Understanding Omeprazole Paste for Horses and the Role of Vitamin B12 Supplementation

Equine gastric ulcers are a common and often painful condition affecting horses of all ages and disciplines, particularly those in training or under stress. One of the most widely used treatments for equine gastric ulcers is omeprazole paste, a proton pump inhibitor (PPI) that reduces the amount of acid produced in the stomach. While omeprazole can be highly effective in healing and preventing gastric ulcers, prolonged use can sometimes lead to nutrient imbalances—including a potential need for vitamin B12 supplementation. Let’s explore how this works.

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What Is Omeprazole Paste and Why Is It Used in Horses?

Omeprazole works by inhibiting the hydrogen/potassium ATPase enzyme system in the stomach lining, commonly known as the "proton pump." This significantly reduces gastric acid production, creating a less acidic environment in the stomach that allows ulcers to heal.

Veterinarians often prescribe omeprazole paste for:

Equine Gastric Ulcer Syndrome (EGUS)

Horses with signs of discomfort during girthing or exercise

Performance horses under high stress or travel demands

Horses that are off feed, losing weight, or showing changes in behavior

It is typically administered once daily and comes in oral paste formulations specially dosed for equine use.

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Potential Drawbacks of Long-Term Omeprazole Use

While omeprazole is a powerful tool, prolonged use (beyond 4–8 weeks) can sometimes interfere with nutrient absorption, especially:

Calcium

Magnesium

Iron

Vitamin B12 (Cobalamin)

This is because stomach acid plays a role in the absorption of several essential nutrients. In particular, vitamin B12 absorption requires stomach acid to release the vitamin from feed and bind it to intrinsic factor—a protein that facilitates its absorption in the small intestine.

When stomach acid production is suppressed long-term, horses may not absorb B12 efficiently, which could lead to:

Fatigue or low energy

Poor appetite

Weight loss

Anemia-like symptoms

Poor coat or hoof quality

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Why Supplement Vitamin B12 in Horses on Omeprazole?

Vitamin B12 is vital for red blood cell formation, neurological function, and protein metabolism. Horses that are on extended courses of omeprazole—especially those with limited access to high-quality forage or who are in intense training—may benefit from a B12 supplement.

Benefits of B12 supplementation in this context may include:

Supporting energy metabolism and stamina

Improving appetite and digestive function

Promoting overall vitality during ulcer recovery

Veterinarians may recommend injectable B12 (cyanocobalamin or hydroxocobalamin) for better bioavailability, especially if gastrointestinal absorption is impaired.

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Best Practices

Short-Term Use: Omeprazole should generally be used for a defined treatment course, often 28 days, followed by tapering or switching to a lower "maintenance" dose.

Diet Support: Pair treatment with a forage-rich diet and ulcer-friendly management practices.

Monitor Response: If energy, coat, or performance seem to decline during treatment, discuss B12 testing or supplementation with your vet.

Avoid Overuse: Chronic suppression of stomach acid may do more harm than good if not medically necessary.

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Final Thoughts

Omeprazole paste can be a game-changer for horses suffering from gastric ulcers. However, like any medication, it's important to use it thoughtfully and understand its broader effects on the horse’s system. Monitoring for signs of nutrient deficiency—and addressing them through supplements like vitamin B12—can help ensure your horse stays healthy and strong, both during and after ulcer treatment.

Always consult your veterinarian before starting or modifying any treatment or supplement regimen.

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