Compounded Pergolide capsules cost / Vet vs Wedgewood vs Avrio

Susan Vaughan

Hi all:
My horse just tested positive PPID with the TRH Stim test.
Our vet reluctantly agreed to Rx compounded Pergolide caps.
I asked for this to slowly increase the dose .25 mgs at a time.
I started Remy on APF Pro a few days ago.
He got his first .25 mg dose last night.  
Vet sent Rx to Wedgewood per my suggestion..
100 of .25 mg caps.
Vet dealt directly with WW .
WW would not tell me cost.
Vet pharm told me cost was $245 inc approx $25 for shipping. I paid the vet directly after meds shipped.
then I got the cost 
So $220 for 100 capsules?
I called Avrio today to get their price.
$66 for 90 of .25 mg caps.
What's going on here?
Two dollars vs 75 cents per capsule?
I will do a CH soon.
Remy has the symptoms. 
Past year LF abscessing, hoof surgery, absccessing again, coffin bone loss, rotation.  
LH suspensory branch tears. 
Skin issues and allergies.  
ACTH Cornell baseline.  (9-35)
Feb 2019 was 8.28...(no symptoms but "footy" on rocks)
July 2021 was 19.3
April 2022 TRH:
Pre:.  15.2.  (2-30)
Post:. 179 (2-110).  (Late afternoon blood draw).

It was only this and previous winter I noticed his hair longer than usual.   Shed out but not slick.

Susan Vaughan 
Houston Texas
Remy - 22 year old Arabian gelding
ECIR member since 2004.   
Two previous PPID Arabians
Halima Two (1976 - 2004)
Rab (1986 - 2017)

Thanks again Dr Kellon and all - helping us help our horses.   


Hi Susan.

One of the hard-working mods will respond soon but I just wanted to say hello and assure you that you will get excellent information here. 

I rarely post but I have a 25 yr old Arab gelding, IR & PPID, with whom I had lots of struggles in the early days and the advice/support from this group really helped keep me from letting despair and frustration cloud my judgement. I've been through several vets since Khari's diagnosis in 2016 but have one now that happily prescribes the compounded Pergolide for me. It is hard to understand the resistance among vets to CP, but it seems to be the norm here. Aside from the slow shedding issue, Khari is in good shape; I still ride him and his ACTH has remained in the normal range for the past two years. My previous vet had him on 3 tabs of Prascend and his numbers were still high. I don't know why the 2 mg Pergolide dose works but I'm happy it does. Good luck with your guy.

I order 100 caps, 2 mg each, every 3 months from Precision Rx Pharmacy in CA and it costs $125, including shipping.
Jill, Khari & Jetty in Idaho


NRC 2010 


LJ Friedman

I think the diff is you went thru your vet at wedgewood and you paid him... so he marked it up.. if you were to have him call in an rx and you were to  pay to wedgewood your price is very much less
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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



ACK!   I'm trying not to disparage your vets (except in my head), but I just received my Wedgewood order: Pergolide granules 1 mg/5 cc's, 100 doses for $90.25.  Your 0.25 mg dose, even in capsules, should have been less, probably in line with the Avrio quote.  Granted, my wonderful vet faxes a script (and even searches for the cheapest pharmacy for me!), but I also have "autofill," so I don't pay shipping, and am tax exempt as my farm is a business.   

Last month, my 90 1mg capsules from Wedgewood were $115 for Horse # 2. (Horse #3 is on don't want to know.)
Beth Benard
Rome. NY

Eleanor Kellon, VMD

Mark up on dispensed medications is often a major profit maker for the practice. This allows them to keep prices down for things like call expenses and surgeries.
Eleanor in PA 
EC Owner 2001

Eleanor Kellon, VMD

If you want to learn about laws and AVMA policy on writing prescriptions go here
Eleanor in PA 
EC Owner 2001

LJ Friedman

It’s the same thing with ordering pentosan. through wedgewood. If you go through your vet and purchase from him he marks it up double, but if he send the script to wedgewood and you pay for it directly to wedgewood,you get it for half of his price
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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



As an alternative, buy CP in the target dose, say 1 mg. To taper up the dose at the beginning, use a dosing syringe that show ml marks. I use this one. Dissolve the contents of a 1 mg capsule in 4 ml water, shake really well to dissolve and then give 1 ml/day for 4 days to administer a 0.25 mg dose. Do similar math for the next 0.5 mg gram dose, except divide 4 ml in the syringe in half instead of quarters. Store the syringe tightly capped in the refrigerator. Alternatively, you can taper using Prascend tablets and do the same math: divide in a known amount of water, dissolve really well, and then divide the liquid by quarters to administer 0.25 mg/day. That way you only need to buy CP in a single dosage and can skip the 0.25 mg CP.

Do shop around for CP.  I did recently get a medication compounded by Wedgewood through my vet with no prescription information on the container. I sympathize with owners and with vets. We are all being squeezed by price increases and unreliable supply.
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

Maxine McArthur

Hi Susan
We know you are a long-time member, but I'm attaching our welcome message for new members below as it has useful links to things like the case history instructions and how to upload and label photos/radiographs, plus links to recent research on suitable feeds, metformin, etc.  Have a read through, as there may be information there that is new to you, 

Let us know if you have any issues uploading a case history for Remy. 


Welcome to the group! 

The ECIR Group provides the best, most up to date information on Cushing's (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). Please explore our website where you'll find tons of great information that will help you to quickly understand the main things you need to know to start helping your horse. Also open any of the links below (in blue font) for more information/instructions that will save you time.

Have you started your Case History? If you haven't done so yet, please join our case history sub-group. We appreciate you following the uploading instructions so your folder is properly set up with the documents inside. Go to this CH message with info on how to use various devices and forms. If you have any trouble, just post a message to let us know where you are stuck.

Orienting information, such as how the different ECIR sections relate to each other, message etiquettewhat goes where and many how-to pages are in the Wiki. There is also an FAQs on our website that will help answer the most common and important questions new members have. 

Below is a general summary of our DDT/E philosophy which is short for Diagnosis, Diet, Trim and Exercise.


DIAGNOSIS: There are two conditions dealt with here: Cushings (PPID) and Equine Metabolic Syndrome (EMS)/Insulin Resistance (IR). These are two separate issues that share some overlapping symptoms. An equine may be either PPID or EMS/IR, neither or both. While increasing age is the greatest risk factor for developing PPID, IR can appear at any age and may have a genetic component. Blood work is used for diagnosis as well as monitoring the level of control of each.

PPID is diagnosed using the Endogenous ACTH test, while EMS/IR is diagnosed by testing non-fasting insulin and glucose.

The fat-derived hormone leptin is also usually abnormally elevated in insulin resistance but because there are many other things which can lower or increase leptin ECIR is not recommending routine testing for this hormone. Leptin is the hormone that says "stop eating".

In Europe, adiponectin is tested instead of leptin. Adiponectin helps regulate glucose and fat burning, and maintain insulin sensitivity. Low levels are associated with EMS. It has come to be preferred over leptin because it is not influenced by things like weight or exercise, and also because it was the only factor other than insulin levels that predicted laminitis risk

*Before calling your vet to draw blood for tests, we suggest saving time and wasted money by reading these details and then sharing them with your vet so that everyone is on the same page regarding correct testing and protocols.

*Please remember to request copies of the results of all the tests done rather than just relying on verbal information. Your vet should be able to email these to you. If you have previous test results, please include those as well. All should go in your CH, but if you are having any trouble with the CH, just post in the messages for now. 

Treatment: EMS is a metabolic type - not a disease - that is managed with a low sugar+starch diet and exercise (as able). The super-efficient easy keeper type breeds such as minis, ponies, Morgans, Arabs, Rockies are some of the classic examples. PPID is a progressive disease that is treated with the medication pergolide. Some, but not all, individuals may experience a temporary loss of appetite, lethargy and/or depression when first starting the medication. To avoid this "pergolide veil" (scroll down for side effects), we recommend weaning onto the drug slowly and the use of the product APF. The best long term results are seen when the ACTH is maintained in the middle of the normal range at all times, including during the annual seasonal rise. To accomplish this, the amount of medication may need to increase over time. Neither condition is ever "cured", only properly controlled for the remainder of the equine's life. If your partner is both PPID and IR then both medication and diet management will be needed. 

DIET: Almost all commercial feeds are not suitable - no matter what it says on the bag. Please see the International Safe Feeds List for the safest suggestions.

No hay is "safe" until proven so by chemical analysis. The diet that works for IR is:

  • low carb (less than 10% sugar+starch)
  • low fat (4% or less) 
  • mineral balanced  

We use grass hay, tested to be under 10% ESC + starch, with minerals added to balance the excesses and deficiencies in the hay, plus salt, and to replace the fragile ingredients that are lost when grass is cured into hay, we add ground flax seed and Vitamin E. This diet is crucial for an EMS/IR horse, but also supports the delicate immune system of a PPID horse. 

*Until you can get your hay tested and balanced we recommend that you soak your hay and use the emergency diet (scroll down for it).  The emergency diet is not intended for long term use, but addresses some of the most common major deficiencies. Testing your hay and getting the minerals balanced to its excesses and deficiencies is the best way to feed any equine (look under the Hay Balancing file if you want professional help balancing). If you absolutely cannot test your hay and balance the minerals to it, or would like to use a "stop gap" product until you get your hay balanced, here's a list of "acceptable" ration balancers

There is a lot of helpful information in the start here folder so it is important you read all the documents found there. The emergency diet involves soaking your untested hay for an hour in cold water or 30 minutes in hot water. This removes up to 30% of the sugar content, but no starch. Starch is worse than sugar since it converts 100% to glucose while sugar only converts 50%, so starch causes a bigger insulin spike. Make sure you dump the soaking water where the equine(s) can't get to it. 

What you don't feed on the EMS/IR diet is every bit as, if not more important than, what you do feed! No grass. No grain. No sugary treats, including apples and carrots. No brown/red salt blocks which contain iron (and sometimes molasses) which interferes with mineral balancing, so white salt blocks only. 

No products containing molasses. No bagged feeds with a combined sugar and starch of over 10% or starch over about 4%, or fat over about 4%. Unfortunately, even bagged feeds that say they are designed for IR and/or PPID equines are usually too high in sugar, starch and/or fat. It’s really important to know the actual analysis and not be fooled by a name that says it is suitable for EMS/IR individuals.

We do not recommend feeding alfalfa hay to EMS/IR equines as it makes many of them laminitic. Although it tends to be low in sugar, many times the starch is higher and does not soak out. Additionally, protein and calcium are quite high, which can contribute to sore footedness and make mineral balancing very difficult.

TRIM: A proper trim is toes backed and heels lowered so that the hoof capsule closely hugs and supports the internal structures of the foot. Though important for all equines, it's essential for IR and/or PPID equines to have a proper trim in place since they are at increased risk for laminitis. After any potential triggers are removed from the diet, and in PPID individuals, the ACTH is under control, the realigning trim is often the missing link in getting a laminitic equine comfortable. In general, laminitic hooves require more frequent trim adjustments to maintain the proper alignment so we recommend the use of padded boots rather than fixed appliances (i.e. shoes, clogs), at least during the initial phases of treatment.

Sometimes subclinical laminitis can be misdiagnosed as arthritis, navicular, or a host of other problems as the animal attempts to compensate for sore feet. 

You are encouraged to make an album and post hoof pictures and any radiographs you might have so we can to look to see if you have an optimal trim in place. Read this section of the wiki for how to get a hoof evaluation, what photos are needed, and how to get the best hoof shots and radiographs.

EXERCISEThe best IR buster there is, but only if the equine is comfortable and non-laminitic. An individual that has had laminitis needs 6-9 months of correct realigning trims before any serious exercise can begin. Once the equine is moving around comfortably at liberty, hand walking can begin in long straight lines with no tight turns. Do not force a laminitic individual to move, or allow its other companions to do so. It will begin to move once the pain begins to subside. Resting its fragile feet is needed for healing to take place so if the animal wants to lay down, do not encourage it to get up. Place feed and water where it can be reached easily without having to move any more than necessary. Be extremely careful about movement while using NSAIDs (bute, banamine, previcox, etc.) as it masks pain and encourages more movement than these fragile feet are actually able to withstand. Additionally, NSAIDs (and icing) do not work on metabolic laminitis and long term NSAID use interferes with healing. Therefore, we recommend tapering off NSAIDs after the first week or so of use. If after a week's time your equine's comfort level has not increased, then the cause of the laminitis has not been removed and keeping up the NSAIDs isn't the answer - you need to address the underlying cause.


There is lots more information in our files and archived messages and also on our website. It is a lot of information, so take some time to go over it and feel free to ask any questions. If you are feeling overwhelmed, don't worry, you will catch on, and we are always here to help you! Once you have your case history uploaded, we can help you help your equine partner even better.

For members outside North America, there are country specific folders in the files and many international lists in the wiki to help you find local resources.

If you have any technical difficulties, please let us know so we can help you. 

Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response


Susan Vaughan

Thanks all.
I requested the compounded as I have health issues and don't want to risk Prascend "dust".
Years ago I heard vets were asking  BI to make lower dose tablets.   Obv that didn't happen (and what would they cost?).
I am upset it seems the vet clinic upcharged me some much.   Like $150 too much.
I will kindly ask if someone made a mistake.
The clinic called in the Rx / it was shipped w/o anyone at Wedgewood contacting me for payment info etc.
I - the horse owner and payer - was not to be privy to the goings-on.
Hoping the vet - or another one - will Rx the compounded after this first month - which had no refills.
And I won't use WW.

Susan Vaughan in Houston Texas
Member since 2004

Sherry Morse

Hi Susan,

Wedgewood isn't at fault here so not sure why you wouldn't use them again.

Susan Vaughan

Sherry.    I know.
It just doesn't sit well with me that WW won't give cost info.
They had the prescription but wouldn't tell me the amount charged.  
Susan Vaughan in Houston Texas
Member since 2004

Lavinia Fiscaletti

Hi Susan,

Wedgewood does prefer to deal directly with vets, not the end consumer. In this case, the vet was Wedgewood's client, not you, so they would give pricing to the vet.

You were the vet's client so your cost was determined by the practice.

Lavinia, George Too, Calvin (PPID) and Dinky (PPID/IR)
Nappi, George and Dante Over the Bridge
Jan 05, RI
Moderator ECIR



Most of the time everyone you go through gets a cut. And it’s that way with prescriptions, glasses, mattresses, etc.  And the more middlemen you have the more expensive it gets.  And to some extent it helps businesses be able to make a profit and to stay in business.  Also each Pharmacy marks up each medication differently too.  Like some Pharmacies will price drug A cheaper than drug B.  But another Pharmacy will do just the opposite.  And with me, if I need something quick and easy - I’ll go through the vet.  If it’s going to be long term I’ll shop around.  
Mary E in Wi 2021