Injectable Omeprazole for stomach ulcers?

[DressageDreamerInAus]

I was wondering if anyone else is trying the latest stomach ulcer treatment - injectable omeprazole?

My horse has had chronic stomach ulcers for many years and I have done WEEKS of paste treatment at various times. I can usually temporarily get him better with Gastrogard/Gastrozol (or whatever brand name my vet was prescribing!) but he is easily set off by small changes in his environment. He’s the coolest, safest horse to ride and vets initially doubted he even had ulcers (he’s also fat and shiny!), until we did an endoscope and saw them!

I’m lucky that I have access to research papers so I’ve been following what has been published and was excited to see that they had been trialing injecting vs paste (who ever knows if you get a full dose of paste into a horse … mine always spits a tiny bit out … and that’s expensive stuff!!). I didn’t think it would be available for a long time but my vet has just been able to prescribe starting this year.

Given most of the research into oral paste has shown it is less effective for pasture kept horses (as it needs to be absorbed on an empty stomach), I’m really fascinated to see what difference injections might make! I might even try to take my horse to a competition (last attempt was 4 years ago and he started going down with colic)!!

If you’re currently using a paste version of omeprazole, are you thinking of changing? For me, the cost per week is $20 extra for the injection rather than the paste so I’m hoping I can eventually use it less frequently!!

[CindyCRNA]

How are you giving it? IV or IM? I would assume IV. In people, we sometimes combine antacids in some that don’t respond to a single medication. I would hate sticking a horse everyday for weeks. I am wondering if adding ranitidine (3 times a day) would help your situation or adding twice a day Neighlox to your omperazole regimine.

[JB]

It’s IM
http://www.equinews.com/article/gastric-ulcers-horses-injectable-treatment-development

[joiedevie99]

I’d certainly give it a shot. I’ll ask my vet tomorrow if she can get her hands on it yet. We’ve tried literally everything else without substantial healing.

[DressageDreamerInAus]

@CindyCRNA

How are you giving it? IV or IM? I would assume IV. In people, we sometimes combine antacids in some that don’t respond to a single medication. I would hate sticking a horse everyday for weeks. I am wondering if adding ranitidine (3 times a day) would help your situation or adding twice a day Neighlox to your omperazole regimine.

It is IM and it is only once every 7 days … which is fantastic as pasting everyday is annoying, and also seeing those tiny bits that get missed when pasting frustrates me as I think about how much I paid for them! I’m in Australia so the costs are different here … to paste my horse it costs me about $140 a week; the injectable omeprazole is $160 for 7 days … hence the $20 difference in cost.

When I’m in full-on attempting to reduce the ulcers and do something with him (lessons etc) then I add in Neighlox and ranitidine … unfortunately for my boy, so many minor things can set off the ulcers again (e.g. changing another horse’s location on the property!). The research also seems to indicate that even 28 days of omeprazole orally doesn’t completely cure the glandular location of ulcers in grazing horses (where the squamous are more easily healed). And even if you cure them, then they can start a new set the next day. Such a horrible thing for the horses.

So far he’s had one dose and I’ve been surprised at the low level behaviour changes I’ve seen. I wouldn’t have said that he was at all fussy to saddle up but now he stands with a whole new level of relaxation and calm. He’s also been incredibly lazy to begin each ride! My vet said that another person asked her if it acted as a sedative, as their horse calmed down so much!!! I’m wondering if this indicates that low level of pain/discomfort that so many horses suffer from and we don’t recognise as symtoms of ulcers.

My horse is hopefully going to be re-scoped in another couple of weeks (he was scoped about 3 years ago, so we wont have recent comparisons) to see if the glandular ulcers are gone. Of course we can’t see hind gut ulcers … so I’ll never know about those! My plan is to do a 5 week course of injectable omeprazole and then decide from there what next. Hopefully we might get away with a 1/2 dose as a preventative, or just dosing around stressful events (if I KNEW what they were for this very odd horse … because spooky trucks, and a puppy dragging things onto the arena and dropping them underneath him are NOT stressful!).

@JB

It’s IM
http://www.equinews.com/article/gastric-ulcers-horses-injectable-treatment-development

I’d been reading articles like that so I was very surprised when my vet said it was now available!

@joiedevie99

I’d certainly give it a shot. I’ll ask my vet tomorrow if she can get her hands on it yet. We’ve tried literally everything else without substantial healing.

I’ll be really interested to hear about how other horses go … and the availability of it. Given the research was only published in 2017 I was thinking it would be years until us normal horse people could get it!!

[VintageCup]

I am starting my 8 year old gelding on the IM injectable omeprazole later this week (as soon as it comes in!). I sure hope it helps him. He’s so sweet when he’s feeling well, but when his ulcers act up, he gets grumpy and, well, angry under saddle when leg aids are used. I’ll post again after I give him the first dose.

DressageDreamerInAust - how many days after that first dose did you horse seem calmer?

[CindyCRNA]

Is it available in the US?

[vxf111]

As of a few months ago my vet said this was NOT available in the US but they were having great success with it so far in Europe/UK

[VintageCup]

@CindyCRNA

Is it available in the US?

It is now available in the U.S.!

[VintageCup]

@DressageDreamerInAust

I’d been reading articles like that so I was very surprised when my vet said it was now available!

I’ll be really interested to hear about how other horses go … and the availability of it. Given the research was only published in 2017 I was thinking it would be years until us normal horse people could get it!!

How many days did it take after the injection for your horse to seem to be feeling better?

[luckycricket123]

@VintageCup

It is now available in the U.S.!

Where could I find this? I can’t find anything using google.

[Twigster]

This is really interesting. Omeprazole is not activated until it reaches the low pH environment of the stomach, which converts the drug into the form which inhibits acid secretion. This makes the orally administered drug very specific to the area you are treating. I wonder if the side effects will differ with IM administration.

[JB]

@Twigster

This is really interesting. Omeprazole is not activated until it reaches the low pH environment of the stomach, which converts the drug into the form which inhibits acid secretion. This makes the orally administered drug very specific to the area you are treating. I wonder if the side effects will differ with IM administration.

Do you have reference to that?

The reason omeprazole has to be buffered/enteric coated/encapsulated is so that it won’t be destroyed in the stomach, so it can make its way into the intestinal tract where it’s absorbed. It doesn’t work by contact on the proton pumps in the stomach.

[Simkie]

@luckycricket123

Where could I find this? I can’t find anything using google.

I’ve read that Wedgewood is compounding it.

Caveat: have not confirmed :lol:

[Simkie]

WHOA. GUYS!

Okay, here’s the product from Wedgewood: https://www.wedgewoodpetrx.com/items/horse/omeprazole-im-injection-suspension.html

Got curious about that note about the licensing, and found THIS.

http://luodapharma.com/further-patent-applications-submitted-by-luoda-pharma/

Which seems to say that the long acting stuff is ESOMEPRAZOLE. Which makes my Nexium thread SO INTERESTING! How cool. I can’t wait to know more about this. :yes:

[Twigster]

@JB

Do you have reference to that?

The reason omeprazole has to be buffered/enteric coated/encapsulated is so that it won’t be destroyed in the stomach, so it can make its way into the intestinal tract where it’s absorbed. It doesn’t work by contact on the proton pumps in the stomach.

Sure. I think I was unclear, as I am not insinuating that it was working on contact as a buffer.

Mechanism of acid activation for chemistry nerds: http://pubs.acs.org/doi/abs/10.1021/acs.jpcb.

Like you said, without an enteric coating, PPIs would be activated in the lumen of the stomach and non-specifically bind to proteins and be excreted.

All of the PPIs accumulate in the acidic environment of the secretory cells of the stomach, and are there transformed into active intermediates that bind to the proton pumps, and reduce acid secretion.

With IV delivery in humans there are side effects such as hypomagnesemia; I would be particularly interested to know if these occur in horses and if they are more/less common compared with oral dosing.

[JB]

Right, I know the How of how they inhibit the PPIs (at least from a layman’s perspective LOL). But omeprazole in its native state degrades quickly in an acidic environment of the stomach, not activated. Oral administration is just one way to get it into the system, it doesn’t mean that the delivery route is specific to the area being treated. This IM administration bears that out. It has to work its way into the system in order to affect the pumps in the stomach.

IV delivery is different from IM delivery, and this is about the IM injectable. Any long-term use of PPIs in people has proven to have a greater risk of Mg deficiency (as well as Ca and B12) , leading to any number of issues caused by that. It’s not really been studied in horses, and there really are so few horses on truly long-term PPIs.

[raisethebar]

Love to have some updates on this and see if this is actually working for everyone! Tomorrow my guy is getting scoped and hopefully going to get some answers fingers crossed

[harr754]

This is very interesting. I just messaged wedgewood to see how much one bottle costs. (100mg/ml). Does anybody know the dosage? I currently use the pop rocks but this sounds easier. I wonder if there have been any side effects with the injectable?

[MCF1991]

harr754…let us know the pricing if hear. This sounds very promising.