Ulcer prevention when using bute UPDATED in OP

[lenapesadie]

Update: Spoke to vet and he said he “isn’t worried one bit about this horse developing ulcers from the bute treatment. If horse does develop issues he said this horse he would give GG/UG + miso (not sure of actual word here)”

I’ve used italics to replicate the vet’s emphasis on “this” horse. The story goes that my vet has treated the horse previously while horse was with his previous owner. Vet may or may not have experience with this horse and bute.

Vet prefers to reserve ulcer meds for if/when ulcers are diagnosed or we have symptoms of such. It was his opinion that the loose manure / stinky ness are more likely related to teeth and feed / environmental changes. He is comfortable scripting ulcer meds detailed above if I see any developing symptoms w out a scope (as horse is old and underweight and fasting seems unkind unless we do need ulcer meds and horse doesn’t respond).

My vet isn’t impressed with Previcox as far as lower risk for gastric upset versus effective pain management. But again if I want it he’ll give it to me should we decide horse needs long term pain management.

My senior rehab project has been prescribed 2grams of bute per day for @ two weeks. I’d like to give him something to protect his tummy while he’s on the bute.

He’s already getting a boatload of alfalfa. Free choice in his stall plus several pounds in turn out.

I was thinking Outlast?

[Simkie]

I’d not muck about with anything but a PPI with that much bute. Nexium or Ulcergard or whatever your personal preference is.

[Feathered_Feet]

A cautionary tale of concurrent bute and PPI usage: https://beva.onlinelibrary.wiley.com/doi/full/10.1111/evj.13323

(long story short, co-administration seemed to increase intestinal complications, so proceed with caution.)

[lenapesadie]

Thanks for sharing.

From the article

Conclusions

Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management

Sounds like risks either which way. I can control management changes (so I can avoid that at least).

[lenapesadie]

Thank you for replying.

I don’t want the poor dear to get ulcers, if he doesn’t already have them bless him.

[mmeqcenter]

With the above information, and the fact that you can’t get Ranitidine anymore ( can’t we just have it back for veterinary use???), I’d go for Famotidine or Cimetidine and Aloe vera juice.

[sascha]

Sucralfate and Aloe vera gel. I personally have had better success with the gel than the juice.

[mmeqcenter]

That’s interesting, first I’ve heard of that. Do you do the capsules or the “Gel lily whole leaf?” Or like, aloe gel for skin (just obviously without licodaine)?

[sascha]

I use Lily of the Desert https://lilyofthedesert.com/product/aloe-gels/

I buy it at the tack shop or health food store by the gallon. If you go that route, READ the label, the juice and gel bottles look almost identical.

[lenapesadie]

@mmeqcenter

, I’d go for Famotidine

Pepcid! I wonder if I can use the human stuff?

[lenapesadie]

I have a some good health food stores near me. I can probably rustle some up! Thanks for tip!

[leheath]

@sascha

Sucralfate and Aloe vera gel. I personally have had better success with the gel than the juice.

I agree with the sucralfate suggestion - my horse responded better to that than omeprazole and it protects the hind gut too. It also doesn’t have significant rebound issues. If I had to give bute, I would co-administer sucralfate and maybe Outlast too assuming the prescribing vet had no concerns regarding that combination.

[lenapesadie]

I’m gonna call vet about the sucralfate as I’m not sure I could get that on my own anyways

[sascha]

Same here. Omeprazole was a disaster for my horse.

@lenapesadie If my horse has to have any NSAID for more than a couple of days, I continue the aloe/sucralfate for another week or so after the anti-inflammatories are done. Your mileage may vary, but this has been the easiest way to get everything taken care of in one round.

[Simkie]

Ranitidine was the most long acting and useful of the H2 receptor antagonisits, IIRC.

Famotidine looks to need a dose of 2.0 mg/kg q 6. So that’s 1100 mg every 6 hours for a 1200 # horse, or 55 x 20 mg pills four times a day. A little more than one bottle daily.

I couldn’t find any similar study in cimetidine with a quick google.

Given the challenge most have in dosing something every 6 hours (geez, I’d even have a rough go of that, and I have horses at HOME) and the cost, it may be a whole lot easier to use nexium and add equishure to protect the hind gut.

[lenapesadie]

This poor horse is one big kettle of problems (probably why his previous owner declined to continue funding his pension).

I’m just hoping to avoid giving him anymore issues trying to fix up the existing issues.

[lenapesadie]

Well there went my Pepcid plan.

He’s at home but I am not planning on waking up at 2 am to dose the horse. He’s on his own between 10 pm and 7 am lol!

I happen to have some Nexium on hand but I’m going to wait for the vet call back to see if he has a preference and also costs. I like the old horse, but I’m not planning on spending big bucks trying to stave off a potential side effect from the medicine given to stave off side effects of the primary medicine.

[Simkie]

FWIW, I just treated a horse on antibiotics and banamine with nexium with no problems. I didn’t use anything for the hind gut, but she does always have hay in front of her.

Yeah, things can go wrong and not every horse out there responds well, but that’s the case for everything. Nexium has great ease of use/cost benefit. IMO, a course of nexium for this guy is a cheap & easy way to go with low (not zero, but low) risk of adverse event and it’s how I’d go in your shoes.

[lenapesadie]

Horse does always have hay! Even when he’s on grass.

I’ve convinced the farrier that I really do need him quicker than two weeks so hopefully we can cut the bute short.

[Fharoah]

I a study I read horse on bute developed ulcers within 5 days. I would consider previcox.