Wow! $8.08 with my subscribe & save discount, plus an additional 20% off if I buy over $50 worth. That might win as best price ever 
Thanks for sharing!
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Yeah, youâre welcome! Since I have a rotating cast of horse characters, I just keep them on subscribe-and-save, so I have a never-ending supply. (I like them for myself too. 
)
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I just got these last week! Such a good price.
Thanks for the amazon link!
My horse has responded well to nexium/generic to treat his ulcers. But it seems like I end up having to do a round about once a year, plus preventative at stressful situations. It seems like I havenât found a reliable way to prevent. He doesnât get any grain and has access to hay and grass 24/7.
So much goes into stress beyond grain and access to forage. Housing, herd, shipping, training, painâŠprobably a whole host of things we donât yet understand.
Iâd look to what precedes his need for treatment to identify whatâs setting that off. You may be able to make changes in advance to mitigate, or you might not be able to do that, and the only option is to treat.
Not every single horse out there is going to be able to avoid ulcers 100% of the time.
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Yes, of course, Simkieâjust wanted to share the diet aspect since I knew it would be the first question asked.
Right now there seems to be no real pattern as to when he needs treatment, that doesnât mean there isnât one, just not one I have been able to identify. He is a nervous horse by nature and has a very sensitive stomach (why I pulled him off grain). He has not done well on any of the gut support supplements Iâve tried, though my hope had been to find one that would act as a preventative. But If I need to treat him from time to time, I am ok with that. One of our vets suggested keeping him on a very low dose of omeprazole/esomeprazole at all times. But I think treating at first sign might be the better route.
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Do you have a link to that study? I know of the one done on Relyne, but that was a bit sketchy as there wasnât a control group. I know Alimend is a similar formulation, but wasnât aware it has a study of its own.
I 100% agree that ulcers are never black and white. All the right drugs donât heal all ulcers, and some ulcers heal with benign neglect, ie Dr Green, removing the source of the stress, etc.
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My PSA for the day - this is not the definition of a white paper 
A white paper is a non-peer reviewed informative piece on an issue for which the author believes clarity or education is needed, and frequently offers a philosophy, perspective, or opinion. It should still be fact-based and very well cited, and, at least for medical white papers, is typically written by experts in the field such as scientists or clinicians.
What youâre describing is simply called a peer-reviewed article
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No worries, and not trying to be pedantic, just trying to minimize confusion for folks Science literacy is such a challenge in todays world as it is!
I have a couple questions for those in the thread who have used esomeprazole/Nexium.
I had my horse 60mg for 10 days in December before tapering down to 40mg then 20mg for 10 days each. However, symptoms returned once the dose went down to 40mg. I wouldâve bumped the dose back up but had to go back to school so I wouldnât have had time to do the taper if I stayed at full treatment dose for longer than 10 days.
My vet ended up prescribing compounded sucralfate in January and we have been using it a little over a month for twice a day but have seen no change in symptoms. Weâre currently thinking itâs glandular, hence the sucralfate. However, if anything the symptoms have gotten worse, definitely no improvement.
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Currently thinking of going back on the esomeprazole since at 60mg, I had my horse back for the first time in months. However, weâre still finishing up the sucralfate and so my vet said Iâm supposed to do a washout period before doing another medication. Does anyone know how long I need to wait in between the compounded sucralfate?
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Also, I know that people mostly have used the esomeprazole for squamous ulcers. However, I did see this study that mentioned use of esomeprazole treatment for glandular ulcers. Has anyone in the thread used esomeprazole for glandular ulcer treatment?
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For those that did see their horseâs symptoms return when esomeprazole dosage was lowered, were you eventually able to taper off of the esomeprazole? Is there a pelleted supplement that would be able to help with phasing out the PPI once I finish treating? I know Equishure and Succeed are popular but any supplements that arenât pelleted are very difficult to get my horse to eat.
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Lastly, it seems that tapering PPIs is somewhat subject to debate based on this thread I saw. I guess itâs because horses react differently to the tapering vs. humans, thoughts?
Ten days of any PPI is not long enough.
Sucralfate can be given concurrent with a PPI, just not dosed at the same time. Separate by a couple hours.
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Yes I was definitely aware that I wouldnât be able to heal them within 10 days but I only had 30 days in in between semesters to give the medication so I thought Iâd do 10 days of 60mg, 10 days of 40mg, and then 10 days of 20 mg to make sure Iâd have time to taper before figuring out a solution in the interim.
Edited to add for clarity: In December I was mostly just doing a brief trial of the esomeprazole to see if it made any difference at all
tapering omeprazole or esomeprazole doesnât do anything, and because symptoms returned, it just means you havenât allowed the ulcers to heal
Dr Ben Sykes research on omeprazole (and Iâm definitely extrapolating to esomeprazole, since they affect the proton pumps the same way), showed that itâs only when you STOP the drug that thereâs a bit of a rebound, and even thatâs short lived, 24-48 hours or so depending on what sort of dose you were using (preventive vs treatment). It doesnât slowly start coming back when you lower the dose, it doesnât start producing higher acid until you stop. So tapering just pushes out that small rebound period.
Itâs not that horses react differently from people to tapering, itâs that horses react differently, and unreliably, to the processes that shut down the proton pumps, and to several other mechanisms that are responsible for the rebound. In horses, those other mechanisms recover very quickly which means the rebound period is very short-lived and you canât prevent it.
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Ahh okay that makes sense, thank you! I think maybe Iâll just add the Nexium back in then as Iâve almost finished with the compounded sucralfate since thatâs not doing anything.
Doesnât Abler suggest treating with both Sucralfate & Omeprazole for best results? Fed at different times as you noted.
If you havenât scoped, or you suspect a potential hind gut issue, or you have multiple types of ulcers, OR youâre also using an NSAID for some reason, itâs always a good idea to add in sucralfate. It will coat lesions all along the GI tract. But it needs a stomach environment separate from omeprazole, as noted.
Just fyi, you can get your vet to write a script or in some states the drug store will sell over the counter, for lower dose Nexium packets.
My son just got prescribed the lower dose Nexium. packets that mix in water. They have 10mg and 2.5mg.
A lower does just means more volume of medication
I assume that luv is suggesting a lower dose for taper or prevention, not using it to achieve a full treatment dose.
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I have a 600 lb pony, the lower dose would be awesome to taper and be able to use a lower dose when traveling, etc.
