A year into managing PPID

Claudia Goodman

Silhouette & I are a year into managing her PPID. Thanks to so many of you, she is  doing quite well. Diagnosed in Jan. 2013 and starting pergolide shortly thereafter, I have learned a great deal from your answers to my questions so  many others, and from your site's huge compilation of files. I am hoping to gain more insight into treating seasonal rise and increasing pergolide dose. 

After reaching the right initial dose at 2 mg Prascend last April, my mare did great through the summer. She had no symptoms, but when retested in Sept, her eACTH had risen from 21 pg/mL (ref 9-35) in April to 79. I did not see a detectible change in her energy or brightness at that time (her most obvious symptoms) and assumed this increase was “okay” given the seasonal rise. 

That was my initial thinking, but after I received some input from one of the moderators and a friend, I upped her dose to 2.5, then 3.5 mg over the next month - hoping to get her eACTH back down or below 35pg/mL. (I also switched over to compounded pergolide in capsule form at that point.) 
Her eACTH only dropped to 61 in mid-Oct. (after 2 weeks at 3.5 mg pergolide), so I continued to raise her dose, finally up 4.5 mg pergolide. Her energy was off slightly during this time and her crest became fuller, so it seemed she needed the higher dose. She remained at 4.5 mg until mid-December, when I slowly dosed down to 3.5 mg pergolide and kept her at that. Her eACTH was at 26 in early January. And, in fact, a week or so later, it seemed that her seasonal rise was really over when she surprised me with how much energy she had out on the trail. It currently doesn’t seem like a good idea to drop her dosage below 3.5mg with an eACTH of 26 - but I will test again in April to see if it is lower and may consider dropping if it is.

I’d like to know if it is generally better to err on the side of too much pergolide or too little? Is there a significant downside to supplying more pergolide than may be needed?
Is it best to keep increasing pergolide in order to try to keep eACTH within the upper limit (≤ 35 pg/mL) during the seasonal rise, or is it okay to see values as high as 60, 70 or even 80 pg/mL if symptoms are not apparent? I’ve read it’s best to treat the symptoms rather than the numbers, but don’t want to risk a more rapid progression of PPID.  

Would truly appreciate any insights that help me dose more confidently.

Claudia & Silhouette 2014 California


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