Esomeprazole (Nexium) for equine ulcers

[EventingMaff]

My mare was scoped and found positive for ulcers last winter. She was to the point of bucking in canter, super girthy, very irritable and unhappy being brushed / loved on.

I did 3 pills AM / PM for 30 days then tapered down reducing a pill from each feed over 3-4 weeks. For the first 2 weeks she was on misoprostol and the second 2 weeks sucralfate.

About 2 weeks ago she started showing just the slightest whispers of ulcers again - bit hesitant to take the bit, early signs of being girthy, slightly resistant to moving off the leg. I started her on 3 pills AM / PM of Nexium immediately and 48 hours later she was happy happy again. I’m going to do out the full 28 days + taper but since she’s already showing improvement I’m just doing the Nexium (no misoprostol or sucralfate).

We had a few stressful outings / weekends away this fall and I did do prevention measures while traveling but don’t think it was enough. For reference my mare is 15.2 and ~1000 lb.

[Amy3996]

How much Nexium would you use to replace a 3 scoop dose of Abler granules? 3 capsules once a day? Twice?

My horse is on Abler now but our next shipment is being held for customs inspection apparently and may not get to us before my current supply runs out.

[JB]

@Amy3996

How much Nexium would you use to replace a 3 scoop dose of Abler granules? 3 capsules once a day? Twice?

I don’t know what scoops are. Nexium at 3 capsules is a treatment dose. If that’s what 3 scoops is, then it’s the same. If 3 scoops is a prevention dose, then that’s harder and kinda guesswork as to my knowledge there isn’t any study on what it takes to prevent. I’ve seen some people use 1 capsule a day, some do 2 every other day. I don’t know the right answer for esomeprazole for prevention.

[Amy3996]

Thanks! Yes - 3 scoops is the treatment dose for the Abler granules.

[JB]

I should have said “Nexium at 3 capsules CAN BE a treatment dose.” Some horses need the higher dose of .5mg/kg, which would be 12-14 pills for the average horse

Studies only say the 40-60mg dose raises pH for 6 hours. It may be more but they didn’t test longer. The higher dose raises pH for at least 23 hours.

[Simkie]

@JB

Studies only say the 40-60mg dose raises pH for 6 hours. It may be more but they didn’t test longer.

Studies showed that the pH was >4 at 6 hours. We don’t know how long the duration of effect was.

It’s disingenuous to say “studies only say the 40-60 mg dose raises pH for 6 hours” as that statement implies the pH plummets after 6 hours (we don’t know, but it’s highly unlikely it falls off a cliff at the six hour mark) and 60 mg wasn’t even studied (the 40 mg dose was shown equivalent to the 80 mg dose.)

For all we know, the duration of effect–particularly with repeat dosing–may be pH >4 at 23 hours. It hasn’t been studied. It would be nice if someone would do that.

It’s helpful to share what we DO know rather than state assumptions as fact, or misstate the data entirely.

@Amy3996 there’s more minutiae about Nexium dosing in this thread where JB and I have gone back and forth about the study details previously.

Esomeprazole (nexium) 20mg vs Omeprazole 20mg

Where are you getting this? If you’re using the Pereira et al study, that’s not what it showed. They measured gastric pH for six hours following administration of 40/80 mg esomeprazole, then at 24h. Between 6h and 24h, the gastric pH returned to baseline. That study doesn’t show when that happened. Saying that a low dose only raises the gastric pH for 6h based on the Pereira paper is incorrect. We don’t know when the pH begins to drop following a 40/60/80 mg dose, only that it was back do…

I’m sorry if this is a little pedantic, but I just see no value in misstating the research.

[JB]

@Simkie

Studies showed that the pH was >4 at 6 hours. We don’t know how long the duration of effect was.

It’s disingenuous to say “studies only say the 40-60 mg dose raises pH for 6 hours” as that statement implies the pH plummets after 6 hours (we don’t know, but it’s highly unlikely it falls off a cliff at the six hour mark)

Well, that’s why I ALSO said “It may be more but they didn’t test longer.” We only know that it DID raise pH for 6 hours. We don’t know anything beyond that.

You’re right about 80 vs 60, my mistake.

@Simkie

It’s helpful to share what we DO know rather than state assumptions as fact, or misstate the data entirely.

I DID share what is known. The study does ONLY say 6 hours, and I stated it may be longer but they didn’t test. I didn’t say “raises pH for only 6 hours”. I said “it only says 6 hours because they didn’t measure beyond that.”

I thought I had made that very clear this time.

[DannyBoysMom]

Questions about treatment-scroll down in comment

Giving this a try as we start on a third round of ulcer treatment
I’m at my financial end and really not sure I can do UG tubes.

I get him feeling good for about 2-3 weeks and then signs start up again. With him it’s gas colicky symptoms and abdominal adhesion discomfort that prevent him from reaching ground.
(Background he’s recovering from nearly dying from salmonellosis in April, GI system was probably completely stripped and he some abdominal adhesions that cause him pain, so he’s on daily Equioxx. Again, he responds really well to treatment. I think I just need to keep him on treatment doses for longer than 4 weeks)

I switched him over to Nexium yesterday.
He has stayed on the treatment dose of sucralfate, given with every meal, since the last treatment. He was on 1/4 tube UG (which was probably tapered too fast).
I’m going to restart misoprostol twice a day, too.

Questions:
Please say it will be okay to dose him mid-day with food that will also have sucralfate and misoprostol? Dosing first thing in the morning an hour before food is probably not an option for my boarding situation. I was able to do that myself for the first two treatment rounds, but I have since taken a part time job and I just can’t get out there.

How soon could I expect to tell that it’s not working for him? (Obviously if symptoms worsen…)

[Simkie]

@DannyBoysMom

Please say it will be okay to dose him mid-day with food that will also have sucralfate and misoprostol?

Nope. I don’t think you’re supposed to give anything with sucralfate? It coats and prevents absorption. Sucralfate is also supposed to be given on an empty stomach.

Have you scoped this horse? When treatment fails–especially the gold standard of gastrogard–that’s a really good sign it may not be just a straightforward ulcer presentation. Taking a look see is a really good next step, even if (perhaps especially when) the horse has a complex history.

[Amy3996]

No, unfortunately. GG, Misoprostol and Sucralfate all have to be given separately. I’ve used all three meds. The way my vet explained it is GG first, miso at least 30 minutes later, and Sucralfate at least 30 minutes after that (so 60 minutes after GG).

The logistics ended up too complicated to manage, so I decided on GG and misoprostol. I use Sucralfate before he works or trailers.

Also, you may be fighting a losing battle to do anything more than manage the ulcers if he’s currently in pain from the adhesions and on an NSAID. Chronic pain and NSAID use are both triggers/irritants to gastric discomfort.

[Bogie]

When I treated my horse for ulcers, the vet told me to give the GG first, on an empty stomach. She told me not to feed Misoprostol and Sucralfate at the same time. We did two weeks on Misoprostol followed by two weeks on Sucralfate. I mixed both Misoprostol and Sucralfate into her feed.

[DannyBoysMom]

Yeah, my vet actually attended a CME last year (2020) at which they stated one could add sucralfate and misoprostol into grain. It was a CME on horses being boarded and treated and how it’s difficult to do the “best course of treatment” and where to make concessions.

[DannyBoysMom]

After discussing with my vet we decided to hold off on scoping. He responds really well to treatment, we just can’t seem to taper the omeprazole. His bout with salmonella was one of the worst the University equine team had ever seen. He is also on daily 57 mg Equioxx for assumed abdominal adhesions secondary to salmonellosis.

We are on day 6 of only Nexium (3 20 mg capsules given at 5pm along with third meal of four).

He is able to reach to ground to graze again (his biggest flag, I am learning). And is more comfortable.

My vet conferred with another and they want me to try shifting the Equioxx to every other day. Two weeks of that to see if he remains comfortable while on Nexium. If so, then half a tablet Equioxx every other day. The “new” theory is maybe the Equioxx is causing or preventing full healing. Also, possibly he never had abdominal adhesions and maybe it’s been ulcer pain all along. At the very least we may be able to lower the therapeutic level of the Equioxx.

He gets one more week of trialing then Nexium and then I’ll try the Equioxx shift.

[BeastieSlave]

This thread has been SOOOOO helpful!! I’m currently tapering my TB down from 5 caplets that were split into two feedings. I recognized the signs of ulcers, having been through the whole scope & treat regime with my guy before. I figured I’d give esomeprazole a shot since so many here have had good results. The results have been AMAZING - thank you!!

[Against_All_Odds2]

I have my guy on 60mg Nexium in the AM and 60g Equishure in the PM. Is this the correct spacing?

[Huntin_Fool]

How do you buy horse Esomeprazole? You aren’t taking about human pills I presume? I googled it and came up with nothing. I would appreciate some direction. I did read part of the thread but at around 200 posts I didn’t have an answer.

And how many mg do you give?

Help much appreciated!

Regards,
Huntin’Fool.

[Simkie]

@Huntin_Fool

How do you buy horse Esomeprazole? You aren’t taking about human pills I presume? I googled it and came up with nothing. I would appreciate some direction. I did read part of the thread but at around 200 posts I didn’t have an answer.

And how many mg do you give?

This is all covered in the first post on the thread.

[lenapesadie]

40 mg Nexium capsules are available by prescription. Has anyone gotten their hands on those to try on horses?

[Lusoluv]

Esomeprazole Magnesium, 20mg capsules, generic human grade pills from the drugstore. Feed 3 capsules (60mg) per day for 4 weeks. Wean to 2 capsules/day for 1-2 weeks. 1 capsule/day for 1 week. Total = 119 capsules. At local Walgreens, pills to cover this plan is about $50 +/- a couple dollars. The brand Nexium is the same 20mg pill is $0.60 ea = $71. (Feel free to correct my math, it’s kinda early here).

Not sure why you’d want to take the time/effort to get a prescription for a pill that will be more expensive and difficult to dose with the higher content?

[lenapesadie]

I don’t.

I get the 40 mg for myself actually per Dr and it made me think of this thread. I don’t know what the cash pay cost is on it as my insurance covers mine.

My understanding was that the studies were done using 40 mg and the protocol was to dose 60 mg in case a capsule was lost in the feed tub. Conceivably a person might have issues getting a horse to eat the pills in feed and a single 40 mg capsule might be easier to give in a special treat or something.

Basically, I was just curious if anyone had tried it or perhaps someone might like to try it for whatever reasons.