Date
1 - 20 of 23
Compounded Pergolide vs Prascend
My 25 yo SSH has just been increased from 1.5 mg to 2 mg Prascend. The cost of the Prascend on a fixed budget is very expensive. I asked our veterinarian's office about compounded pergolide and was told that as long as there was an FDA approved drug available they could not write a script for compounded.
How would one go about getting compounded pergolide? I want to do what is best for my horse however the cost is prohibitive on a fixed income.
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Mary Whitney NH 2022
How would one go about getting compounded pergolide? I want to do what is best for my horse however the cost is prohibitive on a fixed income.
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Mary Whitney NH 2022
In my experience --- and I have had Andy's pergolide compounded now for well over 5 years...I believe many state's laws require a veterinarian to issue a prescription for a compounded formula of a FDA approved drug if asked to do so by the animal's owner. I kind of saw it as "you can't hold the animal's owner over a barrel" if the welfare of the animal is the issue and it can be fulfilled by an alternate method. (That was years ago, I may not be saying this exactly as it was presented to me!)
I hope someone else can elaborate and/or you could look it up in state law fro NH.
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Sandy
I hope someone else can elaborate and/or you could look it up in state law fro NH.
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Sandy
March 2017, Onalaska, WA, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Andy .
https://ecir.groups.io/g/CaseHistory/album?id=6171 .
Sandy,
I'm not sure if there are state laws requiring prescriptions for compounded but there are definitely state laws for prescriptions in general. The veterinarian can write a prescription for " x mg of pergolide from pergolide mesylate " and not specify Prascend or compounded. It's up to the owner what to do with the prescription.
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Eleanor in PA
I'm not sure if there are state laws requiring prescriptions for compounded but there are definitely state laws for prescriptions in general. The veterinarian can write a prescription for " x mg of pergolide from pergolide mesylate " and not specify Prascend or compounded. It's up to the owner what to do with the prescription.
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Eleanor in PA
www.drkellon.com BOGO 2 for 1 Course Sale Through End of January
EC Owner 2001
The first step to wisdom is "I don't know."
I apologize...it probably WAS for prescriptions in general, you are so correct.
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Sandy
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Sandy
March 2017, Onalaska, WA, USA
Case History: https://ecir.groups.io/g/CaseHistory/files/Sandy%20and%20Andy .
https://ecir.groups.io/g/CaseHistory/album?id=6171 .
Hi Mary,
One work-around is to change to a specific dose not easily filled by giving Prascend. So instead of 2 g pergolide mesylate (ie, 2 Prascend), ask for 2.25 mg pergolide mesylate. Veterinarians cannot change a prescription because of the owner's financial situation (which is ludicrous IMO!), but they can change it if the FDA approved drug cannot be easily administered as is. In that case you'd have to quarter a pill, and the tablet is not designed for quartering.
Another work-around that might be more successful at higher doses is if administration of the Prascend becomes an issue because of the number of pills your horse spits out then, you can ask for compounded pergolide in 1 pill for easier administration.
Remember, if you switch to compounded pergolide, you must ask for "x" mg of pergolide mesylate, as Dr Kellon demonstrated, or do some math. 1 mg pergolide (1 Prascend) = 1.3 mg pergolide mesylate.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
One work-around is to change to a specific dose not easily filled by giving Prascend. So instead of 2 g pergolide mesylate (ie, 2 Prascend), ask for 2.25 mg pergolide mesylate. Veterinarians cannot change a prescription because of the owner's financial situation (which is ludicrous IMO!), but they can change it if the FDA approved drug cannot be easily administered as is. In that case you'd have to quarter a pill, and the tablet is not designed for quartering.
Another work-around that might be more successful at higher doses is if administration of the Prascend becomes an issue because of the number of pills your horse spits out then, you can ask for compounded pergolide in 1 pill for easier administration.
Remember, if you switch to compounded pergolide, you must ask for "x" mg of pergolide mesylate, as Dr Kellon demonstrated, or do some math. 1 mg pergolide (1 Prascend) = 1.3 mg pergolide mesylate.
--
Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
Kim Leitch
Kristen, I think you got the numbers backwards. 1 mg pergolide (1 Prascend) = ~1.3 mg pergolide mesylate.
The prescription should be written as x mg pergolide as pergolide mesylate.
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Kim 10-2014
The prescription should be written as x mg pergolide as pergolide mesylate.
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Kim 10-2014
Clover, SC
ECIR Group Moderator
Grits and Bella: PPID, IR; Dually: IR (sold); and Eeyore (deceased, but not PPID related)
Case History https://ecir.groups.io/g/CaseHistory/files/Kim%20and%20Grits%20-%20Eeyore%20-%20Dually
Photo album Grits https://ecir.groups.io/g/CaseHistory/album?id=1314
Photo album Eeyore https://ecir.groups.io/g/CaseHistory/album?id=6586&p=Name,,,20,1,0,0
Photo album Dually https://ecir.groups.io/g/CaseHistory/album?id=9046&p=Name,,,20,1,0,0
Photo album Bella https://ecir.groups.io/g/CaseHistory/album?id=64978
celestinefarm
I recently found it necessary to switch to a new veterinary practice as my long-time vet has experienced some severe health issues and has been unavailable of and on for more than a week at a time. In my area, equine vets are refusing to see emergencies if you are not a registered client whose horses have been seen for non-emergency care in the past year. So, the necessity of becoming established with a new practice. I believe I wrote about this a few months ago, but I'll briefly repeat. The vet who pulled blood to test ACTH on both of my PPID mares discussed her philosophy regarding Prascend vs. compounded. She stated that on every horse she pulled from compounded onto Prascend, their ACTH improved. I told her about the ECIR group, which she was unaware of, and I also told her I thought we had members using compounded pharmacies that had stability testing on file. She asked if I could send her those results and of course, as we have discussed here since and I then found in files, none of the pharmacies will share that information with us. We have in the files very old stability testing done by a member years ago. I have not sent the vet anything as I have nothing to send.
She felt that by Rx compounded pergolide that is not FDA approved as Prascend is, she is risking her license should horses end up with uncontrolled Cushings. It is going to be difficult for me to convince her that I have confidence in compounded pergolide that have no stability testing. Meanwhile, I am now paying $8.64 per day for Prascend for the two mares at 1.5mgs and 2 mgs. respectively.
This is a frustrating and serious problem, IMO. Tipperary was on 13 mgs of compounded when he passed and it leveled his ACTH at 28, prior to him passing. There is no way I could have had him on that much Prascend as it would have cost $26 a day. This is an excellent group practice with 24/7 coverage and with MSU heavily influencing the vet community here, most vets are against Rx compounded pergolide.
Have we made any progress on getting stability testing, etc. from the various compounding pharmacies members use?
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Dawn Wagstaff and Tipperary
She felt that by Rx compounded pergolide that is not FDA approved as Prascend is, she is risking her license should horses end up with uncontrolled Cushings. It is going to be difficult for me to convince her that I have confidence in compounded pergolide that have no stability testing. Meanwhile, I am now paying $8.64 per day for Prascend for the two mares at 1.5mgs and 2 mgs. respectively.
This is a frustrating and serious problem, IMO. Tipperary was on 13 mgs of compounded when he passed and it leveled his ACTH at 28, prior to him passing. There is no way I could have had him on that much Prascend as it would have cost $26 a day. This is an excellent group practice with 24/7 coverage and with MSU heavily influencing the vet community here, most vets are against Rx compounded pergolide.
Have we made any progress on getting stability testing, etc. from the various compounding pharmacies members use?
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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 .
Hi Dawn,
I had my own stability testing done last fall when Shaku's ACTH came back really high, despite amping up his dose considerably in advance. I just had to know if it was his meds or if he really needed a higher dose, so at considerable expense I sent a sample in to ARL. Result: the last 6 pills of a 90-day supply tested at 109% potency, the very upper limit of what is acceptable (90-110%). My prescription is at Island Pharmacy. One example is not representative nor is it likely to convince your vet though. But Island Pharmacy does regular 3rd party potency testing and will go through that with your vet. Dr Clougher also had a sample tested from them a few years back and it was within spec, too.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
I had my own stability testing done last fall when Shaku's ACTH came back really high, despite amping up his dose considerably in advance. I just had to know if it was his meds or if he really needed a higher dose, so at considerable expense I sent a sample in to ARL. Result: the last 6 pills of a 90-day supply tested at 109% potency, the very upper limit of what is acceptable (90-110%). My prescription is at Island Pharmacy. One example is not representative nor is it likely to convince your vet though. But Island Pharmacy does regular 3rd party potency testing and will go through that with your vet. Dr Clougher also had a sample tested from them a few years back and it was within spec, too.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
Lorna, 100% would mean a pill formulated to be 5 mg is exactly 5 mg.
109% means my pills that were formulated to be 5 mg were actually 5 × 1.09 = 5.45 mg.
Kathleen at the pharmacy was concerned the potency was that much higher than she formulated it to be, but for me I just needed to know that the potency of the meds was NOT why my horse had really high ACTH.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Case History
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
109% means my pills that were formulated to be 5 mg were actually 5 × 1.09 = 5.45 mg.
Kathleen at the pharmacy was concerned the potency was that much higher than she formulated it to be, but for me I just needed to know that the potency of the meds was NOT why my horse had really high ACTH.
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Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
Shaku's Photo Album
Snickers' Case History
Snickers' Photo Album
Hi, Lorna.
With compounded medications, potency between 90 and 110% is acceptable according to the US Pharmacopeia. It makes sense if you think about the minute amount of pergolide mesylate that ends up in each capsule. With a drug that is sensitive to moisture and temperature, a little bit extra may assure enough potency after the capsules are exposed to the environment as they are used up.
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Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder
Cayuse Photos Diamond Photos
Mary,
As far as I know, compounded is a legal, acceptable option for any non-standard dose, or when a flavoring or different form of medication is necessary.
For example, a liquid form of a medication for a child too young to swallow pills. Or a flavored version of a medication.
Or, when an individual needs 1.75 mg (just an example) and the FDA approved product comes in 1 mg. pills.
FWIW, I've been treating PPID horses with pergolide since 2008. When I encountered my first PPID horse, there WAS no Prascend. All we had was compounded pergolide. People from this group fought very hard just to have access to compounded pergolide in the early 2000s. And it saved a lot of horses. The archives are FULL of posts about horses coming back from the brink because of compounded pergolide.
In 2013 I went along with a vet who insisted I switch to Prascend. He made all the same arguments your vet has made. Reliability. FDA approval. I finally had a huge discussion with him when I had 2 horses needing pergolide, both needing more than 2 mg. per day to stay under control. One needs a much higher dose during the seasonal rise. Like Dawn, I can't afford $20 per day. And I refused to let them suffer because of his intransigence.
Some vets WILL not write a script for a compounded medicine. It does not mean they CANNOT write one.
Double check your state laws, look up the FDA rules, put some cost calculations on paper; do your research, then ask your vet to have an honest conversation with you. Neither you, nor your horses should suffer because your vet is listening more to a drug company sales rep than his clients and patients.
--
Cindy Martin, KPA CTP
ECIR Group MOD
Mad Dog Ranch
Nov 2009
Lincoln, AR (USA)
Burley - Reuban - Scout - Grace Case Histories
As far as I know, compounded is a legal, acceptable option for any non-standard dose, or when a flavoring or different form of medication is necessary.
For example, a liquid form of a medication for a child too young to swallow pills. Or a flavored version of a medication.
Or, when an individual needs 1.75 mg (just an example) and the FDA approved product comes in 1 mg. pills.
FWIW, I've been treating PPID horses with pergolide since 2008. When I encountered my first PPID horse, there WAS no Prascend. All we had was compounded pergolide. People from this group fought very hard just to have access to compounded pergolide in the early 2000s. And it saved a lot of horses. The archives are FULL of posts about horses coming back from the brink because of compounded pergolide.
In 2013 I went along with a vet who insisted I switch to Prascend. He made all the same arguments your vet has made. Reliability. FDA approval. I finally had a huge discussion with him when I had 2 horses needing pergolide, both needing more than 2 mg. per day to stay under control. One needs a much higher dose during the seasonal rise. Like Dawn, I can't afford $20 per day. And I refused to let them suffer because of his intransigence.
Some vets WILL not write a script for a compounded medicine. It does not mean they CANNOT write one.
Double check your state laws, look up the FDA rules, put some cost calculations on paper; do your research, then ask your vet to have an honest conversation with you. Neither you, nor your horses should suffer because your vet is listening more to a drug company sales rep than his clients and patients.
--
Cindy Martin, KPA CTP
ECIR Group MOD
Mad Dog Ranch
Nov 2009
Lincoln, AR (USA)
Burley - Reuban - Scout - Grace Case Histories
To add to Cindy's post, when the vet writes a prescription it does not have to specify compounded. A prescription for "X mg of pergolide as pergolide mesylate" could be filled by either Prascend or compounded.
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Eleanor in PA
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Eleanor in PA
www.drkellon.com
EC Owner 2001
The first step to wisdom is "I don't know."
celestinefarm
Cindy, thank you and all the others that responded.
Just to clarify for those reading who might be confused on the FDA approval issue, the FDA approves medications for use for certain conditions after a study period of the medication's use in real humans or animals and the results presented. The results must show an efficacy and side effects that are not worse than the disease or contribute to a worsening of the condition. The trials done on Prascend were small, the doses were minimal and the results were not great, but it satisfied the FDA and approval was given for that exact formula. Compounded pergolide mesylate is NOT the exact formula as Prascend( the reason for compounding is to provide a form of a medicationthat is slightly different to provide an alternative) and therefore it is not approved by the FDA as to efficacy, ingredients, etc. This is what concerns the veterinarians. Compounded meds may have the same amount of active ingredients with different carriers or forms(capsules instead of tablets) which makes it a different medication which hasn't been through the approval process.
Having been in licensed health care for 35 years, I understand their concerns. And honestly, I like Prascend as it is easy to keep stable with the blister paks, and it dissolves quickly in water in a syringe and my mares are easy to syringe in their dose. But as I type this, my mailman just brought my $398 box of Prascend I online order through my vet's office( that is really easy, free shipping) and that box will last for the next six to seven weeks. I don't understand why another of the veterinary drug companies do not develop for approval a competing or generic version of Prascend . Prascend has been through , I believe two five year marketing exclusive deals and at this point, a generic version should not be a big issue. Or I may not understand all the problems involved with that.
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Dawn Wagstaff and Tipperary
Just to clarify for those reading who might be confused on the FDA approval issue, the FDA approves medications for use for certain conditions after a study period of the medication's use in real humans or animals and the results presented. The results must show an efficacy and side effects that are not worse than the disease or contribute to a worsening of the condition. The trials done on Prascend were small, the doses were minimal and the results were not great, but it satisfied the FDA and approval was given for that exact formula. Compounded pergolide mesylate is NOT the exact formula as Prascend( the reason for compounding is to provide a form of a medicationthat is slightly different to provide an alternative) and therefore it is not approved by the FDA as to efficacy, ingredients, etc. This is what concerns the veterinarians. Compounded meds may have the same amount of active ingredients with different carriers or forms(capsules instead of tablets) which makes it a different medication which hasn't been through the approval process.
Having been in licensed health care for 35 years, I understand their concerns. And honestly, I like Prascend as it is easy to keep stable with the blister paks, and it dissolves quickly in water in a syringe and my mares are easy to syringe in their dose. But as I type this, my mailman just brought my $398 box of Prascend I online order through my vet's office( that is really easy, free shipping) and that box will last for the next six to seven weeks. I don't understand why another of the veterinary drug companies do not develop for approval a competing or generic version of Prascend . Prascend has been through , I believe two five year marketing exclusive deals and at this point, a generic version should not be a big issue. Or I may not understand all the problems involved with that.
--
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 .
ferne fedeli
I thought I would put in my 2 cents here too. I also had a PPID/IR horse before Prascend was around and so used Compounded Pergolide. I changed vets at some point when my Icelandic became IR/PPID and I think Prascend had just come out and she thought maybe we should be using it and I convinced her that I wanted to use CP also and so she said she would write the RX for it. I have, in fact, never used Prascend on either of the two PPID horses I have owned. Both are now deceased...
Ferne Fedeli Jack 2007
Point Arena, Mendocino County, California
Case History
Frances C
Ha Ha Ferne, are you trying to be funny "Both are now deceased!" Me too, I had an old PPID mare diagnosed in the late 90's. She was given some compounded powder - dont think it was CP - whatever it was it had no effect. She was kept alive with daily bute for 18 months. Shame on me, I should have insisted that she be put down on the day of diagnoses.
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- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382
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- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382
Frances C
There are now 18 messages on this topic. I am trying to make a copy of them all in some comprehensive order so that I could present the information gathered here to a vet and a compounding pharmacy to plead my case for obtaining a script. Has anyone done this? If so, would you be willing to share it with me via private email so that I could print it out. Thanks
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- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382
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- Frances C.
December 2017, Washington & California
Case history: https://ecir.groups.io/g/CaseHistory/files/Frances%20and%20Phoenix
Phoenix's Photo Album: https://ecir.groups.io/g/CaseHistory/album?id=12382
Hi Frances and All
There's a great deal more info in the #Hashtags as well. Here's the link
https://ecir.groups.io/g/main/search?q=%23legalityofpergolide&ct=1
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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2022-2023
There's a great deal more info in the #Hashtags as well. Here's the link
https://ecir.groups.io/g/main/search?q=%23legalityofpergolide&ct=1
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Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President 2022-2023
ECIR Group NEW Case History site open to Early Adopters.
HOW TO SEARCH THE ARCHIVES: https://ecir.groups.io/g/main/wiki/1993