# Adequan injection question



## T-bone (Jul 15, 2009)

*Adequan injection question*

Anybody have any experience injecting Adequan subcutaneously rather than intramuscularly? Know if it affects the efficacy? I've heard that it's being done off-label.

Yes, I know my vet could do the injection, however, I put IVs in people all day long and have good skills. Would rather inject subcutaneous due to the fact that I have a broken right wrist and it would be much easier for now.


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## Thomas D (Jan 27, 2003)

I believe Canada approves it to be done sub q. Not 100% sure.


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## Cappy_TX (Jan 6, 2003)

T-bone said:


> Anybody have any experience injecting Adequan subcutaneously rather than intramuscularly? Know if it affects the efficacy? I've heard that it's being done off-label.
> 
> Yes, I know my vet could do the injection, however, I put IVs in people all day long and have good skills. Would rather inject subcutaneous due to the fact that I have a broken right wrist and it would be much easier for now.


Our 11 year old yellow female was prescribed Adequan in early 2015. I gave her the injections in the scruff of her neck weekly for several months.


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## NateB (Sep 25, 2003)

IM injection, in the back muscle is what I would do. Feel the spine tips, then the outside edge of the muscle (loin muscle), go between you two fingers, needle straight into muscle, 1 inch needle, all the way in, inject and remove. easy-peasy. To me is easier than holding a fold of skin with the other hand.


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## T-bone (Jul 15, 2009)

Thanks for the info. With my wrist in a cast I don't want to take a chance hitting the sciatic nerve using a leg. Will do the loin injection.


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## hotel4dogs (Aug 2, 2010)

My vet said that studies have shown injecting it SQ is 95% as effective as IM. It's a helluva lot easier. Always done it that way, with great results.


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## Gray_Chin (Feb 24, 2017)

My old guy has been on it for several years IM. I started doing subq a few months ago and have not noticed a difference in efficacy.


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## suepuff (Aug 25, 2008)

I've been using it sub q on my dogs for years. On recommendations of my two vets.


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## sbl (Jul 11, 2011)

It is fine to give SQ (subcutaneously), anecdotally and data, though not a ton. I have clients give it to their own dogs SQ and I do the same for my own dogs.


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## Charles C. (Nov 5, 2004)

The vets I and my training partners have talked to lately say sub q is fine.


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## Buck Mann (Apr 16, 2003)

The sports medicine vet that I use says that you get essentially the same levels in joint fluid with sub-q administration.

Buck


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## Hunt'EmUp (Sep 30, 2010)

I will definitely have to try it..IM isn't that hard but sometimes my dog tries to pull away from it...as long as you don't get lumps wit SC and it works as good it might be worthwhile


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## kims (Jan 9, 2010)

I have been doing Sub Q for almost 2 years. Great results. I just pick up the skin at the back of the neck( makes a small tent), and inject. My dog does not feel it at all. My vet advised I do it this way and working for us. 
Best of luck. 
Kim


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## yukonriverriley (Aug 15, 2007)

I do it sub-cue for my 2 girls. Noticeable difference in them so it seems to be working even though off label.


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## hotel4dogs (Aug 2, 2010)

While we are on the subject of Adequan, sports vets are now recommending that it be given from the time a dog is very young, not just to senior dogs. It not only *treats* arthritis, studies in Europe have shown that it helps prevent it, too, if given from a young age.


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## T-bone (Jul 15, 2009)

hotel4dogs said:


> While we are on the subject of Adequan, sports vets are now recommending that it be given from the time a dog is very young, not just to senior dogs. It not only *treats* arthritis, studies in Europe have shown that it helps prevent it, too, if given from a young age.


Interesting ... will have to check that out.

Injection went well last night and hoping the little monkey gets some relief with the Adequan. 

Thanks for all the helpful replies.


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## EdA (May 13, 2003)

hotel4dogs said:


> While we are on the subject of Adequan, sports vets are now recommending that it be given from the time a dog is very young, not just to senior dogs. It not only *treats* arthritis, studies in Europe have shown that it helps prevent it, too, if given from a young age.


Define "very young", the dose, and the frequentcy of administration. Without some supporting evidence of efficacy and potential adverse effects I might proceed cautiously.


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## hotel4dogs (Aug 2, 2010)

Dr. Laurie McCauley originally discussed this in a seminar, and then Dr. Robert Gillette and Dr. Rosemary LoGuidice, all of them diplomates of the VSMR, confirmed it independently during office visits. They suggest the same dose you would give s senior dog (my 70 pound boy gets 1.5 ml) given once a month, beginning at 6 months old. 
According to Dr. LoGuidice, the only reason for not doing so would be either a dog with a genetic bleeding disorder such as Von Willebrands, or a dog who has allergies to beef.
Perhaps he is just genetically fortunate, but my boy, a deep chested dog who has been extremely active, including agility, at 10 years old has no arthritis at all. This was confirmed by a full series of front leg xrays, both legs, within the past 3 months. Made a believer out of me. He's had monthly Adequan injections since he was 3.


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## labdoc (Apr 18, 2003)

I'll go against the consensus here. Adequan is labeled for IM injection. I know of no published studies that confirms similar absorption and efficacy following SQ injection, although it is anecdotally apparent that this route is safe. IM is my preferred route, although SQ is used in aggressive dogs and cats.


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## cowdoc87 (Dec 18, 2014)

There was a study in 2008 on cat knees and found no significant difference between IM and SQ. Also, there have been some studies that seem to say that it can possibly slow cartilage loss and argue for its use as a preventative for normal wear-and-tear "arthritis". I've always told clients the idea is something like using synthetic oil in your car to lessen engine wear. If money is no object, and with the extreme conditions our guys endure, it seems like a reasonable thing to try.


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## retrieverfever (Feb 5, 2006)

I was actually going to ask the same
Question as I have a dog recovering and rehabbing from a TPLO and the sports vet I
Just heard at the Lardy seminar said should use Sub Q. I was looking for thoughts and I found them. Thanks


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## labdoc (Apr 18, 2003)

cowdoc87 said:


> There was a study in 2008 on cat knees and found no significant difference between IM and SQ. Also, there have been some studies that seem to say that it can possibly slow cartilage loss and argue for its use as a preventative for normal wear-and-tear "arthritis". I've always told clients the idea is something like using synthetic oil in your car to lessen engine wear. If money is no object, and with the extreme conditions our guys endure, it seems like a reasonable thing to try.


Yeah, I've seen that. Cats ain't dogs. Pharmacokinetics are probably similar but...? I've also seen some studies that showed clinical improvement with SQ injection but never a comparison between SQ and IM efficacy. Why mess with what works. IM just isn't that hard. 

I do agree that prophylactic use could be beneficial. It seems that clients are more open to that with glucosamine/chondroitin than injections. I'm OK with that non-proven oral supplementation as there are no significant side effects. I have seen occasional minor diarrhea probably associated with this supplement, but never anything else... Cost not being an issue.


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## Ckangel999 (Nov 10, 2021)

I just made an appt to get my 11 year old boy started on these injections and I’ll be honest, I want the injections given IM. In my dogs case the arthritis is advanced, to the point where he takes a long time to get up and his pain and mobility are getting worse and worse. I want to make sure I do everything I can to try to help him and since the drug is recommended for IM injection, I would feel much better with that method. Maybe once it comes to maintenance dose I’ll consider giving the injections myself SC, but I want to make sure he’s getting as much as he can of the loading doses. Maybe SC works just as well, or maybe it works better for earlier stage disease, I just don’t see any reason (besides convenience) to take even the slightest risk of the medication not working as well. And unless my vet can show me documentation or studies that show SC injections work just as well as IM, I’ll have to insist on IM injections. They’re going to hate me, I know..but my intentions are good and it’s not for me.


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## drunkenpoacher (Dec 20, 2016)

Ckangel999 said:


> And unless my vet can show me documentation or studies that show SC injections work just as well as IM, I’ll have to insist on IM injections. They’re going to hate me, I know..but my intentions are good and it’s not for me.


The response I got from Dr. J about IM vs SC injection.

Stan, 

The original Adequan labeling stated that the product was for IM (intra-muscular) use only. In later years, the company, as well as several veterinarians, went on to perform clinical trials using subcutaneous injection of the product and found that the blood levels were exactly the same. The company was going to re-label the product, but the FDA wanted 5 million dollars to do this, so the company decided to forgo the re-labeling and simply advise veterinarians that the research was available showing that it can be given IM or SC. Unfortunately, many primary vets are not familiar with the product because they don’t use it as much as orthopedic/rehab vets do, so I spend a lot of time educating them when they give me kick back about using the product “off-label.” 

Dr. J 




Jennell Appel, DVM, CCRT
_*SPORTVET*_ Canine Rehab & Sports Medicine
(850) 296-6866


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## EdA (May 13, 2003)

Generally speaking the only difference between intramuscular and subcutaneous injections is time of absorption, since muscle is much more vascular absorption from im injections is faster. Most injectables can be given both ways with some exceptions based on idiosyncrasy of the individual product. If not sure always follow manufacturers recommendation. As Dr. Appel stated Adequan works equally well by either route.


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## Ckangel999 (Nov 10, 2021)

EdA said:


> Generally speaking the only difference between intramuscular and subcutaneous injections is time of absorption, since muscle is much more vascular absorption from im injections is faster. Most injectables can be given both ways with some exceptions based on idiosyncrasy of the individual product. If not sure always follow manufacturers recommendation. As Dr. Appel stated Adequan works equally well by either route.


I really appreciate you taking the time to respond, Drs. He got his first injection this evening. Unfortunately, the vet I saw today isn’t his normal vet and she insisted the injection be given IM. When I inquired about SC injection she rejected the idea immediately and then sent in a vet tech to show me how to administer the injections into the muscle. She also became annoyed when I asked if I should continue his normal dose of meloxicam which he’s gotten daily for months. It was my understanding that I was to ask due to possible liver/kidney toxicity, as per the medication instructions. When I asked that outright she said he probably would have had liver issues already but she can do a blood panel if it would make me feel better. Needless to say, I will never take either of my dogs to see that particular vet again. Maybe I got spoiled with their normal vet, but I assumed it was ok to ask basic questions about medication interactions. I just love my dog and want to ensure he’s safe after reading that warning. I’m assuming now that it’s only a precaution and that it’s not a normal side effect, but I didn’t know that.


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## Ckangel999 (Nov 10, 2021)

I couldn’t administer it intramuscularly, I just couldn’t. I put the needle in and he jumped and jerked away, and rather than waste it I injected it SC. The prescribing vet wants no part of SC injections and I don’t know how he’s going to get the remaining 6 injections because I can’t do IM and the vet closes at 6 and that’s what time I work until. Plus the vet gave me 22g 1” needles and they aren’t the best for SC injections. I’m going to look into one of those mobile vets to administer the remaining injections, which I’m not sure they’ll do and would no doubt cost a fortune. I got this to help my golden walk better and unfortunately it seems like the injections just aren’t working out with my vet. Thank you all for your help and best of luck with your fur babies.


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## drunkenpoacher (Dec 20, 2016)

Ckangel999 said:


> I couldn’t administer it intramuscularly, I just couldn’t. I put the needle in and he jumped and jerked away, and rather than waste it I injected it SC. The prescribing vet wants no part of SC injections and I don’t know how he’s going to get the remaining 6 injections because I can’t do IM and the vet closes at 6 and that’s what time I work until. Plus the vet gave me 22g 1” needles and they aren’t the best for SC injections. I’m going to look into one of those mobile vets to administer the remaining injections, which I’m not sure they’ll do and would no doubt cost a fortune. I got this to help my golden walk better and unfortunately it seems like the injections just aren’t working out with my vet. Thank you all for your help and best of luck with your fur babies.


Find different vet to prescribe and give the injections yourself.


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## EdA (May 13, 2003)

Give the injections subq, 22 gauge one inch needles are normal and standard for injections


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## moscowitz (Nov 17, 2004)

On the box that my adequate came in it says the following:

“inject under the skin 1 time a week for 4 weeks, then once monthly.”


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## drunkenpoacher (Dec 20, 2016)

moscowitz said:


> On the box that my adequate came in it says the following:
> 
> “inject under the skin 1 time a week for 4 weeks, then once monthly.”


Can you post a photo?


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## moscowitz (Nov 17, 2004)

drunkenpoacher said:


> Can you post a photo?


I’ll Try


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## moscowitz (Nov 17, 2004)

View attachment 87955


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## drunkenpoacher (Dec 20, 2016)

That is the label from the pharmacy not the manufacturer.


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## EdA (May 13, 2003)

drunkenpoacher said:


> That is the label from the pharmacy not the manufacturer.


The manufacturer would not post that because subq administration was not included in the clinical trial submitted for FDA approval. That does not mean that it is not absorbed subcutaneously


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## Hunt'EmUp (Sep 30, 2010)

Started with IM back when that's what it was. IM to give sucks; much harder and to me the medicine must have something in it that stings when injected the muscle making it painful, you had to pretty much tackle the dog; to get the whole dose in. As time went talking to many horse people they were doing SC and it worked, so I did SC and it works the same. Now most vets recommend SC. Will say that the drug works better for some animals than others in my experience, but worth a try and it really can help in certain animals. Also Adequan is name brand there are other manufactures of the drug ICHON etc. which is same active ingredient; but off brand use; works the same.


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## drunkenpoacher (Dec 20, 2016)

EdA said:


> The manufacturer would not post that because subq administration was not included in the clinical trial submitted for FDA approval. That does not mean that it is not absorbed subcutaneously


It is, as Dr Janell explains in the the email in post #24


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## T-bone (Jul 15, 2009)

When I asked this question ~4 years ago I was trying to keep a dog who severely injured his shoulder as pain free as possible. Have used Adequan (and injected it SC each time) and that dog just turned 13 years old. At the time I was nursing a broken wrist that happened when I stepped on the check cord of my young dog while standing on gravel - not very bright on my part. That young dog is now a high drive talented dog with a mediocre trainer who won't be stepping on their new puppy's check cord any time soon 

Congrats to Alvin Hatcher and Luke for their win today (go Whopper pups)!


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## Ckangel999 (Nov 10, 2021)

EdA said:


> Give the injections subq, 22 gauge one inch needles are normal and standard for injections


If the 22g, 1inch needles are ok for SC injection then I will absolutely just administer the injections myself, as my only concern was without the proper needles he could possibly get lumps and bumps under his skin. I had no problem injecting the last one SC myself, I just lifted his skin into a tent and injected it once I knew I was clear of the skin. I researched Adequan for weeks before calling into my vet and asking if I could try it. I recommend it to them, not the other way around, so I’m not sure she gets a ton of clients who ask for this medication because they had to order it and read the label, and she also doesn’t want me using it for maintenance, only the initial loading dose.


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## EdA (May 13, 2003)

Ckangel999 said:


> If the 22g, 1inch needles are ok for SC injection then I will absolutely just administer the injections myself, as my only concern was without the proper needles he could possibly get lumps and bumps under his skin. I had no problem injecting the last one SC myself, I just lifted his skin into a tent and injected it once I knew I was clear of the skin. I researched Adequan for weeks before calling into my vet and asking if I could try it. I recommend it to them, not the other way around, so I’m not sure she gets a ton of clients who ask for this medication because they had to order it and read the label, and she also doesn’t want me using it for maintenance, only the initial loading dose.


Most dogs on maintenance, if they respond well, receive a single injection every 3-6 weeks. There is no plausible reason to not continue because a relapse would typically require repeating the loading dose procedure which is costly.


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## moscowitz (Nov 17, 2004)

I have two more shots to give to comply with the four every week for a month. Question one shot a month. When do I give it?


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## EdA (May 13, 2003)

moscowitz said:


> I have two more shots to give to comply with the four every week for a month. Question one shot a month. When do I give it?


I generally advise every 2 weeks, then every 3 weeks, then every 4 weeks. Some respond to different intervals, does that make sense? After the last weekly injection wait two weeks to give it, then wait 3 weeks to give the next, find an interval at which the dog does not regress.


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## RetrieversONLINE (Nov 24, 2005)

Can anybody provide me with a peer-reviewed scientific journal article that experimentally demonstrates adequan or any other joint supplement (eg. Dusaquin or Cosequin) has been shown to have a statistically significant benefit either as a joint deterioration supplement or as treatment for osteoarthritis In dogs?


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## drunkenpoacher (Dec 20, 2016)

RetrieversONLINE said:


> Can anybody provide me with a peer-reviewed scientific journal article that experimentally demonstrates adequan or any other joint supplement (eg. Dusaquin or Cosequin) has been shown to have a statistically significant benefit either as a joint deterioration supplement or as treatment for osteoarthritis In dogs?


I have read inconclusive ones.
I think it's like chiropractics. You need to believe in it to make it work.
Don't ask me how to make a dog believe in it.

I started Jake on it about a year ago after hearing from multiple people about the positive effects it has on their dogs and how they could tell when it was "wearing off" a day or two before the next dose. I have talked to some Vets that recommend it and more that do not (none said there was any harm in using it).

In my sample group of one I have seen no effects at all. I am not saying it doesn't work but I canceled my auto ship order from Chewy.


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## EdA (May 13, 2003)

RetrieversONLINE said:


> Can anybody provide me with a peer-reviewed scientific journal article that experimentally demonstrates adequan or any other joint supplement (eg. Dusaquin or Cosequin) has been shown to have a statistically significant benefit either as a joint deterioration supplement or as treatment for osteoarthritis In dogs?


To my knowledge there are no such studies. In the oral joint supplement category they are considered food supplements by the FDA therefore no scientific proof of efficacy is required. 
Complex double blinded studies are very expensive to conduct so they are generally funded by the manufacturer. In the specific case of Adequan (polysulfated glycoaminoglycans) it was approved 30 years ago for the use in dogs and horses so the original manufacturer had no incentive to fund a study. Virtually all evidence is anecdotal although the volume and preponderance of positive effect is large. From my professional, sometimes skeptical, and occasionally contrarian point of view it is both safe and effective for the treatment of musculoskeletal injury and degenerative joint disease. I’ll not bother posting links to many articles using anecdotal evidence but they are readily available via Google under polysulfated glycoaminoglycans and Adequan.


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## polmaise (Jan 6, 2009)

RetrieversONLINE said:


> Can anybody provide me with a peer-reviewed scientific journal article that experimentally demonstrates adequan or any other joint supplement (eg. Dusaquin or Cosequin) has been shown to have a *statistically significant benefit* either as a joint deterioration supplement or as treatment for osteoarthritis In dogs?


Probably lots quoting similar but not definitive nor conclusive and probably lots more with letters after their name than you or I.
...Not being veterinary trained I have fortunately evaded over the last 50 years ever having the situation in all the breeds I have had born/bred/nurtured/trained and kept till old age. Just lucky I guess?
I do know something about joint deterioration and osteoarthritis though. I do wish I had never been forced to run up hills with a 55lb sack on my back and run 10 miles per day in the military when I was 18 ..for 12 years. lol God help us if the brand or brands of food brigade is brought in to the equation of supplements and benefits


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## pappy (Nov 23, 2009)

EdA said:


> To my knowledge there are no such studies. In the oral joint supplement category they are considered food supplements by the FDA therefore no scientific proof of efficacy is required.
> Complex double blinded studies are very expensive to conduct so they are generally funded by the manufacturer. In the specific case of Adequan (polysulfated glycoaminoglycans) it was approved 30 years ago for the use in dogs and horses so the original manufacturer had no incentive to fund a study. Virtually all evidence is anecdotal although the volume and preponderance of positive effect is large. From my professional, sometimes skeptical, and occasionally contrarian point of view it is both safe and effective for the treatment of musculoskeletal injury and degenerative joint disease. I’ll not bother posting links to many articles using anecdotal evidence but they are readily available via Google under polysulfated glycoaminoglycans and Adequan.


That was a good reply. The question has Adequan shown to have a statistically significant benefit either as a joint deterioration supplement or as treatment for osteoarthritis In dogs? 

My personal experience with my 12 year old female after a year of every two week shot along with daily dose of regenza (I believe that is how it is spelled) is not so great. The bone on bone in her right front shoulder still exist. I know its painful especially when she has been laying for an extended period of time.

Unless we opted for surgery, way too old for that, she will never improve. As a side note to the original question she had received daily doses of Dasaquin since she was 18 months old.

I have only ever seen one dog in the FT world that didn't appear to have any physical restrictions and ran trials up to 13 years old. She belonged to the Dubose's and was on Lardy's truck. Maybe she was an exception to the rule.

On a side note I spoke with a friend of mine and ask does he take any supplements. He takes (2) tablets of Glucosamine a day to help with his muscle/joint issues. I started taking it and I am in the 4th week and that has made a huge difference in my shoulders. Would you recommend something like that for a canine?


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## EdA (May 13, 2003)

pappy said:


> That was a good reply. The question has Adequan shown to have a statistically significant benefit either as a joint deterioration supplement or as treatment for osteoarthritis In dogs?
> 
> My personal experience with my 12 year old female after a year of every two week shot along with daily dose of regenza (I believe that is how it is spelled) is not so great. The bone on bone in her right front shoulder still exist. I know its painful especially when she has been laying for an extended period of time.
> 
> ...


I have done a peer reviewed study on myself taking Cosamin ASU I have gone on and off at least 3 times and have objectively concluded that my joint stiffness is significantly improved each time I start taking it again. Holland is 14 today and his daily regimen includes TechnyFlex HA (newzealandsbest.com), Myristol which is a glucosamine plus myristic acid supplement, and Adequan injections every 3-4 weeks. He is remarkably mobile for his age, whether or not that has anything to do with what I give him I cannot tell but have no plans on discontinuing for scientific curiosity.


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## drunkenpoacher (Dec 20, 2016)

EdA said:


> I have done a peer reviewed study on myself


So did I. Mine involved giving up sugar, Anheuser-Busch products, Camel shorts and losing 40lbs. My joint pain has been vastly reduced, I almost never cough anymore and can't remember the last time I had as much as a cold.
To small of a sample to draw any conclusions from though.


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## EdA (May 13, 2003)

drunkenpoacher said:


> So did I. Mine involved giving up sugar, Anheuser-Busch products, Camel shorts and losing 40lbs. My joint pain has been vastly reduced, I almost never cough anymore and can't remember the last time I had as much as a cold.
> To small of a sample to draw any conclusions from though.


Check back with us when you are in your mid 70s 😉


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## Hunt'EmUp (Sep 30, 2010)

Peer Reviewed sample? of 3 dogs starting @ age 9 significant benefit in 2 dogs as I notice when it wears off and see improvement when given again. Will note dogs are very lazy for ~24hrs after injection, practically sleep all day. (anyone else notice this?) 3rd dog really haven't seen a benefit. Long and the short of it is, doesn't hurt the dogs and I can see improvement works for us and we don't really need published articles etc. Worked on eldest dog 9-13 then really wasn't seeing improvement but will give sometimes. What is working for her at 14.5 is Edilibe MJ gummies-cookies; talk about something that really NEEDs studies-should be peer reviewed, regulated and actually monitored for amount of active ingredient (Indica for sleep and Sativa for not sleep). Do not mix the 2 up because then you have a 14.5 year old parading around the house at 2am in the morning partying, she only gets 1/4 a gummy of Sativa ever after that.


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