Use of Abler/generic omeprazole on confirmed ulcers

[awaywego]

I’ve read a ton, yes, a TON of threads by people posting about using the various Abler ulcer products on horses suspected to have ulcers, but I am not seeing any success stories on horses who were confirmed with ulcers via gastroscopy and subsequently scoped again to evaluate the generic treatment.

Has anyone done this? Or if not with an Abler product, another generically compounded omeprazole?

I am asking is because one of my horses was scoped and has ulcers. Prior to scoping, I had recently treated with a month of Abprazole (blue pop rocks - BPR) and maybe the ulcers were improved from what they would have been or maybe he needed another month of BPR - too many maybe’s! Curious if anyone has been able to actual confirm successfully treating with something other than Gastroguard (which I have already done 3x with him!). Not just “my horse seemed better so I think it worked.” :winkgrin:

Presumably if Abler could produce successful results in a clinical trial, we would see some published results.

Also curious if anyone has treated ulcers with antibiotics (and/or in conjunction with a PPI)? This is how most humans with ulcers are treated.

[Ambitious_Kate]

Not sure why a company producing omeprazole would publish results of a clinical trial. Omeprazole has had clinical trials and the results published. Omaprazole works. They are selling omeprazole. I don’t need to see another trial done.

No, I haven’ scoped, but I have treated with Abler, and my horse’s ulcer symptoms were cleared up, so as far as I am concerned it worked well.

[awaywego]

[QUOTE=Ambitious Kate;8201656]
Not sure why a company producing omeprazole would publish results of a clinical trial. Omeprazole has had clinical trials and the results published. Omaprazole works. They are selling omeprazole. I don’t need to see another trial done.

No, I haven’ scoped, but I have treated with Abler, and my horse’s ulcer symptoms were cleared up, so as far as I am concerned it worked well.[/QUOTE]

Well since there are a number of people who believe GastroGuard has the only effective delivery system for omeprazole in horses, I would guess if another company thought their delivery system was equally effective, they would want to demonstrate it

[Simkie]

I have a vet who’s done pre and post scoping studies using the omeprazole paste from precision pharmacy and found it equal in efficacy to the merial products.

[jlphilli]

As long as the omeprazole is buffered or has some sort of enteric coating, it will be equally effective. Abler’s products are like this.

[awaywego]

[QUOTE=Simkie;8201807]
I have a vet who’s done pre and post scoping studies using the omeprazole paste from precision pharmacy and found it equal in efficacy to the merial products.[/QUOTE]

Thank you! That is exactly what I am wondering about - specifically horses who have been scoped and not just “acting ulcer-y” - because otherwise there are just too many variables.

Side note: interesting that they are selling an omeprazole paste - I was under the impression no one will compound it in a paste and risk legal hot water with Merial. My vet said he can only get in powder, so I will tell him about Precision Pharmacy.

[jlphilli]

[QUOTE=awaywego;8201828]
Thank you! That is exactly what I am wondering about - specifically horses who have been scoped and not just “acting ulcer-y” - because otherwise there are just too many variables.

Side note: interesting that they are selling an omeprazole paste - I was under the impression no one will compound it in a paste and risk legal hot water with Merial. My vet said he can only get in powder, so I will tell him about Precision Pharmacy.[/QUOTE]

Merial’s patent expired in April.

[Simkie]

I have another vet who’s used the Precision Pharmacy omeprazole power and likes it fine, but he doesn’t have a scope, so no real data.

The paste is actually omeprazole/ranitidine, 10 cc given once per day and costs ~$300 for a month of treatment.

[Simkie]

[QUOTE=jlphilli;8201842]
Merial’s patent expired in April.[/QUOTE]

No one has brought an FDA approved generic to market. Merial might not go after those marketing omeprazole for horses, but the FDA sure will…hence all those warning letters that went out earlier this year

[wildlifer]

[QUOTE=awaywego;8201680]
Well since there are a number of people who believe GastroGuard has the only effective delivery system for omeprazole in horses…[/QUOTE]

Not quite true. Abler’s enteric coating has also been testing in multiple cases, the delivery works fine. It’s just that the amount of actual omprazole per serving is not consistent, whereas Merial’s is.

If my horse hurts, I can’t afford to spend money & am not going to, on something unless I can verify to the best of my ability that he is getting the amount of substance I am paying for. My bank account pretty much only exists in imaginary land, so no wiggle room or desire for experiments if I don’t have to!

[Simkie]

[QUOTE=wildlifer;8201890]
Not quite true. Abler’s enteric coating has also been testing in multiple cases, the delivery works fine. It’s just that the amount of actual omprazole per serving is not consistent, whereas Merial’s is.

If my horse hurts, I can’t afford to spend money & am not going to, on something unless I can verify to the best of my ability that he is getting the amount of substance I am paying for. My bank account pretty much only exists in imaginary land, so no wiggle room or desire for experiments if I don’t have to![/QUOTE]

Oh, interesting. I’d not heard that the amount of drug per dose in the Abler products was variable. Can you point me to a source?

[candico]

I am fairly certain that the inconsistent amounts were for the Abler paste - and it was that sometimes you got more than what the paste syringe indicated, not that you were getting cheated…

[Simkie]

Right–from the FDA warning letter. “Adulterated” because the paste contained 111% of the label claim. No mention of the “pop rocks” though, in the letter other than the general “knock it off.” Curious what wildlifer has seen about sub-potent issues in the granules…

[CHT]

My horses tested positive for stomach and hind gut ulcers using the Succeed test. 22 days on the generic Omeprazole and L-glutamine, and she tested negative for stomach ulcers and low positive for hind gut ulcers.

It is a liquid, and I think compounded by Precision Pharmacy. Smells strawberry. She was also on Equine Choice Paste probiotics.

Her only outward symptom of ulcers was being grouchy to brush, and being a picky eater. She stopped being a grouch to brush as soon as she went on grass for a few hours a day (but before she was actually tested-so she did still have ulcers, she must have just felt better), and stopped being a picky eater by the end of her omeprazole.

I chose not to have her scoped, but will if her next Succeed test shows the return of stomach ulcers.

[J-Lu]

[QUOTE=Simkie;8201989]
Oh, interesting. I’d not heard that the amount of drug per dose in the Abler products was variable. Can you point me to a source?[/QUOTE]

For one thing, Abler is an Indian Ocean-based distribution company for equine pharmaceuticals. What type of rigor do you think occurs in their manufacturing plants? Their plants have no oversight or regulation. Merial is a large international animal pharmaceutical company that has their own R&D, pipeline development and distribution. I don’t have to really guess that their quality control is much more stringent than Abler’s. You get what you pay for. Even in the U.S., generics aren’t manufactured to the same specs as brand names.

My veterinarian gets agitated when people mention compounding companies! They don’t have the same standards as many drug companies and often use inferior starting ingredients (why do you think they’re so cheap!?). And the places that make them are not regulated by the FDA so how do you know what you’re getting, exactly? FDA-approved facilities HAVE to conform to standards. In 2014, a compounding company released a formula that killed 4 horses. In 2009, a Florida compounding company released a formula that killed 21 horses.

I see the attraction to using cheaper drugs because they are easier on the wallet! No doubt! But I don’t trust these sources. At the very least, you just have to assume the risk when buying products from these places.

[Simkie]

Oh, please. FDA approved drugs are made in India all the time. And being FDA approved hardly means quality control is 100%. Have you seen the FDA recall list??

http://www.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm?tracking=BikePGH

Note this at the top:

[B]NOTE: The recalls on the list are generally Class I., which means there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death.

[/B]Only had to go to page two to find the first “sub potency” issue:

http://www.fda.gov/Safety/Recalls/ucm427952.htmCheck out how long that subpotent drug was on the market (over a YEAR) and the warnings regarding it. All scary.
Being made in India does not automatically = poor quality control and being FDA approved does not automatically = safe.

As with everything, it’s balancing risk/reward.

And the reason the Merial product is so ungodly expensive is being they’re trying to recoup their development costs…

[candico]

FWIW, all of the vets that I have been around actually prescribe compounded omeprazole, usually Precision Pharmacy, or just tell you to get the human kind from the drug store. They only dispense Gastroguard if insurance is covering the expense or you insist. The general consensus among them is that Merial is GREEDY, not that they are a superbly superior company investing gobs of money into quality and research. They do invest gobs of money to try and brainwash vets that their product is the only one that could possibly survive the equine gut and be effective, but for those vets that have witnessed plenty of horses including their own rid of ulcers on compounded and generic human omeprazole, Merial just looks like crooks. Look at all the advertising dollars they spend!! That is what you are paying for as well…

I also have never had any of them frown upon my using a “product from India” and in fact have asked for more info for their patients that struggle to pay for the compounded versions they have to offer. I am sure it would be different if it were a product that had to have precise amounts or else could be fatal, but I have yet to hear of a fatal dose of omeprazole or anyone complain of side effects from Ablers pop rocks vs the side effects from Gastroguard - namely rebound and exacerbation of hind gut ulcers.

Also have yet to find a vet here that actually takes any stock in the Succeed test. Seems they see it more of a gimmick rather than a legitimate test for ulcers - but at least it is not terribly expensive. They get you when you buy the Succeed ???

[awaywego]

[QUOTE=wildlifer;8201890]

If my horse hurts, I can’t afford to spend money & am not going to, on something unless I can verify to the best of my ability that he is getting the amount of substance I am paying for. My bank account pretty much only exists in imaginary land, so no wiggle room or desire for experiments if I don’t have to![/QUOTE]

This is basically where I am - since the ulcers are most definitely there, I don’t want to waste my $ on stuff that no one is sure if it really works! But my 2nd horse has killed my bank account with bouts of EPM and Lyme, so I would like to know if there is sufficient evidence that anything other than the $$$ Gastroguard works I am just not seeing any - but that doesn’t mean it doesn’t!

Mostly I’m skeptical of how we treat horses altogether for ulcers. I really do not understand why we don’t treat with the quad therapy that humans get. I’ve been thinking about this a lot because this horse is retired - theoretically a low stress lifestyle - and yet persists in having ulcers. If you apply current wisdom that stress is the main culprit behind horse ulcers, it just does not add up for me.

[awaywego]

So is it just that those who pay the $$ to scope also cough up the $$ for gastroguard?

For all the people I see on here talking about their ulcer-y horses, it sounds like an overwhelming majority do NOT have their horses scoped because it is just cheaper to do a course of generic omeprazole. So who really knows if 1) the horse actually had ulcers!, or 2) if the omeprazole “cured” the ulcers.

[Simkie]

[QUOTE=awaywego;8202295]
So is it just that those who pay the $$ to scope also cough up the $$ for gastroguard?

For all the people I see on here talking about their ulcer-y horses, it sounds like an overwhelming majority do NOT have their horses scoped because it is just cheaper to do a course of generic omeprazole. So who really knows if 1) the horse actually had ulcers!, or 2) if the omeprazole “cured” the ulcers.[/QUOTE]

Nope, there are plenty of people using gastrogard without a scope, either :rolleyes:

Look, I get that you’re frustrated here. People don’t scope for a variety of issues–including cost–but also access to the equipment, the risks of scoping and likely the requirement to pull a horse off of feed for the exam.

We also don’t scope every single human we supply with PPIs, either. We treat off of symptoms. It is not unreasonable to take a horse with ulcer symptoms, treat for ulcers and assume the horse is better if the symptoms are gone.

As with ANYTHING, youse pays your money and youse takes your chances. If you spend the bills on GastroGard and pay to have the horse scoped before and after, perhaps you have some recourse with Merial if the treatment is ineffective. There are some people here who have scoped pre and post GastroGard and don’t have the healing they expected after 30 days. If they’d been treating with a off brand, you’d probably say the treatment was ineffective…but they weren’t. It took more treatment, even with the Merial product.

It’s all about balancing your personal comfort with the risk/reward. Me? When I’m faced with a horse fresh off the track, with 100% typical ulcer symptoms, I sure don’t bother scoping. Good lord, why put them through that? I use the paste that my vet feels works just as well as GastroGard (confirmed via her own scoping studies!) and I treat the horse. And when it gets better, we move on.

As for the human quad therapy? Zero evidence in horses that ulcers are caused Helicobacter. Not to mention the cost of doing something like that in a horse (you think GastroGard is expensive??), and the chance of impressive side effects.