NSAIDs' mechanism of action by inhibiting the synthesis of prostanoids accounts for both their therapeutic and toxic effects. They are commonly used in acute and chronic musculoskeletal and soft-tissue conditions. Adverse reactions include gastrointestinal disturbances and hypoproteinemia. Their pharmacologic effect seems to have a longer duration than their plasma concentrations indicate. This gives implications on current regulations for competing horses and the relevance of permitted levels has been questioned. The NSAIDs do not appear to enhance performance, but rather allow the horse to run up to its potential by reducing pain and lameness. There is concern over the possible hazards to the horse by this kind of therapeutic use. In conclusion, NSAIDs have well justifiable therapeutic uses in equine practice. They should, however, be used when there is a clear clinical indication, in safe dose rates and without jeopardizing the welfare of the performance horse.