Metformin Issues


a.k.a.petpalace2@...
 

I considered retesting insulin with Apollo on new hay but at cost of $288 and being advised diet alone being unlikely to bring Apollo's insulin down, I've decided best to start metformin and retest insulin in 7-10 days.  Given his size, Apollo's dosage is large i.e. 20 (1000 mg) tablets.  I used electric coffee grinder with blade (as opposed to burr type grinder) with 10 tablets at a time.  Creates a lot of dusty powder which leaks out from under machine's cover. Tried coarsely grinding tablets then finish with mortar and pestle to get fine powder consistency.  Milk of Magnesia used as carrier but volume too large to fit into 50 cc drenching syringe. Went better on second attempt with thicker consistency.  Apollo took med fairly well but rinsing out of his mouth did not go as well.

Would a burr type grinder work better so I wouldn't lose so much medication as dust?  What consistency of metformin/Milk of Magnesia mixture do I need to prevent mouth ulcers (e.g. like mustard)?  Is it okay if he lets water run out of his mouth as soon as I put it in when rinsing, or do I need rinse again?  If he eats his hay right after rinsing his mouth, will it also help prevent ulcers?  I've read some horses eat metformin in their food and mouth ulcers aren't an issue. Do most many horses accept taste of metformin/Milk of Magnesia mixture like they do Jiaogulan?  Apollo is picky about things added to mash and won't eat Jiaogulan out of bowl so haven't tried adding to food.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Tracy
 

Following this post. My vet is coming out Friday to test Salsa’s insulin and give me metformin script. 

I recently started j herb and that is a pain to syringe in - can only imagine what I am in for with metformin. 
--
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827


Sherry Morse
 

Hi Karen,
Can't advise on your metformin questions but the issue with not testing prior to starting the medication and then after the 7-10 days is that you won't have a proper frame of reference of how well it's working compared to just your already implemented diet changes.
--

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response

PA 2014

https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet/Scutch%20Case%20History.pdf

https://ecir.groups.io/g/CaseHistory/album?id=78891

 


Maxine McArthur
 
Edited

Hi Karen
One of the ponies at my paddock is on metformin and the owner does not grind the pills—she soaks them in just enough water to cover them for several hours, and the pills soften enough to be mushed together and sucked up into a syringe. She adds a little peppermint flavoured antacid liquid (we don’t have milk of magnesia here) before sucking it up. Often before syringing she will rub a little (human) lip cream around the corners of the lips to protect the skin there. I looked after this pony for a couple of weeks when the owner was away, and the soaking metformin pills wasn’t much of a hassle at all (provided you remember to do it ahead of time!).

--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


 

Karen,
I had a lot of trouble grinding metformin. It turned out to the particular brand, Heritage, produced very hard pills. I ended up grinding my horse's dose and weighing the total using my kitchen scale. Then I used my kitchen Vitamix to grind up several days of metformin at a time, weighed out each dose, and put the powder in little covered containers. That worked much better than the coffee grinder.

My skin is easily irritated by metformin powder. I added enough Milk of Magnesia to dilute the solution so it didn't burn my skin or turn it red. It ended up being around 30 cc, IIRC, for the 13 pills for my horse's dose. I used a 60 cc syringe with a silicone O-ring that I work easily with one hand. https://www.amazon.com/gp/product/B07BHWCFW4 

Wild Cherry Flavored Milk of Magnesia was Dr Kellon's suggestion. Part of making the syringing acceptable is to do it slowly enough that your horse can swallow. I used the same syringe to rinse with with tepid water. I rinsed twice, and my horse also let the water run out of her mouth. She never got ulcers in her mouth or on her lips. 

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


 

The only time I used metformin was years ago, before I knew about ECIR.  I used it for several years.  I don’t recall whether I ground it or not - I think I most likely did - but I just dumped it in her feed and she ate it.  I don’t know if I was lucky or just didn’t know enough to be concerned.  Apparently, if you feed it, mouth ulcers are no longer a concern.  I just like to remind people to try the easy route first.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


ferne fedeli
 

My Icelandic, Magic, has been on Metformin for awhile now and I just grind it up in an old coffee grinder and mix it in with his ODTB cubes, Stabul1 & other supplements.  He always eats it up just fine.  Never realized I was so lucky, but then I HATE syringing stuff in their mouths and they all seem to hate it too--wormer time is always fretful!
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


a.k.a.petpalace2@...
 

Hi Maxine,

Thanks for suggestion. I hadn't thought of that.  My only concern, having worked as Registered Nurse, is whether Metformin is stable (doesn't deteriorate in strength/quality) while it is soaking.  I called Wedgewood Pharmacy that many ECIR members here use and they couldn't tell me, however, found they carry Metformin for horses in powder and paste form.  Unfortunately, dose Apollo needs is too large for that to be possible using concentrations they have available.  Interesting that you use an antacid.  I've wondered why Metformin isn't mixed with a liquid antacid to prevent mouth ulcers because Milk of Magnesia is actually used a laxative here.

I would love to visit Australia sometime but it's a very long way from Wisconsin here in United States.  Our Wisconsin Public Broadcasting Network has carried TV shows filmed there.  Two of my favorites were "A Place to Call Home" and "McCleod's Daughters".  There was also one about flying doctor's service but I can't remember name of show as only on for one season.


--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


jenbegg@...
 

When I had my pony on metformin I also had issues with losing some of fine powder when used grinder ,found if i added some lindseed at same time in grinder reduced the loss ,then added small amount of water to just make paste consistantancy and syringed (he wouldnt eat in his feed) and as Maxine has already mentioned we cant get Magnesia here ,then rinsed with same syringe and tepid water 
--
Jenny B in VIC joined 2022
https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Wally
https://ecir.groups.io/g/CaseHistory/album?id=275488


Diana RL
 

I use the powder Metformin from Wedgewood and mix with water and syringe it (have never had ulcer problems).  It says it needs to be given 30 mins before food.  Is that not the case?  It seems like a lot of folks are just mixing it in with food/supplements.

Thanks!


On Thu, Sep 8, 2022, 5:03 PM <jenbegg@...> wrote:
When I had my pony on metformin I also had issues with losing some of fine powder when used grinder ,found if i added some lindseed at same time in grinder reduced the loss ,then added small amount of water to just make paste consistantancy and syringed (he wouldnt eat in his feed) and as Maxine has already mentioned we cant get Magnesia here ,then rinsed with same syringe and tepid water 
--
Jenny B in VIC joined 2022
https://ecir.groups.io/g/CaseHistory/files/Jenny%20and%20Wally
https://ecir.groups.io/g/CaseHistory/album?id=275488



Sherry Morse
 

Hi Diane,

That would be a question to ask the pharmacist.  In people it's usually administered with food as this will help buffer the effect on the stomach (which is also the same reason we recommend syringing with a buffer if the horse will not eat it.




a.k.a.petpalace2@...
 

Hi Cass,
Glad to know I'm not the only one.  I do think problem is hardness of tablets. So far, I've found that putting piece of plastic under grinder cover helps but shreds of tablets created by grinding rip holes in it quickly.  Experimenting with different thicknesses of plastic.  Don't have a VItamix but do have food processor and professional Ninja Blender.  Powder in syringe comes up to about 20 ml mark and I add another 20-25 ml of Milk of Magnesia then stir up contents with small spatula to get powder to dissolve.  Bought Wild Cherry flavor because his previous owner said cherry flavored prunes were his favorite treat (I don't give him treats).  Thanks for link to syringes.  Nylon feeding/drenching syringes I have work well since I found rubber tips to cover ends then I can fill them first before putting metal feeding nozzle on.  Available in 3 sizes: 20, 50 and 100 ml.  Only need one hand to use and comes with replaceable O ring.  Here's link if anyone's interested: https://www.jefferspet.com/feeding-syringe-100-ml/p?skuId=7732  I haven't had any skin irritation from powder but concerned about breathing powder that gets into air.
I'm probably syringing it in too fast for fear he's going to try taking off.  Had to chase him early one morning trying to give him his J-herb.  Apollo doesn't wear halter out in paddock because our other horse always pulls it off. Both horses stay out in paddock 24/7.  Helps them both get more exercise and saves of cost of bedding although much more manure to pick up outside.


Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


a.k.a.petpalace2@...
 

I hate syringing stuff into horses too but my horse is a big pain about eating anything but hay.  He doesn't like ODTB cube mash much even before adding anything to it.  After I feed him his mash with supplements, I go back in house so he'll eat it otherwise he watches me over paddock fence and nickers if I stay outside.  Thankfully our barn is only about 75 feet from our house.  It's odd but he eats his 2 Prascend tablets in about 1/4 cup of Stabul 1 pellets put in a bowl.  Thought about trying Metformin in his mash since he doesn't absolutely hate in when I syringe it in.  Thing is, if he doesn't eat it in his mash I'll have to throw everything out and start again.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


a.k.a.petpalace2@...
 

Hi Tracy,
There's definitely a learning curve to preparing and administering both Jiaogulan and Metformin.  Takes some time to know how much water to add to Jiaogulan as it tends to expand after a while.  I use a nylon feeding (drenching) syringe with an angled metal tip. Only needs on hand.  Cleans up well and last more than a week until regular plastic syringes.  Comes in 3 sizes: 20 ml, 50 ml and 100 ml.  Here's a link to what I'm currently using.  https://www.jefferspet.com/feeding-syringe-100-ml/p?skuId=7732

IMO, Metformin is much more challenging if using tablets. Just found out today that Wedgewood Pharmacy, which many members here use for compounded pergolide, also has Metformin for horses in powder and paste form.  Apollo's dose is too large to use either form at concentrations they have available but it might work for your horse.  Don't know how it compares in cost to regular tablets but wouldn't hurt to ask although your vet has to be agreeable to calling it in.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


a.k.a.petpalace2@...
 

Hi,
My google search found following on https://www.ncbi.nlm.nih.gov/    ECEIM consensus statement on equine metabolic syndrome
Dosages range from 15 to 30 mg/kg q8‐12h PO, and the drug should ideally be administered 30‐60 minutes before feeding.  

Maybe giving it to horses with food is why it often does not work.  However, letting a medication sit in a horse's empty stomach for 30-60 minutes, knowing it can cause irritation doesn't seem like a good idea either.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Maxine McArthur
 
Edited

Karen, that ECEIM document is also in our Files, in the ‘Metformin’ folder. Most people I know either feed the metformin in food or syringed directly beforehand. 


Just as a general heads up to all, you can search both Messages and Files via the Search button. There are some handy hints on getting the best search terms in the Wiki.

If there’s info on Google pertaining to PPID/EMS, odds are good that we have seen it or commented on it already. Dr Kellon regularly updates the group on new research. Not saying we mightn’t miss things, but I always search this group, and the sub-groups first. 


--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Tracy
 

How close to j herb can I give metformin?
I will have to play around with timing. 

The things we all do for our beloved animals. 

Just took in a stray kitten our daughter found on Sunday.   Animals are conspiring to bankrupt me and/or drive me crazy. 
--
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827


a.k.a.petpalace2@...
 

Thanks for info but I'm confused as to why article says Metformin ideally should be given 30-60 minutes before food yet most people give it with food.
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817
 


Sherry Morse
 

Hi Karen,

You would probably be best served by reaching out to the researchers in the ECEIM group to ask that question.  I would note that their recommendation is 4 years old and at the time they were also recommending half the dose we've now seen to be effective. 




a.k.a.petpalace2@...
 

Thanks, that's helpful.  Makes sense that increasing dose given with food could offset effect food has on decreasing drug's absorption. All I needed to know is how to best give Apollo his metformin so it works as well as possible. Barefoot hoof trimmer scheduled to see Apollo tomorrow.  Fingers crossed trim goes well and Metformin works so adding exercise isn't too far off in future. 
--
Karen B.
Wisconsin
2022
Apollo Case History: https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Apollo
Photo album:  https://ecir.groups.io/g/CaseHistory/album?id=275817