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Adding Cyproheptadine to Pergolide prescription


Jen Mcgeehan
 

Aloha from Hawaii!

It has been a long time since I came to this site for help...So glad to have your input on a new situation with my 32-year old Palomino - Smoke Signal Dun.

He has been on Pergolide, currently 5mg, for about 3 years. Suffered a coffin bone rotation in 2011 and diagnosed with IR and Cushings. We successfully brought him back to good health, through this site's excellent advise, and we still ride our pastures. In 2013 his ACTH level was 29.6. Just had another blood test done and it is at 51. I know this time of year the count can rise, but am sure it is way too high. He is currently on 5mg of Pergolide from Thriving Pets. The vet won't write a prescription for any higher of a dose even though I shared with her that horses can go as high as 10 or 12 mg, if needed. She wants to add Cyrpoheptadine with the Pergolide. Any studies to share in regards to the success of this? I went on line and it indicated that Cyproheptadine (Periactin) doesn't seem to be anywhere near as effective compared to Pergolide. But I didn't see anything in regards to the combination. Would appreciate your help/input here. (His IR numbers are fine...) Merry Christmas!!!


Eleanor Kellon, VMD
 


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

I went on line and it indicated that Cyproheptadine (Periactin) doesn't seem to be anywhere near as effective compared to Pergolide. But I didn't see anything in regards to the combination.

= = = = = = = = = =

You didn't see anything because there is nothing there!  The suggestion came from the BI sponsored Endocrinology Group but with no formal data at all to support it.


The objection to dosages over 5 mg also comes from BI, but again with no data.  They make two general claims.


One is that horses on over 5 mg/day have more side effects but we have 51 (out of 268) horses, 19%, in the pergolide database, most for several years, with no higher reports of side effects or suspicious health problems.


The other claim is that horses that need high doses must be on low potency compounded drug.  We have roughly twice as many horses on Prascend in the low dose  categories (22% vs 10%) but 215 out of the total 268 horses are on compounded drugs.  Also, some of the high doses horses are on compounded after switching from Prascend (or Permax) because the cost was prohibitive otherwise.


If you read Prascend's New Animal Drug Application presented to the FDA


http://www.fda.gov/downloads/AnimalV.../UCM280354.pdf


There is only formal safety data (i.e. including a control group) for dosages up to 2 mg. The adverse event reporting, which included 113 horses with no controls, only their baseline history, also only evaluated up to a 2 mg dose despite the fact that 41.6% of horses remained with abnormal lab values after 90 days on 1 mg/day and overall success rate at 180 days including horses on both 1 and 2 mg/day was 68.6%.


The suggested upper "safe" dose of 5 mg/day (it was 3 mg/day when Prascend was first introduced in the USA) is based entirely upon that being highest reported dose found in the published literature (literally just a handful of horses)- NOT on formal safety studies. It would be more accurate to state that safety of dosages above 5 (or 3) mg has not been studied.


As for the cypro, it is an old treatment with limited usefulness that was discarded long ago in favor of pergolide.  Again, there is nothing to support the idea that the combination would be more effective than pergolide alone.


Eleanor in PA

www.drkellon.com

EC Co-owner

Feb 2001



Lorna Cane
 

Thank you Dr. Kellon,


> We have roughly twice as many horses on Prascend in the low dose  


categories (22% vs 10%) but 215 out of the total 268 horses are on 


compounded drugs.  Also, some of the high doses horses are on 


compounded after switching from Prascend (or Permax) because the cost 


was prohibitive otherwise.




And thanks to everyone who has contributed, and who continues to contribute, to our Database. 

It is such valuable information, and allows us to be the best advocates for our horses.



Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

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Lorna Cane
 


Now here's the Database link:


http://tinyurl.com/m6syzt4



>And thanks to everyone who has contributed, and who continues to contribute, to our Database. 

It is such valuable information, and allows us to be the best advocates for our horses.



Lorna in Ontario,Canada
ECIR Moderator 2002
*See What Works in Equine Nutrition*
http://www.ecirhorse.com/images/stories/Success_Story_3_-Ollies_Story__updated.pdf

https://www.facebook.com/ECIRGroup

Support the ECIR Group while you shop. It's easy.  

http://www.iGive.com/EquineCushingsandInsulinResistanceGroupInc




Jen Mcgeehan
 

Thanks so much for this information!!! I have copied it and will forward on to my vet and farrier. The vet is respectful of my position but is still a bit on the "old school" side of things.



Jen Mcgeehan
 

Thanks so much! wow, some on 36 mg of Pergolide?