Omeprazole has been widely used in the horse for nearly 20 years. Yet, to date, few studies have evaluated its safety with specific regards to the adverse effects reported in human medicine. Recent studies on omeprazole in the horse have highlighted the potential for rebound gastric hyperacidity at the time of discontinuation of therapy, for decreased calcium absorption during administration and for disruption to hindgut function when administered alongside non-steroidal anti-inflammatory drugs. Unlike human medicine, no clear evidence exists for a link between omeprazole administrations and an increased risk of fractures in the horse. However, evidence exists that the proposed pathophysiological pathways for increased fracture risk which are present in human medicine are also present in the horse. Limited evidence suggests that decreased efficacy may occur over time with long-term omeprazole administration.
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