Increase pergolide??


Ann Conn
 

Seeking advice for Azeem, Arabian gelding will be 18 in march 2019. Listing results of the bloodwork he's had done, all sent to Cornell.
7-13-16. ACTH. 34.8
Insulin. 35.97
9-18-17. Glucose. 105
ACTH. 78.4
Insulin. 81.51
8-14-18. Glucose. 99
ACTH. 51
Insulin. 76.8
Leptin. 12.01
He was on 1 prascend for a year, increased to 2mg in sept. 18. He's taking balance cubes for eating his pill and supplements. Most of his diet is giant Bermuda hay from CA, which I'm having retested next week--concerned about nitrates. Hooves are good except for how wet it's been here. Trimmer is excellent. She attended last October conference.
But he isn't bright.
Vet doesn't want to test until March and refused to give more than 2mg even though I'd asked for 3mg.
So, I have some prascend left over and wondering if I could add half a prascend to his 2mg compounded pergolide? Is there some reason not to? I'm just afraid the .7 increase wasn't enough after a whole year on one prascend had done little difference.
Wouldn't even have him without this group...probably.
Ann & Azeem
Oct. 2017
Central Texas


 

Hi, Ann- group members have found that PPID horses do best when the ACTH is in the low to mid-normal range, so 22 or below; and some members find their horses need to have the ACTH in the 18 range. So, it looks like Azeem definitely needs an increase in pergolide. 

Adding the Prascend to his compounded pergolide is what I would do right now; however, you are somehow going to have to convince your vet that the correct dose of pergolide is the one that controls the ACTH (I quote Dr. Kellon).  

Merlin (who I euthed at age 35 due to renal failure) was on 24 mg pergolide, and full of beans, sound and happy. Maggie is on 14 mg,and Gypsy is on 7 mg. In the Pergolide Stats file, you will see that 58% of equines are on more than 4 mg of pergolide:  https://docs.google.com/spreadsheets/d/1XpNVG1ud-FGCblvFhm_zSyZ1ZXGUeiR_n0v6THLDtbY/edit#gid=0   (you can find this on the Wiki page in the database section).  

If you go here https://ecir.groups.io/g/main/files/3%20Cushings%20Disease%20-%20PPID/Cushings%20Disease%20Treatments/Pergolide/2.%20Pergolide%20Dosage  and scroll down to the third file, there is good information about convincing your vet to increase the dose.   If you go here:  https://ecir.groups.io/g/main/files/9b%20Pulling%20it%20Together  and scroll down to the 11th file, there is good information on getting your vet on board.

It's a dance, and a balancing act. The only reason I haven't had to change vets for my horses is because I have the information from this group, and I am already a vet!
--
Jaini Clougher (BSc, BVSc)
Merlin (over the bridge), Maggie, Gypsy, Ranger
ECIR mod/support, BC 09
DDT+E = effective treatment for PPID and EMS/IR equines: https://bit.ly/2J4ZgYT

https://ecir.groups.io/g/CaseHistory/files/Jaini%20and%20Merlin-Maggie-Gypsy .
https://ecir.groups.io/g/CaseHistory/album?id=34193.
https://ecir.groups.io/g/CaseHistory/album?id=39711