Hello, I have a mare that was diagnosed with grade 4 ulcers (glandular and squamous) at the end of May 2024. She has since been on GastroGard, Misoprostol and Sucralfate. It’s time to wean her off the meds and I’m wondering what is the safest way to do so to avoid acid rebound. I’ve already started her on visceral, which she eats with omneity pellets and beet pulp (no grain). She was on GastroGard for 8 weeks and was just switched to omeprazole suspension. Is it best to slowly decrease one med at a time per dose? i.e. misprostol first and do 75% of the original dosage for a week, 50% for a week, 25% for a week and then take her off? And then repeat the same with sucralfate and omeprazole? Which drug is best to wean first and which should be last? As well, if there are any other recommendations for more natural ulcer protection (in addition to the visceral, which she seems to really like), please share! Thank you in advance!!
Has she rescoped clean?
I chose not to rescope and instead did an extra month of gastrogard to avoid the stress of trailering back to the hospital and fasting her. Her behaviour has completely changed though and previous behaviours that I didn’t realize were out of pain have completely gone away, so I’m confident that the meds have helped. But given we didn’t rescope, I want to take things slowly in case any of the previous behaviours return in which case she’ll 100% be rescoped.
There’s very little research in tapering these things, so you kind of have to play it by ear. Does your vet have any suggestions?
I would discontinue the omeprazole first. Sykes showed an 83% recurrence rate in three days upon discontinuation of omeprazole (but still does not recommend a taper…I wrote about it here) so at the very least, keep the other meds on board when you d/c omeprazole to provide some coverage. My personal feeling is that a short taper won’t hurt and may help. A week or two depending on your comfort level is likely more than sufficient. Don’t do anything stressful over that period (hauling, moves, big barn drama, etc) and if you’re riding, make sure she’s got a stomach full of fiber when you tack up so there’s minimal acid sloshing. Keep rides low key.
After that, I’d drop the miso, and then the sucralfate.
Thanks very much for your suggestions! My vet suggested dropping a dose of misprostol first for a week, then dropping both doses of misoprostol. After that, the same with sucralfate, all while keeping her on omeprazole. But given the omeprazole hinders acid production, I would think I should taper that off first while she still has some protection from the misoprostol and sucralfate, while the acid production starts up again…
She lives outside in a stable herd 24/7 with constant forage (hay and pasture) and complete freedom. She’s a companion animal so she lives the ideal lifestyle to NOT have ulcers, but here we are. I suspect she’s had stomach issues since a young age though and a couple recent injuries and trips to the hospital have caused internal stress which made the ulcers flare up. No way to know for sure, but it’s my best guess.
This may be a useful read for you;
