Ranitidine is one of the most commonly used drugs to treat ulcers — both in humans and horses. Now that it’s being recalled, what does that mean for our horses?
By Joyce Harman, DVM
Ranitidine is a commonly used drug in the horse world for treating intestinal ulcers. The U.S. Food & Drug Administration (FDA) has issued two voluntary recalls to patients and health care professionals. The recall is because of the possible cancer-causing compound N-nitroso dimethylamine (NDMA) being found in ranitidine products. The FDA is still deciding exactly how risky this is, but the effect of the recall is that the drug is rapidly becoming less available and may become more expensive.
As reported in USA Today, one way NDMA is formed is exposure to heat. In the winter this is less of a problem, but during the summer, most people keep horses’ supplements and medications in unairconditioned feed rooms. In warm climates this may increase the risk of contamination.
How does this affect horse owners?
There is no research in horses that directly shows NDMA potentially causes cancer in horses. However, widely used drugs rarely are recalled in human medicine, so for this to happen means there is potential for a serious problem. Even if the compound turns out to be safer in horses, the lack of product directly affects horse owners with limited supply and likely increased costs. I am not sure that a cancer-causing compound would be safer in horses, except they do live for fewer years than humans, and in general have cancer less frequently.
Alternatives for ulcer and hind gut health support
For our readers there are many alternatives to support gut health and, in most cases, these actually work better over a long period of time than drugs. Alternatives fall into several classes and offer many options, depending on what the horse needs and responds to.
Feeding a forage-based diet is healthier for a horse’s gut than a high grain diet, although some horses with a heavy workload or high metabolic rate (the hard keepers) do need more concentrates. For some horses, alfalfa cubes or hay are soothing to the gut, but other horses are allergic or intolerant to it and will become more uncomfortable when fed alfalfa.
For those harder keepers, feeding a hemp protein instead of soy reduces inflammation because the high omega-3 fatty acids in it are anti-inflammatory, while the high omega-6 in soybeans is inflammatory. Feeding healthy fats for calories is often better for the gut than more carbohydrates in the form of grain which can ferment in the hind gut. Coconut meal or coconut oil, hemp oil and unrefined rice bran or oil are all good sources.
There are many probiotic, herbal and nutritional products available that support gut health. One way to decide if a company has quality ingredients is to check for the National Animal Supplement Council (NASC) label. This tells you that the product has met a certain standard of quality. As more research is done on the equine microbiome (the good bugs in the gut) there is a better understanding about which probiotics can help maintain gut integrity and prevent ulcers.
Probiotic supplements should contain a variety of organisms without chemical fillers or sugars (especially if the horse is overweight). Most products currently available contain organisms that support the natural flora of the gut, but do not colonize it. The organisms that actually live there are more soil based and appear in only a few products.
Herbal products usually contain a combination of herbs known to heal the gut wall and are often mixed with some nutritional ingredients. The quality of the formulas is best determined by the training and experience of the herbalists who formulate them. If you try a formula for a month or so and do not see results research different companies and product types. If a formula has the endangered herb slippery elm, be sure the company sources it from ethically grown sources that do not contribute to the destruction of the herb in the wild. Marshmallow is an excellent substitute.
Nutritional supplements and ingredients are often aimed at buffering the acid in the stomach or the gut. These are fine for the short time but do prevent mineral absorption and should NOT be used long term. Minerals such as calcium, selenium and zinc and others, must pass through an acid stomach in order to be absorbed.
Online webinar on probiotics for horses: