Cabergoline


Ereimers90@...
 

My vet has now suggested using cabergoline for my horse as 2.5 MG of prascend is not managing the PPID. Current levels are Acth: 159 and Insulin: 200

I'm at a loss as per my vet, his diet is great and he was upped from 1.5 MG of prascend to 2mg over the fall, and then up to 2.5 MG since March. He had a laminitic attack last November and is still recovering. At the age of 25 I know his body can't go through another attack and I'm at my wits end trying to manage the cushings and his overall health and need some help with PPID medication. 
My vet wants to charge $375 for the 5ml bottle of cabergoline and start him off at 1ml every other week. Where are others purchasing this from and how much is it? I found it at Bet pharmacy for $250 but can't seem to enter a California address. I've placed a call into them to see if they can ship to CA. If not I definitely can't afford it through my vet as the $375 is more than what I pay for the prascend. 
She wasn't too confident about compounded pergolide but I feel that may be the best option to go since the 2.5 MG of prascend is not working. Almost seems like he would need to go up to 3.5 or 4mg of prascend daily. 
--
Erica H CA 2021


celestinefarm
 

Erica, many of us here have horses that are on much larger doses of pergolide and manage symptoms well. Tipperary is my 25 year old stallion and is currently on 8 mgs of compounded pergolide in oil from Pet Health Pharmacy in AZ and an additional 1 mg tab of Prascend dissolved in water and syringed in. He will have a blood draw next week for a new ACTH and Insulin review and if he needs more pergolide, a new Rx.  There have been horses on 30-40 mgs of pergolide here who lived into their thirties( I believe one member had a pony in their 40s) . The pharmacies recommended here are accredited veterinary compounding pharmacies with experience in dispensing pergolide for horses. Wedgewood veterinary pharmacy, Pet Health, and in Canada, Island Pharmacy. I would strongly urge you to provide your vet with their links. Pet Health pharmacists will also speak personally to her regarding any concerns she has. I would certainly try increased doses of oral meds at this stage as Cabergoline is normally used when horses become refractory to the oral meds, of which there is no way to know that with your horse since he is getting a beginning dose of prascend currently.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Sherry Morse
 

Hi Erica,

We don't usually recommend cabergoline until horses are not responding to oral pergolide or you've hit a tipping point in pricing (which is usually at a MUCH higher dose than 2.5mg/day.)  As far as pricing you're currently at 75mg of pergolide at an average of $2.12/mg which is $159 per month.  Your vet is now proposing to charge you $75 per dose of cabergoline or $300 a month IF a 1ml dose every 7 days works.  Even at $250 a 5ml vial that's still $50/dose or $200 a month IF your vet is willing to let you purchase from some place else.

Based on that math I'd choose increasing Prascend but to get the most 'bang for your buck' compounded pergolide is the way to go.  That may involve a serious discussion with your vet or looking for another vet who is more willing to work with you. 




Ereimers90@...
 

I'm currently spending $170 per month for the prascend at 2.5mg daily and need a way to lower the cost as the 2.5mg is not managing the cushings.  I'm concerned with his elevated acth and Insulin that he may have another laminitic attack and I just can't do that again. 


On Wed, Jun 2, 2021, 12:59 PM Sherry Morse via groups.io <sherry_morse=yahoo.com@groups.io> wrote:
Hi Erica,

We don't usually recommend cabergoline until horses are not responding to oral pergolide or you've hit a tipping point in pricing (which is usually at a MUCH higher dose than 2.5mg/day.)  As far as pricing you're currently at 75mg of pergolide at an average of $2.12/mg which is $159 per month.  Your vet is now proposing to charge you $75 per dose of cabergoline or $300 a month IF a 1ml dose every 7 days works.  Even at $250 a 5ml vial that's still $50/dose or $200 a month IF your vet is willing to let you purchase from some place else.

Based on that math I'd choose increasing Prascend but to get the most 'bang for your buck' compounded pergolide is the way to go.  That may involve a serious discussion with your vet or looking for another vet who is more willing to work with you. 

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891



--
Erica H CA 2021


Erica Reimers <Ereimers90@...>
 

Also, I'm confused where 75mg of pergolide is coming from. I thought the conversion from prascend to pergolide capsules is 1.305=1. So if I switched him from 2.5 MG of prascend, that would equal 3.26 MG of pergolide. With the elevated Acth it seems he would need 3.5 MG of prascend daily or 4.57mg of compounded pergolide capsules. 


On Wed, Jun 2, 2021, 1:07 PM Erica Reimers via groups.io <Ereimers90=gmail.com@groups.io> wrote:
I'm currently spending $170 per month for the prascend at 2.5mg daily and need a way to lower the cost as the 2.5mg is not managing the cushings.  I'm concerned with his elevated acth and Insulin that he may have another laminitic attack and I just can't do that again. 

On Wed, Jun 2, 2021, 12:59 PM Sherry Morse via groups.io <sherry_morse=yahoo.com@groups.io> wrote:
Hi Erica,

We don't usually recommend cabergoline until horses are not responding to oral pergolide or you've hit a tipping point in pricing (which is usually at a MUCH higher dose than 2.5mg/day.)  As far as pricing you're currently at 75mg of pergolide at an average of $2.12/mg which is $159 per month.  Your vet is now proposing to charge you $75 per dose of cabergoline or $300 a month IF a 1ml dose every 7 days works.  Even at $250 a 5ml vial that's still $50/dose or $200 a month IF your vet is willing to let you purchase from some place else.

Based on that math I'd choose increasing Prascend but to get the most 'bang for your buck' compounded pergolide is the way to go.  That may involve a serious discussion with your vet or looking for another vet who is more willing to work with you. 

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891



--
Erica H CA 2021


--
Erica H CA 2021


Eleanor Kellon, VMD
 

Erica,

There is only one source for the cabergoline injections, BET. The 2.5 mg pergolide dose isn't that high and obviously not high enough.  There's no way to predict what the effective dose would be but I would titrate his dose up to 4 or even 5 mg/day and not consider the cabergoline until the cost of pergolide is getting higher than what you would pay for cabergoline.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 

Erica,

As you pointed out, the cabergoline would cost more and there is no guarantee the 1 mL dose would be any better than your current pergolide - sometimes it is, sometimes not. Compounded is your best avenue for controlling costs.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Eleanor Kellon, VMD
 
Edited

The concentration of pergolide in the compounded capsule depends on how the prescription is written. If it is written as:

                                       "X mg of pergolide base from pergolide mesylate"

it will be the same as Prascend - i.e. 1 mg = 1 mg.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Erica Reimers <Ereimers90@...>
 

Thank you for the additional information Dr Kellon. I'm trying to get my vet to prescribe me compounded as I cannot afford to pay for Prascend at 4 mg per day. The 160 count prascend box would only last me 40 days on 4mg a day and that would run me $330ish per month.
If he was on 4mg of prascend, how many mg of compounded pergolide capsules would he need daily? 

Thank you


On Wed, Jun 2, 2021, 2:05 PM Eleanor Kellon, VMD <drkellon@...> wrote:
Erica,

There is only one source for the cabergoline injections, BET. The 2.5 mg pergolide dose isn't that high and obviously not high enough.  There's no way to predict what the effective dose would be but I would titrate his dose up to 4 or even 5 mg/day and not consider the cabergoline until the cost of pergolide is getting higher than what you would pay for cabergoline.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


--
Erica H CA 2021


celestinefarm
 

Erica, Sherry was calculating what you are paying per month for Prascend . At his current dose of 2.5mgs, you are using 75 mgs of Prascend a month. Prascend costs $2.12 per 1 mg tablet so 75 mgs, per month is costing you $159 a month. If you switch to Cabergoline and give your horse the same dose, your costs will rise to $300 a month.  For comparison, Tipperary's Rx. from Pet Health Pharmacy of 8 mgs of pergolide as mesylate in 1 ml  in apple flavored oil cost me $285,04 including shipping to Michigan for 90 days supply.. .$39.5 cents per mg.or $3.17 per day./$90.35 per month for 8 mgs. 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


celestinefarm
 

Erica have your vet write the Rx as Dr.Kellon wrote it in her post below.( Where the x is , insert the amount of pergolide you want. The pharmacy will calculate the amount of pergolide for you, you don't need to write it in.) If you are using capsules, each capsule will have whatever amount you want in it ( however, there is a limit per capsule of what can be fit , the pharmacy will publish what amount of pergolide per capsule they can fill). If you choose oil instead, they will mix according to how much you want per ML.  ECIR does not recommend pergolide mesylate in water or in any other delivery form( Wedgewood has lozenges, etc.) because to the best of our knowledge only the capsules and oil have had independent lab studies for length of time of potency, etc. at the different accredited pharmacies.



Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Erica Reimers <Ereimers90@...>
 

Thank you for the clarification. I definitely read the response wrong. Now all I need to do is convince my vet to prescribe me compounded pergolide. 


On Wed, Jun 2, 2021, 2:41 PM celestinefarm <celestinefarm@...> wrote:
Erica, Sherry was calculating what you are paying per month for Prascend . At his current dose of 2.5mgs, you are using 75 mgs of Prascend a month. Prascend costs $2.12 per 1 mg tablet so 75 mgs, per month is costing you $159 a month. If you switch to Cabergoline and give your horse the same dose, your costs will rise to $300 a month.  For comparison, Tipperary's Rx. from Pet Health Pharmacy of 8 mgs of pergolide as mesylate in 1 ml  in apple flavored oil cost me $285,04 including shipping to Michigan for 90 days supply.. .$39.5 cents per mg.or $3.17 per day./$90.35 per month for 8 mgs. 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


--
Erica H CA 2021


LJ Friedman
 

Shouldn’t more focused be given to controlling the insulin? I know that often the correct amount of pergolide medication would  not control over 200 insulin,?
The next time you retest for insulin have your vet write  on the lab report to report the exact number over 200. If it’s not reported you can call up and get it reported.,Best to write it on the report before sending
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

Jesse( over the rainbow) and majestic ‘s Case History 
Jesse's Photos

 


Erica Reimers <Ereimers90@...>
 

I'm trying to do both but know the ACTH will be the more expensive option.  What methods would you suggest for insulin? 
--
Erica H CA 2021


Eleanor Kellon, VMD
 

LJ,

You won't be able to get the insulin controlled until the PPID is controlled. They both have to be addressed.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Erica,

As Dr. Kellon already mentioned in a horse that's both PPID and IR getting ACTH under control is the first priority as that will help bring insulin down in most cases.  Additional insulin control comes through changes in diet and then medication if necessary.  Without a case history we can't advise you on any diet points that you can fix now to help address that though.



Erica Reimers <Ereimers90@...>
 

Thank you Everyone for your suggestions and input on the cabergoline. The vet called me back this morning and agreed to prescribe compounded pergolide mesylate as this is significantly cheaper for me and will allow me to afford his medication if/when I need to up the dosage again. We are upping him from 2.5 mg to 3 for the next couple of weeks and then up to 3.25 for a couple more weeks, and will then retest levels. 
We are also adding in metformin(which I'm hoping he will eat ground up in his hay pellets/supplements). Due to boarding situation, syringing it is not an option twice a day. 
I'm optimistic that these changes will prevent another laminitic episode this year. Trying not to stress and over worry myself, but it's super hard not to. My guy has been through two laminitic attacks in the last 4 years and it's emotionally and financially taxing, no to mention physically taxing on him especially now that he's older. 

Appreciate all of the input and patience from everyone <3

On Thu, Jun 3, 2021, 8:30 AM Sherry Morse via groups.io <sherry_morse=yahoo.com@groups.io> wrote:
Hi Erica,

As Dr. Kellon already mentioned in a horse that's both PPID and IR getting ACTH under control is the first priority as that will help bring insulin down in most cases.  Additional insulin control comes through changes in diet and then medication if necessary.  Without a case history we can't advise you on any diet points that you can fix now to help address that though.

Thanks,
Sherry and Scutch (and Scarlet over the bridge)
EC Primary Response 
PA 2014
https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet 
https://ecir.groups.io/g/CaseHistory/album?id=78891


--
Erica H CA 2021