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No Response to Prascend #legalityofpergolide

 


I was super disappointed to get Khari's repeat ACTH back today after seven weeks on his full 1 mg dosage. It was 100, so not really any change from the 102 we started at in May. The glucose, insulin and leptin were essentially identical as well. I was surprised because he looks better: he has shed the little patches of remaining long hairs on his belly and upper legs, his crest has gone down a little and his shoulder pads are almost gone.  The sheath swelling has decreased as well, though it is still not normal.  His appetite is good - for hay and anything that does not contain pergolide - and he has plenty of energy on our 15 minute rehab walks. (I'm treating him for fibrotic myopathy.)  He walks comfortably on the gravel lane as well so I think his feet feel ok for now.

I'm sorry but I cannot update my CH from work and my home computer is out of commission until I can afford to bail it out from the repair shop but nothing else has changed for him other than a slight increase in the rehab walking time and the elimination of the alfalfa pellets as carrier for his minerals.  (I'm dissolving them in water and sprinkling on his hay.)  These things should be helping, if anything, right?  With the G/I values anyway?

I am confident the lab work was handled properly and shipped correctly - I had a long discussion about it with this vet before we did the first set of labs. I'm getting the blood drawn at home, a few hours after Khari's a.m. feeding and it is being taken directly back to the office just ten minutes from my place.  

I have been struggling to get the Prascend into him from the beginning so it is slightly possible that he doesn't always get the entire dose.   I was syringing it for a few days and that was easy enough the first day (he has never been a problem to worm), but the next day he began making a serious effort to avoid swallowing. I can't hold his head up and massage his throat simultaneously because he fights so hard to to get his head down & spit out the applesauce/Prascend mixture.  He has rejected every hiding place (prune, date, piece of apple, piece of carrot) I have tried after the second day.  He will eat it dissolved & dribbled over a large amount of LMF stage 1 but there is some dropping out of his mouth and he pushes it around in the bowl which makes the pellets crumble into powder which he won't eat and sometimes he loses interest before all the pellets are gone.  I'm sure he would eat it on some molassed oats but I'm afraid to use that with his GI ratio of 2.  On days when I'm pretty sure he didn't get the entire dose I've been giving him another .25 mg in the evening so, if he hasn't been consistently getting the 1 mg every day, I think its close.  To think, I was worrying that I might give him too much by doing that!

Is this unusual? Does the total lack of response indicate that he will be one of those horses who require very large doses?  Is there anything I can give him to "boost" the efficacy of the pergolide?

 My vet is going to talk to the internal medicine person at the major equine hospital here and I expect they are going to recommend more testing because they already told me that they don't think the endogenous ACTH is the best method.  I really can't afford more labs now; I don't even know if I can manage much of an increase in the Prascend.  Or if I can get a larger dose into him.

I admit I'm feeling rather desperate right now and I don't know what else to do unless there a better way to get the Prascend into him that I haven't tried yet.  
-- 
Jill, Khari & Jetty in Idaho

 

--
Jill, Khari & Jetty in Idaho

 

NRC 2010

https://ecir.groups.io/g/CaseHistory/files/Jill%20and%20Khari 

 

macivor macivor <macivor19@...>
 


Hi Jill,
I have experienced the same things!

First, May is a low ACTH month for horses.  And in Aug my horse (and I think others) is well on his way to the top of the seasonal rise.  It comes a lot earlier and lasts a lot longer for my horse.  So, it could be that the 1 mg. was working just fine and if you hadn’t been giving it, the ACTH would have been much higher. Of course there could be other reasons, too.


My horse hates prascend.  I did every trick and nothing worked, except syringing and he didn’t like it but it was doable.  Then Prascend became so expensive I switched to compounded and Eureka! he can’t smell the pergolide in the capsule so now I just put a very small amount of little pellets in my hand, drop the pill on top, and put some pellets on top of that and he gobbles it up right out of my hand.  I do hold a blue plastic container under my hand in case the pill falls out of his mouth.  The capsule is white so shows up good if it falls in the blue container. (blue Costco container that mushrooms come in). A couple of times I can tell he bit into the pill and then he won’t eat the carrier for 3 or 4 days so I keep two carriers, using the other one until he forgets that the first tasted bad. 

casey oregon 2014

On Aug 3, 2017, at 5:15 PM, Jill, Khari & Jetty in Idaho via Groups.Io <kharimom2001@...


_._,_._,_

Maxine McArthur
 

Hi Jill
My horse will also eat the compounded capsule in her food, but not Prascend. Unfortunately, I use Prascend 9half or quarter) when I am increasing her dose.
I do dissolve and syringe it, but what I'm trialling now is an empty capsule from the pharmacy (just large enough to hold the Prascend). Unscrew capsule, insert half Prascend, screw capsule together. So far, she has eaten this twice in her food. It might be worth trying? At least until you can get hold of the compounded...
--
Maxine and Indy

Canberra, Australia 2010

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy

https://ecir.groups.io/g/CaseHistory/album?id=933

 

 

Thanks for the replies - are these empty gelatin capsules from the pharmacy?  Do you just buy them off the shelf or did you have to make special arrangements to get them?

If there are any members from southern Idaho here, do any of you have a vet that will prescribe the compounded pergolide?  I've spoken to several in my area and none of them are willing.
--
Jill, Khari & Jetty in Idaho

 

NRC 2010

https://ecir.groups.io/g/CaseHistory/files/Jill%20and%20Khari 

 

Lavinia Fiscaletti
 

Hi Jill,

Yes, you can buy empty capsules "off the shelf". You can buy them on Amazon:

https://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=empty+gelatin+capsules

Tough when the vets won't work with you on the script angle. Have you tried asking them why they won't prescribe the compounded pergolide? If they say it's because it's illegal, here's some discussions we've had regarding that aspect:

https://ecir.groups.io/g/main/message/208115?p=Created,,%22compounded+pergolide%22,20,2,20,11717140

https://ecir.groups.io/g/main/message/208093?p=Created,,%22compounded+pergolide%22,20,2,20,11708523

Many more in the message archives.

It is also interesting to note that the same vets that say they won't prescribe compounded pergolide because of the "legality" issue, will quickly write a script for Previcox for their equine patients because it's much more affordable than Equioxx, the legal version available for horses.

If it's because they believe that compounded perg is unstable/unreliable, that can be an issue if the pharmacy involved doesn't follow best practices for the industry. There are a number of pharmacies that members have used (and had the product independently tested) and found it to be exactly what it is supposed to be. Check here:

https://ecir.groups.io/g/main/message/208093?p=Created,,%22compounded+pergolide%22,20,2,20,11708523

HTH.
--
Lavinia and George Too

Dante, Peanut, Nappi and George over the Bridge

Jan 05, RI

EC Support Team

 

Thank you Lavinia,

The one vet that I had the longest conversation with seemed to be saying that prescribing compounded pergolide when the FDA has only "approved" Prascend is taking an unnecessary risk of someone suing them if the compounded version doesn't work. I got the impression he wasn't even interested in pursuing a conversation with me about his reasons and I have not had extended conversations with the other vets - only called to ask and was told no.  I did show the info from this group to a local compounding pharmacist  and was told that the legal issue is "vague" and they are not interested in being involved with it.  

I am going to revisit the conversation with my current vet and will print all of the information for him.  I didn't push it at first because I was really hoping the 1 mg Prascend would do the trick. 
--
Jill, Khari & Jetty in Idaho

 

NRC 2010

https://ecir.groups.io/g/CaseHistory/files/Jill%20and%20Khari 

 

Eleanor Kellon, VMD
 

There is absolutely no reason at all for your vet to be involved in the legality issues.

It is legal for any vet (or MD) to prescribe a compounded version of pergolide in a dose or form (liquid, powder, capsule, "treat"/flavor etc) different from the commercially available form.  The legality issue arises, in the opinion of the FDA, when the pharmacist chooses to use bulk pergolide rather than crushed up Prascend to fill that prescription.  Using the bulk drug is what lowers the cost to the customer.

To write you a prescription, all the prescription has to say is the drug, the dosage and the form. It does not have to specify bulk drug or Prascend.

It's really that simple!
--
Eleanor in PA

 

www.drkellon.com 

EC Owner 2001