The flip side of “it doesn’t work for all” is it DOES work for some. Mirroring the ulcergard prevent dose is not an unreasonable thing to try, especially for an owner concerned about over treating and adverse side effects.
Absolutely. The point I tried to make is that using a low dose as the standard on which to base a preventive dose has some limitations.
I’ll definitely be trying it again next year to see if it continues to work. He’s a 17.2h warmblood, I’ve never weighted him precisely but always put him at 1200lbs+.
Last time I read through this thread, I didn’t see anything about using esomeprazole for long term prevention, so wanted to share my experience and add to the collective knowledge. Worst case, it didn’t help and I would have to go back to a GG treatment.
I think it’s a cool concept, and really appreciate you doing the work & sharing the outcome! Dose size has certainly been a limitation in using esomeprazole as a preventative.
At 17.2, and a WB, my guess is he’s at least 1400 if he’s more modern, and 1500-1600 if he’s heavier. My 17h Oldenburg, short-backed with an 80" blanket, but wearning a 60" long girth, was around 1500. My 16.2 dainty TB mare is 1200 when she’s in good weight (ie not when it’s muzzle time on grass LOL).
I do hope it works next year!
Has anyone been directed to or tried using this permanently instead of permanent ulcergard?
There are a few challenges with using Nexium permanently, especially in the place of ulcergard:
Long term PPI use carries heady risks.
and
Trying to achieve 1/4 treatment dose (as with ulcergard) is impossible to challenging, if you accept that 40 mg of esomeprazole is a treatment dose. One quarter of that is less than a capsule. You can scroll up and read how @Bewildered approached that, her posts and discussion about them is right above yours.
It’s a shame we lost ranitadine, it was really a better option, imo, for treating long term. I’d be exceedingly hesitant to keep anything on a PPI permanently and would explore every other option first.
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COuld you tell me about this? Thx
Withdrawn from the market due to potential cancer causing component.
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Reading through the paper this thread is based on, and comments, am I right in saying the 40mg is the lowest functioning dose to help MANY horses with ulcers, but that many OTHER horses need the standard dose (0.5–2.0mg/kg q24h)?
That would amount to a 1200# or 544kg horse getting 272-1,088mg/day? Or (rounded up) 14-55 capsules?
At the 0.5mg/day dose that’s basically one whole 14 pill bottle per day. Still around $5, cheaper than Gastrogard. Anyone done this? Sorry if I missed that people have tried it… this thread is loooong.
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I did this. 1200 lb mare, 14 pills for 30 days then reduced by 2 per week to taper. Rescoped to confirm it worked.
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Thanks!
Dr Ben Sykes’ recent research (put out either early this year or late last year) shows there’s no need to taper omeprazole, since in horses, unlike people, not only does the rebound only last up to a couple of days (dependign on treatment vs prevention dose), but it doesn’t even start until omeprazole is stopped. Granted, the study was on omeprazole, not esomeprazole, but since they are very closely related, and affect the same mechanics, it seems that it works the same. Just food for thought. At least esomeprazole is cheap enough it’s not a hit to the wallet to do a taper if it makes you feel better, just know that when you stop, that is really likely to be the rebound, so supporting that in ways of stomach buffers (like alfalfa), low stress/no work, etc, is useful too
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Just curious, was it squamous, or glandular ulcers? This class of drug is best for squamous ulcers, but not glandular. I know esomeprazole doesn’t work for all squamous, but also know that omeprazole doesn’t either, for some reason. And sometimes it takes longer than 30 days to really affect treatment
That’s actually something else Dr Sykes found in his research - not all horses had the same physical response to omeprazole. Some who got a treatment dose responded only as if getting a preventive dose, and even vice versa, so I’m sure that plays a role in all this too.
Yes, I did two rounds of Nexium, the first was at the lower 4 pills a day for 30 days. Rescoped, no improvement. Then did 14 pills a day for 30 days, rescoped, no improvement. We then switched to a full tube of Gastroguard, Misoprostol 2x per day and Sucrulfate 3x per day. Rescoped, all healed.
Hugs to your bank account. 
but glad it worked!
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It was Grade 3/Grade 4 squamous ulcers only. For whatever reason, my gelding did not respond to Nexium at all. Just sharing my experience, to add to the collective wisdom.
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