Hi again, I wanted to add the website for Fury's file to my message above, but I don't know how to edit my message. The only options that I see are reply or delete. Anyway, here is the website of his file:

Hi, Stephanie -  Most definitely Fury should start on pergolide, as your vet and Dr. Kellon have stated.  Since this is your first foray into PPID, here are a few tips:  start out at 0.25 mg daily; increase by 0.25 mg every 4 days until you are at the target dose (which is usually 1 mg to start with).  This helps prevent the "Pergolide Veil", a transient condition of lethargy, reduced appetite and spaciness.  Using APF  from Auburn Labs has also been shown to reduce the incidence of the Pergolide Veil. 

Thank you Cynthia for your kind and thoughtful reply! I already appreciate the support and encouragement from this group.

Hi again Jaini, I just ordered the APF or whatever from Auburn labs. The lady I spoke with, Karina maybe her name? suggested that I use 4 ml twice daily for a while and see how he does on that. Thanks again for suggesting it!

I all, I am waiting on the Pergolide shipment, and I have ordered the APF adaptogen original formula. If the Pergolide comes first, should I wait until I have the APF before giving it? Is the APF squirted into the mouth, or onto the food? According to my vet.'s instructions for the Pergolide, I am to begin with .5 mg for 7 days, then .75mg for 7 days, then 1 mg for 7 days, and then another blood sample for ACTH level. 

Hi, Stephanie - I agree with Sherry. At the beginning, syringing it is a much better way. If it were me, I would have the APF on board for a couple of days before starting the pergolide. At this time of year, you have a bit more leeway time-wise for the newly diagnosed.

Regarding when to retest after starting pergolide or changing dosage,

Yahoo is being a major pain today....

I don't think we have very good data anywhere to answer that question (when to retest).  It is pretty universally agreed that improvement in clinical picture can be expected within 1 to 2 weeks, although blood work may not be normalized.  Dr. Schott reiterated that in a 2011 presentation but recommended waiting 6 to 8 weeks to retest, without really saying why.  In 2014, Dr. Frank recommended 30 days. Equine Endocrinology Group recommends 30 days although they state ACTH may rise within 48 hours of stopping pergolide.

At least part, if not most, of the reason the long waits to retest are recommended is because these authors consider improvement in clinical signs a satisfactory response - i.e. don't necessarily have to have ACTH (or all symptoms) back to normal. They settle for this because they impose a ceiling of from 2 to 5 mg/day (depending on author) for pergolide dosing.  However, they also admit that this can result in new cases of laminitis.

On the other hand, Denise just reported ACTH of over 250 can be normalized within 3 hours of dosing and be back up again in 12 hours.  This fits with what we know about the pharmacology of pergolide in horses and also shows that it likely behaves the same way in horses that have been on pergolide once a day for a prolonged period of time.

We need more data and some of it may already be right under our noses in the case histories.  How many hours from the last pergolide dose did your recheck your horse's ACTH? Was the result normal?  Have you ever checked at a different interval after the last dose?

Since pergolide doesn't build up in the system like it does in humans and horses dosed once a day likely have no overlap at all with the last dose, it's entirely possible you can retest in 4 hours and have no difference from a repeat test performed in 1, 2, 4 etc. weeks again at 4 hours after the last dose.  Clinical signs will take longer to change and are influenced by things like diet and trim but when the goal of pergolide is to restore ACTH to normal all we need to consider is that blood test result.

For now, I think we can say that if you want to know the peak effect of your pergolide dose, check 1 to 3 hours after dosing.  To see the worst case scenario of level between doses, check at 12 to 24 hours after the last dose.

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

Dr. Kellon, thank you for this info.!  So, I guess a month or so after I begin giving Fury the Pergolide, I'll have my vet. draw another ACTH level 4 hours after dosing to see how the Pergolide's peak time is effecting the ACTH level.

This is extremely interesting. So if I have a horse suspected of being early PPID, with definite but subtle clinical signs and ACTH levels just above normal range, who is starting a trial of 0.75mg of pergolide (as Prascend), when I re-test her could I do it a couple of hours after the pergolide dose to see if the ACTH has fallen? If it has not fallen, would that indicate she is not PPID and the higher levels of ACTH is a stress or pain response? 

Thanks Jaini, I like the idea of a slower increase the dose, so I'll follow your suggestion of .25 mg for 4 days, .50 mg for 4 days, .75 mg for 4 days, then 1.00 mg for 4 days. Is this the protocol that this group follows mainly?  It makes sense anyway. Also thank you for telling me about your horses, and it's so good to hear that they are doing so well. It really helps to encourage me. These days are rattling to say the least, and I worry about Fury. I hope he responds well to the Pergolide, and can stay healthy and happy for years to come.

Hi Sherry and thanks for your suggestion about the APF. I will begin using it as soon as it gets here!

Hi Maxine. Those are great questions! I wish I could help you, but I'm a new kid on the block. I'm sure someone from this group knows the answers! Dr. Kellon also does consults if you need to go that route.

Ferne,

Your horse either responds to very low levels of pergolide, or he's one of the few with a very long half life. In the last study using oral pergolide half life ranged from 3 to 12 hours but the mean was just under 6.

We've talked about timing before in connection with half life but it's been a while.