Agreed. I’m going to be starting my taper at a higher dose, like IPEsq, but think it makes sense to draw it out when down to lower numbers (i.e., 4 to 3 to 2 to 1).
I don’t think I bothered with going to 1 pill. But most of that was because I’d started to see some benefit at that time from starting Succeed, horse was going off to boot camp and it would have to go in his grain, which because he lived outside, he dribbled a lot getting distracted looking at the neighboring horses, and he’d wander off. I figured he’d more than likely drop it some days. He had a hard enough time eating what he got before it froze or he forgot about it and dumped hay on it instead. He will eat them out of my hand with a cookie, but I didn’t see him every day during that time.
My guy is coming up on 2 weeks since starting nexium (I’m doing 3 of the 20mg capsules daily) and no noticeable difference yet. I’ve read that quite a lot of people saw improvement within several days of starting, but is there anyone who didn’t see changes until the second half of the month? Hoping it might still work for him with more time.
Maybe that’s not enough for your horse to see a difference. Rather than waiting additional time, I’d try a higher dose. (But I acknowledge that it appears I’m in the minority with going with the other study that used a higher dose.)
Or could it be something other than ulcers? Or something other than a gastric ulcer? For example, I know (3 scopes later) that we’re trying to get rid of a stubborn pyloric ulcer, so our primary medication is actually sucralfate, which is the preferred drug for ulcers in that location. We’re using omeprazole as well, but if I were only to choose one, it would be the sucralfate for what we’re dealing with.
Btw, sucralfate is super cheap compared to name brand GastroGard/UlcerGard.
I’d scope the horse. There are a lot of things that might present as “ulcers” that are not, or ulcer conditions that require a treatment that is not only a PPI.
I’m two weeks in. No mild colic episodes since she’s been on it, but probably too early to determine its the nexium helping. I have noticed she is much less grumpy while grooming. Under saddle she is noticeably more relaxed and looser in the back. I’m going to taper to two capsules after I’m done with a full month.
I’ve been having excellent luck with 1 per day as maintenence with my ulcer prone mare. She’s feeling fantastic, shiny and actually a little chubby for the first time since I’ve had her.
@Pico Banana @Simkie thanks, I agree, I think I will set up a scope. If I stop the nexium now after 2 weeks of it, would you still wean off the same way as if I had done a full month?
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I certainly would 
But I’d also wait until the scope to discontinue. Just because you’re not seeing results doesn’t mean you don’t need a full course with a PPI. Sometimes the ulcers are SO bad it just takes a LONG time (and you need a longer treatment) or you’ve got something like delayed gastric emptying which may be treated with a PPI plus other stuff. So I’d hold tight until you go for a looksee. Then taper if it’s not ulcers, or adjust if it is.
I am reading on the injectable omeprazole thread about a 2017 study of esomeprazole and omeprazole efficacy and they were dosing the esomeprazole at 0.5mg/kg which for my guy would be 300 mg. While they found this dose to be as effective, it certainly isn’t the 60mg reported here. Any thoughts? Or was this in the discussion earlier in the thread?
@CindyCRNA This thread is really based on the paper linked in the first post. The paper you’re referring to wasn’t looking for a lowest effective dose, I don’t think. The paper in the first post here was more focused on that specific element.
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Thanks Simkie for starting this thread. My OTTB mare has been on the 60mg daily dose for 10 days or so now. I could tell a difference in 48 hours. She went from being a grudging eater to whinnying at me to hurry up with her feed and she’s put on a few pounds to boot. Definitely a less costly way to treat the issue. Thanks for sharing the knowledge.
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In a recent thread on a FB group, many people claimed Nexium didn’t work for them… Although I’m not sure if dosage, taper, etc was followed appropriately, and there’s no way to know if these horses actually had ulcers to treat in the first place.
However, one person said the study we are all going off the esomeprazole was not administered via pill as we are doing but in some other manner. Would this impact the effectiveness of the Nexium?
on a similar note, would omeprazole in a buffered paste be more or less effective than a granule/enteric coated product?
@CindyCRNA that second paper has been discussed here. It is the dose my vet’s from CSU recommend.
In both studies, the drug was administered via NG tube. The limitation of the low dose study is that they didn’t measure pH for as many hours after dosing as the second study, so we don’t know if pH would at some point before the next dose go out of the therapeutic range. We also don’t know if the higher dose of the second study is necessary. Both have gaps.
So, per my vets , when I did a treatment course, I used GG or the 0.5mg/kg of Nexium. I used that dose basis for the taper schedule as well. However, when my horse recently was acting NQR but not indicating he needed a full month treatment, I tried 3 pills dose, and it seemed to get him out of the little flare up quickly. For whatever that’s worth!
We’re talking NG tube directly to the stomach versus orally, not IV vs oral. The only question is making it past the teeth, which we’ve accounted for by giving 50% additional product with that third pill. The paper showed 40 mg was effective–we give 60, assuming one whole pill can be 100% obliterated by teeth. Really, it’s unlikely that will happen. If this is a terrific concern, just paste the horse.
Any buffered product like this (omeprazole, esomeprazole…anything that needs protection to get through the stomach) is LESS bioavailable than the same product enterically coated. The enteric coating is a better method of protecting the product. There’s an article on thehorse.com that states the % different between the two preps–I think it’s ~20-25%, somewhere in there–but no time to go find the paper right this moment. I have linked it several times in the AUS study threads. Nexium is buffered, not coated.
But shrug, haters gonna hate. This seems to have worked for many here. Given the paper linked in the first post, it is reasonable to assume it works. Until there are some scoping studies, it is impossible to say with any certainty.
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Oh, one more quick observation: I suspect in general the people who this sort of treatment appeals to are those who have been through ulcers before with their horse, may have spent some serious cash with Gastro/Ulcergard, and are looking for something less costly. They recognize the symptoms in their horse from before and they feel comfortable making the diagnosis, and treating.
Which is all well and good, but if a horse is a repeat offender on the ulcer front, there is a WHY. Sometimes those whys are benign…the horse always gets touchy with travel, or has just moved barns, or has been ill. All reasonable.
But horses that just continually redevelop ulcers without an obvious “event” probably have some underlying pathology–like perhaps delayed gastric emptying syndrome. Or they have additional problems, like hind gut ulcers. Or there’s something in the environment that is a continual stressor. Those horses aren’t going to be ulcer free on gastrogard, they’re not going to be ulcer free on nexium, and they may require a different treatment all together. So someone with a horse like that comes back and says “it didn’t work!” Well, no. Because it wasn’t the right treatment. That doesn’t mean it doesn’t work, but that it was the wrong way to go for that horse.
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Agree with the above, Simkie. In my case, my mare is a OTTB who was confined a lot at the track due to a bowed tendon. Then I had her shipped across the country from CA to GA, and have had her on pasture let down ever since. While she has been a good if somewhat listless eater, I gave her a few months to settle and see what she needed. When she didn’t pick up weight despite plentiful food, I decided that some omeprezole was needed to see if that wouldn’t improve matters and started looking up options and fortunately found this thread. No lie, by the next day she went from “okay, maybe I’ll eat” to nickering at me saying, “hurry the hell up with my grain woman!”. I know there are recommendations out there that OTTBs should be started on meds as a matter of course once they come off the track and this regimen makes it quite affordable to do that.
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The only issue is if your horse crunches a pill or all three, the dose is inert. I would have to say one of those pill syringe thingys would work better. Maybe globbed together with a bit of crisco or coconut oil (solid at room temp but will help the pills glob together ) would have a higher chance of making it to the stomach intact.
I dunno. The horse molars go waaaaay back in there. Plenty of opportunity for crunching.
Actually, since Nexium is buffered, not coated, crunching is immaterial. I keep forgetting that.
The capsule doesn’t matter at all. As long as it makes it into the horse instead of on the ground, the horse gets the dose.
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