This is rather confusing. Wedgewood has a post on their website stating that they compound pergolide capsules in 22 strengths. Here is the copy.
Strengths:22 strengths of Pergolide Capsule are available, ranging from 0.2 mg/cap to 5 mg/cap.
So there shouldn't be an issue with getting at least 5 mg capsules. When I was using Wedgewood several years ago, Tipperary was on 6.5 mgs of pergolide mesylate and yes, I had to get two Rx. one for 5 mgs and one for 1.5mgs. Yes, it was more expensive than Pet Health who could compound the entire amount into one capsule. I talked to Pet Health/Avrio when I returned to using capsules last month and asked if they could compound a 13 mg.pergolide mesylate capsule.( ten mgs. pergolide) . They were puzzled I was asking, the person I talked to checked with the pharmacist and said that they had compounded 20mgs in one capsule and felt capsule size was not an issue. Why Wedgewood will limit pergolide to 5 mgs is beyond me, I suspect it has something to do with all the FDA/court case over bulk pergolide. But I have no idea.
I know members are upset over the price increases of pergolide and with the limited pharmacys that compound it. If you don't know the history of using pergolide mesylate for horses after it was taken off the human market( Permax, long term use in humans could cause heart problems and the newer parkinson drugs worked better that replaced it), I believe in the files here is a record of some of the fight that ensued to allow vets to Rx. it. If memory serves me right,, we had a member here who went back through the different veterinary trials to try to figure out where the hysteria in the vet community originated over giving horses more than 3 or 4 mgs of pergolide if ACTH numbers remained high. Apparently when pergolide was first tried on horses, no one knew what dose to use, so they went with human doses, which were in the 100 mg plus range. You can imagine how that went . Lots of serious side effects immediately. Then eventually, when the dosage was figured out better, Boehringer Ingleheim developed Prascend and trialed it at 1-2 mgs. Trials were small, horses were not managed as we know how to manage PPID horses, some horses didn't respond and developed laminitis, etc. But the trial went well enough that the FDA approved BI to market Prascend. So you have a combination of a major drug company with FDA approval and the memory of large doses of pergolide in the vet community to combine to make vet's fearful of anything more than 1-2 mgs. ( in Europe it's 4 mgs, for the exact same drug) . Add in issues with illegal compounding by veterinarians themselves in the racing and competition equestrian community for joint injections, etc. at the time and the FDA started cracking down on compounding and vets who were doing so and selling the compounds themselves were prosecuted. Pergolide got lumped into that fight, because now there was a FDA approved med ( that was unaffordable at the higher doses many horses require) and for a while it was scary that pergolide would be forbidden to be compounded. It took a court case , a lot of letters from owners ( I was one) and written professional testimony( Dr. Kellon was involved in that) to get a court order issued that said the FDA could not restrict compounding in animal drugs. It's a very tenuous victory and one that could be overturned any time. We should be grateful there are compounding pharmacies willing to compound pergolide as there are many prominent ones that wont.( Rood and Riddle and Hagyard in Lexington Kentucky come to mind). We need to work with them, not be angry with them.
Dawn Wagstaff and Tipperary
Saline, MI 2003