Horse Ulcer Treatment
When treating horse ulcers, GastroGard (Rx) is given once a day for 28 days. It's possible to use UlcerGard to treat ulcers by increasing the dose, that is by giving an entire tube rather than ¼ tube per day. This brings the dose to 4 mg/kg and is effective therapy for existing ulcers. Work with your veterinarian if your horse needs ulcer treatment.
GastroGard is the only FDA-approved ulcer treatment. There are many less expensive ulcer treatments, but they have not been shown to work. Some holistic veterinarians find that Succeed and products made with algae, such as CT Essentials, help horses with, or prone to, ulcers.
If the ulcers are chronic and have eroded deeply into the muscular layer, it may be necessary to treat with GastroGard or four times the regular dose of UlcerGard for longer than one month. Your veterinarian can pass an endoscope into your horse's stomach, show you on a video what the lining of the stomach looks like, and discuss how long ulcers of that severity take to heal.
Horse ulcer symptoms should ease within a few days for horses on GastroGard, but it takes about a month for ulcers to fully heal. Withdrawing omeprazole before healing occurs caused the reappearance of ulcers in over 90% of horses. Once horses are treated and ulcer free, they can go onto preventative doses of UlcerGard during times of stress. For example, horses being shipped to shows can start UlcerGard the day they are shipped and continue it until they are back home eating normally.
Several steps help prevent horse ulcers:
Maintaining a non-stressful environment helps prevent ulcers, but for active horses, UlcerGard is the only proven preventative. UlcerGard contains omeprazole, which is given at a concentration of 0.45 mg/lb of body weight (1 mg per kg). This usually equals about a quarter of a tube a day. Omeprazole at higher doses will treat ulcers. For example, ulcers are treated with omeprazole at 4 mg/kg, which is the concentration of GastroGard. Thus, ulcer treatment is the same as ulcer prevention, but at four times the dose.
Sucralfate is used for preventing ulcers in foals at the dose of 5-10 mg/lb (10-20 mg/kg), 3-4 times a day.
In addition to using GastroGard or UlcerGard to block hydrochloric acid production, it is helpful to coat the stomach with Sucralfate. Sucralfate tablets can be crushed and mixed in syrup so your horse receives 1 g/100 lb body weight 2-3 times a day. Sucralfate is also available as a liquid.
Sucralfate coats the stomach most efficiently when it is given one hour before feeding or two hours after feeding, and again at bedtime. Since Sucralfate only coats the stomach when acid is present, it should be given a half hour before Cimetidine or Ranitidine, which block acid production. Sucralfate should also be given at least a half hour before an antacid. Sucralfate can interact with some oral medications: Cimetidine, Tetracycline, Phenytoin, and Digoxin.
High carbohydrate diets can contribute to ulcers, so for some ulcer-prone horses it's best to provide calories from oils rather than from carbohydrates.
Phenylbutazone (bute) and Banamine Paste (flunixin meglumine) are the most commonly used non-steroidal anti-inflammatory drugs (NSAIDs). While most horses can tolerate these drugs at normally prescribed doses, some horses develop ulcers when using these drugs at even half the normal dose. If your horse has problems with ulcers, work with your veterinarian to set up a program to avoid NSAIDs, especially bute. If it's necessary to use an NSAID, Ketoprofen is less ulcerogenic than Phenylbutazone or Banamine. If continuing with Phenylbutazone or Banamine, consider using a lower dose.
Never use more than one NSAID at a time. For example, don't use Dexamethasone with bute. If possible, rather than using an NSAID, use other techniques to control pain. For example, work with your farrier to correct foot and heel pain. Consider acupuncture, chiropractic, and massage treatments to reduce muscle and bone pain.
UlcerGard, an over-the-counter medication, is for horse ulcer prevention. GastroGard, a prescription medication, is for ulcer treatment.
The only stomach ulcer treatment that is effective and approved to prevent stomach ulcers is UlcerGard, which is omeprazole given at a dose of 1 mg/kg. The only effective and approved treatment for ulcers already present is GastroGard, which is omeprazole given at a dose of 4 mg/kg. UlcerGard and GastroGard are exactly the same medication but at different doses. It's possible to use UlcerGard to treat ulcers by increasing the dose, that is by giving an entire tube rather than ¼ tube per day. This brings the dose to 4 mg/kg and is effective therapy for existing ulcers. Work with your veterinarian if your horse needs ulcer treatment.
UlcerGard and GastroGard are different than the omeprazole medication used to treat human ulcers (Prilosec) because they are not microencapsulated. Prilosec is microencapsulated so that it does not dissolve inside the human stomach. Because the equine and human stomachs are significantly different, the drugs used to treat their ulcers must be formulated differently.
Ranitidine or Cimetidine are used to treat and prevent ulcers, but these medications are less effective than omeprazole and must be given 3-4 times a day because they lower stomach acids for only a few hours. Ranitidine is more effective than Cimetidine. Although Ranitidine is not FDA approved for use in horses, many veterinarians prescribe this medication to treat ulcers in horses.
UlcerGard is usually more cost effective than Cimetidine and Ranitidine.
Any steps that reduce stress help reduce ulcers. When possible, relax your horse's training schedule, use longer pasture turnouts, and provide pain relief that does not include NSAIDs.
Parasites cause colic symptoms that mimic symptoms seen with ulcers. Regular worming may not reduce ulcers, but it will help prevent misdiagnosis and it will improve overall equine health.
Omeprazole is expensive. Because omeprazole is expensive, horse caretakers have tried a number of alternatives, but passing an endoscope and checking the stomach lining of treated horses shows that ulcers remain.
Unsuccessful ulcer treatment for horses include:
- Corn oil fed for six weeks
- Refined rice bran oil for six weeks
- Unrefined rice bran oil for six weeks
- Human omeprazole (Prilosec)
Veterinarians who pass an endoscope and observe the stomach lining don't find the above methods effective in treating horse ulcers.