Help please: Need to justify high pergolide dose to vet


lisanne5
 

My vet is "very uncomfortable" increasing my horse's pergolide scrip to 8 mg. I only have 4 day's supply left, so I need some answers quick! Are there sources out there (preferably scientific research papers) I can point him to where doses higher than 5 mg have been used? I know IR is a big piece of the problem here, maybe more so than the Cushings per se, but I don't know what else to do to stave off the laminitis.

A bit of history on my horse's case is below (also see http://pets.groups.yahoo.com/group/ECHistory3/files/Lisanne%20in%20Oregon/).

My 22-y-o TWH mare Lacey has been on pergolide since September of 2010 when she had serious laminitis and was diagnosed with Cushings and IR based on bloodwork.

She started at 0.5 mg and that kept her basically sound until August last year. At that point I had to gradually increase her dose up to 4 mg by the end of 2011 to keep her feet from getting hot. I felt like I was always on the edge of laminitis.

She was OK on 4 mg for the first half of 2012. Most recent bloodwork done in March 2012 showed ACTH within normal limits but near the high end of the lab normal range. (March should be the lowest ACTH levels of the year!) Insulin was the highest it's been yet at that time, 228 pmol/L, with glucose at 5.0, for a ratio of 26 pmol/mmol.

In June I started to taper up pergolide again when she got tenderfooted and heat in her feet. I have had a really difficult time keeping this horse sound this summer, but increasing pergolide always seems to help -- for at least a short time. I've just started 8 mg this weekend (gradual taper from the 7 mg she was on the first half of August).

She did not shed out normally this year -- the first year it's been really obvious. When she did shed it was much slower than usual. She didn't finish shedding until the first part of July, and normally she would have been done by the end of May.

I know a big part of the problem here is IR, not just Cushings, but I'm doing everything I've learned to do on this list (diet balancing, proper trim, exercise) and have her on a very low sugar diet (<7.5% s/s). I'm giving her 11g/day of Acetyl L-Carnitine which I learned from someone here is helpful for IR. Is there anything more I can do? And what can I say to my vet.

I am getting to a point where I'm seriously thinking of putting my horse down, even though other than the footsoreness she seems to feel fine, is perky and alert and seems happy.

Lisanne and Lacey
W. OR 09.2010


 

Hi Lisanne

At the European Equine Endocrinology Symposium in March this year, Andy Durham mentioned in his presentation that Jill Beech has a horse on 8 mg pergolide (your vet could contact her?) - notes and link to his presentation here:

http://thelaminitissite.myfastforum.org/about32.html

Some vets in the UK are using Metformin at the same time as Pergolide for PPID horses with high insulin - Andy Durham's recommended dose for Metformin is 30 mg/kg bodyweight twice a day.

Andrea
France/UK Jan 2010
www.thelaminitissite.org


aliby100
 

30 mg twice a day? So, 60 mg all together?
Alison/Diesel 08/11
Parker, TX

--- In EquineCushings@..., "andrealefley" <androbjon@...> wrote:
Andy Durham's recommended dose for Metformin is 30 mg/kg bodyweight twice a day.

Andrea
France/UK Jan 2010
www.thelaminitissite.org


tomtriv <ThePitchforkPrincess@...>
 

My vet is "very uncomfortable" increasing my horse's pergolide scrip to 8 mg. I only have 4 day's supply left, so I need some answers quick! Are there sources out there (preferably scientific research papers) I can point him to where doses higher than 5 mg have been used? I know IR is a big piece of the problem here, maybe more so than the Cushings per se, but I don't know what else to do to stave off the laminitis.
Hi Lisanne
My mare is currently on 13mgs. I'm sorry I thought I had replied to this already! In the files you will find a bunch of documents giving hints and ideas on how to convince your vet to increase pergolide dosage. There is one called GETTING HIGHER PERGOLIDE DOSAGES explaining how to approach your vet about getting higher dosages:

http://tinyurl.com/yaj4g8w

It has some links to the science but there are likely even more documents in the files since the writing.

I just want to remind members that the files are full of documents that summarize or explain many important topics. WHEN TIME IS OF THE IMPORTANCE LOOK IN THE ECIR FILES TABLE OF CONTENTS (TOC). In it you will find the "Also See" sections that lead to more information hidden through out the ECIR Group - this is feature you won't find in the files. For instance in the TOC's pergolide dosage folder Also See section, is a link to Pergolide Dosage Database - where members list their pergolide dosages, give links to case histories and other important data for people wanting to know what is really going on with pergolide dosages.

I hope this answer isn't too late for you Lisanne. Links to Database and TOC in my signature below.

- LeeAnne 03/04
Newmarket, Ont
ECIR Archivist
Are you in the Pergolide Database? http://tinyurl.com/yfahmda
ECIR Files Table of Contents: http://tinyurl.com/6lsvppq
http://TakenForGraniteArt.webs.com


 

Hi Alison

Just to clarify, this is for metformin (for insulin resistance), not pergolide (for PPID).

For metformin, it's not 30 mg twice a day, it's a calculation -
30 mg per kg of horse's bodyweight, twice a day. So for a 500 kg horse, 500 kg x 30 mg = 15000 mg / 1000 = 15 g per dose, and you give that 15 g dose two times a day.

Andrea
France/UK Jan 2010
www.thelaminitissite.org

30 mg twice a day? So, 60 mg all together?
Alison/Diesel 08/11
Parker, TX

--- In EquineCushings@..., "andrealefley" <androbjon@> wrote:
Andy Durham's recommended dose for Metformin is 30 mg/kg bodyweight twice a day.


aliby100
 

Yes, thank you, Andrea (again!). Diesel is IR/PPID and on Metformin (as well as pergolide), and hasn't been doing very well since his last chemo for SCC in early June. I am busy in the trenches with him and so haven't had time to keep up with the group like I was, but try to scan the posts in hope of finding something to help him. That's how I realized that my vet's RX for Metformin was only 1/2 the recommended amount, and so was wondering if recommendations had increased.
Diesel hates the Metformin anyway. Has anyone else had adverse reactions/effects from using it? He is a super trooper, but when he sees the dose syringe with the Metformin he does what he can to get away and it is breaking my heart. I know it causes stomach upset in some human patients. I have been trying to justify it because of purported cancer-fighting properties, (http://www.ncbi.nlm.nih.gov/pubmed/22847511), but that is getting more and more difficult.
We are having a hard time, and I am in despair.
Alison/Diesel 08/11
Parker, TX
http://pets.groups.yahoo.com/group/ECHistory4/files/Alison%3B%20Parker%2C%20TX/

--- In EquineCushings@..., "andrealefley" <androbjon@...> wrote:

Just to clarify, this is for metformin (for insulin resistance), not pergolide (for PPID).


aliby100
 

I sent an apology to Lisanne; Just wanted to say that I didn't mean to be thoughtless and hijack her post. I know how frustrating it can be when you are just trying to get answers so apologies to all. Sometimes in the heat of the battle I forget stuff.
Alison/Diesel 08/11
Parker, TX


lisanne5
 

The current research on PPID is well presented by Andy Durham at the link that Andrea gave in message # 170604. Great graphics on the seasonal rise (slides 23-29) and on dosage (slides 30-33). I got this information to my vet and he approved the 8 mg dose.

Sometimes I am successful in finding what I need in the group files, and sometimes not. For example, I searched the Table of Contents with control-f for "pergolide dose" and got nothing. But "pergolide dosage" worked.

Thank you, Andrea and LeeAnne!

Lisanne and Lacey
W. Oregon 09.2010