This year has been challenging with trying to keep my horse Lad's ACTH levels in the normal range; they have increased from:
35.3 - May 2014
247- July 2014 (July and August we slowly increased his pergolide from 2.5 to 5mgs) we waited 30 days on the 5mg and retested. His levels came back at 332 last Thursday.
He's had no physical aspects associated with laminitis and is acting normal. My question to the group is, do I try increasing the pergolide during the seasonal rise or wait and retest the ACTH the beginning of December?
Lad is a 33 year old SB/TB cross whose been on a small dosage of pergolide since 2005.

Jane Hewitt in North Reading, MA
Sept 2000

http://pets.groups.yahoo.com/group/ECHistory8/files/Lad and Jane/Revised Case History for Lad/Lad New Case History 082014.doc/

This is a difficult question to answer because we just don't have the knowledge to do it.

The dramatic rise may be because his loss of dopaminergic neurons has reached a critical level - or it may be because your pergolide is not up to potency.

We don't know what would happen if a horse on pergolide controlled the rest of the year was allowed to just weather out the seasonal rise with no dosage adjustment when good IR management of exercise and diet is in place, as it is with Lad.  We do know though that allowing ACTH to get out of control makes it more difficult to rein it back in again.  We also know that diet and exercise alone might not be enough to prevent  laminitis in the face of a high ACTH.

Since he's totally asymptomatic though, what you might try is putting him on 2 weeks of Prascend at 5 mg then retesting.  If there is a dramatic difference, your pergolide is the problem.

If you are already on Prascend, I would be inclined to titrate your dose up even though you have no symptoms. If you don't, the first symptom you get is likely to be laminitis.

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

Thank you Dr. Kelllon; I just got the pergolide from Thriving Pets; would you still recommend trying the Prascend?

I just checked out the prices for Prascend on ThrivingPets and I'm unable to afford the listed price, also only being available in 1MG tablets, I'd need five tablets per day. What would the group recommend I do with increasing Lad's pergolide, he's on 5MG.
Thanks,

Jane Hewitt in North Reading, MA
Sept 2000

http://pets.groups.yahoo.com/group/ECHistory8/files/Lad and Jane/Revised Case History for Lad/Lad New Case History 082014.doc/

Hi Jane

I hope Dr Kellon might weigh in but will give you input based on my experience.

The best route is the 5 mg per day of Prascend for two weeks then retest as she outlined in her message to you:

Since he's totally asymptomatic though, what you might try is putting him on 2 weeks of Prascend at 5 mg then retesting.  If there is a dramatic difference, your pergolide is the problem.

That would be about $125.00 investment if you cand get  them to give you 2.3 boxes (versus three).  Then retest.

If not in the budget, and I get that, then switching pharmacies would be my next move. Then retest.

You may still need to titrate up as Dr Kellon outlined in her message.  Might want to reread it if you have not already.

FWIW, Beau gets a lot of pills right now.  I have had great luck using a Cashel feed bag and a cup of Nuzu Stabul one.  He loves the Nuzu and never fails to eat the pills with this method. I'm able to put the bag on, attend to my other gelding Skip, water, throw hay,  then remove the feed bag.  Everybody is happy.

Cashel Company: FEED RITE™ BAG

 

Keep us posted

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
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Hi Nancy:
Thanks for your input; I know you have Beau on a higher dosage of pergolide and wondered if you ever tried the Prascend? I'm concerned with the price and the fact that he'd have to five pills as opposed to just one with the pergolide. I'm due to get another script for my pergolide through ThrivingPets and I don't know if I should try another pharmacy or have my vet increase the dosage to 6MG and then retest or increase dosage to an even higher amount within that two week period? I'm very confused on how to go about finding what I need to do in keeping him from a laminitis attack. The ACTH is steadily increasing and is now at 332 up from 247 in July. I can't afford to try the Prascend and then the retesting of ACTH, the pergolide with a recheck is more cost effective for me. I look forward to your response.
Thanks,

Jane Hewitt in North Reading, MA
Sept 2000

http://pets.groups.yahoo.com/group/ECHistory8/files/Lad and Jane/Revised Case History for Lad/Lad New Case History 082014.doc/

Hi Jan

I know this is hard.   Prascend at 5 mg, it did not control Beau's ACTH. 

It seems there is not a clear "go here, do this" kind of answer for you.  You have to pick your best option based on your situation. 

Five pills is a piece of cake for us as I outlined.  He actually gets 4xs that number using the method I described. And he still loves me. :-)

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
Equine Cushing's and Insulin Resistance Group Inc.

 

Hi Nancy:
Thanks for your input; who would you recommend for another compouding pharmacy? I've used ThrivingPets for years and I checked the files for other facilities but they want me to set-up accounts and I'm just really interested in how much 5mg capsules are?
Jane

Hi Jane,

We're only talking about a 2 week supply here.  If you don't want to go Prascend, try Pet Health.  Again, two week supply then recheck ACTH.  If there is a dramatic drop in that short a period of time this time of year, good chance it was the pergolide.  You really need to know this because if the pergolide you are currently using is not up to potency you will waste a lot of time and money trying to increase it and get control - not to mention risking laminitis in the process.

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

Thank you!

Thank you!

Hi group-- Just an interesting little tidbit on this pergolide question. I just got my latest order of pergolide (up to 8 mg now). It came in two bottles--one with only six capsules in it. The other bottle of 29 said "Use this first" and it made me wonder if they just got a new shipment of pergolide in. I am going to be very alert for veil symptoms when I start the last six in case it is stronger.

Deb and Cory in NC
July 2012
http://pets.groups.yahoo.com/group/ECHistory5/files/Deb%20Funderburk%20in%20NC/
https://groups.yahoo.com/neo/groups/ECHistory5/photos/albums/1275105710

Hi Nancy:
I was wondering if you could give me your input on my next steps.
Thanks,
Jane Hewitt

I did want to mention that I will be increasing Lad's pergolide to 6.5 for one week and then increasing to 7mg for November. My question is related to decreasing; I'm assuming I would decrease by 1mg weekly? Not sure about the decreasing and retesting once we hit December?