You'll need to discuss this with your vet but if this was one of my horses, I would definitely be starting him on pergolide as soon as possible.

Generally, 1mg is a common starting dose. As the rise has peaked, ACTH levels will be declining in normal horse now but that may or may not be the case in one with PPID. The good thing is that Twister's ACTH is likely not going to climb any  more this year, so you have a good chance of getting it controlled fairly quickly now.

Generally, it is recommended to retest after 3 weeks at the targeted dose to see where things stand. Titrating up the the prescribed dose,is also recommended to help prevent a possible "pergolide veil" effect from developing. You cna also administer the adaptogen APF when starting the meds to help combat any veil effects. How a horse reacts to the meds is very individual.

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Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR