Ulcergard to Nexium

[BackintheSaddle2]

Hi Everyone,

Question: What should I watch out for if I switch from Ulcergard to Nexium and then to Abprazole granules (when they arrive in 2-3 weeks)? Would you recommend against these changes? Maybe stick with Nexium or use Ulcergard until the Apbrazole arrives?

Update: I may try just going with Nexium and seeing how that works before putting in the order with Abprazole–I haven’t read that anyone has had an issue with moving from Ulcergard to Nexium, but I am interested in hearing stories if that did happen. Thanks!

Context: My horse had colic surgery at the end of September. I haven’t scoped for ulcers, but since the surgery she starts to exhibit signs of discomfort around feeding time. Specifically, she will eat a little bit of hay and then walk away from it–sometimes laying down–only to get back up and eat more. I have found that a 1/2 tube of ulcergard stops the behavior, but a 1/4 tube does not. These past few weeks I have tapered her back down to 1/4 and then added Purina Outlast in hopes that she would be good to go. Unfortunately I saw her laying down again during feeding last night, get up and look at her flanks a few times–and then go back to eating. So back to the drawing board.

I need to find an alternative to Ulcergard–it’s just too expensive. Abprazole will take up to 21 days to get to me, so I was hoping to finish off the little bit of Ulcergard I have left, put her on Nexium for the next few weeks, and then put her on Abprazole when it arrives. But I am hesitant to switch brands like that…

[Martina]

I think talking to your vet is your best bet, and just be honest about the expense of longer term use of ulcergard. Have you tried sucralfate? You can give that 1/2 hour before meals/meds. It coats their stomach and can also help the hind gut. It isn’t a permanent solution but might help as she heals and regains her appetite.

[CindyCRNA]

You did what I would do. Stick with the Nexium.

[BackintheSaddle2]

Thanks, Cindy! My mare is currently on Day 4 of Nexium–she is doing very well so far!

[CindyCRNA]

How many capsules are you doing?

[JB]

@Martina

It coats their stomach and can also help the hind gut.

Sucralfate doesn’t exactly coat the stomach.

It is attracted to, and sticks to (so covers) open wounds, ie ulcers. But it needs the stomach all to itself to do that well.

[BackintheSaddle2]

@CindyCRNA: After reading the long Nexium thread, I decided to start with 7 capsules.

Overall, I think that it is working well. My mare did leave her hay for a few minutes last night though–no laying down, pawing or flank watching like the incident before I made the switch, so I am not too concerned yet. But if I see her do it again, I may up the dose.

I am in a boarding situation, so some management ideas–using Sucralfate x3 per day on an empty stomach or providing 24/7 hay–are difficult. Trying to figure out solutions that can work.

[EventingMaff]

How are things going with your horse on the Nexium? I have a mare on gastroguard right now and am thinking of switching to Nexium as the cost is just prohibitively high and my mare is tough to get oral injectables into so it means I’m having to get to the barn early every morning to give her the gastroguard (which is tough to fit into the morning routine of daycare drop off, dogs needing walking, random early work meetings)

[candyappy]

@BackintheSaddle2

After reading the long Nexium thread, I decided to start with 7 capsules.

Where in the Nexium thread did they advise to start at 7? The recommendation for horses was 3. I don’t know if they can OD or have issues if you overdose?

[JB]

Something I realized about esomeprazole after taking some time to really read the whole study is this:

They only tested gastric juice for the first 6 hours of each day of treatment. Not 12, not 24. 6.

They didn’t find any difference between the 40mg and 80mg doses (remember the study was done on roughly 500kg horses, from a little more than 1000lb to a tad more than 1200lb.

They were a bit surprised there was no difference between the doses since people to respond more to a higher dose (hence Rx is higher than OTC pills).

BUT, they also said they don’t know if horses would respond with more acid reduction (ie higher pH) on the higher dose if they had tested more hours after dosing.

They ALSO found that by the next morning when they did their new baseline testing, before that day’s dose, the pH was right back to ground zero.

Is that because esomeprazole doesn’t work as long as omeprazole? Is it because we need to use a higher dose?

I’ve run across a few people now who are using much higher doses than 3-4 capsules. some are using 14 or more. That’s more in line with this study
The effects of dose and diet on the pharmacodynamics of esomeprazole in the horse - PubMed (nih.gov)

In that study, pH was measured over 23 hour periods each of the baseline and treatment days. What worked best? 2mg/kg and “high grain low fiber” diet. What the frack. I think I’m reading right thought that 2mg/kg of a hay-only diet was good enough.

So, .5mg/kg means 250mg for a 500kg (1100lb) horse, which is 12.5 (round to 13) of the 20mg pills. So 14 pills I see used is really in line with that study, showing effectiveness over 23 hours. Sadly, we don’t know a lower dose that is still effective for 20-24 hours.

The 40-80mg dose study also stated (as a function of horses, not of the medication, and I did not know this), that acid production increases at night. What? I don’t know why, haven’t gone that far yet. But that right there is a GREAT reason to dose at night if you’ve got options.

[BackintheSaddle2]

@EventingMaff
So far my horse is doing great. It’s been 3 weeks, and no mild colic symptoms so far on the 7 per day. She seems relaxed and happy. I put 7 mini pills on top of her feed every night. Starting next week, I will bring her down to 6 pills for two weeks…and then continuing the one fewer every two weeks until she is done or until she starts exhibiting symptoms again. But I am happy with this solution so far–I use the non-generic Nexium, and it is ~25 dollars a week instead of ~120 per week on gastrogard.

I also have my horse on SmartDigest, which targets the hindgut. I have read that it is good to take care of the hindgut while treating for ulcers, and I can say that my horse has had good droppings through this trial. I would recommend a similar solution, if not SmartDigest, for your mare.

@candyappy: Apologies for the long explanation: Because my horse started exhibiting signs of discomfort at 1/4 tube of gastrogard, I was very skeptical that the 3 Nexium pills would work. So I started focusing on IPEsq’s posts in the long Nexium thread where (s)he referenced the article that JB mentions above. The dose is higher, and it seemed liked their tests showed better effectiveness. Like JB mentioned, the 3-pill study showed that horses went back to baseline after 24 hours. IPEsq and the associated vet figured that the a full tube of gastrogard is more equivalent to 14 pills, not 3. And since my mare did really well on 1/2 tube of gastrogard, I started with 7 pills. So it was a little bit of a guessing game, but the stall has a video camera so I could see if she was laying down or showing stomach discomfort. So far, so good.

[candyappy]

I will admit I found the Nexium thread well after it started so I didn’t read every post, didn’t know some people use more. Glad it seems to be working for your horse @BackintheSaddle2 .

[joiedevie99]

@JB

They only tested gastric juice for the first 6 hours of each day of treatment. Not 12, not 24. 6.

A friend is using 4 pills, 3x a day - breakfast, dinner, night check and claims to be having good results.

[fizzyfuzzybuzzy]

Question – I’ve been taught that Ulcerguard needs to be give on an empty (mostly) stomach. I applied that to my Nexium, and gave in a small handful of food or a small treat prior to breakfast. This thread intrigues me that people are having good results with Nexium given with a meal or meals. Is this addressed in any of the papers mentioned?

[BackintheSaddle2]

Not that I know of, Fizzy. But I can confirm that my horse’s symptoms were relieved when I gave Nexium with her evening feed.

[Simkie]

@fizzyfuzzybuzzy

This thread intrigues me that people are having good results with Nexium given with a meal or meals.

There are a lot of anecdotal reports of success with Nexium given with feed in the long Nexium thread. If you’d like to read it, you can click on my username to view my user card–it’s linked there.

[Bugs_s_Mom]

This makes so much sense given what I have seen with my horse on Nexium for the past 30 days fed AM only! He is on week 1 of taper (40 mg vs 60mg) and we have only noticed some changes in his behavior. He stopped grinding his teeth when girthing BUT has increased his wood eating at night, which would definitely reinforce the higher acid production at night. He is roughly 1250-1300lbs so definitely not getting the therapeutic dose recommended here. high grain low fiber definitely baffles me but if they consider TC sr. gold at 8lbs per day high grain he is there.

I do have an appointment to get him scoped on 2/19 and will likely be going down the Ulcergard route if he does have them (I will be shocked if he doesn’t). It is good to know that Nexium may work in the future just at 4 times the dose he is getting now.

Thanks for sharing all of that!