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Esomeprazole (Nexium) for equine ulcers

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  • Originally posted by Redemption3 View Post
    My Ol Man has been on Nexium four days. As of this morning he is no longer acting starved and ravenous, which was a very pleasant surprise. For two nights he has been chill when the neighbors start their post July 4th stupidities. Very pleased we have found yet another way to help him feel better.
    This is fantastic!
    ______________________________
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

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    • Original Poster

      Originally posted by MissAriel View Post
      In preparation for a stressful week with an off-property lesson on Sunday (yesterday) and a show this Friday, I decided to start my horse on esomeprazole Thursday in hopes of staving off the stress poops he gets when going off property and any other tummy issues. He has always been prone to a loose pile every so often, and it gets worse when trailering.

      I've been giving him 3 capsules a day and if anything the runny poops have been worse! Cleaning his stall Saturday and Sunday morning (before we left for the lesson) there were a number of loose piles, although there were also a few normal ones. Then during the lesson yesterday, there was one episode of *very* loose and gassy poo. And he didn't seem himself, although that could have been because it was horribly hot, it was a new place and the arena had mirrors. And he's six, so teenage moments aren't completely behind us yet.

      Anyway, now I'm trying to decide if I should keep him on the esomeprazole the rest of the week and taper a few days after the show (my original plan) or start tapering now.
      Stress poops and loose manure would have me looking more toward the hind gut, personally. And PPIs are known for disturbing the pH of the hind gut, either causing or exacerbating hind gut problems.

      Ranitidine is good for gastric and hind gut both, or something like succeed or equishure will treat just the hind gut.

      With a negative response, my inclination would be to immediately switch to ranitidine, treat for awhile, and see what changes. It sounds like you might need something for hind gut maintenance, if your horse has chronic poop problems.

      Good luck!

      Originally posted by Redemption3 View Post
      My Ol Man has been on Nexium four days. As of this morning he is no longer acting starved and ravenous, which was a very pleasant surprise. For two nights he has been chill when the neighbors start their post July 4th stupidities. Very pleased we have found yet another way to help him feel better.
      How awesome is that?!? That's fantastic, so glad he's doing well!

      Comment


      • Simkie How did you taper after the 60mg/day for a month? I’m sure it’s in here somewhere but this thread has gotten lengthy and I can’t find it.

        Comment

        • Original Poster

          Originally posted by Amy3996 View Post
          Simkie How did you taper after the 60mg/day for a month? I’m sure it’s in here somewhere but this thread has gotten lengthy and I can’t find it.
          I usually do a week at two and a week at one 😁

          Comment


          • An update and question. My boy had been doing really really well for a few months. Then he had his semi-annual stifle injections and the wheels fell off. He was off for a few days because he's a sensitive TB, but then he was still acting sore behind - stifle and ulcer symptoms can be similar for him and it didn't occur to me that injections would cause an ulcer flare. But at 10 days and he's still not right, I realized this was ulcers not stifles.

            Gave him 2 days of Ulcerguard because I had a tube and now he's back on three Nexium a day. He's not as bad as he was this spring before I did the first round of treatment.

            Anyone know if I should do the entire course again? Or if this might be a shorter term fix?

            Mr Sensitive will not be getting stifle injections again. Adequan or Legend for him.

            Comment


            • Originally posted by Simkie View Post

              Stress poops and loose manure would have me looking more toward the hind gut, personally. And PPIs are known for disturbing the pH of the hind gut, either causing or exacerbating hind gut problems.

              Ranitidine is good for gastric and hind gut both, or something like succeed or equishure will treat just the hind gut.

              With a negative response, my inclination would be to immediately switch to ranitidine, treat for awhile, and see what changes. It sounds like you might need something for hind gut maintenance, if your horse has chronic poop problems.

              Good luck!



              How awesome is that?!? That's fantastic, so glad he's doing well!
              Simkie, I was just at the vet Monday and the topic of ulcers came up and I mentioned the above to her as a concern, and she basically told me no. That RDC was actually very rare and the use of PPI's was highly unlikely to be a causing factor.
              ????????????

              Personally, I tend to think she's wrong "in general". Just thinking about long term use in humans, and extrapolating to horses.

              Thoughts?

              Comment


              • "hind gut issues" does not equate to JUST RDC. I agree that RDC probably is pretty uncommon (not sure how rare it is, but certainly it's not common), and it's a lot more serious than something like hind gut acidosis in general.

                Granted, people not horses, but we already know omeprazole works the same way on horses as it does people, and while things may not be exactly the same, since horses constantly produce stomach acid and people don't, there is precedence for PPIs to cause an overgrowth of small intestine bacteria
                https://www.mayoclinicproceedings.or...ulltext#sec1.3

                "Small intestine bacterial overgrowth (SIBO) has been associated with PPI use. Decreased gastric acid production associated with PPI use can lead to overgrowth of small-intestine bacteria. A meta-analysis of 11 studies found an increased risk for development of SIBO among PPI users compared with nonusers (OR, 2.28; 95% CI, 1.24-4.21). This risk was 7.5-times greater among studies that utilized the more sensitive and specific duodenal/jejunal aspirate for diagnosis of SIBO. "

                This study didn't find any changes, but the duration of the PPI was short (compared to typical human use), and only 12 horses, and no mention of diet or other management details. I also don't know how reliable testing feces is in determining changes to bacteria in the large and small intestines, especially since the human study above states that it's much more accurate to do a duodenal/jejunal aspirate
                https://onlinelibrary.wiley.com/doi/...1/eve.07_12792
                ______________________________
                The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                Comment


                • Originally posted by Hilary View Post
                  An update and question. My boy had been doing really really well for a few months. Then he had his semi-annual stifle injections and the wheels fell off. He was off for a few days because he's a sensitive TB, but then he was still acting sore behind - stifle and ulcer symptoms can be similar for him and it didn't occur to me that injections would cause an ulcer flare. But at 10 days and he's still not right, I realized this was ulcers not stifles.

                  Gave him 2 days of Ulcerguard because I had a tube and now he's back on three Nexium a day. He's not as bad as he was this spring before I did the first round of treatment.

                  Anyone know if I should do the entire course again? Or if this might be a shorter term fix?

                  Mr Sensitive will not be getting stifle injections again. Adequan or Legend for him.
                  Mine seemed to have a relapse as I was tapering down and I went up to 4 for a month and then tapered down again. I added Outlast now and it seems to be working well for him.

                  Comment


                  • thanks - I'll give him at least 3 weeks before tapering. He was on the 3/2/1 program and hadn't had a symptom for 2 months. He eats a lot of alfalfa cubes already but people seem to swear by outlast.

                    Comment

                    • Original Poster

                      Hilary I agree with a full treatment. Steroids can hammer the stomach, and the can also cause a painful flare...so you've got an assault to the stomach plus stress, and ulcers from that--not unusual! Good to note for next time you get some joint injections, though. Just pretreat (IRAP had been great for stifles for me, fwiw.)

                      Obsidian Fire I'm surprised your vet was dismissive of hind gut problems from PPI use, as that's always been an "of course" kinda thing in the discussions I've had! Sure, rdc isn't common, but that's not the only thing that can bother a horse. JB provided some great points, but there's really a lot out there about how PPIs can alter the hind gut in people. Did I see something about this in horses in the KER site, too? I'll have to go look. At the very least, there are quite a lot of anecdotal reports of hind gut "issues" in equines following a course of PPIs--we've seen that much just here on this board!

                      Comment


                      • I'm sure the answer to my question is probably somewhere buried in this thread...

                        How long after giving esomeprazole should I wait to feed an actual meal. I'm giving it in a small amount of grain (just a handful does it).

                        And Magnesium supplements with esomeprazole? I always thought they shouldn't be fed after giving omeprazole.

                        Horse is turned out at night now. I'm giving magnesium and all supplements in the morning feed. He's in his stall during the day with alfalfa and free choice orchard grass. I have been giving esomeprazole around 4pm. Then feeding dinner two hours later at 6pm. No supplements with dinner.

                        Comment

                        • Original Poster

                          Originally posted by scrbear11 View Post
                          I'm sure the answer to my question is probably somewhere buried in this thread...

                          How long after giving esomeprazole should I wait to feed an actual meal. I'm giving it in a small amount of grain (just a handful does it).

                          And Magnesium supplements with esomeprazole? I always thought they shouldn't be fed after giving omeprazole.

                          Horse is turned out at night now. I'm giving magnesium and all supplements in the morning feed. He's in his stall during the day with alfalfa and free choice orchard grass. I have been giving esomeprazole around 4pm. Then feeding dinner two hours later at 6pm. No supplements with dinner.
                          I don't withhold food. I give nexium with dinner.

                          Not sure about your magnesium question. I've fed magnesium with nexium with no issues, afaik.

                          Comment


                          • So I suspect my senior horse's ulcers are back (if I don't have to put him through the stress of a scope, I won't. He's 100% retired and my deal is he never has to leave the property again). I treated with nexium this winter (February-April) and he's been fine until recently. That said, the last couple of weeks, he's gotten a little spooky walking to his stall at night. I didn't think anything of it until he started leaving some of his breakfast behind (more and more) of over the last several days. He hasn't left a drop of feed since he completed his treatment over the winter/spring. He's still eating hay at night and eating his dinner, but breakfast? Not so much. And he doesn't seem interested in hay in the field either. This morning he'd eat about 3 bites, pace, then eat, then pace. He wasn't necessarily trying to get out either, but just seemed... uncomfortable.

                            I started him Saturday night on 3 pills so I'm hoping I'll see some sort of improvement soon. I'm also throwing him back on equioxx in case his joints are bugging him (he's been extra creaky lately -- I try and keep him off medicine throughout the spring/summer months when he's usually feeling better) and in the future I might be a little proactive in the summer when we start to lose light (he hates dusk/darkness as he has mild vision issues) -- senior horse problems.

                            Comment


                            • Originally posted by pompeiii View Post
                              I started him Saturday night on 3 pills
                              I'm also throwing him back on equioxx in case his joints are bugging him (he's been extra creaky lately
                              I wouldn't do both of these at the same time. Make changes one at a time, or you won't know which of the multiple changes had an impact.

                              Also, if you suspect ulcers, I wouldn't go back on any NSAIDs, at least for now, until you at least rule out ulcers.

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

                              Comment


                              • Originally posted by JB View Post



                                I wouldn't do both of these at the same time. Make changes one at a time, or you won't know which of the multiple changes had an impact.

                                Also, if you suspect ulcers, I wouldn't go back on any NSAIDs, at least for now, until you at least rule out ulcers.
                                Good point. I’ll hold off on equioxx for now. I will add in alfalfa as I need him to eat but otherwise...

                                Comment


                                • I am so happy I found this thread. My horse came home from training and seems ulcery. :[

                                  Does anyone know if my human prescription for omeprazole that comes in capsules would work? Or is there something about Nexium that makes it the best choice. Thank you!

                                  Comment


                                  • If you're following the prescribed treatment plan outlined in this thread, it just needs to be either esomeprazole magnesium (Nexium or generic, 20mg capsules).

                                    3 capsules (60mg) for 4 weeks, then 2 capsules for a week, and finally 1 capsule for a final week to wean off.
                                    Last edited by Lusoluv; Sep. 19, 2019, 09:21 AM.
                                    Savor those rides where you feel like a million bucks, because there will be those where you feel like a cheap date...

                                    Comment


                                    • Great, thank you. Yes, I plan on doing the treatment plan you posted.

                                      Comment

                                      • Original Poster

                                        I've had two unapproved posts. Frustrating.

                                        bingbingbing

                                        No. Has to be esomeprazole.

                                        Treatment dose of omeprazole is 2.28 GRAMS. Gastrogard is cheaper than human meds at that dose.

                                        Nexium is more potent and bioactive, which is why the lower dose is effective.

                                        60 mg of omeprazole is spitting into the wind. Not sure why lusoluv thinks that's appropriate.

                                        Comment


                                        • Thank you, Simkie. I did some further research after posting and found that the emoprazole was found to be more effective than omeprazole in humans, so I bought 126 Nexium on Amazon for $71.43. Probably not the best price around, idk. But they're fast and free shipping with Prime. Thank you again. This will save so much money over the horse products.

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