FWIW, human ranitidine is off the market, but I did buy some through Valley Vet. My horse detects the horse-sized ranitidine pills (300mg vs human 150mg) and thinks the taste awful. So I’ve switched to human famotidine (Prevacid). It’s still more $$ than the generic Nexium treatment, but I feel better about long term use for a horse with the best management - 24/7 turnout and hay, but lingering ulcers chronic pain and daily Equioxx. This keeps him eating and happy.
If you’re interested in going the Succeed route, definitely take advantage of their challenge program. You buy it through them, complete a weekly journal thing, and if it doesn’t work, they refund your $$, minus shipping.
I used it once, didn’t see a change in the horse, and they were very prompt in returning my dollars. I’d not fault the product, and would absolutely use it again if I had one that could perhaps benefit.
https://www.succeed-equine.com/challenge/
I can’t recall where you are, but I do know a barn in northern Colorado (near Fort Collins) that feeds free choice hay, and will purchase alfalfa for your horse if you’d like that. It’s not a sexy show barn, but the people are very nice and willing to work with you. LMK if you’d like their info, it might be a good option for you if you’re in the area (and willing to consider yet another move, know that’s always so tough. :()
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My vet relied on a different study that has a dose of 0.5mg per kg if I remember correctly. For my huge guy that meant a full bottle of 14 pills once a day. Still cheaper than gastrogard. And he ate them fine in some grain that I fed.
I have a couple bottles of ranitidine I think that you could have (was Walmart brand that last I checked wasn’t recalled), but it’s a lot of pills and I think recommended twice a day, so that won’t get you very far. You probably could get it compounded in a powder.
@IPEsq can I ask which vet you used? My vet isn’t very familiar with nexium.
And thank you that’s very sweet of you. I think be better off sticking with nexium and a hind gut supplement or a compounded paste of something. He’s very smart and very picky. I don’t see me getting a large amount of pills in him a few times a day :lol:
@Simkie thank you! Unfortunately fort Collins is too far for me. I’m near Firestone. He was in training in Fort Collins and the drive was rough for me and my schedule to get up there! Sounds wonderful though.
My vet at CSU didn’t exactly recommend using Nexium over Gastrogard but said if I wanted to try that as an alternative, she would go with the study / dose I mentioned. She was not aware of the other study. I have heard that some vets at Littleton are also ok with using Nexium but I don’t know the dose recommendations from them.
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I’d personally be really hesitant to up the nexium dose on a horse with potential hind gut issues.
Thanks guys. I’m going to talk to my vet. Right now I have him back on 3 pills a day.
If the goal is to keep gastric pH from crossing a certain threshold to allow for healing of ulcers, the dose should not matter. Having a horse on any PPI that is doing its job of controlling gastric pH when there is a hind gut issue is a potential problem. It would be best for the OP to scope the horse and develop a game plan from there with her vet. We know that these drugs are not effective alone at treating certain types of ulcers. And there can be side effects such as on the hind gut. All we seem to know from what the OP has done so far is that if there is some control of gastric pH with Nexium, the horse feels better. Then again, omeprazole and similar compounds can have an effect on mood as well.
Here’s a study that looked at enteric coated 0.5mg/kg esomeprazole paste in comparison to enteric coated 1mg/kg omeprazole paste.
The 40/80 mg nexium study reported a mean pH of >5. This reports >6. That’s a big difference and a potential issue downstream for a hind gut horse. The stomach isn’t supposed to be neutral…how does digestion even happen at pH >6? pH >4 is the threshold for healing.
This study also didn’t seek to find a lowest effective dose, like the other one.
Did you ever share the low dose paper with your vet?
I have discussed both studies with my vet and he recommended following the study cited by IPEsq. The way he explained it to me is that the study with the lower dose was done with horses on a high grain, low forage diet, and the study with the higher dose was done with horses on a low grain, high forage diet. Considering my horse is basically on no grain (as I suspect most ulcery horses are), we thought the higher dose was appropriate.
I have found it to work on my horse, confirmed by scoping. That said, she has chronic gastritis, so we are trying to figure out how to deal with that without keeping her on a low dose of Nexium all of the time.
I did (you have asked me that before). The paper above was not the one she referred me to for the 0.5 mg/kg dose. There are flaws in all of the studies. But I think the one that tested from 0.5 mg/kg to 2.0mg/kg and measured pH for longer in the 24 hour period (23h) than the 40/80mg study to determine if the pH was maintained for closer to 24 hours. But it was administered similarly to the 40/80mg study (via gastronomy tube, not via tablet or paste). It was found that at the 2.0mg/kg dose, there was an undesirable cumulative effect. 0.5mg/kg IV administration of esomeprazole has also been studied.
This one I linked above was trying to compare an administration route similar to Gastrogard and compare its effect to the omeprazole paste. We don’t have any study that looks at the lower dose for as long to see if you could go less than 0.5mg/kg and have >4 pH for enough hours in a day.
In humans, we know that we need to maintain pH above 4 for at least 16 hours to have healing. Gastrogard was found to be effective for 24 hours in horses. Ranitidine is also effective at 6.6 mg/kg if dosed 3x a day–otherwise it doesn’t do much for pH.
In normal horses, the glandular portion is very acidic, with a pH of 1 to 2, while the nonglandular region has a fairly neutral pH of 5 to 7. In the squamous part of the stomach, the cutoff is pH of 4 for healing. I’m not finding anything even in the FDA materials on Gastrogard what the pH readings were for it. Just says over 4 and then focuses on improvement in ulcer scores over time. Hard to say if a single reading at 6 would be bad. For one, we don’t know what time of day that was taken.
The authors of the first study included:
“In addition, it is important to note that, at T0, which reflects the gastric juice pH of the first measurement before the administration of esomeprazole magnesium for all 5 days of experimentation, the pH was between 2 and 3. Such a pattern leads us to consider the works of some authors who emphasized the need for a wider evaluation of gastric pH fluctuation (24 hours), the time interval in which acidity would be capable of supplanting the action of the proton-pump inhibitors. They indicate an especially harmful behavior of gastric pH during the night, when there is strong tendency for a decrease in pH 5 hours after the last meal of the individuals of the groups studied.”
This horse didn’t respond as expected to the nexium, and increasing the dose to raise the pH of the stomach longer, higher, carries risk, especially given the “maybe hind gut” presentation.
Treating with nexium without a scope is cool with simple cases that respond as expected. This one didn’t and everyone here acknowledges that. Without a scope, I would certainly not be comfortable increasing the nexium dose, and would prefer to switch meds (to the precision omeprazole/ranitidine paste) or continue with the lower dose of nexium and add hind gut support. When “some” doesn’t work, “more” is not necessarily the answer.
You obviously have a different opinion, IPEsq, and that is fine. We don’t have to agree here. ðŸ‘
Well he did respond very well to nexium. It did eliminate all symptoms as long as he was on 2 or 3 pills.
I understand what you are both saying though. I’ll discuss this with my vet.
No scope happening because now possible COVID 19 exposure at the barn and my husband is temporarily laid off with no pay. So I’m going to get ulcers next :mad:
Yep, totally understand the stressful situation and need to skip the scope. I’m really sorry it’s so bad. What a scary time we live in right now, I hope you’re okay. Take care of yourself, nexium does work great on people too!
If it helps at all, (probably not :lol:) I had a similar presentation in my own horse. Back when all we had was gastrogard, though. I just could NOT get her off without huge “my belly hurts” signs. Scoped her…pristine stomach. A big head scratcher. So kept her on gastrogard. What else could I do? Finally retired her, kicked her out in a field and kinda ignored her. She finally got better. Looking back, I absolutely think it was a hindgut issue. Info about that wasn’t really as available then.
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@Simkie yeah it’s so crummy. We will be okay although year will now be much different. All savings will go to bills for a bit instead of the horse, vacation, a new roof. We are lucky to have any savings though…
”‹”‹”‹”‹”‹”‹”‹I definitely think there is no harm in adding a hind gut treatment. It’s worth a shot for sure.
We don’t actually know if it raises the pH higher. Both the 40/80 mg study and the study my vets relied on just reported pH of greater than 4. The first one looked at pH for 6 hours. The latter for 23 hours. I don’t think the median pH was given except whether it was above 4 or not. Except that they found an increased and cumulative effect that was too high at 2mg/kg dose. The link above tested 6 horses using 2 pastes. We know that the pH of Gastrogard (the paste) is part of why it is effective for 24 hours compared to some compounded pastes where the paste itself is more acidic (thought to affect and degrade the drug). I looked at the FDA data for Gastrogard and it also didn’t say what the pH was when tested, just that it was over 4. So, for all we know from that last pilot study, Gastrogard does raise the pH to >6 at some point throughout the day. The goal is to have >4 for the majority of the 24 hour period. What isn’t apparent from the published data that I have seen is how that might fluctuate throughout the day exactly except that mid day peak for 2mg/kg was “too high” (whatever that is) and there was a cumulative effect of the drug (half life too long for daily dosing at that dose).
We also don’t know how capsules administered orally affect pH.
I’m not saying I know which dose is the best, but I followed my vet’s advice and had success as if I had used Gastrogard. I also had a hard time getting him off of PPIs the last time I did a full treatment, and after trying various things, Succeed seemed to be the thing that was the best for my guy. I did put off trying it due to cost but I wound up wasting money on other things.
OP, is the horse getting any grain? I forget. One thing you might do is to switch to an all forage diet for the time being if possible. I think that could include hay / alfalfa pellets and oil for weight if needed. And beet pulp. That might help him with comfort while we deal with the current lockdown. And a hind gut supplement also wouldn’t hurt anything most likely except your wallet a little more.
Huh? No, it didn’t. The 40/80 study reported a mean pH >5. The esomeprazole/omeprazole study you linked above reported a mean pH >6.
Yeah, there’s not really enough study out there to call it definitively. All the more reason, in my mind, to not drastically increase the dose without understanding what’s happening in the stomach. I realize you disagree.
Why are you battling so much to give this horse a whole lot more nexium when, when you were faced with a similar issue, the solution wasn’t more nexium, but therapy for the hind gut?
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