cabergoline changeover???


LJ Friedman
 

After reading Dr. Kellons  "brief history of ppid.," I got a bit more interested in cabergoline after it was stated that it is now preferred over pergolide in humans..  My pause is,, that all equine studies that I've read, show cabergoline was used as an attempt to help IR or estreus. etc.and was not effective. Not many or enough studies for cabergoline concerning ppid  in equines..      Jesse had a recent cp increase to 20mg and his eyes are a bit goopy. With acth on the seasonal low side.. I am re testing now.. and now feel a bit more comfortable with changing to cabergoline..but just a bit more comfortable,,, and I'd ;like to be more sure it is a path to choose..  Also. I'm more or less sure my current vet wont write an rx for 22mg...of cp. Now that I write this. might it be prudent to call Pethealh Pharmacy and ask them to test their latest batch.?  I don't remember any new increased dose, not showing an improvement till now. though acth testing will prove/disprove my thoughts...
--
LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos

 


Eleanor Kellon, VMD
 

There is no reason at all to think that cabergoline would have an effect on IR so no surprises there. The other studies aren't about estrus. They are about cabergoline's ability to influence prolactin (which is dopamine controlled, just like the median lobe of the pituitary) and therefore the seasonal changes. It does do that.

Cabergoline is used to treat pituitary Cushing's in dogs. In this study, a fixed dose was 70% effective, better than Prascend's FDA data in horses.

https://www.vin.com/apputil/content/defaultadv1.aspx?pId=11196&meta=generic&catId=30767&id=3854425&ind=75&objTypeID=17

They didn't try a higher dose on the larger tumors. We know treatment with this class of drugs is not one size fits all.

There is more data on cabergoline use in horses than there ever was for pergolide when pergolide was first used.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


LJ Friedman
 

thanks for the reply... I cant locate any studies in dogs using cbg for cushings within the last few years.  Wouldnt it be reasonable to see data studies from the past few years?  or is it totally mainstream.. hence no recent studies?  I called BET.. they have 80 clients using the product,, but have no recent data in horses. as well..   I asked which vets are using cbg.. they say   many in tx  . In CA , my state,, there was one in bakersfield..  ( I was hoping I could use a local vet that uses the cbg..    aka  cabergoline)  You state there is much data in horses.. I see none done recently addressing  ppid.. For ex,,, Equine PPID.: changing from pergolide to cabergoline..   that is the kind of data I seek.  and I've been searching.. but I dont have vet access for detailed searching...
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LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos

 


Josephine Trott
 

HI LJ,

Can you open these pdf file? From 2014 and 2017.

https://ac.els-cdn.com/S0737080613009647/1-s2.0-S0737080613009647-main.pdf?_tid=979060c5-4dde-42d5-b6ca-249f66eb40d9&acdnat=1523072815_58ef89a30a5316463a3bc27cd0a47614

https://ac.els-cdn.com/S0749073916300785/1-s2.0-S0749073916300785-main.pdf?_tid=131e7924-277e-47e3-b4bf-04d08334f055&acdnat=1523073959_089dd2970f9431eef35b7e58a47b6034

2014 paper says cabergoline reduces serum prolactin, and they also measured MSH (Melanocyte Stimulating Hormone) and found it too was decreased by cabergoline treatment - and that the treated mares grew their winter coat faster than the controls.  Also cabergoline treatment did not increase insulin sensitivity.

2017 paper says cabergoline hasn't had as much research done on it as pergolide but switching patients with drug resistant hyperprolactinemia (too high prolactin levels) to cabergoline from pergolide (cabergoline is more effective than bromocryptine as a dopamine agonist) has been successful.  

"
Bromocryptine is a selective D2 dopamine agonist with a shorter half-life than pergolide, but it has been shown to be effective in controlling PPID at a dose of 0.1 mg/kg PO every 12 hours.29 Anecdotal reports exist of the use of cabergoline, an especially long-acting D2 receptor agonist, in PPID cases. This author is not aware of clinical studies of cabergoline in PPID cases, although pars intermedia responsiveness has been shown to be decreased in normal horses by administration of 0.01 mg/kg cabergoline intramuscularly every 10 days.30"

Reference 30 is that 2014 paper I gave you the link to.  

If you want me to email you the pdf files I can do.
Josie
Davis CA 06/09


LJ Friedman
 

I can only view the first page of each  .ie preview.   if you can email.. that would be great..  luke4275@...
--   thanks for locating these
LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos

 


Eleanor Kellon, VMD
 

LJ,

I've stated multiple times there is no equine data published on cabergoline for PPID (although at least one of the publications, or a thesis, also  mentioned it as a good choice for that).

What we do have is good and repeatable evidence that cabergoline effectively suppresses prolactin. That is solid proof of cabergoline's dopaminergic effects in the horse which is exactly the effect we are after with PPID.

About research:
1.  Good research is timeless. Facts are facts and they don't change with time.
2.  Someone has to pay for formal research to be done.  Until someone has accumulated sufficient clinical/"field" data to publish, or has managed to obtain funding, you won't see it.

Like pergolide, cabergoline is an ergot derivative. Both drugs are used for exactly the same dopamine deficiency diseases in humans - e.g. some pituitary tumors, Parkinson's. It makes perfect sense to use it for PPID but we had no information on dose, duration of action. We have that basic information now from the studies that looked at prolactin levels. Valencia et al's 2014 study showed cabergoline effective at suppressing MSH release from the pars intermedia. MSH is the predominant hormone produced in PPID at a dose of 0.01 mg/kg intramuscularly every 10 days. That is the usual starting dose.

Another option for horses not responding well to oral pergolide is to go to a daily injection of pergolide. See my post 197024  from 2015.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


LJ Friedman
 

I'm close to jumping on the cabergoline bandwagon.. ( I have to play a youube video to remember how to pronounce it..) You state to inject every 10 days... this article agrees.. says 7-10 days and lists 10 days at the end of the article  , BET, the pharmacy, writes every 14 days..  Is there a reason there is a difference in the dosing days..?  I hope my vet wont balk at every 10 days when 14 days is listed on the pharmacy page???

cabergolineJEVS33_773-7782013.pdf
 

-- 
Cabergoline BioRelease LA 5 mg/mL Injection - 10 mL vial - PPID/Cushings - Equine - Products



LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos

 


Eleanor Kellon, VMD
 

Your vet should contact Dr. Douglas at BET if there are any questions. In Dr. Valencia's paper she mentions that the prolactin responses were beginning to return by day 12 (unpublished findings).  The 10 day interval is based on the repeated prolactin testing 10 days after cabergoline and is probably ideal for sustained maximum suppression but we know that even with pergolide there is at least a 48 hour window after the last dose before ACTH begins to significantly rise.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Is there a way to get Dr. Valencia's unpublished paper?  I have my vet interested in the research.  I am trying to get her to join the list and cosider compounded pergolide.  She might be coming around.  

Gail Russell
Forestville  CA July 2008
Brother, PPID 28 years  Quarter Horse

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


 

I’m following along with interest to see how this goes.  I’m very interested in how you plan to make the transition?  I haven’t read anything about doses, except a quick mention of ‘fixed dose’.  A 5 mg Cabergoline dose was compared to 2 mg of pergolide.  How does 20 mg of pergolide translate?   Would you test ACTH to verify that it’s working and when would you do that?  

In terms of the goopy eyes, have you considered dissolving one of your 20 mg capsules in water and dividing it among 10 syringes to increase his dose for ten days?  I would definitely test his ACTH before and ideally after.  Then decide where to share your findings.  I’m not sure why your vet draws a line between 20 and 22 mg.
--
Martha in Vermont
Logo, Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)
Logo's Case History: 
July 2012


LJ Friedman
 

My vet doesnt draw the line at 20 to 22?  He has been reluctant to increase since 16mg..  ( I increase at 2 mg intervals)  and I'm pretty sure he has reached his comfort level...  as far as cabergoline... if the regular dose doesnt keep acth level in normal range..  I'll be disappointed,,I believe it is supposed to????     $3.75 a day is how this translates out... to go higher.. ie even double..  would be disappointing... and Id consider a change back to cp at higher dose.s.. As far as the eyes,, they are slightly goopy.. I use prascends when I want to titrate till the new cp dose arrives... I am testing acth and insulin on tuesday;;; I have a funny feeling that the fenugreek that I started a few weeks ago, is going to help with insulin...  ( gotta be hopeful)   Jesse was just body clipped so his muscles show,.. and that pleases me..  He will be 28 on august 26th.  

Jesse's Photos

 


Tina Hughes
 

On Sat, Apr 7, 2018 at 05:47 am, Eleanor Kellon, VMD wrote:                                                                                                                                                 Another option for horses not responding well to oral pergolide is to go to a daily injection of pergolide. See my post 197024  from 2015.
How would you describe a horse not responding well to oral pergolide?

 
Thank you very much.
Tina
4/2014  Santa Rosa, California
Honey Case History:  https://ecir.groups.io/g/CaseHistory/files/Tina%20and%20Honey  .
Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=36565  .


 

I am trying to find message  197024 and all that comes up is the current thread "cabergoline changeover???"

--
Gail Russell 8/30/2008

 

 https://ecir.groups.io/g/CaseHistory/files/Gail%20and%20Brother%20-%20Odin%20-%20Decaffe%20%20-Gunthar .


Maggie
 

Hi Gail,

Here you go:  https://ecir.groups.io/g/main/message/197024  
--
Maggie, Chancey and Spiral in VA
March 2011
ECIR Moderator/Primary Response


Eleanor Kellon, VMD
 

As with pergolide, there is no one size fits all dosage. There are horses on from 0.5 to 2.5 mL.  Using a 3 mL syringe you can titrate dosage in 0.1 to 0.25 mL intervals.  It is recommended to start at 0.5 mL. Possible side effects are the same as for pergolide and if present will last for 1 to 3 days after the injection but do decrease the longer the horse has been on it.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Not responding well would be ACTH not controlled despite escalating pergolide dose, or severe side effects that are not helped by slowing increasing dose or over time. Some people may also choose to use it because of the ease of dosing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

Thanks for your reply, LJ.  My horse, Logo, is about the same age as Jesse and using a similar dose of pergolide.  I expect he will continue to need an increase in dose so I’ll be most interested in what your Cabergoline experiment shows.
--
Martha in Vermont
Logo, Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)
Logo's Case History: 
July 2012


Eleanor Kellon, VMD
 

There is no fixed dose for PPID.  The 5 mg dose is what has been determined to suppress prolactin and MSH in normal horses.  There may not be a direct conversion factor with PPID. I posted dosage ranges currently reported earlier today.  Yes, test ACTH to follow response. We have tested as early as 72 hours after starting and seen a large improvement but may want to give it 2 weeks or so to stabilize before testing.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Jodie's Copper was 23 YO and on 22 mg pergolide with an  ACTH of 72, down to 40 three days after starting cabergoline last March. He had a rough fall and winter but in January his ACTH was down to 15 on 1.6 mL cabergoline so he was dropped back to 1.3 mL. No retest yet. His insulin was staying up, crest hard at that time so he started metformin with very good results from that too.  He'll come off that this month and be retested for everything in mid-May.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


LJ Friedman
 

I was thinking that one dose of cbg fits all..  Not true.. it seems.  Is there a correlation between pergolide dose and the cbg dose needed?  If one is considering a change to save money, and you need a higher dose than the studies show... this can be a dealbreaker,,at least for me..  If I'm paying $4.50 per day for 20mg cp and switch to cbg and wind up using a dose that cost $7.50 per day..... this gives me pause.. and perhaps I'll stick with cp, if I can.. For those who cant guarantee that their horses would get their cp, daily from barn staff etc,, cbg makes good sense,,,especially for the horses at lower doses of cp?
--
LJ Friedman  Nov 2014  San Diego, CA

Jesse's Case History 
Jesse's Photos