26 yo Morgan requiring less pergolide (tested ACTH)

Mary Niemela

Lots of numbers in here (and they're all in the CH), so scroll on by if you don't like numbers.  :-)

I finally managed to get a bunch of information into Desi's CH.  I wanted to share that he is requiring significantly less pergolide to control his ACTH.  He was diagnosed in Feb 2011 and required 3mg pergolide to get him under control in the spring.  I doubled the dose for the fall but was behind the curve and he wasn't controlled on 7mg in Nov (we kept increasing it trying to get control). He was being boarded at that time.
2012 we bought a small farm and he's been with me since then.  ACTH controlled at 4mg spring, climbing to 8mg in the fall. Compounded pergolide. In 2014 I didn't like how he was doing (low energy), controlled diet, tested hay, etc.  Dirt paddock. Kept fall pergolide dose lower (6mg) and retested in Oct.  He was controlled (13.2 uL) and felt better.  2015 - New dosage ranged from 3mg spring to 6mg September.  
2022 - again, he wasn't feeling well in the spring.  ACTH on 3mg was very low at 8.95 pg/uL and I thought "I wonder" and lowered his dosage to 2mg.  5 days later he felt SO much better.  He has always responded to dosage changes on day 5.  ACTH remained low.  I lowered him to 1.5mg pergolide in June, then 2mg July, 2.5mg August and rechecked ACTH.  He felt pretty good during all of this and ACTH was 10.8!  So I didn't raise the dosage in Sept, then lowered it to 2mg in Oct and mid Oct his ACTH was 22.5.  I'm happy with that and intend to do the same next fall as long as he feels okay.  
I am shocked that this has happened, although he was under a lot more stress when we initially tested him - and then we moved the next year. 
With the initial lowering of the dose in 2014, I thought we had simply overdosed due to us being behind the curve in that first year.  That made sense to me.  This latest change seems pretty extreme to me.  
If anyone has insight, that'd be awesome.

Mary in MD, 2004

LJ Friedman

do you lower doses because of side effects of pergolide or because of acth lab values?
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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Nancy C

Could be either. If you have the veil, rolling back to begin titrating up would be in order. Rolling back for lab values is not generally advised b/c with a solid diagnosis, most of the time it means you are in control. Exceptions to that might include animals who have iffy diagnosis and need to be retested, or who were put on the drug just for seasonal rise. In the latter situation, I'd want to retest to make sure you are still okay.
Nancy C in NH
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