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Discussion on Equine Antacids
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Member:
Lindac
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Posted on Saturday, Jan 11, 2003 - 9:15 pm:
Dr. O.
Are there "equine" antacids available for horses the same way there are antacids available for people who suffer from excess acid? I'm not referring to "ulcer meds" like cimetidine, ranitidine, gastrogard, etc., but rather something which can be added to a horse's diet on a daily basis to combat acidity and possibily prevent an ulcer condition from reoccurring. If there are such products available, what are they and can they be used on a long term basis without causing serious side effects?
I've read about the Mylanta and Maalox remedies in the article "Gastric Ulcers In Horses" article. Would these products also be helpful in pulling a horse through an ulcer attack in the same way banamine is used for a colic attack?
Thanks.
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Moderator:
DrO
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Posted on Sunday, Jan 12, 2003 - 9:09 am:
Hello Linda,
The reason we have medications like ranitidine is because antacids don't work very well. Though they can give temporary relief they are followed by a rebound acidity.
But that does not mean there is no preventive measures. There are a number of specific feeding management recommendations in the article that help reduce the ulcergenic factors.
DrO
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Member:
Lindac
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Posted on Sunday, Jan 12, 2003 - 4:47 pm:
Dr.O
Thanks so much for your prompt reply. The reason for all my interest in this subject is because I have an older horse (18 yr. old TB mare) that suffers from ulcers. She was treated last year with cimetidine and the difference was like night and day as soon as the treatments were started .... I guess I'm one of the lucky ones when I read what other horse owners have gone through. Right now her ration consists of a high fiber pellet mixed with soaked beet pulp, plus alfalfa choppings, which I also soak, as she seems to prefer this. I also add a tablespoon of baking soda to each of her rations (twice a day), as per a recommendation made by my vet. Her hay diet is basically a timothy/grass mixture, which I am now considering changing to a timothy/alfalfa mixture for this coming season due to her condition. Needless to say I'm trying to do everything possible to make sure she has lots of fibre with a buffering agent in her diet. But even with all this she had a very mild attack the other day. When I was finally able to coax some alfalfa choppings into her, she settled right down, but the signs were classic, so I'm 99.9% sure the source of her discomfort was excess acid. This is where my question regarding antacids comes into play. I went to the drug store and asked the pharmacist what the difference between Mylanta and Maalox was. She said they are exactly the same in terms of the ingredients and dosage amounts, (here in Canada anyway). Why then if these two medications are exactly the same would you give 240ml of Mylanta as compared to 380ml of Maalox? The pharmacist said that sometimes the dosage ingredients may differ between the Canadian and American markets and that I should confirm the dosage ingredients with you. I did finally purchase the "Mylanta Double Strength" which the pharmacist said might be considered "regular strength" in the states. The ingredients on the label states that "each 5ml contains 400mg magnesium hyDrOxide, the equivalent of 400mg dried aluminum hyDrOxide gel (306mg aluminum hyDrOxide). So, my question is, do I give my mare 240ml of this or 120ml of this to help lower her stomach acid?
Thanks again.
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Moderator:
DrO
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Posted on Monday, Jan 13, 2003 - 4:21 am:
Neither Linda, as neither are effective at treating or preventing ulcers. If you are sure she is suffering from a reocurrence you should be back on ranitidine or omeprazole.
DrO
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Member:
Lindac
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Posted on Monday, Jan 13, 2003 - 8:39 am:
Dr.O
I realize that these products do not prevent ulcers and I've already left a message with my vet explaining what happened and asking if she should be put back on ulcer meds. As my vet does not stock the ulcer meds and they have to be ordered in, I am looking at 3-5 days before treatments could be started. If she does have another attack I would feel more comfortable if there is something I could give her to ease her discomfort and get her to eat some chopped alfalfa to help buffer her stomach. I'm just not certain how much to give her of the Mylanta ..... 240ml or 120ml?
Thanks.
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Member:
Jessie
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Posted on Monday, Jan 13, 2003 - 12:46 pm:
Dr. O, are you saying that a product like "Neigh Lox" is not effective? Am I wasting my money on this product? I have an 18ish year old gelding who has minor colic episodes on a regular basis (about every 3-4 months). During one particularly bad espisode which went on for a few weeks, my vet suspected he may have developed ulcers - no scope was done. We treated with gastroguard and he recovered. My vet mentioned this Neigh Lox product and while not giving it a hearty endorsement, said I might want to try it. The problem with this, and other supplements, is it is hard to know if they are working or not. If my horse doesn't get sick, is it the supplement or is he just not getting sick? Do I want to stop the supplement and find out that it was helping and I've now got an emergency call in to the vet?
Have you heard of, know anything about "Neigh Lox?"
Thanks
Jessie
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Moderator:
DrO
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Posted on Tuesday, Jan 14, 2003 - 6:03 am:
Hello Linda,
The dosage for Mylana and Maalox are in the 7th paragraph under the treatment section of the article on gastric ulcers. I apologize for getting here so slowly but I want to be clear about the little it known about using this therapy.
Hello BL, what is in the Neigh Lox? The article explans that the effectiveness and prognosis of a horse treated for ulcers. It turns out that how long you treat initially effects the reocurrence rate. See the article for the details.
DrO
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Member:
Lindac
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Posted on Tuesday, Jan 14, 2003 - 9:28 am:
Hi Dr.O
I've read that paragraph which is where I originally got the dosages I quoted to you in my 1st post. The only problem is that the pharmacist here (Canada) said that the amounts of dosage ingredients can sometimes vary between the american and canadian markets, so if I do use Mylanta at some point as a temporary relief measure I just wanted to be sure that I was giving her the correct amount of the product, which at this point I'm not sure whether it would be 120ml of the "Double Strength" Mylanta or 240ml? (please see bottom of my 1st post for the canadian amounts of dosage ingredients of magnesium hyDrOxide in Mylanta to compare to the amounts in the american product).
As well, judging from your response I gather that you yourself have never used this as temporary relief method on a horse or know of anyone who has. If so, are you in essense saying it would be unsafe to use, and if so, why would it be published under the treatment section on Gastric Ulcers? Do you know of another product that would be better to use as a temporary relief method? (which in my case would be used while waiting for the ulcer meds to arrive).
Thanks again!
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Member:
Kathleen
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Posted on Tuesday, Jan 14, 2003 - 10:16 am:
Jessie & Linda,
We have a mare who went through about 8 years of recurring ulcers. She was treated at Texas A&M and at Marion duPont Equine Medical Center in Virginia (Morven Park). At Morven Park, the vets have done extensive research and treatment on equine ulcers. Apparently the more they learn, the less they seem to know about what causes the ulcers. It seems that stress (physical and mental) plays a large role. They finally found that this mare needed to be treated longer than the amount of time they normally recommend. She was scoped repeatedly over the 8 years as the ulcers kept coming back (or maybe they never really left). The last bout with this mare was about 3-4 years ago. At that time the vets at Morven kept scoping her after the initial treatment with Ranitidine and continued the treatment uninterrupted until the ulcers were completely healed. At the same time, we worked very hard on eliminating the stresses the we feel were contributing to the reoccurance of the ulcers. We continued to have her scoped every 2 months until we felt certain that they were not recurring. She has been symptom free for the 3-4 years since the last bout. During the 8 years of fighting the ulcers, we tried everything the vets thought might work, including Neigh-Lox. She had a recurrance of the ulcers while on the Neigh-Lox. She had been treated with Prilosec (omeprasole) for bleeding ulcers and then was on the Neigh-Lox for over 6 months when she had symptoms again. Each time she had symptoms, she was scoped, so we know for certain that is was ulcers. The vets at Morven Park said that after the initial treatment, even though the ulcers are sometimes not completely healed, that they normally continue to heal, that in fact many horses have ulcers with no symptoms whatsoever and that they come and go much more often than we realize. They once made the comment that if there was a horse with ulcers, and they treated it with peanut butter on its rump, that it had a good chance of recovering completely. In other words, horses usually recover on their own. We found that removing the source of the stress (if known and if possible) is the best way to keep the ulcers from becoming a problem. We also gave her generic Gastrogard when we knew she would be under stress (such as shipping). The problem with Maalox and Mylanta or any other treatment is that unless you scope the horse you really don't know if it is helping or not. We used both Maalox and Mylanta and sometimes we saw relief and sometimes not. The only thing that seemed to be consistant was the Gastrogard. The generic Gastrogard is much less expensive than the original Gastrogard, but still not cheap. I think it is about $20/day.
Kathleen
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Moderator:
DrO
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Posted on Tuesday, Jan 14, 2003 - 7:28 pm:
Linda,
My concern is in your first post you wanted to know about, and I quote, "long term use" while the article is quiet clear, and I quote, "They can very rapidly relieve clinical signs, making them useful at the onset of treatment. I am trying to talk you out of using these medications in the method you describe.
If the amount of active ingredient is different in the Canadian Mylanta, adjustments would have to be made. I do not know the strength of the product in the US so will have to look it up. I suspect that these two recommendations are taken from different references and if they are the same concentration, either would be found acceptable. It is unlikely we know what is optimum in horse do to lack of research in horses. I have used Maalox in foals with acute colic symptoms that I thought were associated with gastric ulcers without ill effects and rapid relief of symptoms. I'll bet I did not have a published dosage available to me at the time and used human adult dosages, printed on the bottle. This is what I will do next time too. I did institute ranitidine at the same time. We get this over the counter down here.
While there is no research on the use of these Mg based over the counter products these recommendations appear in standard veterinary text books and considered safe from lack of a toxic principle and the writer's experience. Considering everything it is not an acceptable substitute for other established ulcer treatment. If you want to use it before beginning effective ulcer treatment you must understand, it is not the dosage or the concentration that will get you into trouble, it is the rebound effect that may make things worse.
DrO
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Member:
Lindac
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Posted on Tuesday, Jan 14, 2003 - 8:22 pm:
Dr.O & Kathleen
Thanks for your reply, I really appreciate your patience with all these questions. When I mentioned "long term use" I was referring to a the possibility of an antacid specifically produced for horses not the Mylanta or Maalox products, which are essentially for human use. But when I read the gastric ulcer article I thought how interesting and that's actually where everything got started. I now realize though from the information you've supplied that there are not antacids produced specifically for horses, which is unfortunate. I did speak to a veterinary professor today at the Ontario Veterinary College who said he is aware of the using Mylanta and Maalox in horses and stated that he has never heard of any ill effects but did say it would be wise to confirm the dosage amounts as these things do vary between Canada and the States. I will wait to hear from you on this.
Kathleen,
I really appreciated your post, it was very informative. After reading what you've been through, it's obvious that even after the recommended treatment all ulcers don't necessarily go away and quite frequently return. I think this time, if I have to put my mare back on the ulcer meds I'm going to talk to my vet about the possibility of a longer treatment. I'm also going to really pay attention to the stress factor. She is a typical TB and it doen't take much, just bringing out the shipping boots is enough to get her excited. Oh, the joy of owning horses!!
Linda
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Member:
Jessie
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Posted on Wednesday, Jan 15, 2003 - 8:05 am:
Dr. O, The ingredients in Neigh-Lox are ground wheat, steamrolled oats, dihyDrOxy-aluminum sodium carbonate, aluminum phosphate, soybean oil, dicalcium phosphate and calcium carbonate. I do not have the percentages of each ingredient, this is just from the advertisement at KV Vet Supply. I feed my gelding 4 oz per day.
Next question, if I decide to stop giving this supplement, should I slowly wean him off or could I stop when my supply is gone?
Thanks
Jessie
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Member:
Paul303
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Posted on Wednesday, Jan 15, 2003 - 5:29 pm:
Almost sounds like baking soda
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Moderator:
DrO
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Posted on Thursday, Jan 16, 2003 - 9:12 am:
BL, as Elizabeth notes the active ingredients are antacids. Dr Murray writes in a recent text on equine gastroenterology that antacids have not been effective at preventing gastric ulcers, but he does not give a reference for this statement. Ranitidine has shown to be helpful at prevention but horses that remain in race training still developed them. Omeprazole (2mg/kg daily) was very effective at preventing them but expensive. Concerning the Neigh-Lox Iwould half the dose every week for 3 weeks then stop or stop when I ran out.
Linda, searching on the internet regular Maalox and regular Mylanta are identical. Dr Murrays gives the almost identical recommendations in our article, but reverses which of the 2 is the larger dose. On top of that he says the Mylanta should be given every 2 hours and the Maalox every 4 hr. I suspect the reason is the same for our variation. He is looking at two different clinical reports that used different dosages but both found effective. The bottles instructions themselves vary the recommended dose by 100%. To prevent confusion I am going to convert the dosage to mg in the article.
DrO
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Member:
Swainl
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Posted on Friday, Jan 17, 2003 - 7:32 pm:
I have a horse that continues to have ulcer recurrence, despite long periods on gastrogard. He remained on gastrogard until the ulcers fully healed (8 weeks), then went on half dose for another 6 weeks, during which time he sprung ulcers again (this time bleeding). I'm the sole client in possession of a "frequent scoping club" card at our local surgical center 
Currently, I am managing by feeding alfalfa pellets, and a combination of alfalfa and coastal bermuda hay, all of it soaked before feeding. I administer Neigh-lox about 30 minutes before I ride, and if it's been a hard schooling session, I give him some more after as well.
Since it appears that many horses with ulcers show no symptoms, and many horses that are in low stress pasture environments still develop ulcers, that perhaps the answer isn't to rid the horse of ulcers, but to manage the severity and accompanying discomfort better.
I keep Ranitidine on hand and use it during trailering, clinics, and horse shows. I also have a supply of mylanta (just for fun), and a couple of emergency tubes of Gastrogard (in case things get really ugly)---haven't had to use those, though. The other product I like to use is Finish Line's U-571. It contains aloe, cinammon, apple cider vinegar, and a whole bunch of other spices. It smells horrid, but my horse LOVES it. He gets 60 cc's and practically sucks it out of the syringe.
This program is working reasonably well, but I'm sure not as willing to just "pack up and hit the road" as I've been with prior horses. I think long and hard before I stress him with off-property excursions.
I really don't know if ANY of this concoction is doing any good, but it certainly seems that in many cases we need to be managing a condition rather than curing an illness.
Laura
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Moderator:
DrO
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Posted on Saturday, Jan 18, 2003 - 7:51 am:
Hello Laura,
The order of rapidness of onset of relief would be:
1) Mylanta (minute to an hour)
2) Ranitidine (12 to 24 hours)
3) Omeprazole (2 to 3 days)
This is also the order of the relatvie abilities to prevent ulcers. As the U571 has acetic acid in it, I would think it would be contraindicated.
I really question the use of an antacid as a preventive given at meal time: first there is no evidence that it helps, in fact just the opposite, and the stomach is suppose to have a certain amount of acidity to digest the food.
DrO
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Member:
Swainl
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Posted on Saturday, Jan 18, 2003 - 11:01 am:
Hello all--
I don't believe the program that I'm using is, in fact, preventing ulcers. By administering antacids (Neigh-lox or mylanta) before riding, I am hoping to buffer the acids that will splash up onto the unprotected part of his stomach during work (since the diaphragm flattens during trot and canter work, this is the time the most threat of that happening). If those acids have been buffered, then the splashing of the acid onto any possibly existing lesions may not be as painful. And if he can work without pain, then I have perhaps lessened the stress that may be contributing to the ulcers in the first place.
I know NONE of this has been scientifically proven, but logic and process of elimination leads me to try this. I do not feed antacids with meals, and I am fortunate that I work at home and keep my horse at home, so I can alter his feed program in slight amounts on a daily basis (ie on days he seems uncomfortable, I may throw him small amounts of alfalfa hay out in the pasture throughtout the day).
I will take another look at U571. Thanks for the heads up on that one.
Laura
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Moderator:
DrO
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Posted on Sunday, Jan 19, 2003 - 10:54 am:
There is one problem with your logic: the stomach is not a big open vessel, unless inflated by air like it is when scoped. It contracts and expands so there is no air spaces: there is no splashing going on. The stomach "senses" its acidity and tries to constantly adjust it to the optimum range for digestion. Your meddling just confuses it and there is a rebound phenomenea that can actually make things worse. While we use these products for acute pain relief they are not suitable as treatment or preventive, we know this through experimentation under controlled conditions. Though I do not know this for sure, logic suggests your efforts may be worsening the situation, not improving it. If chronic ulcers are your problem, persistant ranitidine is more logical and if it fails, persistant omeprazole your next step.
DrO
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Member:
Swainl
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Posted on Sunday, Jan 19, 2003 - 1:01 pm:
Up until June of 2002, I was working with a vet with an internal medicine specialty. She went to the ACVIM meeting in Dallas in May, and consulted with Drs. Murray and Merritt regarding equine gastric ulcer synDrOme. Among her recommendations were the following:
1. Short chain faty acids play a role in the development of gastric ulcers. Horses fed high grain diets make short chain fatty acids and contribute to the development of ulcers with exposure to acid. I would try eliminating grain altogether and adding more alfalfa for its buffering effects. In addition high fat diets delay gastric emptying and are not recommended.
2. Dr. Merritt presented a paper on exercise and its relation to gastric ulcers in the horse. He found that the stomach collapses during trotting and galloping and that acid is in contact with the nonprotected, nonglandular portions of the stomach during these phases and he thinks that is why exercise and training is also a part of equine gastric ulcers. His suggestions are to give omeprazole 1-6 hours prior to exercise to protect this portion during the exercise. The omeprazole is also most effective if given with a meal.
3. The last interesting topic presented was a human researcher trying to identify a Helicobacter that is species specific for the horse. He has good data to suggest that there is one but we do not know the clinical significance of its presence.
It was this information that led me to my current approach. I, too, am concerned about a "rebound" problem, particularly as it pertains to long term use of omeprazole and trying to wean a horse off of it. All I know is that right now, I'm able to train my horse, not administer omeprazole, and this is the longest we've been able to stay "drug-free" in over 18 months. Perhaps I should put a glob of that peanut butter on his rump!
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Moderator:
DrO
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Posted on Sunday, Jan 19, 2003 - 7:17 pm:
Interesting stuff. I had thought the 3rd question had been researched and in a fairly large sampling Helicobacter sp had not been found to be associated with equine gastric ulcers. But I cannot put my hand on that reference right now, I will look further.
The number 1 point runs counter to other findings that diets of grain and alfalfa actually resulted in higher gastric ph (lower acidity) than those consisting of grass hay (reference in the article).
If you would like to read the summary of the number 2 point it is presented in the article as the first scientific summary. Dr Meritt's work consists of the observations of 3 horses working on a treadmill. Your picture of splashing around made me smile but your basic point is excellent that the ph lowered in the stomach for these horses during threadmill exercise, thanks for the reminder.
I present the information to help you make up your mind what might work and what might not. There is no doubt our current understanding of gastric ulceration is incomplete. Research in both humans and horses strongly suggest your past use of omeprazole has contributed more to your current disease free status than your current use of antacids but I have a rule that no one should change what they are doing if they feel it is working for them, unles we have proof it is harmful and I have no such proof, just conjecture.
DrO
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Member:
Lindac
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Posted on Sunday, Jan 19, 2003 - 10:55 pm:
Dr.O
The one common thread I'm seeing is how ulcers are more of a management issue than anything else. The response to this topic has been great and it's been very interesting to read how other owners are coping with this problem.
Thanks for the research you did on Mylanta dosages. I understand your concern regarding the "rebound issue" and my plan is to only use Mylanta to relieve her discomfort prior to calling the vet. If it encourages her to eat some alfalfa cubes to settle things down bit, all the better. Fortunately, she has not had another attack but I just wanted to be prepared this time. You feel so helpless when you watch them suffer.
I realize that the following would depend on the type of exercise you're doing, but if we're talking strictly flat work would giving your horse a "small" amount of alfalfa cubes before and after exercise be helpful in keeping the acidity level down and protecting their stomach?
In one of your posts to Laura you questioned the use of antacids at mealtime. Do you feel adding baking soda to a horse's rations could possibly do more harm than good in the long term?
Linda
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Moderator:
DrO
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Posted on Monday, Jan 20, 2003 - 6:46 am:
Yes, I do not recommend any antacid be given at meal time as a preventive, or even treatment.
DrO
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Member:
Tmo0hul
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Posted on Monday, Jan 20, 2003 - 10:06 am:
Has anyone used the "Dynamite Miracle Clay" for ulcers? I read an article on a special type of clay that can be used by people and horses to assist in gastric problems. It contains volcanic ash, among other things which supposedly absorbs toxins. Once I read the artice, I though back to some behavior I noticed in 2 horses we know to have ulcers. They would consistently dig in the same spot in the pasture and eat the clay (not just licking - but eating chunks of carefully selected clay). At first I though they were going after minerals, and added loose mineral to their feed s well as a free choice mineral block. It didn't help. We have tried Gastric guard and many other vet prescribed medications. They are otherwise very healthy. We have racehorses who are under constant stress, and I hate to keep giving them all this medicine. Especially since it doesn't work very well. They clay can be given daily (as noted on the instructions) in a 1 oz dose that is mixed as a paste and given orally. Just wondering if anyone has heard of or used this product and the results. Thanks.
Christy
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Member:
Amara
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Posted on Monday, Jan 20, 2003 - 5:58 pm:
I have several horses here who are on the Dynamite products.. none have/have had any ulcers, but the people who are using the stuff swear by it (honestly my pony looks a lot better than theirs, and all he gets is a good quality vit/min supp., but..)...
Dynamite says it has a cure /for just about everything, including the common cold i think.. maybe it does...
i HAVE had good success using the vitaroyale program (vitaroyale.com) on horses with ulcers..
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Member:
Terivc
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Posted on Tuesday, Jan 28, 2003 - 11:03 pm:
Why ranitidine over cimetidine?? Cimetidine is actually cheaper per dose($11.27/100tabs cost on cimetidine 800mg vs $15.68/100tabs of ranitidine 300mg). Thanks, Teri
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Moderator:
DrO
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Posted on Wednesday, Jan 29, 2003 - 9:15 am:
The article on Gastric Ulcers explains why Teri.
DrO
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Member:
Soda
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Posted on Sunday, May 25, 2003 - 11:24 am:
I read the article and just need clarification. My horse was just diagnosed so I want to know what changes to make. She currently is feed grass hay/grain 2x a day. Should I switch to free choice grass hay with alfalfa/grain 2x a day? Or is it one or the other.
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Moderator:
DrO
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Posted on Sunday, May 25, 2003 - 11:55 pm:
Free choice forage (grass hay) is best.
DrO
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Member:
Redalert
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Posted on Friday, Oct 15, 2004 - 9:24 am:
DrO,
Are you still recommending no type of antacid given at mealtime as help avoid ulcers ?...I have started some of my young horses in training on the product UGard so that they hopefully can avoid ulcers. I have one horse(older show horse) with ulcers, and so I was hoping to avoid them by managing these young horses with proper nutrition and this additive(what do you say?). I know that the literature is changing all the time...however, your previous advice on not changing the acidity of the stomach at mealtime seems so logical to me. None of the young horses are showing any signs of ulcers, however they are not in the pasture 24/7 any more, and they have begun training. One of the young horses is a very nervous horse, and does not gain weight well. The other two actually seem quite fine. What would be your recommendation? I have to say how great it has been reading some of the articles and posts on "Horseadvice". Being able to learn more about gastric ulcers has definitely made MY stomach feel alot better! THANKS
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Moderator:
DrO
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Posted on Friday, Oct 15, 2004 - 1:27 pm:
Yes while antacids can reduce stomach acidity, they do so only for a short time and once used up may create a rebound effect that actually causes a transient period of increased acidity. They are not effective as a ulcer preventive in humans or horses.
DrO
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New Member:
desmom
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Posted on Wednesday, Jul 15, 2009 - 6:11 pm:
Dr. O,
My mare has been on Gastrogard for 6 doses but results are slow. Would it help to give also her doses of Mylanta or Maalox to aid in relief of the gases?
Thank you!
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Moderator:
DrO
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Posted on Thursday, Jul 16, 2009 - 7:54 am:
Welcome Gail,
We cover the use (indications and dosages) of antacids in the treatment subtopic of the article associated with this discussion. To reach it use the navigation bar at the top of this page and click one page back: Gastric Ulcers in Adult Horses.
DrO
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