Best time to switch to cabergoline
Hi Dr. Kellon,
Thank you so much for sharing your information about alternative medications and treatment protocols with my veterinarian. After discussing the situation with her, I think I will give cabergoline a try but I am not sure about the timing.
Qiqi’s pergolide dose has in the meantime already been increased to 14 mg and the swelling of her udders has improved a bit. Being already in the period of the seasonal rise and that close to winter, I am planning to increase it two more times to 16 mg before re-testing her ACTH (until her symptoms disappear with a 15 mg dose). While both, her glucose (97 mg/dL) and insulin (22.38 ulU/mL) were at the beginning of August within the normal Lab range, the ECIR calculator still shows her as being uncompensated IR (G:I Ratio) or poorly compensated IR (RISQI). Having the ACTH, glucose, and insulin numbers of several years, we at least have comparable data should her situation worsen and, in that case, could increase the pergolide again.
For these reasons, I am nervous to switch medications now. My gut feeling is to get her through the winter by increasing the pergolide until we have better control and switch to cabergoline in the spring time. That way, we can experiment with the new medication without the risk of winter laminitis.
Does that sound reasonable or would there be an advantage of switching the medications now? Thank you so much for your input.
Angelika and Qiqi & Apollo