Let’s talk ulcers: omeprazole and sucralfate

[fivestrideline]

I’ve done a search but I have a specific question I didn’t find well addressed. And yes I do have a vet involved - I’m just looking for more info, as the vet suggested top dressing his feed with both meds and I know better; I’m a bit on my own for the details here.

When using omeprazole and sucralfate to treat ulcers (and suspected hind gut cause it’s THAT horse and of course he’d have them) - is best practice to dose both drugs concurrently? Spaced out - sucralfate 2 hours before OR 30 min after supps or omeprazole - but in the same 30 days? Is there a risk or downside to doing a month of one and then a month of the other? I’m using “a month” as a catch-all here, not necessarily restricting to that timeline.

I ask because I board and timing out these meds + his supps (he’s got an essential one) is a NIGHTMARE. Logistically, I can probably do 2 sucralfate doses and 1 omeprazole dose. 3 sucralfate (as suggested by my vet) might be impossible. The BOs work and there’s no other boarders that come out daily, and the staffer is so nice but I just don’t trust that person with something important like meds.

So, is there a reason to move heaven and earth to do both meds concurrently, or can I do them sequentially?

[Critter]

I have one that’s had two rounds of severe ulcers (scoped)…due to some other health issues (first was two fracture ribs causing pain…next was EPM/Lyme).

I did space out the sucralfate and ulcergard…because both meds were important and I didn’t want to risk one negate the other. I did put the sucralfate in with the feed…and did the UG in between. I used some soaked alfalfa pellets for that…so he got sucralfate/alfalfa in AM…UG and then PM feed with other supps, then late night sucralfate with alfalfa. This worked…he scoped completely clear with this and it wasn’t too much of an issue to do.

Then I kept him on 1x sucralfate for a while. Let’s just say that by itself is not enough for my guy…as he did redevelop bleeding ulcers on that. Added back in UG and cleared them up again. You could also give the UG…then do about 30 minutes of other stuff…then feed with the sucralfate. We did that sometimes on the second round and we also cleared everything up that time.

Now he is just on a maintenance dose of UG…because I don’t know what else to do for him (it’s not a management issue…he has near 24/7 turnout with others, grass, low concentrate amount). But clearly recurrent ulcers are a major issue for him.

[MissusS]

When my last mare was being treated for ulcers we did sucalfrate early morning, omeprozole before lunch, sucalfrate early afternoon. This was the vet-recommended schedule based on the barn staff schedule and my mares needs. After a month or so we went down to just omeprozole once a day for about another month.

This worked well for her.

[JB]

No, you shouldn’t dose the 2 together.

Omeprazole first, and then ideally 60 minutes later, but at least 30, the sucralfate (no food in between). And THEN, no food for another 30 minutes.

And ideally omeprezole is given on an hours-empty stomach, but that’s not possible for a lot of people. I’ve seen post-treatment scoping of ulcers all healed just by having no food for 30 minutes before the omeprazole. I don’t pretend to imply that will work for ALL horses, but certainly LOTS of horses have been successfully treated on a barely-empty, or really not empty stomach. I’d still suggest doing the best you can manage, even 30 minutes of no food.

“no food” can include a tiny meal to get the meds in if necessary.

And though sucralfate should ideally be given roughly every 8 hours, often just twice a day is what it has to be. That timing should make it such that it’s not difficult to work with the 2 hours before, or 30 minutes after omeprazole

You want to go both in the same month. Omeprazole won’t help hind gut issues, and may cause or worsen them.

[fivestrideline]

Thanks y’all - the vet threw me off with the “feed both meds in the same bucket” thing so I was second guessing myself big time.

I can pretty easily do sucralfate first thing before work, omeprazole at lunch (there’s not much pasture so that’s about as empty a stomach as they get), and sucralfate again after dinner (or at least after his supps - I can toss those in with some yummy alfalfa and then groom for 30 minutes). I can also switch the meds around but that’s the timing.

He’s definitely showing ulcer signs - I pulled him off Nexium when I wasn’t seeing improvement this time - but I’ll be out of town for most of December so I wanted to wait to start his meds after the new year. At the same time I feel bad for him if is stomach hurts, but am I right in thinking it would basically be a waste to do 2 weeks of meds, stop for two weeks, and then start again?

[JB]

Here’s what a recent acquaintance did, which proved to clear her horse up completely, so you can get a general idea of how it might all look for you

6am - sucralfate in a tiny bit of food

1:30 - GG
2:00 - sucralfate
2:30 - meal

11:30 - sucralfate

@fivestrideline

am I right in thinking it would basically be a waste to do 2 weeks of meds, stop for two weeks, and then start again?

yes, don’t do that Some will tell you they fixed their horse in 2 weeks. MOST of the time I’ve seen that, they never had a scope to begin with, so they might have started with only a few really low grade ulcers. Sometimes it worked, even with worse grade ulcers, but again - outliers, not the rule.

Full time meds for at least 30 days.

[tabula_rashah]

My gelding was scoped and diagnosed with ulcers a couple of weeks ago. He is currently on 7 tabs of misoprostol AM & PM daily and 10 tabs sucralfate 30 mins before anything stressful and then again 12 hours later. I give both in his feed. We’re also working around the fact that both misoprostol and sucralfate are banned substances with AERC (72 hour withdrawal for misoprostol, 8 hours for sucralfate). This plan seems to be working very well as far as outward signs- remarkedly improved appetite, less objection to being girthed up, etc. We’ll see how much healing we’ve got with the rescope in January

[Critter]

If it were me, I would start both meds now…then if you are away, if you can at least get the omeprazole in him for that period (since that’s also less complicated). Then when you come back add the sucralfate back in.

Mine got ulcers again when on just sucralfate (after he had scoped clean), so with him, the UG is the more important med…yours might be different of course.

[mrsgrieves]

My vet says to do Gastrogard before grain, and then Sucralfate at least 30 mins after, preferably an hour. So we always give the GG, then feed the horse, and usually when they’re done eating/we make up grain, etc. it’s been almost an hour and then we give them the Sucralfate orally (vet said to NOT feed in grain, so we mix it in a dosing syringe with water and let it dissolve). This definitely works, because we had a horse get scoped with streaks of bleeding ulceration, and 60 days later when it rescoped, its stomach was healed completely.

[fivestrideline]

Let me tell y’all - meds like this when you board and have to drive 30 minutes each way (and have other obligations!) ain’t easy.

I’m still waiting until the new year to start his meds, but I have been trying to figure out the timing. I cannot be there for an hour+ multiple times a day. This is what it looks like:

6:30am - swing by before work. Max visit of 10 minutes

12pm - lunch break. Max visit of 20 minutes

4:30pm - after work. Max visit of about an hour, maybe two. Coincides with feeding time, which means kicking around until 30 minutes after he eats. I cannot go out there any later than directly after work.

I’m thinking of doing sucralfate in the morning (he gets breakfast a bit afterwards, but no supplements in breakfast). Omeprazole at lunch, should be a mostly empty stomach at that point except for scraps of hay and grass. Sucralfate after work, he gets supps in his dinner but I could potentially feed him myself and then give him sucralfate right before turning him out.

It will mean missing my lunch break and burning serious fuel, but I can do it for a month. More than that, I’m not sure if the SO will be pleased the weekends may be one visit days, omeprazole and sucralfate, but it is what it is.

[Angela_Freda]

Barn staff here
I would gladly, personally dose the meds myself, even if it meant doing it on my own time/break.

[fivestrideline]

I board at a small place with no staff - there is no one around to do it! If it went in the feed, it would be different. The evening meds might be done by the BO - but that’s actually the easiest one for me to do since I’d be there anyways

In the past at other places I’ve had both experiences - staff used to and able to do pretty much any med routine and never missed a day, as well as places where you were lucky if the horse got his daily smartpak . It made me a little overly hands-on, but in this case it is what it is.

[Texarkana]

Man, my horses are at home and I still found Sucralfate + omeprazole to be the biggest drag ever. So not worth it. I groan every time I have to put a horse on Sucralfate.

[Gardenhorse]

When i had to have my horse on omeprazole and Sucralfate, I put the sucralfate in her grain. Not ideal, but the only way it was going to work for us. I would do the morning Sucralfate in his grain and save yourself a trip.