A prospective, randomized, masked, placebo-controlled crossover study for the effect of 10 mg omeprazole capsules on gastric pH in healthy dogs

Evaluation of proton pump inhibitor administration in hospitalized dogs in a tertiary referral hospital

BACKGROUND

Although proton pump inhibitors (PPIs) are commonly administered to hospitalized dogs, prescribing patterns and appropriateness of use require continued investigation.

HYPOTHESIS/OBJECTIVE

Describe prescription patterns and appropriateness of use associated with PPIs in hospitalized dogs at a single tertiary care facility. We hypothesized that the majority of prescriptions would not comply with current guidelines for the rational use of acid suppressants.

ANIMALS

Two hundred randomly selected hospitalized dogs.

METHODS

Retrospective evaluation of the medical records associated with a randomly selected sample of hospitalized dogs that received PPIs between January 2013 and December 2018.

RESULTS

A total of 12 610 dogs were admitted for first-time hospitalization between January 2013 and December 2018. Forty percent of these dogs (5062/12610) were prescribed a PPI PO or IV. Of the 200 randomly selected records, an adequate indication for use was identified in 27% of dogs (54/200). Of the dogs surviving to discharge, 54% (95/175) were discharged with a PPI and 51.6% (49/95) of those were prescribed an inadequate dose.

CONCLUSIONS AND IMPORTANCE

Our findings support other studies in which the majority of PPI prescriptions for hospitalized dogs at a tertiary care hospital lacked an appropriate indication. Furthermore, analysis of the prescribing patterns of dispensed PPIs identified a frequent occurrence of dosages considered inadequate, raising concern for ineffective treatment even with appropriate indications of use. With growing concern of adverse effects associated with PPI and other acid suppressant administration in human and veterinary medicine, rational use of these medications following consensus guidelines should be emphasized and treatment should be reserved for dogs with historical, physical examination, clinicopathologic, and imaging findings supportive of an appropriate indication for use.

Prescribing habits for the use of omeprazole as a gastroprotectant in dogs in a veterinary teaching hospital

OBJECTIVES

To examine the prescribing habits for omeprazole in a veterinary teaching hospital and to evaluate the effect of a clinical audit on omeprazole prescription.

MATERIAL AND METHODS

Observational study with retrospective clinical audit followed by a prospective study. The evaluated data about omeprazole prescription included the dose, frequency and indication. These were assessed according to published guidelines. A seminar about the audit and current guidelines on the use of omeprazole was organised for all members of clinical staff. Prospective data collection was conducted after the seminar. A comparison of the collected data before and after the clinical audit was made.

RESULTS

A total of 301 dogs were prescribed omeprazole in the veterinary teaching hospital during the study period (including the retrospective and prospective parts). Complete data were acquired from 240 patients. The prescribed frequency of omeprazole was inappropriate in 23 (16.5%) of the prescriptions in the retrospective section but in only five (5.0%) in the prospective study. Inappropriate indications were reported in 12 (8.6%) patients in the retrospective section and in two patients (2.0%) in the prospective study. Overall inappropriate omeprazole prescription was identified in 34 (24.5%) patients in the retrospective part and in seven (6.9%) patients in the prospective part. There was a statistically significant difference between the two groups in frequency, indication and overall prescription of omeprazole.

CLINICAL SIGNIFICANCE

This study details the frequency of inappropriate prescription of omeprazole in a veterinary teaching hospital and provides some evidence that dissemination of guidelines based on clinical audit can improve prescribing habits.

Evaluation of a long-acting injectable formulation of omeprazole in healthy dogs

BACKGROUND

To evaluate the efficacy of a single intramuscular adminsitration of long-acting omeprazole (LA-OMEP) in increasing gastric pH in dogs.

HYPOTHESIS

We hypothesized that LA-OMEP would meet in healthy dogs the clinical goals defined for human patients for treatment of gastroduodenal ulceration.

ANIMALS

Nine healthy research dogs.

METHODS

Prospective experimental study. Dogs were given a 4 mg/kg intramuscular injection of LA-OMEP. Intragastric pH was continuously recorded on treatment days 0 to 7. Daily mean pH and mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were determined.

RESULTS

The mean onset of action for the LA-OMEP was 98.11 min (SD 46.39). The mean number of days the dogs' pH met established goals for MPT pH ≥3 was 5.5 days (range, 3-7) and 5.25 days for MPT pH ≥4 (range, 3-7). Long-acting omeprazole met the human clinical goals pH ≥3 for 72 hours in 8/8 of the dogs and MPT pH ≥4 for 96 hours in 7/8 of dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The LA-OMEP formulation produced gastric acid suppression in healthy dogs for an average of 5 days and up to 7 days, after a single intramuscular injection. No major adverse effects were observed.

A prospective, randomized, masked, placebo-controlled crossover study for the effect of 10 mg omeprazole capsules on gastric pH in healthy dogs

Background

Enteric‐coated omeprazole capsules are commonly used as a gastric acid suppressant in dogs. However, the efficacy of this formulation has not been evaluated for clinical use in dogs.

Hypothesis/Objectives

To evaluate the efficacy of a 10 mg PO omeprazole capsule (TriviumVet) undergoing FDA approval to increase gastric pH in dogs. We hypothesized that encapsulated omeprazole would significantly increase the gastric pH compared to placebo and reach pH goals extrapolated from people for the treatment of esophagitis and duodenal ulceration.

Animals

Six healthy research dogs.

Methods

Randomized, blinded, 2‐way crossover study. Dogs were PO administered omeprazole at 0.5 to 1.0 mg/kg or placebo (empty gelatin capsules) twice‐daily for 5 days. The intragastric pH was recorded on days 2 to 5 of treatment. Mean pH and the mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were compared between and within treatment groups.

Results

Dogs treated with omeprazole had a significantly higher MPT ± SD intragastric pH ≥3 (91.2% ± 11.0%), ≥4 (86.9% ± 13.7%) and mean ± SD pH (5.4 ± 0.8) than dogs treated with placebo (19.7% ± 15.5%, 28.3 ± 20.7, and 2.4 ± 1.0, respectively) (P < .001 for all).

Conclusions and Clinical Importance

The 10 mg enteric‐coated omeprazole capsule PO administered evaluated in this study is an effective gastric acid suppressant in healthy dogs.