Equioxx, for example. Still has side effects but gentler in the long run. But I think your question still remains, just change the drug in question.
I think about good days and bad days. If medication helps a horse have more good days than bad – well, that’s simple-ish to me.
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100% agree with Nicole. We have long term use cases for other NSAID and NSAID like medications. I tend to use bute the way I use OTC NSAIDs in myself. A bit after an invasive medical procedure (post dentals for example), use it within USEF Guidelines after a strenuous day of horse showing, I use it when the horse might be sick to take the edge off the sickness (dependent on sickness obviously).
When a horse is acutely lame, I tend not to give bute because I want the horse to present lame when the veterinarian is there and then we medicate after diagnosis.
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Also agreeing with Nicole above. In Rio’s last years he was quite comfortable with a daily Equioxx and he was no worse for the wear for it.
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