confusion of pergolide dosage in the files


bigwhitevan2002
 

Hello All,

I have been reading all the files and threads from days past on compounded pergolide as I am addressing this with my vet today(.as well as Dianne) been closely following her postings and answers.


I ran across a tidbit from Mandy in a long ago post that if your horse needs one mg of pergolide it has to be praecende because someone has the market on this dosage...HUH? 


could someone please explain this, If I start kayla out on one mg does this mean my vet cannot go compounded route, so I should go less or more than 1 mg...?

Julie

Oregon 06

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PapBallou@...
 



I ran across a tidbit from Mandy in a long ago post that if your horse needs one mg of pergolide it has to be praecende because someone has the market on


Hi Julie -


Since 1 mg Prascend is fda approved, any compounded versions of pergolide can't be the same as Prascend.  The compounding pharmacies offer 1.05 mg and .95 mg to be close to the 1mg typical dose.  They also can compound many other doses.


Linda

EC Primary Response

West Coast

May 2004




Mandy Woods
 

Hey Julie,
 
BI,  the makers of Prascend have the patent (1mg) on that dose only.    So to get around this,  any  compounding pharmary can make a gelcap or wafer or whatever at  .95 mg and lower or 1.05 mgs or higher.   For some reason only BI can manufactor (repackage) the 1 mg strength.  Since PPID is a progressive condition why not get a higher dose?  You will eventually need to go up so you don’t chase the numbers.   Patents don’t last forever.  The compounded pergolide in the Prascend tablet is the SAME compounded pergolide being mixed for you. 
 
If Kayla was in my barn,  she would get compounded gelcaps like this:   order 1/4 mg for 4 days ~ then half a mg for 4 days and then 3/4 mg for 4 days.   On the 12 day she would get 1.05 mgs a day **IF** she wasn’t showing symptoms of the pergolide veil.  Then you would increase as needed after her 4 week recheck. 
 
Yes your vet can use compounded pharmacies ~  he/she just cant order 1 mg. 
 
Does that help ?

Mandy in VA
EC Primary Response
OCT 2003
 


bigwhitevan2002
 

Okay thanks,

that's about the most ridiculous thing I have ever heard of,
 things like this just get my dander up...actually anything to do with the FDA gets my dander up...( having a type 1 diabetic tends to make one rather annoyed the fda, insulin does not have to cost 600$ a month, but if you don't have it you die, so there is no supply and demand, just demand .....grr...plus European studies...oh never mind wrong forum to rant on..)

--Good to know so I can have the solution handy for the Vet, 

question..do most horses start out at 1mg ( leading up to that with .25 increments?)
or is that a lot considering kayla is only  a bit high in her ACTH.

Julie
Oregon 06
Yahoo Groups

 




bigwhitevan2002
 




---In EquineCushings@..., <bittersweetfarm@...> wrote :

Hey Julie,
 

Does that help ?

YES, very much thank you...
got it all written down on my card of info for the vet, off we trot to see if we can get kayla  feeling and lookin better she is starting to look like an old warn out horse that sweats all the time..
Julie
Ps I am ordering APF because Kayla reacts to everything... always... and forever. ....sigh.
 


Eleanor Kellon, VMD
 


---In EquineCushings@..., <bigwhitevan2002@...> wrote :

I ran across a tidbit from Mandy in a long ago post that if your horse needs one mg of pergolide it has to be praecende because someone has the market on this dosage.

= = = = = = = = =

That's not exactly correct. The FDA contends that because Prascend is the only approved form of pergolide for horses, it is the one that has to be used.  It's OK to compound dosages that cannot be achieved from the 1 mg tablets (which can also be split in half or you can use more than one) *but* the FDA contends that the pergolide to make those custom dosages has to come from Prascend tablets. This obviously wouldn't save any money.

However, several recent federal court decisions have said that the FDA is not able to prohibit the compounding of veterinary drugs from bulk powders. Those decisions are only enforceable in the jurisdictions of those courts, but they set a precedent that would be considered in any other cases challenging bans on compounding.

In any case, it is not illegal for your veterinarian to write a prescription for pergolide in any dosage they see fit. You could use that prescription to buy Prascend or compounded. How the pharmacy fills the prescription is not the vet's responsibility.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


Mandy Woods
 

Julie,
Dr. Kellon likes the ACTH value in the middle of 35.  That would put your target at  17.5    We have two months before the rise begins in August.   I’m not a vet but if Kayla was here she’d be going on 1.05 mgs tapered on.   What date was the blood pulled on her for ACTH?  A little too much is better than not enough.
 
Mandy in VA


bigwhitevan2002
 

Hi again mandy,
just last week was blood the  pull for both her and pony who is also just a bit over high normal, looks like they both will be getting a new med regime, this is obviously why Pony keeps coming up lame in the fall....DUH...
shoulda figured that out years ago...
Thanks, I am meeting with the vet in 10 minutes will let you know how it turns out..
Julie
Oregon 06


bigwhitevan2002
 




Thanks Dr. K,
I will ponder these things not quite understanding but the light bulb will turn on eventually,
Julie
Oregon,06




>>>>>>>>>>>>In any case, it is not illegal for your veterinarian to write a prescription for pergolide in any dosage they see fit. You could use that prescription to buy Prascend or compounded. How the pharmacy fills the prescription is not the vet's responsibility.

Eleanor in PA
www.drkellon.com
EC Co-owner
Feb 2001


bigwhitevan2002
 

Okay 
Got the meds ordered I think I used the wrong compounding pharmacy tho, meant to give them' thriving pets' but instead gave them the info for ' pet health pharmacy'...hopefully it isn't a huge price difference, 

It was nice of them to accommodate my high maintenance request and i thanked them accordingly, after listening to the Vet suggest cinnamon, chromium, metformin, thyrol-L , I smiled and said no thanks, she then let me know she would prescribe the caps, as long as I understood that it was not the preferred treatment, and that praecend is the better product...I acknowledged this , and now have 8 bottles of pergolide coming my way 4 scrips each for pony and Kayla, stating with .25 mg dosing and moving up to 1. mg after 12 days.

Whew...one less stress ....
Julie,
Oregon 06





palomino.1982@...
 

Hi Julie

Do not fret re: compound pharmacy!

Pet Health Pharmacy is an excellent choice!

PS...they are used to our  members 'high maintenance' requests!

Congrats Warrior Princess!

Susan
EC Primary Response
Oceanside, CA 2007




---In EquineCushings@..., <bigwhitevan2002@...> wrote :

Okay 
Got the meds ordered I think I used the wrong compounding pharmacy tho, meant to give them' thriving pets' but instead gave them the info for ' pet health pharmacy'...hopefully it isn't a huge price difference, 

It was nice of them to accommodate my high maintenance request and i thanked them accordingly, after listening to the Vet suggest cinnamon, chromium, metformin, thyrol-L , I smiled and said no thanks, she then let me know she would prescribe the caps, as long as I understood that it was not the preferred treatment, and that praecend is the better product...I acknowledged this , and now have 8 bottles of pergolide coming my way 4 scrips each for pony and Kayla, stating with .25 mg dosing and moving up to 1. mg after 12 days.

Whew...one less stress ....
Julie,
Oregon 06





bizzibizzigirl
 

You're all very lucky in US to be able to purchase your compounded Pergolide so cheaply.  I looked up your recommended sites to see I could purchase 100 x 1.5mg capsules for $85.00.   Here in Australia, I recently paid AUD $360 for that very quantity/dose!

Sadly, at those prices, I'm left with no alternative but to go back to liquid.  At the moment, the dose he's on needed topping up so I bought liquid for that and the total of both was AUD $475 - that makes it about AUD $1700 per year at his current dose.  If he needs to go much higher, I'm afraid he won't be.

We can get a 1mg in 1ml suspension here and that will be my only option as it works out less costly at AUD $255 for a 200ml bottle, so about 88 doses at current dose.

Lisa & Miami (Arab x RP)

Plus Condor & Woody (unchallenged)

Victoria, Australia – 2010

 

CH:    https://groups.yahoo.com/neo/groups/echistory8/files/Miami%20and%20Lisa/

 

PICS:  https://groups.yahoo.com/neo/groups/ECHoof/photos/albums/846035640

 



Nancy C
 

I may not be following you Lisa, but want to make sure you have seen the Australian compound pharmacy info in the files

https://groups.yahoo.com/neo/groups/EquineCushings/files/Australia/Compounding%20Pharmacies/

I hope this helps your search.  Also hoping other Aussie members will chime in.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
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Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
Equine Cushing's and Insulin Resistance Group Inc.

 





---In EquineCushings@..., <glconley@...> wrote :

 I looked up your recommended sites to see I could purchase 100 x 1.5mg capsules for $85.00.   Here in Australia, I recently paid AUD $360 for that very quantity/dose!

 



takarri@...
 


---In EquineCushings@..., <threecatfarm@...> wrote :

I may not be following you Lisa, but want to make sure you have seen the Australian compound pharmacy info in the files

Hi Nancy,

Unfortunately Lisa is right,

Pergolide capsules are extremely expensive over here- up to 4 x  + more than what you pay depending on how the vet wants to mark it up. I recently got a quote from a new compounding pharmacy that has opened for 5mg x 100, their  price was just over $1000 au!

 The Ranvet liquid is readily available & reasonably affordable for the average horse owner & while we are aware of the issues involving the liquid, sometimes it has to be a better option than doing nothing at all.

But I guess I won't worry too much about how to afford my monthly pergolide. We'll all be saved next year when Prascend becomes available  & I'll be able to maintain Jack on 1mg daily instead of 11mg. Hopefully, I'll make a huge saving.... right? 

Pauline

Jack & Spur

Sth West Vic

Australia Aug 07

http://tinyurl.com/7qbdyas

 











 



Nancy C
 

Thanks Pauline.  Somehow I missed that info. Wish it were not so.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc




bigwhitevan2002
 

Okay does this sound right for a price.....for two horses 42 day supply of compounded pergolide,

 starting with 4 days of .25, then four of .50 then four of .75 then 30 of 1. mg's  ..

..cost me a bit over 223$ that works out to 2.00$ a day , somehow I was thinking the compounded pergolide was a bit less expensive than this...

Am I mistaken or is my math wrong or am i being charged a larger then usual amount..an

 extra 250 a month for horse care is not going to be able to be put in my budget, ever,... this is stressing me out some...thats two months board...if this be the case in all this drama, other decisions will have to be made.....SIGH... 
Julie
Oregon,06


Mandy Woods
 

I’m no math whiz but that seems high to me.   They must be charging you labor for mixing and packing the starter pills.   I pay $37.60 for 30 pills of 3mgs including s/s.   I think I’d call and talk to the pharmacist. 
Mandy in VA
 


Sara Gooch
 

Julie,

It's my understanding that the pharmacy I use, Pet Health Pharmacy, has a  $27 or $29 "minimum" for any prescription order they fill. So you are probably being charged that or a similar minimum for each of the dosages, even if the dosage is just a few pills. And your monthly bill wouldn't be at all that high once the dosages are consistent.  

I forget exactly what I pay for 30,  3mg capsules, but it's in the mid-30-something range.


Pet Health Pharmacy is very helpful about answering questions--I imagine others are too.  If in doubt about the extended cost, call and ask the pharmacy.


Good luck--


Sara,  2011 NE California




 

 

  


PapBallou@...
 



..cost me a bit over 223$ that works out to 2.00$ a day , somehow I was thinking the compounded pergolide was a bit less expensive


Julie -

Did you order online?  You should have an invoice with everything broken down for you.

Like Mandy, I'm wondering if they aren't charging you more for the lower dose caps since they may not have them on the shelf as they do with the more typical 1 mg, 2 mg doses etc, and have to special process them.

Linda
EC Primary Response
West Coast
May 2004


bigwhitevan2002
 

ahhh, I see, well that makes sense sort of, I will call and find out, I did not order online , the vet had her office manager do it with me dictating what I wanted in her other ear, 

This info makes me feel a little better, I just was not going to be able to afford that for the next X amount of years, it has been weighing heavy on my mind today..

As always Thanks for all the help, suggestions and support.
Julie
Oregon ,06