Sucralfate and omeprazole help resolve gastric ulcers through different mechanisms. When compared to each other, omeprazole is more effective than sucralfate alone at reducing the severity of glandular and squamous gastric ulcers. [14]
Sucralfate is commonly used in combination with Omeprazole. In one study, a group of 204 sport and leisure horses in the UK were given 12 mg/kg sucralfate twice daily along with 4 mg/kg omeprazole once daily. This combination resulted in a healing rate of 63.2%. [20]
In comparison, another study showed a healing rate of 22% following 28 days of 4 mg/kg omeprazole along with 10 mg/kg twice daily. [21]
Although there are differences in total healing in these two studies, more studies are required to determine the most effective protocol and for which horses sucralfate would be most beneficial. [22]
Sucralfate for Foals
Sucralfate can be administered to foals to address gastrointestinal issues including ulcers or to reduce the side effects of phenylbutazone treatment on GI health. However, there is limited research in this area and conflicting results.
In one study, sucralfate (4 grams per day) decreased phenylbutazone-induced gastric ulceration and hindgut pathologies in 3- to 4-month-old Belgian cross foals. [23]
In 6- to 7-month-old foals with naturally occurring subclinical gastric ulcers and inflammation, sucralfate (22 mg/kg every 8 hours) was no better at healing gastric lesions than corn syrup. [24] However, this study provided the treatment for just 15 days. Longer treatment duration may have shown greater differences.
Dosage and Administration Guidelines
Most veterinarians will instruct horse owners to give Sucralfate when their horse’s stomach is empty – commonly in the morning before grain or hay is given.
Sucralfate is only effective for 6-8 hours and must be administered several times per day. Because your horse’s stomach is likely to have food contents during the day, the first dosage is thought to be the most effective.
For gastric ulcers, veterinarians recommend giving Sucralfate at 10 – 20 mg/kg orally every 6-8 hours. For hindgut ulcers, Sucralfate is given at 22 mg/kg orally over the same period.
Liquid forms of this medication are considered more effective than tablets. If using tablets, it is recommended to crush the tablets to increase their protective effect. The tablets dissolve in lukewarm water, making them easier to administer. [17]
Sucralfate should not be given at the same time as Cimetidine or Ranitidine. These H2 blockers inhibit the production of hydrochloric acid in the stomach. Because Sucralfate forms a protective coating when it comes in contact with acid in the stomach, it should be given half an hour prior to Cimetidine or Ranitidine.
This medication is commonly used for a period of 21-28 days, but it can be used long-term in horses with high ulcer risk. Some horses are switched to a half dose for maintenance after the initial treatment period.
Store this medication in a sealed, light-resistant container away from children and pets.
Side Effects and Precautions
Sucralfate is not absorbed systemically and it has a low risk of adverse effects. Although rare, Sucralfate administration can cause some mild side effects including:
Sucralfate can slow gastric emptying and the transit time of food through the gastrointestinal tract. Because of this, some horses may experience mild colic symptoms associated with constipation. [17]
If your horse exhibits colic symptoms while on Sucralfate, call your veterinarian to discuss other treatment options.
Hypophosphatemia refers to a below-normal concentration of phosphorus in your horse’s blood. This side-effect is extremely rare and not well researched study. Although it hasn’t been confirmed, researchers believe that the aluminum in Sucralfate may bind to phosphorus, reducing its absorption into the blood. [12]
Sucralfate may inhibit the absorption of other drugs and supplements, such as fluoroquinolones and tetracyclines. [17] It is recommended to administer this medication one hour before or two hours after meals.
There is a concern that long-term use could cause an accumulation of aluminum levels in the body, potentially contributing to cognitive issues or brittle bones. [17]
Caution is recommended, but sucralfate can be used in pregnant or nursing horses under the guidance of a veterinarian. [17]
Monitor your horse closely to determine whether sucralfate is working. If your horse develops blood in stools, or if your horse is grinding its teeth, contact your veterinarian immediately to determine whether the ulcers are worsening. [17]
Talk to your vet if you think your horse may have ulcers. They may suggest Omeprazole and Sucralfate along with diet and management changes.
Your vet may also suggest feeding your horse Visceral+, a safe and natural nutritional supplement that is clinically tested in horses with ulcers and shown to support a healthy gastric environment.