I read somewhere that ranitidine and Sucralfate should not be given at the same time. Is the same true with omeprazole and Sucralfate? I’m doing one GG tube before breakfast. And have just started Sucralfate, 12g, tid. Can I give the first dose with his breakfast? Like within 10-15 minutes of the GG? TIA…
[QUOTE=Fox Wood Farm;8572180]
I read somewhere that ranitidine and Sucralfate should not be given at the same time. Is the same true with omeprazole and Sucralfate? I’m doing one GG tube before breakfast. And have just started Sucralfate, 12g, tid. Can I give the first dose with his breakfast? Like within 10-15 minutes of the GG? TIA…[/QUOTE]
Sorry, I can’t really answer your question, but I’m wondering what “breakfast” consists of?
No food for an hour before and an hour after sucrafate and two hours between sucralfate and gastroguard. Sucralfate protects the stomach, but will block absorption of gastroguard.
[QUOTE=Brian;8572232]
Sorry, I can’t really answer your question, but I’m wondering what “breakfast” consists of?[/QUOTE]
Breakfast is 1.2 pounds TC SR with 1/2 pound TC safe starch forage. (He gets the same at dinner + 1/2 pound TC30, flax, salt and E-Se-Mg.
He has orchard-Timothy hay free choice 24/7, so tummy is never empty. Also 1-2 flakes alfalfa every day. And stall to paddock 24/7 at his option.
[QUOTE=XTAC;8572259]
No food for an hour before and an hour after sucrafate and two hours between sucralfate and gastroguard. Sucralfate protects the stomach, but will block absorption of gastroguard.[/QUOTE]
Does that really mean NO food at all or just no concentrate? If it really means no food, that’s 6 hours without food every day. Seems counterintuitive for ulcer horse? Thanks for the info.
[QUOTE=Fox Wood Farm;8572294]
Breakfast is 1.2 pounds TC SR with 1/2 pound TC safe starch forage. (He gets the same at dinner + 1/2 pound TC30, flax, salt and E-Se-Mg.
He has orchard-Timothy hay free choice 24/7, so tummy is never empty. Also 1-2 flakes alfalfa every day. And stall to paddock 24/7 at his option.[/QUOTE]
Is that normal protocol to continue feeding concentrates while treating with omeprazole? Just curious since omeprazole can block about 90% of the acid production for up to 27 hours after treatment.
While your not feeding a lot of concentrate, I’m not sure I would be feeding any during treatment. If it were me, I think I would replace the breakfast and dinner with more alfalfa hay until treatment ceased. JMO
Might be a question to ask your vet.
[QUOTE=Brian;8572383]
Is that normal protocol to continue feeding concentrates while treating with omeprazole? Just curious since omeprazole can block about 90% of the acid production for up to 27 hours after treatment.
While your not feeding a lot of concentrate, I’m not sure I would be feeding any during treatment. If it were me, I think I would replace the breakfast and dinner with more alfalfa hay until treatment ceased. JMO
Might be a question to ask your vet.[/QUOTE]
When this same horse had stomach ulcers 2 years ago, I treated with GG only and the vet never said to stop - or even reduce - concentrates. And he was getting more TC SR back then. I insisted on a scope before treatment, because I really didn’t think he had ulcers. Found 3 bleeders. Rescoped clean 6 weeks later. Other attitude symptoms got better. But still girthy. Vet was not interested in even discussing the possibility of hind gut ulcers.
I get your point about GG suppressing acid. That’s why it works for gastric ulcers. I know that means some concentrate ends up digesting in the hind gut which can set up other problems. Which is why vets routinely advise smaller, more frequent meals while managing gastric ulcers. I’m not going to eliminate his supps or chaff. I don’t really think a pound or two of TC SR feed, which is very low NSC and very high fiber could cause that much trouble. But then again, I’m giving the Sucralfate because I think he has had hind gut ulcers all along.
Would be interested in any research or data you might have about treating ulcers with multiple meds and best dietary practices. Thanks.
Feeding/dosing wise, I go to the barn first thing in the morning and give Sucralfate anywhere from an hour all the way up to 10 minutes before breakfast. In the evening I give Sucralfate and Omeprazole together before I ride and then feed her afterwards.
My horse has a giant haynet so she is never truly without feed. She does not get a lot of breakfast. It’s about a double handful of a roughage type pellet, Purina Integrit-T. Lunch is the same. Afternoon is the same. Her “big” meal is given after I ride. That one has all her supplements, about a couple double handfuls of a Purina Senior, her oil, and her aloe vera.
This regime for treating during times I know will stress her guts works really well. In a perfect world, I’d be better about the morning dosing, but I’m not.
Obviously, this is not research, but a little sample of one horse who went from thin and crazy and anorexic during times of stress to FAT (oops!) with a great appetite. She’s also much less crazy 
How much of that is maturity and training and loving her routine, and how much is appropriate medications is anybody’s guess.
Per my vet: gastrogard preferably 1-2 hours prior to feeding grain. Sucralfate can be fed with grain, but not within an hour of the gastrogard.
[QUOTE=Gumby80;8573669]
Per my vet: gastrogard preferably 1-2 hours prior to feeding grain. Sucralfate can be fed with grain, but not within an hour of the gastrogard.[/QUOTE]
My vet had said same thing, when i treated my gelding for ulcers. Gave gastrogard then fed him grain…was maybe 10 or 15 minutes between ulcer meds and feed.
I was told by a pharmacist that omeprazole should be given 30-60 minutes before sucralfate.
Sucralfate can bind with a lot of medications and reduce absorption, so in general its recommended to give it well separated from all oral meds.
Update?
hey Foxwood - I was wondering how it was going with your horse?
I am in a similar situation with my gelding and have found a program that seems to work for us.
here is some background. He presents typical ulcer symptoms - lack of appetite, hard to keep weight, spooky/reactive etc. I had him scoped twice - once as a 3 y/o and again around 7 and both times he scoped clean. For most of his life I shrugged it off as “just him” and did GG as a preventative (1/4 tube for stressful situations for 2 days before and the day of) and just dealt with it. He had flareups a couple times a year- mostly when we changed from summer schedule to winter and he was in more, and also when his workload would increase. i did papaya juice and whatever else home remedies I could think of and worried about his weight constantly. I’ve done this for most of his life, but this past winter I did some research on my own and decided that instead of listening 100% to the vet who scoped him, i would consult a couple - come up with a plan on my own and implement it. I also did more research into hindgut ulcers and i while I believe thats what he had - i chose not to do the test. The vets I was working with indicated that the fecal test wasn’t super reliable and his symptoms and response to medication was a stronger predictor of his condition. Apparently the only sure way to know there are hindgut ulcers is through a necropsy.
Also, before I started this round of medication i did the normal route of dentist, blood panel, chiropractor etc just to eliminate anything else.
Here is what we do that works.
Turnout/Hay: He is on about 12/12 turnout on excellent pasture. When he’s in he gets a mix of orchard grass/timothy hay but he is not super interested in it (he has never been keen on hay) he might eat 1/2 - 1 flake the entire time hes in. Additionally, he gets about 2-3 lbs (dry weight) of soaked alfalfa cubes when hes in at night and about .5-1 lb (dry weight) soaked alfalfa cubes around noon.
Grain: The barn im at uses the Horse Sense products. He gets that as well as barley, oats, ground flax meal, rice bran and rice bran oil. According to Horse Sense all their grains are roasted in such a way to make digestion super easy and to eliminate the load on the hindgut. Additionally, I think that the no added sugar in this grain really makes a difference. i do think that he is calmer/quieter on this compared to other feeds. This is not a plug for Horse Sense - i don’t actually love this product for a hard keeper. I think Fibergized or something similar might even be better, but he does fine on this.
Medication: When he had his most recent flare up in November, I did and eliminated a week of treating ONLY with GG 1 tube one/day (helped slightly) and 1 week of treating ONLY with Ranitidine three times a day (did nothing). The ONLY medication that made a difference was Sucralfate. After about 2 - 3 days of it, he was eating everything. I did 10 grams of sucralfate once/day for a week and have been slowly easing the amount back so that now we are on about 7 g/day. I’ve been tapering myself the amount for about 3 months now and I just want to see the minimal amount that I can give him and have him stay happy. I grind the sucralfate, and mix it with a little bit of applesauce, and dose it with a syringe. I do this around noon before I ride, and then I bring him in and let him have his small bucket of alfalfa cubes prob 20 or so minutes after i’ve dosed him. If I can’t make it out to the barn they give it to him before his PM feed.
Additionally, i did the vet strength Succeed for one month, followed by the regular strength Succeed for 2 months. He gets this before his AM feed. Personally, i kind of thought Succeed was me blowing my money away and after he finished month 3 of it, i tried to switch him to a cheaper priobiotic/digestive supplement and within about 3 - 4 days he stopped eating his breakfast. I put him back on it and after about a week of the succeed he’s eating normally again.
I still do the preventative 1/4 tube of GG the day before and the day of a stressful situation (show, trailering, whatever)
On this program he has gained probably at least 100 lbs, and he happily comes in his stall during the day and eats his alfalfa cubes. He no longer has diarrhea when we trailer (or I bring him in) and hes a lot quieter on the cross ties. I would say his weight/body condition is the best it has ever been and we have had no problems with his eating other than when I tried to take him off the succeed.
Ulcers are so stressful, and I don’t think there is ONE solution to end all solutions. Just like people - there are different things that are going to exacerbate it, and it will probably be something that has to be managed their entire lives, until/if you’re willing to retire them and let them live on pasture 24/7. For us, what has worked the best is me taking a more active role and treating my horse like the individual he is and making adjustments as we go. For so long I was told that the only way to know if they have ulcers is through a scope and that the only thing to treat it is GG and so i thought that this was just the way it was going to be. I’m glad that I decided to do some more research on my own and had several vets that were willing to work with me and help me tailor a program that seems to work for us (for now).
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[QUOTE=Brian;8572383]
Is that normal protocol to continue feeding concentrates while treating with omeprazole? Just curious since omeprazole can block about 90% of the acid production for up to 27 hours after treatment.
While your not feeding a lot of concentrate, I’m not sure I would be feeding any during treatment. If it were me, I think I would replace the breakfast and dinner with more alfalfa hay until treatment ceased. JMO
Might be a question to ask your vet.[/QUOTE]
But the majority of calories and nutrition are coming from forage, so in most cases, the concentrates are just a smaller % of the total.
Acid is still needed to start breaking down the forage.
Some horses need a significant enough amount of extra calories, above forage, that not doing that for a whole month could have detrimental effects on their weight.
[QUOTE=JB;8596622]
But the majority of calories and nutrition are coming from forage, so in most cases, the concentrates are just a smaller % of the total.
Acid is still needed to start breaking down the forage.
Some horses need a significant enough amount of extra calories, above forage, that not doing that for a whole month could have detrimental effects on their weight.[/QUOTE]
Agree, but typically work or activity level is what creates the need for added calories over and above what is supplied by the forage. If added activity is the case, why not give the horse time off to reduce calorie needs while treating for ulcers? I guess my thinking is that if there is a chance of the concentrate not being utilized and bypassing to the hind gut during ulcer treatment, why feed it?
I would think if 30 days without calorie supplementation is going to have a detrimental effect on weight or body condition, there’s something seriously amiss with the forage being fed. JMO
[QUOTE=Brian;8596954]
Agree, but typically work or activity level is what creates the need for added calories over and above what is supplied by the forage. If added activity is the case, why not give the horse time off to reduce calorie needs while treating for ulcers? I guess my thinking is that if there is a chance of the concentrate not being utilized and bypassing to the hind gut during ulcer treatment, why feed it?
I would think if 30 days without calorie supplementation is going to have a detrimental effect on weight or body condition, there’s something seriously amiss with the forage being fed. JMO[/QUOTE]
As i understand it, a horse with ulcers does not have a “normal” gut pH so any therapeutic whether its omeprazole or ranitidine or whatever works in some fashion to help regulate pH and normalize their system. So theoretically, a horse with ulcers on ulcer medication would process its food much as a “normal” or ulcer free horse would. Many ulcer medications act to reduce the amount of acid being produced - i think this is where people see a danger in undigested food passing through to the hindgut. Because if your horse does not have an overly acidic pH, then the reduction could bring their stomach acids to a below normal level. Sucralfate, however, does not reduce the amount of acid being produced. It acts by creating a physical barrier that protects the stomach lining. This physical barrier while protecting it from stomach acid also inhibits the uptake of other things. Such as other medications, minerals/supplements, whatever. This is why MOST vets and ALL human doctors suggest taking sucralfate on an empty stomach and at least 2 hours outside of any other medication.
The other comment about cutting concentrates for 30 days and stopping physical activity is problematic for many reasons. First, most ulcer horses are underweight or very hard keepers to begin with and may not be able to eat enough even very high quality forage to supply the calories they need. Even if they are not being ridden they can be high strung, anxious and burn it off on their own. Second, stress exacerbates ulcers. So while, it might make sense to give them time off and cut their concentrate - when you bring them back into work and start upping their grain again, you’ve created a stressful situation…which may cause ulcers…which would put you right back at square 1
I know this is an old thread but this came up when searching for answers. My vet recommended to give ameprazole on an empty stomach. I forgot ask her how long it takes to get an empty stomach. Would also like to know how soon after administering the meds the horse can be fed. This pertains to pasture and hay only.
I have a friend going through this with her horse. I will ask her what her vet prescribed. I know there was some sort of delay in his morning feed, so he wasn’t being turned out “after breakfast” like all the other horses at the barn.
My vet recommends giving omeprazole as soon as you arrive in the am. Even if the horse still has some hay in his stall from overnight, he’s likely not been eating much recently. Then wait 1 hour before giving morning hay/grain. In reality, we often wait about 30 minutes.
My vet got back to me. My horses are out all night on a decent pasture. I bring them in around 10 a.m… She said wait an hour, no food. One hour after his meds he can have hay. I usually hang a nibble net which they don’t bother with for a while. They have a nap first. In the evening they get their vitamin/mineral mix along with flax and salt. None of them work very hard and they are all in good flesh except for the patient who is starting to look a little tucked up. We believe his stomach problem is due to 5 years of Previcox.
I recently asked the internal medicine specialist this exact question and sheet they must be given at least 1 hour apart from each other or you would be waistline your money. Gastrogard is most effective given at least one hour before breakfast as it is poorly absorbed with food.
