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Esomeprazole (Nexium) for equine ulcers

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  • Omeprazole can have a mild effect on personality that can be seen as "calming", according to one of my vets. Not sure if esomeprazole would do the same, but if he scopes clean Equestrianette that may be one thing to consider about his response to Nexium.

    Comment


    • Is Nexium/Ulcerguard USEF legal?
      "People who think their brains are not worth protecting are probably right!"
      - quoted by Martha Drum

      Comment


      • Originally posted by wishfulthinking711 View Post
        Is Nexium/Ulcerguard USEF legal?
        They're different drugs. Nexium uses esomeprazole and UlcerGard/GastroGard use omeprazole. Neither are on USEF's prohibited substances list.

        Comment

        • Original Poster

          Originally posted by ake987 View Post

          They're different drugs. Nexium uses esomeprazole and UlcerGard/GastroGard use omeprazole. Neither are on USEF's prohibited substances list.
          They're kind of different drugs, but also kind of not. Omeprazole contains s-omeprazole, as well at the other isomer, r-omeprazole. Esomeprazole is just s-omeprazole.

          Huh, here's a little blurb about it:

          Omeprazole is a racemate, from which the R‐ and S‐isomers can be isolated. At the cellular level, both of these isomers convert to the same inhibitor of the H+,K+‐ATPase and produce the same reduction in gastric acid secretion. However, the S‐isomer, esomeprazole, is metabolized more slowly and reproducibly than the R‐isomer and omeprazole, and therefore produces higher plasma concentrations for longer and, as a result, inhibits gastric acid production more effectively and for longer. Thus, esomeprazole has the pharmacological properties of a more effective form of treatment for disorders related to gastric acid secretion. Clinical studies have confirmed the anticipated increased efficacy, but have shown no evidence of impaired tolerability or increased toxicity when compared with omeprazole.

          From https://onlinelibrary.wiley.com/doi/...2036.17.s1.1.x

          Interesting.

          Comment


          • Simkie S- and R-omeprazole are non-identical mirror images, or enantiomers, where enantiomers are a type of isomers. That's where the "es" of esomeprazole comes from. S and R stand for sinister and rectus, respectively. These non-identical mirror images have the same physical and chemical properties, except when they interact with something else that's not identical to its mirror image. An analogy would be feet, which are non-identical mirror images, but your right vs left foot interacts the same way with, say, tube socks that are identical mirror images. Your right vs left foot does not interact the same way with right vs left shoes, bc shoes are also non-identical mirror images.
            The Evil Chem Prof

            Comment

            • Original Poster

              Peggy yes, I understand what enantiomers are. I've posted repeatedly in this thread about the enantiometers of omeprazole. S and R omeprazole do not have the same properties, as is described in my previous post. Esomeprazole is "metabolized more slowly and reproducibly than the R‐isomer and omeprazole, and therefore produces higher plasma concentrations for longer and, as a result, inhibits gastric acid production more effectively and for longer." Presumably this is why esomeprazole can be dosed at such a drastic lower dose than the racemic mixture of s and r omeprazole with success.

              Comment


              • Simkie, I'd love to know which vet practice you're working with.

                Comment

                • Original Poster

                  Originally posted by Sansena View Post
                  Simkie, I'd love to know which vet practice you're working with.
                  I make use of a couple different local practices that seem well regarded. Why? Who do you use?

                  Comment


                  • https://onlinelibrary.wiley.com/doi/...1/evj.47_12732

                    Did you see this ?

                    i was wondering if anybody in Canada has used this drug?I was thinking of trying the strong but I realized I can get it in Canada it’s alread I was thinking of trying this drug because I still worry about ulcers sometime.I realize they removed it from Amazon.ca. You have to have a prescription to have to this drug in Canada.I have bought it from the states in the past without a problem but last time it was flagged at customs.
                    Last edited by Fharoah; Apr. 21, 2019, 12:56 PM.

                    Comment

                    • Original Poster

                      Originally posted by Fharoah View Post
                      https://onlinelibrary.wiley.com/doi/...1/evj.47_12732

                      Did you see this ?

                      i was wondering if anybody in Canada has used this drug?I was thinking of trying the strong but I realized I can get it in Canada it’s alread I was thinking of trying this drug because I still worry about ulcers sometime.I realize they removed it from Amazon.ca. You have to have a prescription to have to this drug in Canada.I have bought it from the states in the past without a problem but last time it was flagged at customs.
                      Cool find, thanks for sharing! That dose is quite a lot higher than the one in the first paper on this thread, but love to see more study on this medication.

                      Do you have Nexium OTC in Canada? Would be pretty easy to give it a try if so

                      Comment


                      • Originally posted by Simkie View Post

                        Cool find, thanks for sharing! That dose is quite a lot higher than the one in the first paper on this thread, but love to see more study on this medication.

                        Do you have Nexium OTC in Canada? Would be pretty easy to give it a try if so
                        No I’m pretty sure he can only get it by prescription in Canada. It sucks!

                        Comment


                        • If a horse is turned out 24/7, free choice pasture and hay, NO GRAIN, good body condition, would half a scoop (1.5qt) of beet pulp with molasses be enough to cause ulcers? I have to use beet pulp and alfalfa/Timothy pellets to mix in his supplements for him to eat them. Nutrimix plus, equine omega complete, smart digest ultra. Just wondering why after a full treatment with cessation of symptoms did the ulcers come back not even a few weeks later. He tests moderate severity on palpating. Was supposed to get scoped on Friday but my vet cancelled and waiting to reschedule until tomorrow. I’ve had to put him back on nexium for MY safety while grooming him until he can get scoped.

                          Comment

                          • Original Poster

                            Originally posted by Equestrianette View Post
                            If a horse is turned out 24/7, free choice pasture and hay, NO GRAIN, good body condition, would half a scoop (1.5qt) of beet pulp with molasses be enough to cause ulcers? I have to use beet pulp and alfalfa/Timothy pellets to mix in his supplements for him to eat them. Nutrimix plus, equine omega complete, smart digest ultra. Just wondering why after a full treatment with cessation of symptoms did the ulcers come back not even a few weeks later. He tests moderate severity on palpating. Was supposed to get scoped on Friday but my vet cancelled and waiting to reschedule until tomorrow. I’ve had to put him back on nexium for MY safety while grooming him until he can get scoped.
                            Does he have stress in his life? Pasture mates he doesn't get along with? Any pain or soreness in his body? Routine that just doesn't agree with him? Sometimes there's just something about their life in general that is setting them off

                            Another alternative is something like delayed gastric emptying syndrome. That requires different, and longer, treatment than straight up "boring" gastric ulcers.

                            Or maybe his belly was bad enough that he needs longer treatment.

                            Or maybe the nexium just doesn't work 100% for him.

                            Lots of options, unfortunately. I hope you get some clarity with the scoping! Do come back and let us know what you find

                            Comment


                            • Originally posted by Equestrianette View Post
                              If a horse is turned out 24/7, free choice pasture and hay, NO GRAIN, good body condition, would half a scoop (1.5qt) of beet pulp with molasses be enough to cause ulcers?
                              There is so little molasses even in beep with added molasses, that it is so, so so very unlikely. There's WAY more sugar in his daily forage than in 6c of beet pulp w/ added molasses.

                              I have to use beet pulp and alfalfa/Timothy pellets to mix in his supplements for him to eat them. Nutrimix plus, equine omega complete, smart digest ultra. Just wondering why after a full treatment with cessation of symptoms did the ulcers come back not even a few weeks later. He tests moderate severity on palpating. Was supposed to get scoped on Friday but my vet cancelled and waiting to reschedule until tomorrow. I’ve had to put him back on nexium for MY safety while grooming him until he can get scoped.
                              Some horses just need 60 and even 90 days of real treatment. So his (confirmed?) ulcers may have healed enough after 30 days to be symptom-free, but not enough to withstand not being treated. Did you taper after the full treatment? I think it's really critical to do so, and that can be hard with Nexium

                              ______________________________
                              The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                              Comment


                              • Originally posted by Simkie View Post

                                Does he have stress in his life? Pasture mates he doesn't get along with? Any pain or soreness in his body? Routine that just doesn't agree with him? Sometimes there's just something about their life in general that is setting them off
                                He shares a fence line with 3 other horses so he is not "alone" by any means, but one of the geldings attacks him so for his safety, and the fact he is my show horse, he is separated. The only source of stress for him is our daily trailering Monday through Friday that amounts to about 40 minutes a day. He does not exhibit any signals of stress from trailering, he is calm as a cucumber and a dream to trailer. I did put alfalfa in the trailer for several months as a means to buffer any extra saliva/acid from the stress but found that it didn't reduce his propensity for ulcer symptoms and it made him too hot. I know the controversy surrounding the theory that alfalfa makes a horse hot, but there is a significant difference in his rideability since the alfalfa has been removed. Although ulcers affects his rideability as well so it's difficult to say. I am in the process of building a riding arena at home and it's 60% complete. That will allow us to decrease trailering significantly but it will still happen about once or twice a week for lessons or shows.
                                Originally posted by JB View Post


                                Some horses just need 60 and even 90 days of real treatment. So his (confirmed?) ulcers may have healed enough after 30 days to be symptom-free, but not enough to withstand not being treated. Did you taper after the full treatment? I think it's really critical to do so, and that can be hard with Nexium
                                Ulcers are not confirmed. I tapered 2 weeks with 2 capsules and 2 weeks with one capsule. I also started him on smart digest ultra prior to the weaning process to ensure he would be at therapeutic levels of preventative supplements before complete cessation of the nexium.

                                Comment


                                • Originally posted by Simkie View Post

                                  I make use of a couple different local practices that seem well regarded. Why? Who do you use?
                                  I'm pretty well connected w/NEEP & Dunbarton. But FEA, Grand Prix and Willow Lane are also awesome.

                                  Comment


                                  • Originally posted by Fharoah View Post

                                    No I’m pretty sure he can only get it by prescription in Canada. It sucks!
                                    We are able to get OTC here in Canada - you just need to go up to pharmacy and ask for it. No prescription but it is behind the counter. Although often times they don't have the "supply" on hand needed for the full dose so may have to go around and grab a few boxes from the different pharmacies. Ones that I know of that have are Lawtons, Walmart, Superstore.

                                    Comment

                                    • Original Poster

                                      Originally posted by Equestrianette View Post
                                      He shares a fence line with 3 other horses so he is not "alone" by any means, but one of the geldings attacks him so for his safety, and the fact he is my show horse, he is separated. The only source of stress for him is our daily trailering Monday through Friday that amounts to about 40 minutes a day. He does not exhibit any signals of stress from trailering, he is calm as a cucumber and a dream to trailer. I did put alfalfa in the trailer for several months as a means to buffer any extra saliva/acid from the stress but found that it didn't reduce his propensity for ulcer symptoms and it made him too hot. I know the controversy surrounding the theory that alfalfa makes a horse hot, but there is a significant difference in his rideability since the alfalfa has been removed. Although ulcers affects his rideability as well so it's difficult to say. I am in the process of building a riding arena at home and it's 60% complete. That will allow us to decrease trailering significantly but it will still happen about once or twice a week for lessons or shows.
                                      My money is on the trailering. Were he mine, I'd be sorely tempted to get him happy again on the nexium and then switch him over to ranitidine for maintenance. It won't disrupt the hind gut like the PPIs will.

                                      Comment


                                      • So ranitidine is something that can be taken long term?

                                        Comment


                                        • Originally posted by Equestrianette View Post
                                          So ranitidine is something that can be taken long term?
                                          It depends who you ask. Where I am veterinarians that recommend long-term use of Gastrogard for maintenance. One of my friends horse stays on a 1/3 tube daily as recommended by her vet. The most important thing is to remove all stress and also to wean very slowly. I recently read a paper where the horses were kept on a 1/4 tube of gastrogard dailyFirst six months after the initial treatment. Then if doing well they were switched to a coating agent such as rite track.
                                          Last edited by Fharoah; Apr. 22, 2019, 07:19 PM.

                                          Comment

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