Misoprostol - sources and long term use

[kashmere]

crossing fingers a vet may chime in here, but general collective COTH wisdom also very much sought and appreciated.

I’ve been through the ringer with my ulcery mare: gastrogard, generic omep, probiotics etc. The only thing that really seems to turn her around is Misoprostol. She is a different creature when receiving it. I ended up trying it as a treatment flying solo from my vet, because she was not willing to consider alternatives to GG.

I’ve tracked down a number of studies that support misoprostol as a treatment for EGUS and my mare’s response to it is really night and day. What I have NOT been able to find is information about longer term use - I have done two 30 day courses with her so far, but symptoms return each time after treatment.

I want to try an extended course of treatment (90 days) and see if I see sustained improvement. From my research, it appears relatively long term use in humans, dogs, and cats has no giant red flags - it seems to be based on inidividual reaction to the drug: if the animal is fine with it then they’re good to go.

Does anyone have any insight on longer term use of misoprostol for ulcer treatment? Is it possible to use a maintenance dose of it like some people do with omeprazole? It has a completely different mechanism of action (synthetic prostaglandin vs PPI) but I’m not a vet nor do I play one on TV so I’m a bit at sea.

Lastly - does anyone have a good source that is cheaper than the $200CAN I pay on racehorsemeds?

[joiedevie99]

My horse was on it for a year or so without issue while we were trying to cure his ulcers. Sadly, it didn’t help.

[DressageChic2]

my horse was on miso and then we moved to abler sucralfate as it was cheaper and worked in the same way-by coating the ulcer.

so see if abler sucralfate works out cheaper? my sister horse has been on this for 3 years with NO issues

[Larbear]

@DressageChic2

my horse was on miso and then we moved to abler sucralfate as it was cheaper and worked in the same way-by coating the ulcer.

Misoprostol isn’t meant to coat the ulcers, it acts on the gastric parietal cells inhibiting the production of acid (decreases proton pump activity).

[kashmere]

@joiedevie99

My horse was on it for a year or so without issue while we were trying to cure his ulcers. Sadly, it didn’t help.

When you say it didn’t help, do you mean his ulcers didn’t heal long term, or you didn’t see improvement while using it?

It’s basically a miracle drug for my mare, but symptoms return about a week after finishing treatment.

[Angela_Freda]

@Larbear

Misoprostol isn’t meant to coat the ulcers, it acts on the gastric parietal cells inhibiting the production of acid (decreases proton pump activity).

So it’s a PPI, proton pump inhibitor?
What about side effects? I see it can cause abortion… I’m not sure that other PPIs don’t as well… but I did wonder about the AE/side effect profile of it, compared to other treatments, when someone local to me recently said their horse was put on it.

Is it supposed to be used in conjunction with other meds? Why would it be the choice to use, vs other, more common meds?

[tabula_rashah]

One of the horses under my care was on it long term and it worked well for him. We purchased it in pill form directly from the vet. Another horse that was on it whose owner needed to be a bit more thrifty, had the vet call in a human script for it from Walmart and was able to use a discount prescription card. Although with being in Canada and having a very different health care system (lucky, lucky you!!!) I’m not sure if that’s something that’s an option for you.

[kashmere]

Thanks!

My equine vet has been really frustrating through this process, but I do have an absolutely wonderful canine vet who is a former equine practitioner. I may talk to him to see if he is able to help me out.

I very luckily have health coverage through my employer so I don’t know whether discount prescription cards are a thing here for those without medical benefits. I don’t think so, though - have never heard of them.

Appreciate the replies! It’s frustrating to struggle with spotty vet advice.

TR: Did the horse under your care end up coming off of it eventually or was it a forever thing? And was this a horse who was scoped for diagnosis/ recovery? Among the other veterinary frustrations I am going through, we also do not have access to a scope in my province. So. It’s a rough go!

[DressageChic2]

@Larbear

Misoprostol isn’t meant to coat the ulcers, it acts on the gastric parietal cells inhibiting the production of acid (decreases proton pump activity).

hmmm, i was under the impression it causes the body to produce more secretions that coat the stomach and thus the ulcer? i did not think it was a PPI.

[Angela_Freda]

DressageChic2- it looks like it does some of both-ish?

From Wikipedia [my bold]:
prevention[edit]
Misoprostol is used for the prevention of NSAID-induced gastric ulcers. It acts upon gastric parietal cells, inhibiting the secretion of gastric acid by G-protein coupled receptor-mediated inhibition of adenylate cyclase, which leads to decreased intracellular cyclic AMP levels and decreased proton pump activity at the apical surface of the parietal cell. Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for the treatment of acute peptic ulcers, misoprostol is only indicated for use by people who are both taking NSAIDs and are at high risk for NSAID-induced ulcers, including the elderly and people with ulcer complications. Misoprostol is sometimes coprescribed with NSAIDs to prevent their common adverse effect of gastric ulceration (e.g. with diclofenac in Arthrotec).

Misoprostol has other protective actions, but is only clinically effective at doses high enough to reduce gastric acid secretion. For instance, at lower doses, misoprostol may stimulate increased secretion of the protective mucus that lines the gastrointestinal tract and increase mucosal blood flow, thereby increasing mucosal integrity. However, these effects are not pronounced enough to warrant prescription of misoprostol at doses lower than those needed to achieve gastric acid suppression.

However, even in the treatment of NSAID-induced ulcers, omeprazole proved to be at least as effective as misoprostol,[SUP][10][/SUP] but was significantly better tolerated, so misoprostol should not be considered a first-line treatment. Misoprostol-induced diarrhea and the need for multiple daily doses (typically four) are the main issues impairing compliance with therapy.

That last bit really makes me wonder why it would be RX’d over other PPIs in horses not on NSAIDs…?

[Larbear]

@Angela Freda

So it’s a PPI, proton pump inhibitor?
What about side effects? I see it can cause abortion… I’m not sure that other PPIs don’t as well… but I did wonder about the AE/side effect profile of it, compared to other treatments, when someone local to me recently said their horse was put on it.

Is it supposed to be used in conjunction with other meds? Why would it be the choice to use, vs other, more common meds?

Proton pump inhibitors will affect all cells that produce acid so while I believe the misoprostol will act on the gastric parietal cells, I personally don’t know if it will affect other cells that produce acid and therefore not sure you could classify it as a PPI.

[Larbear]

@DressageChic2

hmmm, i was under the impression it causes the body to produce more secretions that coat the stomach and thus the ulcer? i did not think it was a PPI.

Well I believe the misoprostol will also stimulate an increase in mucus thickness, so it’s not acting in the same manner as the Sucralfate, at least to me. Doesn’t Sucralfate actually bind to the ulcer? I guess I should have said in my previous post that misoprostol doesn’t bind to the ulcer (and to me), a different mode of action.

[Angela_Freda]

I copied/pasted the Wikipedia info on Misoprostol… but that post is unapproved, apparently caught in the anti-spam barrier somewhere.

What I read, which I may muddle, is it’s real niche is wrt NSAID ulcers, and administration alongside NSAIDS.
Also it does have some PPI effect, but it also increases secretions of mucous, so that may be the coating idea some have.

Still is appears to be way less effective, even in it’s niche wrt NSAID than omeprazole… so I am not sure why it would be used, unless it’s way cheaper, maybe?

[EmilyM]

i think Misoprostol works more for ulcers past the stomach. so my vet said. my horse’s pylorus was awfully bright red. Became pink after 3 weeks of treatment on misoprostol.

[kashmere]

@EmilyM

i think Misoprostol works more for ulcers past the stomach. so my vet said. my horse’s pylorus was awfully bright red. Became pink after 3 weeks of treatment on misoprostol.

Do you mind elaborating a bit more on your overall treatment? My mare responds incredibly positively to misoprostol, but I have not had success taking her off the treatment. Within a week she is miserable again. How long did you treat your hours and what was your treatment plan for withdrawing the meds, if you don’t mind sharing?

[tabula_rashah]

@kashmere

TR: Did the horse under your care end up coming off of it eventually or was it a forever thing? And was this a horse who was scoped for diagnosis/ recovery? Among the other veterinary frustrations I am going through, we also do not have access to a scope in my province. So. It’s a rough go!

I actually don’t know. The trainer that the horse was with left the barn I worked for and the client went with him. Hmmm, I still keep in touch with his groom, I’ll shoot her a message and see. Also, not sure if it makes a difference, but he’s a high performance dressage horse doing a lot of traveling including back and forth to Europe and has a bit of a nervous disposition to begin with. Basically he’s the ulcer poster child.

[EmilyM]

@kashmere

Do you mind elaborating a bit more on your overall treatment? My mare responds incredibly positively to misoprostol, but I have not had success taking her off the treatment. Within a week she is miserable again. How long did you treat your hours and what was your treatment plan for withdrawing the meds, if you don’t mind sharing?

no problem sharing. no issues taking mine off of it.
my horse had a chronic colic winter of 2015 (in florida every week he was supposed to show). he had previously had one or two impactions over 2 years. finally got him scoped while in florida (maybe late feb), and he had clear ulcers in stomach and pylorus. I don’t know the grades. but enough to be bothering him. I did 7 weeks of ulcerguard daily, and I put him on assureguard supplement per vet orders. he had been living on compounded omeprazole powder since prior summer (i had thought he was just a picky eater, because when I bought him, I was told that). I had seen an increase in appetite from that before our diagnosis.
so after the 7 weeks of ulcerguard, I went for follow up scope, and he was still riddled with ulcers. zero improvement. they sent me home with misoprostol and told me to do 3 weeks of treatment and come back week 4. 5 pills2x/day. side effects can be colic. yikes, but he didn’t have any issues. when I came back, his stomach and pylorus looked perfect. They said if he seems iffy, put him on another course.

so basically they told me a lot of the other stuff was a waste (i think every horse reacts differently and also depends on length of condition). i still gave compounded omeprazole, assureguard. eventually i added equishure, becuase he had some mild colics. his colics would usually be impactions. i think his stomach would hurt, and he would stop drinking. I came to realize that he cannot tolerate nsaids for horse showing. I spend a lot of money on legend and adequan.
now I’m using alimend, and I’m doing misoprostol 2x per year as a prophylactic. I’ve spend oodles of money on supplements with limited success. the miso seems to work well. he’s also on free choice alfalfa and overnight turnout on grass. I feed ultium for its high fat and low(er than most grains) sugar. I feed maybe 1 lb 2x daily. I also put salt in his feed so he drinks a lot. and if it’s weather change or any chance he won’t drink, i make him a grain soup -handful ultium, salt and tons of water that he drinks. warm in cool weather cold in warm weather.

Basically, i’m trying to rationalize all the stomach supplements and just do miso 2x per year. i did not have any issues with him feeling bad once he was off of it. I have heard second hand of horses on Miso for a very extended time, but I’m not sure what the risks aside from colic.

hope that helps.

[kashmere]

This is super helpful! Thanks everyone!

[joiedevie99]

@kashmere My horse had no major ulcer symptoms - but had grade 4/4 bleeding ulcers when scoped. We’ve never seen behavioral changes as a result of different treatments - but he has had 12 or so scopes in the last 2 years. After his time on Misoprostol (and other things), his ulcers didn’t heal.

[Flashymover]

@kashmere

crossing fingers a vet may chime in here, but general collective COTH wisdom also very much sought and appreciated.

I’ve been through the ringer with my ulcery mare: gastrogard, generic omep, probiotics etc. The only thing that really seems to turn her around is Misoprostol. She is a different creature when receiving it. I ended up trying it as a treatment flying solo from my vet, because she was not willing to consider alternatives to GG.

I’ve tracked down a number of studies that support misoprostol as a treatment for EGUS and my mare’s response to it is really night and day. What I have NOT been able to find is information about longer term use - I have done two 30 day courses with her so far, but symptoms return each time after treatment.

I want to try an extended course of treatment (90 days) and see if I see sustained improvement. From my research, it appears relatively long term use in humans, dogs, and cats has no giant red flags - it seems to be based on inidividual reaction to the drug: if the animal is fine with it then they’re good to go.

Does anyone have any insight on longer term use of misoprostol for ulcer treatment? Is it possible to use a maintenance dose of it like some people do with omeprazole? It has a completely different mechanism of action (synthetic prostaglandin vs PPI) but I’m not a vet nor do I play one on TV so I’m a bit at sea.

Lastly - does anyone have a good source that is cheaper than the $200CAN I pay on racehorsemeds?

I am just starting the misoprostol pills received from my vet starting tomorrow but have been looking at the racehorsemeds.com option but am frankly wary as it is not from a pharmacy. How did you get comfortable using it and do you think there are any risks?