Esomeprazole (Nexium) for equine ulcers

[JB]

The point is, via the thread I posted about Dr Syke’s recent research, is that tapering is useless because the rebound effect doesn’t happen until you totally STOP the drug. And even then, 48 hours or so is about it, so just give your horse some downtime, extra buffering (some added alfalfa for example), and then go on with life.

I wouldn’t even worry about a smaller horse. Why?

The lowest studied does was only evaluated for 6 hours for how long it increases pH. Maybe it keeps it high enough for longer, but they didn’t study that. The higher doses were measured for up to 23 hours. So just use a higher dose which is still not a lot for a pony, and hedge your bets on actually being able to heal things.

[Simkie]

One single study has suggested tapering isn’t necessary. Has that data been published yet? Can you link the paper? What omeprazole product was even used? Drawing conclusions from one study with small sample (I assume, because damned near every equine study has a small sample size) using a different product and prep is perhaps a stretch.

It’s hardly settled science. Let’s see more data and research before saying unequivocally that tapering is worthless.

[scislandsprite]

Dr. Ben Sykes talks about the the research in this video.

Dr. Tania Sundra also did a study with esomeprazole treating glandular ulcers. I reached out to her and she said she did not taper during the course of the study so I’m not sure how it impacted the results.

I don’t really know enough about tapering to say much else than posting these links

[Simkie]

@scislandsprite

Dr. Tania Sundra also did a study with esomeprazole treating glandular ulcers . I reached out to her and she said she did not taper during the course of the study so I’m not sure how it impacted the results.

Do you have the full text of this one? I’d love to read it if so. Couldn’t find it online or at scihub. Thx!

[luvmyhackney]

So I’m basing my tapering guide by what I learned about PPI’s from a human Dr that specializes in GI. Now I fully understand horses are different and our stomach acid is different, but I see no harm other than my pocketbook in tapering and following a similar protocol to what Gastroguard/Ulcerguard suggest.

[scislandsprite]

No sorry! However the vet who was involved with the study is really great with answering questions about the research so maybe that could be of help?

[trailtrottin]

I have a horse that has been on esomeprazole
For 4 years now (2 pills - 1 in the am - and 1 in the pm. This year he was really sun burned on his blaze in August/Sept 2022. He was wuite bad with ooen sores. His hair has not grown back. Has anyone else had that issue? When looking up serious side effects of esomeprazole it higjlights this ‘ * blistering, peeling, or loosening of the skin’. I am going to stop it for a while and see if his white hair grows back.

Just wondering if anyone else had problems. It may not be the esomeprazole. Auch a bummer

[Bewildered]

Wanted to share my experience with using esomeprazole as a maintenance for ulcer prevention. Before I did anything, I consulted with my vet and they gave me the OK and we worked out a schedule around the rest of his medication.

For some background, horse has a history of developing ulcers going into winter for the last 4-5 years. He has a very ulcer friendly lifestyle (24/7 turnout, hay, low stress environment, never leaves the property) but he has chronic pain from arthritis and old injuries. Winters here are very long and cold and current theory is the cold aggravates the arthritis and causes the ulcers. I’ve done winters with previcox and without, and in the previcox years it took longer for the ulcers to show up. In the past years, I’ve done 1 month of gastroguard in the early winter/late fall when he starts showing symptoms and he’ll be good for the rest of the season.

Last year I ordered the Kirkland brand esomeprazole delayed-release 20mg capsules and some empty gelatin capsules(regular capsules, not delayed release or enteric). I broke open all the esomeprazole capsules and used a jewelry scale to fill the empty capsules with ~90mg of esomeprazole. This came out to a little over half of the contents of the original capsules, so he was getting 10-15mg of esomeprazole (he’s a very large horse, so went a little over the recommended dose).

Starting in November, he received one esomeprazole capsule in the morning then previcox and cetrizine hydrocloride(Zyrtec) in the afternoon. My vet recommended a couple hours between the esomeprazole and other medication to allow for proper absorption of all meds. He received this daily in a fig newton until end of April. Through the entire winter he showed no signs of ulcers, even the subtle ones I’ve learned to watch for. No other apparent side effects or interactions. My vet was out on May 1 to draw blood to check everything. His blood calcium was a touch low, 0.007 below the reference range, which is a change from previous blood work. My vet wasn’t concerned since we are stopping the esomeprazole for the summer. I was a little worried that he was start showing ulcer symptoms after the esomeprazole was stopped, but 3 weeks later he’s still doing great.

I will most likely repeat this next winter.

[Feathered_Feet]

That’s a neat case study, thanks for sharing! Glad you seem to have found something that works (and is more affordable than GG).

Can you clarify, though, how much was he getting per day? I was a little confused by this part:

I broke open all the esomeprazole capsules and used a jewelry scale to fill the empty capsules with ~90mg of esomeprazole. This came out to a little over half of the contents of the original capsules, so he was getting 10-15mg of esomeprazole (he’s a very large horse, so went a little over the recommended dose).

[Bewildered]

The total weight of the capsules was ~90mg. The amount of actual omeprazole in that amount was 10-15mg. If you weighed a full, straight from the bottle capsule it comes out to around 140mg but the capsule is labeled as 20mg omeprazole. The rest of the weight is filler/other ingredients.

[emeraldcity]

I’m confused- it seems like you’re talking about both the weight of the capsule in it’s entirety, and the amount of drug within that, at the same time. Of course the whole thing weighs more than the amount of drug it contains, I’m not sure why that matters?

Can you clarify specifically what dose of esomeprazole you gave?

[JB]

I’m entirely confused too. The contents of the capsules are little “beads”, and the entire content contains 20mg of esomeprazole (coming from 22mg esomeprazole magnesium sulfate). It’s not 10-15mg, it’s 20mg.

You can’t separate inactive ingredients.

10-15mg of eso is a really low dose, lower than anything I’ve ever found showing to have any impact on stomach pH. The lowest studied dose is 40mg, and that’s for an average 1100lb horse (not sure what “very large” means for you)

[Simkie]

I get what @Bewildered is doing here. She’s repackaging as a “prevent” dose, like how ulcergard is labeled to prevent ulcers, rather than treat active ones, by dosing 1/4 tube/day rather than a full tube.

So she’s noted one capsule of nexium contains 140 mg of stuff. 20 mg of that is active ingredient and the rest is filler, hopefully buffer.

She’s repackaged about 90 mg into a new capsule, for about 12 mg of active ingredient.

I’m dubious that this can be effective–the product literature says to not crush or chew or open the capsules for a reason. But hey, if it’s worked here, who am I to judge. Sounds like quite a bit of work, but also a significant savings over using 1/4 tube/day of ulcergard over the course of the winter.

@JB I’m not sure what specific product you’re taking about, but the Nexium capsules and the generic Costco capsules both contain a white powder. No beads. They’re also sealed.

[JB]

My mistake, I thought they also had microbeads

[Posting_Trot]

I think the Walmart brand does have microbeads as does the store brand version that I’ve gotten from Stop 'n Shop.

[JB]

Yes, many of them do, I wrongly assumed the Costco brand did as well. Either way, you can’t separate anything out. At 10-15mg, why not just use 1 capsule at 20mg? That seems like WAY too much work to cut in 1/2 or 3/4.

[Simkie]

@JB

Either way, you can’t separate anything out.

But no one is separating anything out. The active ingredient is being reduced to approx 1/4 of a 40 mg treatment dose, for a larger horse. The carrier or buffer or inactive ingredient is being reduced as well.

If the drug is buffered inside the capsule, and not protected by the sealed capsule itself, the last thing you’d want to do is somehow isolate the active ingredient.

If @Bewildered is looking to find the lowest effective dose this is one way to go about it.

[JB]

Yes, that’s more clear now, but how it sounded made it seem like she was somehow thinking she was isolating the active drug.

Sure, it’s one way to go about it, but for a “very large horse” I’d just give 1 capsule/20mg.

[Bewildered]

The esomeprazole capsule I have contain the little enteric coated granules/beads. Because of that, I felt ok to take them out of the original capsules and using non-enteric/delayed capsules. I’m definitely not trying to separate out the ingredients. Using the assumption that the contents are evenly distributed, it was simply how much active ingredient is in each mg of total contents, then multiplying that up to get my targeted dosage. No different that taking a previcox pill and cutting it in half to half the dosage.

I chose to go this route because in my reading and the math I worked out, the equivalent of the Ulcerguard maintenance dose was 10mg of esomeprazole. Now, my math/understanding could be totally wrong, but that’s what I was trying to do. I could have given the whole 20mg capsule and it probably would have been fine, but given the risks associated with long term PPI use, I wanted to avoid intentionally “overdosing” it. Evidently that low of a dosage did work since he finally went an entire winter without ulcers developing.

Sorry for any confusion.

[JB]

@Bewildered

I chose to go this route because in my reading and the math I worked out, the equivalent of the Ulcerguard maintenance dose was 10mg of esomeprazole.

Your math is right, no problem there.

The problem is, the 40mg dose you’re using as your treatment dose, was only tracked in that study to raise pH for 6 hours. Rather, they only checked for 6 hours, it’s not known if it raises pH for longer than that.

In reality, that low 40mg dose doesn’t work for all horses, and they need a much higher dose, like .5mg/kg, so 250mg for a 500kg (1100lb) horse. I don’t know how much your horse weighs, but to me, “very large” means more than 1100lb. But if you’re used to 800lb 14.3 Arabians, then 1100lb might be very large LOL

That’s fantastic that he did well over the Winter! Whether it was coincidence, or that 10-15mg did enough work for long enough each day, can’t be known, you’d have to go through a few Winters to really say it’s the drug.