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!
If youāre 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.
Great, thank you. Yes, I plan on doing the treatment plan you posted.
No. Treatment dose of omeprazole is 2.28 GRAMS per day. At that dose, gastrogard is less expensive than human OTC pills.
Esomeprazole is more bioactive.
@Lusoluv your statement is incorrect. 60mg omeprazole is spitting into the wind.
No. The treatment dose of omeprazole is 2.28 GRAMS.
Esomeprazole is more potent and bioactive.
Iāve had two unapproved posts. Frustrating.
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 thatās appropriate.
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 theyāre fast and free shipping with Prime. Thank you again. This will save so much money over the horse products.
Esomeprazole, yes. Yes to the 60mg for most horses.
Omeprazole, no. Youād need 114 of those 20mg pills to equal a tube of GG/UG
The āesā in front of omeprazole makes the 2 chemicals light years apart.
Thanks for this clarification/correction, JB!! I went back and edited my post as to not confuse anyone whoāll be dosing.
Great. Thanks!
Iāve read this whole thread and it has been super enlightening. I have a horse who took 6-7 months of treatment to get rid of Squamous and Pyloric ulcers. We did the misoprostol, sucralfate, and gastroguard. Plus aloe vera. We finally got him better and heās been largely symptom free, but Iām pretty anxious about a return.
We show about once a month but the end of the year has a bit more consolidated schedule. Our last competition is two weeks in a row, but he will have turnout, which helps him a lot.
I would love to not use Gastroguard at shows for him. He typically gets GG and we add sucralfate as well at shows.
Iām not sure what the preventative protocol for Nexium is if 60mg is a healing dose? If we have a show then two week break and then the 2 week back to back show, do I just keep him on three pills the whole time and then taper? Heāll go on vacation after the shows for a nice long break.
Longer term, whatās my protocol for 6 day long shows once a month? If Iām constantly treating and tapering, his hind gut, I worry his hind gut never gets a break?
Also is there any consensus on which hindgut supplement is best?
Thank you everyone for this outstanding thread, Iāve learned a ton!
@greysfordays a prevent dose is not possible with the capsules. It would be something like 10-15 mg/day. For prevention, youāre probably best off with a quarter tube of ulcergard/gastrogard.
If you have hind gut concerns, consider ranitidine instead of a PPI.
So I should just take down the dose of GG? Weāve been giving a full tube per day starting day before and ending one or two days when we return.
when folks on this thread talked about giving Nexium as a preventative measure for something like a joint injection or occasion where the horse would get bute, is that different?
Iām also not so much trying to treat hindgut ulcers, but rather provide support when Iām using any PPI preventativelyā¦ does that make sense?
Following this. Iāve learned a ton from this thread and subsequently have had my recently imported mare on generic esomeprazole since August. I had to bump her back up to the 3 pills/day after she started acting out of sorts once I began the tapering dose 
Sheās being scoped in a few weeks and I suspect once I have the results from the scope, sheāll need a prevention program for competitions. Iāve never dealt with ulcers before so this thread has been very helpful ā thanks to all who have contributed!
The prevent dose of omeprazole is how ulcergard is labeledā1/4 tube/day. That has been proven to prevent ulcers in an ulcer free horse through stressful events.
When I give nexium āpreventativelyā itās when thereās a pretty big assault to the horseāfor example, when the mare popped with a giant cellulitis. She was three legged, on antibiotics, banamine, and naquasone. Thatās so much, and I use the treatment dose of nexium through the duration of the antibiotics and then taper. Perhaps sheād be okay with a prevent dose of omeprazole, but since Iām not able to PRE treat for a few days prior (I canāt dose her prior to the cellulitis, I donāt know itās coming, ya know?) Iām really playing catch up and feel the treatment dose is warranted.
In general, itās usually best to use as little medication as possible to get the response you desire, for as little time as possible to maintain that responseā¦so a full dose of nexium when 1/4 dose is all you āneedā seems unnecessarily risky, especially since we do know there is some possible risk to the balance of the hind gut.
That said, however, pyloric ulcers are a bit of a different beast, and if a full tube of GG has been necessary for your horse for stressful events, and you have not found the smaller dose effective, it would be prudent to keep doing what youāre doing. You could try nexium at the full dose but perhaps scope to confirm its working for you.
Equishure, Rite Track and Succeed are all things that offer hind gut support. Ranitidine also treats both gastric and hind gut ulcers, so if you have concerns in both areas, it can be a nice choice.
@springpaard super curious what your scope shows! I hope you come back and update us 
I certainly will!
This makes a lot of sense. I totally agree with the philosophy as little as possible, as much as necessary. Stupidly, Iāve never tried just going to a 1/4 tube for preventative, weāve just been doing a full tube out of caution and habit. Now Iām worried that dosing that much on and off is probably not ideal bc we donāt really taper.
My plan is to scope him at the end of the show season to see where we end up with the stress. Itās been more than a year since our last scope and while he has days where his spookiness kicks up, he generally feels good.
Would you recommend maybe 20mg of nexium as a preventative while weāre competing? Iām really attracted to the idea that it might be less stressful on the hindgut. Since you canāt really scope for hindgut, Iām almost more concerned about that than anything else. But hopefully the sucralfate helps with that.
Thank you again Simkie for all your advice on this thread, I feel like you should get community service points to be used in future at willā¦
The tricky thing with 20mg is if the horse crunches the capsule on the way down, you get zilch We give an extra 20 in the ātreatā dose as protection against that crunch factor, but when youāre dealing with smaller doses, youāre either risking crunch and zero, or moving into treatment dose if everything goes down intact.
Perhaps one way to mitigate that risk is to give it with a buffer. Gastrogard is buffered to protect the omeprazole instead of coated, so thereās some precedence. You could try one capsule nexium + a dose of your buffer of choice, like UGard or Outlast or whatever, and see how that works out. If the single capsule does crunch on the way down, the buffer will help protect the esomeprazole from getting destroyed in the stomach.
(If you try that, report back!! :yes:)
Thank you again Simkie for all your advice on this thread, I feel like you should get community service points to be used in future at willā¦
Aww, thanks! 
Iām just so happy that this seems to work for so many horsesā¦and, selfishly, my own 
Itās so much easier and cheaper than so many other options!
Do you think it makes a difference if I shoot back the pill with one of my zillows of GG empties and a little coconut oil to avoid crunching?
While I have you (bless you), what if I tried a half tube of GG (heās 1440lbs/18h) for our show in October, tapered to a 1/4 dose the following two weeks and then went to 1 pill of Nexium plus UGard while heās in Thermal for two weeks?
I mean, for the sake of experiment, I probably should just do one pill of Nexium plus UGard the entire time and then scope for cleanest results. But I know have a lot of GG in anticipation of our upcoming shows.
You know I will definitely report back post scope, thatās the least I can do for all this concierge medicine help!
You certainly could dose him with a single pill. That would help keep it intact, if you get it past the molars
Since heās a big dude, your prevent dose of ulcergard is more like 1/3 tube. His size actually makes nexium a little more attractive for using to prevent, since he needs a larger dose than a ānormalā horse. A single capsule is appropriate, just do what you can to protect it.
If youāre treating him with nexium, stepping up to 80mg (4 capsules) would probably be the way to go. Big guy!!!
(Did your vets ever have you using more than a tube/ day of gastrogard when treating his ulcers? Those tubes are good up to 1250lbs, iirc. Heād need a little more there, too.)
Good luck with your fall schedule
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