which begs the question - what will you use instead?
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Sucralfate.
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By itself? That won’t “protect against bute-induced EGGD” though. It would certainly help any lesions that did develop
Does this mean we should be looking at combo drugs to help protect everything?
Yes, by itself. That said, I try to avoid use of Bute because it seems to be the worst offender of Bute, Banamine, and Previcox for upsetting my own horse’s guts.
Knock on wood, sucralfate by itself (with the blessing of my vets) is the ticket to having repaired and maintaining my horse’s gut health. YMMV.
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But wouldn’t that maybe affect the absorption of the NSAID? Just curious!
I don’t know. However, I can say that when my horse got to the point of long term Previcox (founder) that she went off her feed and I started Sucralfate, she got her appetite back and her pain level continued to be managed adequately - she did not suffer a set back in her rehab.
Same deal a couple of years later with another problem that required a couple of months of Previcox. I started the Sucralfate earlier that time (a couple of weeks in instead of a month) and again didn’t see a reduction in rehab.
Of course this is nowhere near a scientific study, just my observation of my one horse who is very clear with her aggravation when she is in pain of any kind.
Ok thanks! Yes, pretty complex problem. Looking at all this I now have about 15 pages open doing some reading!! One paper I was looking at (same issue for people) examining the same issues, ie co-administration of NSAIDs with PPIs.
The incidence of GI damages (upper and lower ) were reduced with the COX2 selective inhibitors vs ns-NSAIDs (non-selective, COX1 and COX2 inhibitors) but not eliminated. Also that the damage to the lower GI (due to NSAID) was proportional to the acidity of the drug and it’s permeability and the PPIs were thought to increase the damage by modifying the intestinal microbiota.
Maybe there would be some benefit to using a probiotic supplement if someone was co-administrating a ns-NSAID (non-selective) and PPI? There’s a couple of papers out there looking at (haven’t made it that far down the rabbit hole yet…).
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There are some drugs that aren’t affected by, and don’t affect, absorption when given with sucralfate - ranitidine is one. So it’s not a given that bute would be negatively affected, or negatively affect, but TBH I have not done that research.
