Esomeprazole (Nexium) for equine ulcers

[Simkie]

Ran across someone asking about esomeprazole for equine ulcers on FB awhile ago, and I went poking around to find this paper:

https://www.researchgate.net/publication/232679844_Preliminary_Study_of_the_Gastric_Acidity_in_Thoroughbred_Horses_at_Rest_after_Enteral_Administration_of_Esomeprazole_Magnesium_Nexium

Dove was cribbing quite a lot after the move and Pigs is just prone, so I thought I’d try it.

Nexium is ~$20 for 42 20 mg capsules on Amazon.

I’ve been giving 3 capsules (60 mg) a day to each horse for about a week.

I’m seeing FAR less cribbing in Dove…actually, I don’t think I’ve seen her crib at all since we started. Pigs looks to be picking up, too.

Treating a horse for four weeks at 60 mg/day = 40 bucks.

Overall has been a successful experiment for me and my horses so far. Curious to see if it’s ever brought to the equine market. Would love to see a vet doing a scoping study with it!

[HiJumpGrrl]

esomeprazole is just the S-enantiomer of the racemic omeprazole. There is no reason it wouldn’t work, but it is more expensive than omeprazole at treatment doses for horses. I’m glad it’s helping your horse!

[Simkie]

HiJumpGrrl, please read the paper I posted above. The full text is there. Demonstrated that 40 mg and 80 mg doses were equally effective at raising the pH. 60 mg/day = 40 bucks for the month. Hardly more expensive than omeprazole.

There is the risk that the horse will crunch the capsule and negate the coating. But by dosing 60 mg/day, they can totally obliterate one capsule and I still have an effective dose.

[Maude]

Nexium is a capsule. It’s in capsule form so that it is not broken down in the stomach but reaches the hindgut or in a human’s case the small intestine where it can be absorbed. I would think you’d have to open the capsules to give them to horses in which case the medication would not get back to the hindgut where it needs to absorb to be utilized.

[Simkie]

@Maude

Nexium is a capsule. It’s in capsule form so that it is not broken down in the stomach but reaches the hindgut or in a human’s case the small intestine where it can be absorbed. I would think you’d have to open the capsules to give them to horses in which case the medication would not get back to the hindgut where it needs to absorb to be utilized.

I drop the capsules, intact, into the grain. Horses certainly don’t chew everything.

Not much different than hoping Abler pop rocks don’t get chewed on the way down. The capsules are teeny.

[HiJumpGrrl]

Ok, read the paper. Interesting.

I wonder if the much lower effective dose could be further applied with omeprazole. I know they determined that 1/4 tube of gastroguard (or ~570mg) was equally effective as a full tube with that paper last year; could it be further reduced with equal outcomes? Nexium is twice as potent, so 60mg esomeprazole = 120mg omeprazole… or about 1/19 of a tube.

Also, they did not show that the decreased acid production enough to be associated with ulcer healing–I didnt’ read that the higher pH observed is clinically enough to promote healing, but maybe I missed that small picky piece of information.

in human medicine, Nexium and Prilosec are equivalent treatments, and arguments have been made that Nexium should never have come to market at all.

[Simkie]

@HiJumpGrrl

Ok, read the paper. Interesting.

I wonder if the much lower effective dose could be further applied with omeprazole. I know they determined that 1/4 tube of gastroguard (or ~570mg) was equally effective as a full tube with that paper last year; could it be further reduced with equal outcomes? Nexium is twice as potent, so 60mg esomeprazole = 120mg omeprazole… or about 1/19 of a tube.

The Australian study didn’t use GastroGard–it used an enterically coated granular paste product that’s not available in the US. Enterically coated preps have higher bioavailability than buffered preps, so that study really isn’t applicable to GastoGard at all.

Also, they did not show that the decreased acid production enough to be associated with ulcer healing–I didnt’ read that the higher pH observed is clinically enough to promote healing, but maybe I missed that small picky piece of information.

Nope, they didn’t. Let’s go look at the GastroGard data…

https://www.ncbi.nlm.nih.gov/pubmed/14649361

pH >4.

The esomeprazole definitely hits that.

Oh, the >4 number is also in the abstract of the esomeprazole paper.

[Texarkana]

Hmm, interesting. Thanks for the share. I may have to try this out with my ulcer-prone sensitive redhead. We have an impending move. Even just doing some weekly trailer loading practice has her slowing down on her feed. I plan on putting her on at least a maintenance dose of omeprazole for the move, but this may be an economical way to keep her stomach happy until that time. Just our cleaning up the property sends her into a tizzy. “Oh my god, why are you removing that big pile of brush? Oh my god, why are you cleaning the junk out of the barn??? I like that junk there!” :lol:

[Simkie]

Try it, Tex! Report back :lol: Oh, the joys of moving with touchy horses :sigh:

When I bring them off of it, I do intend to carefully taper. If it’s so effective at stomping on those proton pumps, I could see that there might be an impressive acid flare if removed suddenly.

[HiJumpGrrl]

Love it. Good work.

[Simkie]

Reporting back that this really seems to be going well. Piggy has put on a considerable amount of weight and Dove’s cribbing is back to her usual “cigarette after a meal” baseline that is normal for her. Really, zero complaints about this super easy and cheap method of treating ulcers.

Although I certainly haven’t scoped, I would call it a success based on symptoms.

[enjoytheride]

What is the generic? When I google it just throws back to Omeprazole.

[Simkie]

@enjoytheride

What is the generic? When I google it just throws back to Omeprazole.

What generic?

Esomeprazole is Nexium. It is still under patent. I don’t think any generic has been discussed on this thread.

[enjoytheride]

Well excuse me. I assumed as with Omeprazole (non generic Prilosec)there might be a generic option and was just asking as I was interested. I’ll continue on my own.

[Obsidian_Fire]

@enjoytheride

Well excuse me. I thought there might be a cheaper option and was just asking as I was interested. I’ll do my own research, apologies.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431648.htm

Generic esomeprazole approved in 2015 by the FDA.

https://www.tevagenerics.com/product/esomeprazole-magnesium-delayed-release-capsules-usp
this is a company making generic.

Hope this helps.

I too am interested in Simkie’s testing, because I have an ulcer-prone horse.

[Obsidian_Fire]

@enjoytheride

Well excuse me. I thought there might be a cheaper option and was just asking as I was interested. I’ll do my own research, apologies.

I tried to post a reply it told me ‘unapproved’.

Perhaps because I did find generic Nexium and tried to post a couple of links. Anyway, a google searched turned up that in 2015 generic esomeprazole was approved by the FDA.

Hope that helps.

[Simkie]

@enjoytheride

Well excuse me. I assumed as with Omeprazole (non generic Prilosec)there might be a generic option and was just asking as I was interested. I’ll continue on my own.

Hope you find whatever it is you’re looking for.

@Obsidian Fire

I tried to post a reply it told me ‘unapproved’.

Perhaps because I did find generic Nexium and tried to post a couple of links. Anyway, a google searched turned up that in 2015 generic esomeprazole was approved by the FDA.

Hope that helps.

Ah, interesting. Didn’t realize. Looks to have limited distribution, and only by RX.

With Nexium being so cheap and OTC, I’m not surprised a generic hasn’t garnered a whole lot of interest.

[csaper58]

@Simkie

https://www.researchgate.net/publica…gnesium_Nexium

Both esomeprozole and omeprazole need to have enteric coatings, so that they pass thru the stomach unaltered.

With horses, chewing and saliva can disable any enteric pills.

According to that study the Esomeprazole was administered thru a nasal gastric tube (NGT) 30 min prior to eating in the AM.

Did you give it 30 min before their AM feeding?

If you still have some of the capsules, can you tell if they have little enteric coated beads inside, or is the capsule the enteric coating?

I wonder if a balling gun would work? Could one maybe do all 3 caps at once if they are little.

[Simkie]

@csaper58

Both esomeprozole and omeprazole need to have enteric coatings, so that they pass thru the stomach unaltered.

With horses, chewing and saliva can disable any enteric pills.

According to that study the Esomeprazole was administered thru a nasal gastric tube (NGT) 30 min prior to eating in the AM.

Can you share how you administer it to your horses? Did you give it 30 min before their AM feeding?

I drop the three capsules in their grain, which they get when they come in at night. There is certainly the risk that they’ll chomp through a capsule, but that’s why I went with 60 mg instead of the 40 that was found effective in the study–they can totally obliterate one capsule and I still have an effective dose.

I do wet my grain, but I don’t add the pills until the horses are eating and do my best to add to a “dry” spot.

Horses are generally milling about and not eating for awhile before coming in, so that’s about as close to “empty stomach” as it gets around here. They have hay available 24/7.

I realize isn’t ideal, or study parameters, but it really isn’t any different than using the Abler pop rocks and just hoping that the horses don’t chew them and that the wet grain doesn’t trash the coating.

You could easily up the dose or use a balling gun to deliver the capsules to the back of the tongue, were you so inclined.

[OTTBs]

@HiJumpGrrl

Nexium is twice as potent, so 60mg esomeprazole = 120mg omeprazole… or about 1/19 of a tube.

Well, you would think so. As a pharmacist it has puzzled me that several of these drugs that only have the “active” enantiomer or isomer are still dosed at the same dose as the older drug that had the active & inactive forms. I wasn’t sure about omeprazole vs. esomeprazole, so I just looked up and compared doses for 5 indications that both drugs have. The dose was the same for both for all indications.

Now that my boy has been off Ulcergard for a month or so, it seems his symptoms may be coming back. I think I’ll be giving Nexium a try.