They are very small. Horses don’t thoroughly chew every bite.
If this is a concern, however, you could dose with a balling gun, or you could dose with a buffer of some sort before dosing the Nexium.
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I’m dredging this up to ask a question. My 3 year old went into training (colt starting) and immediately displayed ulcer symptoms (refusing grain, kicky, bucky, listless, cranky). I put him on 28 days of ulcergard, administered by the staff and I’m not sure that it was consistently given or given at the same time every day. I tried to then taper him on the pop rocks (two packets a day) but he refused the grain with the pop rocks. Switched then to abler paste and I don’t think that is effective. He’s bitey and kicky, but he is eating his grain. I’d like to give this a try (this is simple economics–it’s not in my budget to pay $1,500/month for training board and $1,000/month for gastrogard). My questions:
- Horse is about 1,250 pounds.
- Dosing would be in morning feed baggies that will be smaller than the afternoon ones and in separate drawers. There is a chance that the staff will mess up. I tried the abler pop rocks 2x a day for this reason, but he refused to eat the grain). He does eat 3 vitamin e capsules in his grain so I think he would eat these.
Would you recommend 2x a day dosing if there is a chance they might skip a day? I was so anxious when I had to count the baggies–there are four different people who feed at this place in a week. - Does it matter if he doesn’t get his dose at the same time (there is a large window when they feed)?
- Since nexium is a time release product (it is a 24 hour product), I don’t understand the arguments that the 3-2-1 dose only works for 6 hours. Is the argument based on the fact that the research only tested it for that long or that the time release function doesn’t work on horses?
- I have taken daily generic nexium for YEARS without side effects. Is there a different risk for horses for long term use? This guy could be in training for more than 3 months and I will keep him on this the entire time (and then taper when I bring him home).
TIA!
You’ve had this horse on a PPI for quite awhile without a resolution of symptoms? Scope him. Understand what you’re dealing with. There’s plenty that can happen in the stomach that isn’t addressed solely by a PPI, and plenty that can make a horse crabby in this way that’s not in the stomach at all.
To answer your questions:
I personally would not dose twice a day. Others have. You can look at the literature and decide if that’s something you’re comfortable with.
Yes, it matters if dosing is more than 24 hours apart. How large is the window?
Nexium does indeed raise the pH of the stomach for longer than 6 hours. At six hours post 40 mg dose, the pH of the stomach was >5 iirc as reported in the Pereira paper.
Yes, there are risks with long term dosing, namely risk to the hind gut and potential alteration of magnesium and calcium absorption.
But this doesn’t sound like a horse that needs further treatment with a PPI. This sounds like a horse that needs workup to understand what’s bothering him, because treatment with a PPI had been ineffective.
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Treatment with ulcergard (full tube x1/day for 28 days). He went back on food, stopped bucking, stopping trying to bite and kick. When I went to taper him (onto abler pop rocks, 2 sachet per day), he stopped eating the grain again and didn’t get the meds. Both times that he stopped eating (when he first got there and then when I tried to taper on the pop rocks, they didn’t tell me until he hadn’t eaten for several days). So then I went to once per day full tube of Abler paste and he has been on that since Sunday, but it does not seem to be effective. That may be because they started giving it to him at all times of day and evening (once in front of me at 7pm because they forgot), after eating, and may have skipped it for a day, or because he had a rebound and we just haven’t given it long enough. I have enough tubes of abler paste to complete another 28 days. There is a better chance that he will get his daily dose if we put it in am food bags. I will not scope him while he is in training because of the withholding of food for 12 hours and the fact that I think he is already stressed at this facility (this is only the second time he’s been away from home since I got him here as a weanling); I would scope him when I bring him home and can control everything. He is in the middle of his second month of colt starting so I do not want to bring him home now–he needs another month at least (I will bring him home as soon as I can start riding him), possibly two. The training part of the journey is excellent.
Ulcers are a reasonable deduction because he went off his grain completely for four or five days and they did not tell me (he was eating voraciously at home) when I first brought him out there. His grain baggies were made up with a preventative dose of abprazole, but he didn’t get it because he refused to eat it. I went out to watch them work him and he was trying to buck the western saddle off (with the hind strap). He NEVER bucked under saddle in the year that I was ground driving and lunging him prior to sending him for training. He also tried to bite and kick me when I was posture prep grooming him in his stall on his sides. That’s why I started treating him with ulcergard. As soon as we got about 6 or 7 days of ulcergard in him, he stopped the bucking and they were able to get on him. He stopped trying to bite and kick me when I was grooming him. He then worked very well while he had ulcergard on board. I was looking to taper but have not found a reliable solution. If I have to put him back on ulcergard for the six to 10 weeks longer that he will be there, I will, but it will really stretch my budget. I have two other horses and one that has other veterinary needs right now. I was hoping to give this a try and see if it doesn’t curb the rebound of symptoms and provide a more reliable means of delivery when I can’t really depend on the barn to be consistent. I did have a horse many years ago that I scoped and had to rescope and rescope (subject to an insurance claim), and because the administration by the barn staff was so inconsistent, he needed to be on the gastrogard and sulcrafate for three cycles before the ulcers were healed and I could taper him.
I spoke to his breeder last week and she told me that his year older full sister gets ulcers every time she goes to a show. They are managing it with preventative ulcergard and outlast.
Omeprazole alone can raise pH enough to make squamous ulcers feel better, but won’t get them healed(well), so when you stop the drug, the pH lowers again, and the squamous ulcers hurt (more) again. That’s why scoping is best
Honestly, I’d take him out of training and put that money towards scoping and suitable treatment. If the ulcers are due to the stress of the whole training scenario, which is what squamous ulcers are highly linked to - stress - then you’re not likely going to fix him while in training, especially if they developed so quickly. He may simply not be mentally ready for “colt starting”
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I’m (obviously) a huge fan of Nexium. I’ve used it repeatedly over the years in various horses in various situations and find it effective.
This horse is not a candidate. While gastrogard alleviated his symptoms, it apparently didn’t cure anything, hence the quick return of symptoms when you dropped the dose.
If you’re giving Abler omeprazole, you’re already giving more esomeprazole than the low dose discussed in this thread. You’re not finding it effective. Why do you want to drop the dose even further?
It sounds like this guy needs to come out of training, have his issues worked up, treated, and a management plan established for when he can return to training. And perhaps you can find a trainer you trust to medicate him as you request?
If you’re just really wedded to trying Nexium, I’d match the dose that was effective at making him feel better, which would be 2 mg/kg, or about 57 20 mg capsules a day. I don’t think that saves any money over gastrogard, but could be wrong.
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Quoting myself here: I started 14 caps per day and in just a few days noticed a difference. Kept the mare on it thru 2 shows and tapered off. Seems to have done the trick! Not scoped though.
To prevent ulcers next year, I plan to give 14 caps/day for several days leading up to a show and during the show. Anything wrong with that?
For daily training is there anything I can give pre ride to prevent ulcers? Short of keeping her on omeprazole type meds forever.
She has a slow feeder with grass hay always available and is fed loose grass or alfalfa 3x a day too. She lives out 24/7 and gets about 3# Tribute Kalm Ultra mixed w 3# beet plus vits/mins of which she sometimes leaves some in the bucket. Might just skip the Tribute going forwards as she’s a high energy mare.
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A few pounds of alfalfa hay will provide an anti-splash mat on top of her stomach, and the higher Ca will help buffer the acid
A few pounds of alfalfa pellets will do a faster job of buffering the acid, but no mat This might be the better (and faster-eaten) option since presumably she’ll go to work having just eaten regular hay already
Purina Outlast or Tribute Constant Comfort (pellets) will raise stomach pH pre-ride
KU is a bit high in sugar and starch, so I’d replace that and the v/m with Tribute Essential K at the higher feed rate, and you can keep some of the beet pulp. The lower starch especially will be less of a problem on the stomach lining
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Have you tried herbs?
They have worked wonders for me. I give Marshmellow Root and Slippery Elm.
The Marshmellow Root stopped my cribber from cribbing completely. In a matter of a week or two. I give it now to all my horses. Slippery Elm helps the ucler prone horses.
How much Marshmallow root and Slippery Elm are you giving?
A question about Esomeprazole. Anyone know why trying to find Esomeprazole in Canada is now extremely (impossible?) to find?
Nexium in Canada is pretty expensive. You can purchase a big box of 14 capsules for almost $16 and that’s the cheapest price… Plus tax.
There are also products for sale that contain marshmallow root and slippery elm, in appropriate amounts. Just as with omeprazole and esomeprazole, some horses respond well and some don’t on different products. I ended up with Visceral+ from Mad Barn, which has marshmallow root and slippery elm, and also magnesium, which helps with lowering stress. And of course stress is one of the things that cause ulcers and other gastric distress. Just sayin - I take magnesium too and it does help keep me on an even keel (ohmmmm). It also has other beneficial ingredients. Visceral+ is not cheap, but it made a big difference in my young gelding’s Ulcer-like behavior, so he is on it. And he can be on these ingredients for the long term, which you can’t do with omeprazole and esomeprazole. Plus the nutritionist at Mad Barn can help you with your feed program - just send what you are feeding and she can help you decide what your horse needs. She’s pretty good.
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Need some advice. Sorry in advance for the novel.
My 26yo OTTB is having a rough time right now and I suspect it’s ulcers. Again. Over the years he’s been treated with a variety of drugs, largely omeprazole of some kind. He’s not been scoped because with treatment it would resolve. He would go years in between flare ups. He’s been retired for many years now and has had no flare ups. This summer he did go to the vet college for a few days for an impaction colic that resolved. Vets said likely dehydration. Since then he has been back to normal and put weight back on, all was well. I board him and now live 2.5 hours away and work insane hours. Which makes this all very hard.
He has been on Prevequine for around 1.5 years. He had a fairly long race career and is a bit creaky.
Nov 23 vet was called out for a puncture wound on his elbow. At this point it was badly infected. Vet said stop Prevequine and prescribed the following:
SMZ suspension 30ML 2X/day for 10 days
Metronidazole 30 tabs 2X/day 5 days
Banamine 5ml 2X/day 2.5 days
Compounded omeprazole 22ML/day 21 days
Wound was cleaned by vet twice. X-rays done. Blood work done. Nothing remarkable.
12/13 BO reports doing well, poops good, eating ok
12/14 last day on omeprazole.
12/20 rhino flu vax
12/21 not eating well. BO says sneaking prevequine into stud muffin
12/23 explosive diarrhea, not interested in grain
BO says she has been giving him some sort of probiotic paste.
This is what I have pieced together. He’s also doing some chomping and grinding of his teeth which was always a pretty good indication of a flare up.
I think the prevequine needs to stop asap. I ordered Nexium from Amazon and it will arrive at the farm tomorrow. I’m going to ask them to give 3/day in am.
I have asked for a full report on what they are currently trying to feed him. No answer yet.
I do know he is on Mad Barn: W-3 oil, Omneity and Visceral+. He’s been on those supplements for a few years now and done well.
I ask that he’s fed wet alfalfa cubes and salt.
I do not know what they are feeding for grain but likely a senior feed of some sort.
I am thinking sucralfate may not be a bad idea but worry about it being administered correctly.
I wonder if the Prevequine hasn’t helped and all it took was the drugs to treat the wound to trigger this flare up.
Any advice on feed and treatment would be greatly appreciated. I’m in Canada so I can no longer buy from Abler (had success with pop rocks years ago) which stinks.
I’m feeling so guilty and horrible right now that I can’t be there with him 
Explosive diarrhea does not immediately scream gastric ulcers. I would be more concerned about his hind gut…like a right dorsal colitis or bacterial overgrowth issue. A proton pump inhibitor like Nexium may be counter indicated.
I’d really get the vet back out for a work up and a game plan.
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If anyone is looking for inexpensive esomeprazole magnesium capsules, this place has bottles of 200 that work out to just under $0.10 per capsule, compared to $0.30-40 per capsule elsewhere. Has anyone use this company?
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I’ve purchased this brand through Amazon - no complaints. There were a few broken pills in the bottle, but not enough that it was a big deal. I can’t find them on Amazon anymore so thanks for the reminder to order through their website!
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I started nexium tonight. 3 caps 1x a day. Did 14 days of UG, then a week of sand clear but my guy is getting grumpy again, not eating well again, and standing funny again (like an elephant on a ball). We’ve been battling his health issues for a couple years now. I do believe now that he has ulcers. He was remarkably better while on UG and his funny stance went away! For a couple years now we thought that stance was due to hind end joint issues, but after seeing the difference I believe it’s from ulcer pain. I will report back in a week and let you all know how it’s going! Thank you so much for this info! A friend told me about it!
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I have a horse just down to his last 5 doses of GG. We begin to start tapering off. Does he still need to fast before and for an hour past feeding the GG?
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This thread is specific to Nexium. You may want to start a new thread about your Gastrogard question.
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No need or benefit to tapering, there’s no dimmer switch in horses, per Dr Ben Sykes. And the rebound is not only short-lived, like 2-3 days, it doesn’t even start until the drug is stopped.
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