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  Discussion on Injectable famodine?
Author Message
Member:
lindas

Posted on Friday, Jul 25, 2008 - 12:07 am:

Hi Dr. O,
I have a good friend who is also a small animal vet. He used to work on horses so he still treats his own horses without consulting an equine vet. His daughter's horse is currently being treated with bute and banamine for laminitis. (personally I have concerns about using the two together, but I guess that is what their trainer's vet recommends) They were worried about gastric ulcers with the NSAIDS and wanted to use famotidine. We talked about it at work today and I said I would check it out. From what I have read, Famotidine might not do the trick here, it might be better to use Omeprazole?
What do you think? Or should they do anything about ulcers since the NSAIDS will hopefully only be short term?
I have the oral Famodine dose of 1-2 mg per Kg every 6-8 hours. Is there an injectable dose?
If so, how is it administered? Your thoughts on this would be greatly appreciated.-- Linda S.
Moderator:
DrO

Posted on Friday, Jul 25, 2008 - 9:10 am:

Hello DrS,
Actually it is uncertain that omeprazole will be useful for the prevention of the type ulcers caused by NSAID's. The mechanism of formation of exercise induced ulcers (EGUS) in horses and NSAID toxicity are completely different. For instance they form in completely different parts of the stomach. I think there is interesting work here for someone with someone with the time and funding. That said in humans a beneficial effect has been found that the summary says may be through some method other than the ph raising effects of the omeprazole:

Drugs Aging. 2008;25(3):197-208.
Clinical efficacy of esomeprazole in the prevention and healing of gastrointestinal toxicity associated with NSAIDs in elderly patients.
Blandizzi C, Tuccori M, Colucci R, Gori G, Fornai M, Antonioli L, Ghisu N, Del Tacca M.
Division of Pharmacology and Chemotherapy, Department of Internal Medicine, University of Pisa, Pisa, Italy.

NSAIDs are widely prescribed for the treatment of pain, inflammation and rheumatic disorders, but their use is associated with adverse gastrointestinal effects, ranging from dyspeptic symptoms and peptic ulcers to more serious complications. Elderly patients are at high risk of experiencing NSAID-induced gastrointestinal tract injury and should be considered candidates for prophylactic pharmacological therapy. In studies conducted in adult patients, proton pump inhibitors (PPIs) such as esomeprazole have been shown to prevent or reduce NSAID-induced gastrointestinal injury. The beneficial effects of esomeprazole can be ascribed largely to its ability to maintain sustained inhibition of gastric acid secretion, although there is evidence to suggest that pharmacodynamic properties unrelated to acid inhibition may also contribute to the gastroprotective effects of this agent. Although there are limited data on the use of esomeprazole specifically in elderly patient populations, studies of patients at high risk of NSAID-induced gastrointestinal toxicity because of advanced age indicate that this PPI is both effective and well tolerated when administered in conjunction with NSAIDs. Thus, esomeprazole can be regarded as a useful option for prophylactic therapy in elderly patients receiving long-term NSAID therapy.


If I were going to attempt NSAID induced ulcer prevention I would go with one of the specifically formulated equine pastes but I don't do this routinely but neither do I usually mix NSAIDs either. Though I use bute routinely for mild to moderate founder without problems I believe the flunixin slightly less toxic at equal pain relieving levels. So I use it for severe cases. What I wonder is if firocoxib would be useful as it may be less toxic? For more see Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » EQUIOXX (firocoxib).
DrO
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