Pet health pharmacy


lj friedman
 

So excited to get my first 30 capsules of c-pergolide for Jesse from Pet Health Pharmacy, .  How disappointing to see they dispensed 4.0 mg capsules when the script clearly shows 3.0mg.  lj friedman san diego nov 2014 


Leigh Jacobs
 

Hello LJ,
I work with PHP regularly for our clients and for myself.  Was the script written as Pergolide or Pergolide Mesylate?  If written as Pergolide, then the conversion would be close.  1.31mg pergolide mesylate is equivalent to 1.0mg Pergolide.  (3.93 versus 3.0) respectively. 
Regards,
Leigh, Ace and Shadow
2011 AZ



On Saturday, August 29, 2015 6:15 PM, "lj_friedman@... [EquineCushings]" wrote:


 
So excited to get my first 30 capsules of c-pergolide for Jesse from Pet Health Pharmacy, .  How disappointing to see they dispensed 4.0 mg capsules when the script clearly shows 3.0mg.  lj friedman san diego nov 2014 



lj friedman
 

script written as pergolide 3.0mg capsules..  My goal was because .. I;ve been using 2.5mg of prascend and wanted to increase to 3.0mg prascend so the vet wrote 3.0mg pergolide..   


lj friedman
 

Not sure if my previous post came thru... the rx was written as 3.0mg pergolide capsules..  jesse is now on 2.5mg prascend and I wanted to bump it up to 3.0mg prascend and thought that instead of using 3 tablets of prascend , I'd use one capsule of comp pergolide..  So, is 4.0 mg comp pergolide  the equiv of 3.0mg of prascend? 


Leigh Jacobs
 

So, is 4.0 mg comp pergolide  the equiv of 3.0mg of prascend.
Prascend 1.0mg is equivalent to 1.31mg pergolide mesylate so if your script had been written for 3.0 mg Pergolide (as in Prascend) then you can "assume" the compounding pharmacy would have used ~4.0mg of Pergolide mesylate to create your horse's script.  My suggestion is to check your original script and if you are still not sure you can call them.
Leigh, Ace, and Shadow
2011 Az



On Saturday, August 29, 2015 8:15 PM, "lj_friedman@... [EquineCushings]" wrote:


 
Not sure if my previous post came thru... the rx was written as 3.0mg pergolide capsules..  jesse is now on 2.5mg prascend and I wanted to bump it up to 3.0mg prascend and thought that instead of using 3 tablets of prascend , I'd use one capsule of comp pergolide..  So, is 4.0 mg comp pergolide  the equiv of 3.0mg of prascend? 



Nancy C
 

lj

You absolutely need to call the pharmacy.

I'm sorry Leigh, I don't follow the Prascend vs pergolide mesylate equation.  As I understand it, both compound and Prascend are pergolide mesylate.  I think we have had these conversations before.  Can you or anyone please point me to sources or archived messages?

Thanks

Nancy C in NH
ECIR Moderator 2003
Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers

 





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

So, is 4.0 mg comp pergolide  the equiv of 3.0mg of prascend.


lj friedman
 

I left the pharmacy a  voice mail message and sent an email . I  havent started using these  capsules as I have plenty of prascend remaining..  thanks.. lj friedman san diego nov 2014


Leigh Jacobs
 

Nancy,
You are correct: both compounded & Prascend's Pergolide are made from pergolide mesylate.   But BI advertises Prascend as pergolide. In small font they say pergolide mesylate. 1 mg pergolide is the equivalent of 1.31 mg pergolide mesylate. Therefore, the 4 mg reported by LJ on her script that was sent to her from Pet Health pharmacy was in question. If it's 4 mg of pergolide mesylate that equates to around 3 mg of pergolide by Prascend standards. I wrote about the conversions about two or three years ago in some emails and even sent the chemical formulations of both pergolide and pergolide mesylate. Pergolide mesylate is a salt of pergolide. That's it. However you need 1.31mg of pergolide mesylate salt to create 1 mg of pergolide. So it is a matter of semantics and understanding whether or not the pharmacy is thinking in terms of pergolide mesylate versus straight pergolide. Say she says she wants three mgs of pergolide. They send three mgs of pergolide mesylate, she's not getting the 3.0 mgs equivalent of Prascend pergolide, but 3.0/1.31 which would be equivalent to 2.29 mg of Prascend pergolide. 
When I started working with Pet Health pharmacy, calling in scripts for our PPID horses as well as for my own I talked to the pharmacists, asking them how they wanted us to tell them what we wanted.  Whether we wanted straight pergolide or if we wanted to do it in the format of pergolide mesylate.  3.0 mg of pergolide mesylate is not the same as 3.0 mg of Prascend. I apologize for being long-winded.
Respectfully,
Leigh, Ace, and Shadow
2011 Az
Sent from my iPhone

On Aug 30, 2015, at 5:40 AM, threecatfarm@... [EquineCushings] <EquineCushings@...> wrote:

 

lj

You absolutely need to call the pharmacy.

I'm sorry Leigh, I don't follow the Prascend vs pergolide mesylate equation.  As I understand it, both compound and Prascend are pergolide mesylate.  I think we have had these conversations before.  Can you or anyone please point me to sources or archived messages?

Thanks

Nancy C in NH
ECIR Moderator 2003
Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers

 





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

So, is 4.0 mg comp pergolide  the equiv of 3.0mg of prascend.


Lorna Cane
 

Hi Lj,



From Dr. Kellon,on November 28/14:


"All pergolide is pergolide mesylate. There is no such thing as pure pergolide."


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


ECIR Group - Equine Cushings and Insulin Resistance

 


Nancy C
 

Hi Leigh.

Yes, I recall the conversations.  I was looking for more back up.

What small print/font please? I do not have a package insert so cannot check.  is there something else on line I could read?

This web link to Prascend their logo says loud and clear "pergolide mesylate". See this link.

Prascend®

 

Thank you for helping me with my confusion.

Nancy C in NH
ECIR Moderator 2003
FACT:  With over 12,000 members and thousands of detailed case histories the ECIR Group has made it possible to spot patterns, many of which have been confirmed later by formal study.

Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers

 






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

 In small font they say pergolide mesylate.


Nancy C
 

Here's the link to the message Lorna references.

Equine Cushings and Insulin Resistance

 

Nancy C in NH
ECIR Moderator 2003

Iron overload has been identified as a significant factor in IR horses that are not receiving a mineral-balanced diet.

Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers

 





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

Hi Lj,



From Dr. Kellon,on November 28/14:


"All pergolide is pergolide mesylate. There is no such thing as pure pergolide."



Lorna Cane
 

Sorry,Dr. Kellon's message was Nov. 28,2013, not 2014.
Here's it is:

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

My vet also told me that Precision was using the base of pure Pergolide and 

Pet Health uses Pergolide Mesylate.  I just received my new script from Pet 

Health and it was for 4.6 mgs.


--------------

All pergolide is pergolide mesylate. There is no such thing as pure pergolide. 

You have increased his dose by just over 1 mg so yes,the reaction is 

probably to the drug.

Eleanor in PA

www.drkellon.com

EC Co-owner

Feb 2001

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










Leigh Jacobs
 

Hi Nancy,
I don't have an insert in front of me either!  I can check on Monday when I am in the clinic.  I will admit that the last box I really looked at was over 6 months ago.  Have they changed the front of it?  When it first came out, you had to look at the insert to see pergolide mesylate.  I tried your link and yes the Prascend logo is loud and clear in its pergolide mesylate print. I tried a copy and paste to pull up the front of the box to see what it stated but it is too blurry.
I guess the point I am trying to get across is that not all pharmacies, pharmicists, nor veterinarians or their reps speak in the same terms.  In not understanding the differences, some horses may be underdosed or overdosed because of semantics. This is from my own experience with helping clients who have come to my vet after frustrating experiences with others.
Out of curiosity, has anyone recently been told that 1mg Prascend works better than 1mg compounded PM?  And then given the reason?
Regards!
Leigh, Ace and Shadow
2011 Az






On Sunday, August 30, 2015 11:00 AM, "threecatfarm@... [EquineCushings]" wrote:


 
Hi Leigh.

Yes, I recall the conversations.  I was looking for more back up.

What small print/font please? I do not have a package insert so cannot check.  is there something else on line I could read?

This web link to Prascend their logo says loud and clear "pergolide mesylate". See this link.

Prascend®
 
Thank you for helping me with my confusion.

Nancy C in NH
ECIR Moderator 2003
FACT:  With over 12,000 members and thousands of detailed case histories the ECIR Group has made it possible to spot patterns, many of which have been confirmed later by formal study.

Please join us at the 2015 NO Laminitis! Conference, Georgetown TX, November 6-8, 2015

Guest Speakers
 





---In EquineCushings@..., wrote :

 In small font they say pergolide mesylate.




Lisa S
 

Leigh (and all),

Being a remedial PPID student I am going to need The Final Word on this to clear up my current confusion!

I seem to remember (though I cannot quite find it) a discussion that mentioned that as of 2012 or so, ALL compounded pergolide would need to be made from, essentially, Prascend.

Here is the wording on the FDA website (addressed to veterinarians) that would seem to say this:

You may have specific patients that need pergolide in strengths or dosage forms not offered by PRASCEND. In these limited cases, pergolide can be legally compounded by using FDA-approved PRASCEND as the source of the active pharmaceutical ingredient. Please find additional requirements for legal animal drug compounding atTitle 21, Code of Federal Regulations, Section 530.13.

So if all compounders (or at least all legal compounders) are starting with Prascend as the base compound, then wouldn't we be talking apples to apples if we are comparing Prascend dosages to compounded dosages? I could understand a compounder being extremely specific if using bulk parent drug that had a different name and/or was different in strength from the branded drug, but as I understand it, that is not supposed to be the case with pergolide.

I welcome any and all clarification on this topic--at my age I can reprogram my brain, but I need things to be spelled out clearly if I am doing a wipe and erasing previous information! Thanks,

Lisa in TX

Coming out of the closet with Zippy, Rita, and Bunny - IR

June 2010





Eleanor Kellon, VMD
 

Both Prascend and compounded pergolide are made with the same base drug - pergolide mesylate.

Many are told that 1 mg of Prascend is better than 1 mg (or even any dose) of compounded pergolide because it is presumed the compounded is not full potency, based on studies that showed compounded breaks down quickly and/or may not be as claimed when first purchased.

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


--


Eleanor Kellon, VMD
 


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

I seem to remember (though I cannot quite find it) a discussion that mentioned that as of 2012 or so, ALL compounded pergolide would need to be made from, essentially, Prascend.
= = = = = = = = =

That is what the FDA says, but two federal courts have ruled against the FDA claim that drugs cannot legally be compounded from bulk material - in this case bulk powder pergolide mesylate.

If the compounder is giving you a product that actually contains the dosage as claimed, the only difference  between compounded and Prascend is that the Prascend is stable for longer because of the coating and the blister packaging.  If a compounder did take it out of the packaging and grind it up to make compounded, it would lose that advantage.

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


Leigh Jacobs
 

Hi Lisa,
Currently, it is my understanding that both Prascend and compounded pergolide are made from pergolide mesylate.  Both BI(Manufacturer of Prascend) and compounding pharmacies make their products from bulk sources and in fact may even use the same sources.  Logic dictates that compounded products made from Prascend would cost the same or more than Prascend. I don't think this is the case.  (My Ace's capsules of 3.5mg would be close to $7.50 each versus the $0.32)
I found where you found the statement to the vets about having scripts compounded using Prascend. It is a product safety information sheet.
CFR530.13 (Current as of today)
I read it 3 times trying to figure out what it is saying and what I get from it: is that it is stating that you may compound a new concentration of a drug from a concentration that is already approved. 530.13.a It specifically states "Nothing in this part shall be construed as permitting compounding from bulk drugs."  BUT it does not say that you can not. And I suspect that somewhere else in the CFR(Code of Federal Regulations) there is an ambiguous statement that allows compounding pharmacies to compound from bulk sources. I think that could be found in using CFR530.30(animals not used for food) that then refers you back up to 530.20.a.1  Otherwise, I think the compounding pharmacies would be notifying their clients of a change in the rules and to expect an increase in costs especially if the only source is to be Prascend. 
In the FDA releases running from 2007-2012, the last one (May 2012) stated the following:
"As a result of the recent approval for PRASCEND, FDA says it will no longer exercise enforcement discretion over the pharmacy compounding of pergolide for use in animals." And I am not quite sure how to interpret that except to make the observation that they have not, to my limited knowledge, gone after any of the compounding pharmacies that our clinic uses. Doesn't mean that they won't.
I can't find anything dated later than 2012 from the FDA.
Ok Lisa.....you made me work today!  By having to research what you wrote, I have become more informed.  I don't for a moment think I found everything, but it was a good start.
Leigh, Ace and Shadow
2011 AZ



On Sunday, August 30, 2015 1:34 PM, "mostlyaggies@... [EquineCushings]" wrote:


 
Leigh (and all),

Being a remedial PPID student I am going to need The Final Word on this to clear up my current confusion!

I seem to remember (though I cannot quite find it) a discussion that mentioned that as of 2012 or so, ALL compounded pergolide would need to be made from, essentially, Prascend.

Here is the wording on the FDA website (addressed to veterinarians) that would seem to say this:
You may have specific patients that need pergolide in strengths or dosage forms not offered by PRASCEND. In these limited cases, pergolide can be legally compounded by using FDA-approved PRASCEND as the source of the active pharmaceutical ingredient. Please find additional requirements for legal animal drug compounding atTitle 21, Code of Federal Regulations, Section 530.13.
So if all compounders (or at least all legal compounders) are starting with Prascend as the base compound, then wouldn't we be talking apples to apples if we are comparing Prascend dosages to compounded dosages? I could understand a compounder being extremely specific if using bulk parent drug that had a different name and/or was different in strength from the branded drug, but as I understand it, that is not supposed to be the case with pergolide.
I welcome any and all clarification on this topic--at my age I can reprogram my brain, but I need things to be spelled out clearly if I am doing a wipe and erasing previous information! Thanks,
Lisa in TX
Coming out of the closet with Zippy, Rita, and Bunny - IR
June 2010






Leigh Jacobs
 

Dr. Kellon,
Since I was so busy researching my way to an answer to Lisa I did not see your response. :/
Am I correct in understanding that it is the rulings of the courts that have prevented the FDA from going after compounding pharmacies? Is there an appeal in progress anywhere?
Leigh, Ace and Shadow
2011 AZ



On Sunday, August 30, 2015 3:26 PM, "drkellon@... [EquineCushings]" <EquineCushings@...> wrote:


 

--In EquineCushings@..., wrote :

I seem to remember (though I cannot quite find it) a discussion that mentioned that as of 2012 or so, ALL compounded pergolide would need to be made from, essentially, Prascend.
= = = = = = = = =

That is what the FDA says, but two federal courts have ruled against the FDA claim that drugs cannot legally be compounded from bulk material - in this case bulk powder pergolide mesylate.

If the compounder is giving you a product that actually contains the dosage as claimed, the only difference  between compounded and Prascend is that the Prascend is stable for longer because of the coating and the blister packaging.  If a compounder did take it out of the packaging and grind it up to make compounded, it would lose that advantage.

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




ThePitchforkPrincess@...
 

Ha ha!  I have just the thing as long as Canadian inserts are the same as American. 
It was so small I needed to take 2 pictures:
Insert part one:

Insert part two:

Box Front:


- ​LeeAnne, Newmarket, Ontario

ECIR Archivist 03/2004

 

Are you in the Pergolide Dosage Database?

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View the Database Stats 
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ThePitchforkPrincess@...
 

I think I've finally found the source message  (#103801)  about where pergolide comes from: 
Eastern Europe and China
The message was from 2008 and posted by Dr. Frank K. Reilly equinemedsurg.com

Is there not a way we can find out more accurately where pergolide is made?

- ​LeeAnne, Newmarket, Ontario

ECIR Archivist 03/2004

 

Are YOU in the Pergolide Dosage Database?

​​
   
View the Database Stats 
Taken For Granite Art - Lightweight Cement Sculpture and Memorials