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Paracetamol For Horses: UK Legal Use, Dose & Safety
9 min read Last updated: January 2026 Cold-weather flare-ups and colic have your horse in pain and you wondering if paracetamol is an option? Heres how UK vets legally use it under the cascadetypical dosing is 20 mg/kg by mouth twice daily with 91% oral bioavailabilityso you can discuss a safe, effective plan with confidence. Quick Summary Short on time? Here are the key takeaways. Area: Legal use (Cascade) What To Do: Only use paracetamol on a veterinary prescription after a clinical assessment; ensure your horse is under your vets care. Why It Matters: Its unlicensed for horses in the UK and must meet cascade and RVP requirements. Common Mistake: Giving human paracetamol without vet approval. Area: Dosing & administration What To Do: Follow the prescribed dose (typically 20 mg/kg by mouth twice daily) and use the formulation your vet supplies; do not alter dose or frequency. Why It Matters: Correct dosing maximises efficacy and safety given high oral bioavailability. Common Mistake: Estimating tablet numbers yourself or mixing products to make up a dose. Area: Monitoring & side effects What To Do: Track appetite, demeanour, droppings and hydration; stop the drug and call your vet immediately if diarrhoea or sudden changes occur. Why It Matters: Early recognition of adverse signs prevents complications and guides safer pain control. Common Mistake: Waiting to see if gut signs settle before contacting your vet. Area: Passport & food status What To Do: Check Section IX now; sign your horse out of the food chain if appropriate and keep the passport accessible for treatment notes. Why It Matters: Food status determines if cascade medicines can be used and whether withdrawal periods apply. Common Mistake: Discovering an unsigned passport during an emergency and delaying pain relief. Area: Combining medicines What To Do: Give your vet a full list of all medicines, feeds and supplements; only add or stop products with veterinary guidance. Why It Matters: Combination therapy is common, but interactions and additive side effects must be managed. Common Mistake: Adding herbal or electrolyte supplements without clearing them with your vet. Area: When NSAIDs arent suitable What To Do: If NSAIDs cause gut or renal concerns, ask your vet whether paracetamol under the cascade is appropriate as an alternative or adjunct. Why It Matters: Paracetamol can provide analgesia while reducing NSAIDrelated colonic ulceration risk. Common Mistake: Persisting with ineffective or poorly tolerated NSAIDs without discussing options. Area: Immediate pain plan What To Do: Call your vet, gather vitals (heart rate, respiratory rate, temperature, mucous membranes), keep the horse warm and follow feeding advice while you wait. Why It Matters: Clear information and supportive care speed diagnosis and safe prescribing. Common Mistake: Offering feed during suspected colic or exercising without veterinary advice. Area: Storage & human safety What To Do: Store medicines securely, log doses, and keep a clean dosing kit; if a person takes more than two tablets accidentally, seek urgent medical help. Why It Matters: Safe storage prevents dosing errors and human toxicity. Common Mistake: Leaving tablets loose in the tack room or skipping records needed for passport and withdrawal tracking. In This Guide Whats the legal status of paracetamol for horses in the UK? When do vets prescribe paracetamol to horses? How should paracetamol be dosed and given to a horse? What risks and side effects should you watch for? How does your horses passport affect paracetamol use? Can paracetamol be used with other equine pain medicines? What should you do if your horse needs pain relief right now? Pain management can make or break your horses recovery especially through a damp, cold UK winter when colic and musculoskeletal flare-ups are more likely. If your vet mentions paracetamol, youll want the facts, fast, so you can make the safest, most effective plan.Key takeaway: In the UK, paracetamol is unlicensed for horses but vets can legally prescribe it under the cascade at 20mg/kg by mouth twice daily, with 91% oral bioavailability and proven shortterm safety in healthy adult ponies.Whats the legal status of paracetamol for horses in the UK?Paracetamol isnt licensed for equine use in the UK, but vets can prescribe it under the veterinary prescribing cascade after a clinical assessment. This requires the horse to be under the vets care and the decision to meet Routine Veterinary Practice (RVP) standards.Under Regulation (EU) 2019/6 Articles 112114 (the cascade), UK vets must prioritise authorised veterinary medicines first; if none are suitable or available, a human medicine such as paracetamol may be prescribed. The UK Government guidance is clear:When prescribing medicines under the cascade, you must first carry out a clinical assessment of the animal which must be under your care. You must also ensure that the evidence base for your prescribing decisions is robust and complies with Routine Veterinary Practice (RVP). GOV.UK: The cascadeIn practical terms, this means you must not give paracetamol without a veterinary prescription. The Royal College of Veterinary Surgeons (RCVS) undercare rules (updated 2023/24) also expect an examination (in person or appropriate remote consult) before prescribing a medicine like this. Horses declared as nonfood producing (see Passports & food chain status below) can receive unauthorised medicines under the cascade; otherwise, withdrawal periods apply.When do vets prescribe paracetamol to horses?Vets consider paracetamol when licensed NSAIDs are ineffective or contraindicated, and in some cases alongside other analgesics for severe pain. Its particularly useful where NSAID side effects are a concern.Evidence summarised by Mercer et al notes both efficacy and practical dosing:Although unlicensed, paracetamol is useful under the cascade in some equine patients that arent suited to licensed NSAID alternatives (20mg/kg twice daily by mouth). It has 91% oral bioavailability in horses and has been shown to be safe dosing twice daily for 14 days in healthy adult ponies. Vet TimesMany practices frame its use like this:Paracetamol is a painkiller drug that may be used alongside other painkiller medicines in horses with severe pain... used in horses where traditional painkillers are ineffective in controlling severe pain. Coach House VetsWhy might your vet reach for paracetamol? The most common NSAID adverse effect in horses is colonic ulceration (often presenting as diarrhoea and weight loss), with kidney issues less common. In the UK winter with higher colic risk due to wet weather, reduced turnout, and dietary shifts paracetamol can be an important option for NSAIDintolerant cases under veterinary supervision.How should paracetamol be dosed and given to a horse?The typical equine dose is 20mg/kg by mouth twice daily, prescribed and supervised by your vet; do not selfmedicate. Studies in healthy adult ponies show this regimen is safe for 14 days, and oral bioavailability is high (91%), so oral dosing is effective.Your vet will calculate the exact dose and advise on formulation. For illustration only, a 500kg horse at 20mg/kg equals 10,000mg (10g) per dose, twice daily. Because human tablets are commonly 500mg, thats a large number of tablets another reason dosing must be planned by your vet, who may source a suitable formulation under the cascade.Give exactly as directed and for the duration advised. Do not change dose or frequency without checking with your vet.Store securely, follow the label, and record administrations if your vet requires it for passport notes or withdrawal tracking.If a person accidentally ingests more than two tablets, seek urgent medical help immediately (paracetamol overdose can be serious in people).Quick tip: Keep a dedicated storage box for prescribed medicines in your tack room. Our customers often add a thermometer and syringe/measure to their grooming and firstaid essentials so dosing and monitoring are easy in an emergency.What risks and side effects should you watch for?Paracetamol is generally well tolerated shortterm in healthy adult ponies, but you must monitor your horse and report any concerns to your vet immediately. Stop the medicine and call your vet if you notice diarrhoea, loss of appetite, depression, or any sudden change in demeanour.Context matters: with NSAIDs, the most common adverse effect is colonic ulceration leading to diarrhoea and weight loss, and kidney problems are less common (Vet Times). Paracetamol can help avoid NSAIDrelated gut issues in selected cases, but any new digestive sign still warrants swift veterinary input. For chronic pain management, your vet may choose to monitor blood proteins and renal parameters periodically.Practical pointers:Report all concurrent medicines and supplements to your vet to avoid interactions.Watch droppings, appetite, and hydration closely especially in cold weather when horses often drink less.If diarrhoea occurs on any painkiller, stop treatment and contact your practice; do not wait to see if it settles.Pro tip: Once your vet is happy, simple support like welltimed electrolytes and digestive supplements may help maintain hydration and gut comfort through winter routines. Always clear new supplements with your vet when pain medicines are on board.How does your horses passport affect paracetamol use?If Section IX of the passport is signed, your horse is declared nonfood producing and can be treated under the cascade with unauthorised medicines like paracetamol. If Section IX is unsigned, the horse is treated as foodproducing and your vet must set an appropriate withdrawal period.This is essential legal housekeeping. Horses not signed out of the food chain must follow foodanimal rules; vets then set withdrawal periods for cascade medicines (a statutory six months applies for certain essential substances). To streamline care in an emergency, make sure Section IX is completed in line with your intentions and keep the passport accessible on the yard. Your vet will advise if any treatment needs to be recorded in the passport itself.Quick tip: Review your passport status at the start of winter and before show season travel. It takes seconds and can save hours of delay if emergency pain relief is needed fast.Comfort counts while you and your vet put a plan in place. A wellfitting rug keeps muscles warm and reduces shivering stress; choose breathable layers like winter turnout rugs for wet days or stable rugs when boxresting.Can paracetamol be used with other equine pain medicines?Yes vets often use paracetamol alongside other analgesics, but you must tell your vet about every medicine and supplement your horse is receiving. Do not add or remove anything without veterinary guidance.Combination therapy can target different pain pathways in severe cases, or allow lower doses of NSAIDs where gut risk is a concern. Your vet will balance benefits with potential interactions and monitor for additive side effects. This includes considering nonmedicines such as herbal products and nutraceuticals, so share full details of any supplements or feed changes.Handling and movement support also matter during recovery. Consider protective support such as supportive bandages and boots if your vet recommends controlled exercise.What should you do if your horse needs pain relief right now?Call your vet first; do not give paracetamol without a prescription. While you wait, make your horse comfortable and gather the information your vet will want.Phone your vet and describe signs clearly (onset, severity, triggers, any recent medicines).Check your horses passport status (Section IX) and have it ready if the vet prescribes under the cascade.Record vital signs: heart rate, respiratory rate, mucous membrane colour, and temperature. A digital thermometer in your yard kit is invaluable; many riders keep one with their yard firstaid and grooming kit.Keep your horse warm and dry without overheating. Layer appropriately with breathable turnout rugs for wet weather or a cosy stable rug if boxresting.Follow your vets feeding advice; for colic suspicion, do not offer feed until advised. Encourage small sips of fresh water if allowed.Prepare for medication: a clean bucket, dosing syringe, and something to help acceptance (a slice of soaked feed or a couple of lowsugar treats if your vet approves).If you must hack carefully to keep a restless horse moving on vet advice, make safety visible with hivis rider gear during lowlight winter hours.At Just Horse Riders, we recommend writing your dosing schedule on paper and setting phone reminders the moment a plan is agreed. Consistency reduces relapse risk and helps your vet interpret progress.FAQsIs paracetamol licensed for horses in the UK?No. Its unlicensed, but a UKregistered vet can prescribe it under the cascade after assessing your horse and confirming its under their care. See GOV.UK guidance on the cascade.What dose do horses receive?Typical dosing is 20mg/kg by mouth twice daily, prescribed by your vet. Research reports 91% oral bioavailability and safety for 14 days in healthy adult ponies (see Vet Times).Can I give my horse human paracetamol without a vet?No. Its illegal to give unauthorised medicines like paracetamol without a veterinary prescription under the cascade, and it risks breaching horse passport rules. Your vet must assess and prescribe first (see Coach House Vets guidance and GOV.UK).What if my horse develops diarrhoea on painkillers?Call your vet immediately and stop the medicine unless your vet tells you otherwise. Diarrhoea is a common NSAIDrelated sign due to colonic ulceration; your vet may adjust the plan and consider alternatives like paracetamol under the cascade (see Vet Times).Can paracetamol be combined with other equine medicines?Yes, vets often use it alongside other analgesics for severe pain. Always tell your vet about every medicine, feed change, and supplement to avoid interactions.What if my horse is not signed out of the food chain?If Section IX is unsigned, your horse is treated as foodproducing. Your vet must set a withdrawal period for cascade medicines; some essential substances carry a statutory sixmonth withdrawal (see GOV.UK).How should I store paracetamol, and what about accidental human ingestion?Store securely as labelled by your vet, keep a dosing log, and prevent access by children or animals. If a person accidentally takes more than two tablets, seek urgent medical help immediately.Need winterready kit while you and your vet finetune pain management? Explore breathable layers from WeatherBeeta rugs or comfort upgrades from LeMieux, and keep hydration and gut comfort on track with carefully chosen supplements approved by your vet.Bottom line: work handinglove with your vet. Used correctly under the cascade, paracetamol can be a valuable addition to your equine pain toolbox safely, legally, and with your horses welfare front and centre. Shop the Essentials Everything mentioned in this guide, ready to browse. Shop SupplementsShop Turnout RugsShop Stable RugsShop Grooming KitShop Boots & Bandages
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