I knew Dr Ben Sykes was working on some research looking into whether tapering omeprazole was necessary, or not, useful or not, and the verdict is in, based on what he found:
Don’t bother.
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Is there a layman’s version or summary/abstract anywhere? Sorry I don’t really understand too much of the terminology, I suck at biology
Whoops never mind I reached the conclusion so all good sorry
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The cliff notes is that people react predictably to omeprazole, if they are among those who are reactive to it (ie most people). Horses don’t. So a horse could have as much acid suppression on 1mg/kg as another horse on 4mg/kg, and a 4mg/kg horse could have as little suppression as one on 1mg/kg. This explains why some horses don’t respond to omeprazole even for the 'right" ulcers.
The mechanisms that cause rebound in people either don’t do that in horses, or it self-corrects within 24-48 hours, which is what led to the “give 1 day, or 2 days off, based on whether you did a short-term course or long-term” protocol at the end.
Meaning, any rebound effect of any potential significance was found to be a non issue after about 48 hours tops
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Thanks, JB. Good to know.
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Do you think this tapering info also applies to esomeprazole/Nexium or only omeprazole?
And yet, the anecdotal evidence seems to say otherwise for a lot of people? Or maybe they’re not treating all the way to full healing? Or, it just isn’t the right drug for some horses?
both are PPIs, so would apply to both.
That’s what my cliff notes comment talks about. Horses aren’t people and this drug doesn’t behave in them the same way it does in people, and its effects on other processes aren’t the same either
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oops, I phrased that badly using “people” where I should have used “horse owners.” My personal suspicion is that either folks seeing what we’re calling rebound in horses actually have their horse on the ‘wrong’ drug for that particular horse, or are not treating long enough to get full healing. Does that make sense?
that makes more sense! Yes, I am quite certain (as certain as a layman can be) that those who “see” rebound are seeing the horse reacting to the return to normal acid production on ulcers that aren’t healed (well). Maybe their horse is one who doesn’t respond as well to a treatment dose of omeprazole as another horse does (part of this whole issue), and maybe that’s why some horses just need 60-90 days of treatment vs just 30
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