how to determine dosage of pergolide


luktannr@...
 

Wondering how the rest of you have determined the correct dose of
Pergolide for your cushings horses. My vet currently has my mare on
.75
mg per day(split into 2 doses) - he has done 2 dex. suppression tests
before this and wants to do another in October. I have heard this
may
cause founder - is there any truth to this or just a theory? Any
other ways to determine how much she should be on? Thanks!!


conny <concal@...>
 

I had sundance tested through BET LABS and they recommended the
dosage of pergolide. THey recommended I start off with 2mg, but my
vet and I decided to start him with 1mg and retest him in a month;
2mg seemed kind of high to me. you always have the option of raising
or lowering the dosage,especially after being tested again. conny


conny <concal@...>
 

I had sundance tested through BET LABS and they recommended the
dosage of pergolide. THey recommended I start off with 2mg, but my
vet and I decided to start him with 1mg and retest him in a month;
2mg seemed kind of high to me. you always have the option of raising
or lowering the dosage,especially after being tested again. conny


conny <concal@...>
 

I had sundance tested through BET LABS and they recommended the
dosage of pergolide. THey recommended I start off with 2mg, but my
vet and I decided to start him with 1mg and retest him in a month;
2mg seemed kind of high to me. you always have the option of raising
or lowering the dosage,especially after being tested again. conny


Makyla Waters <twolegged@...>
 

My first vet also had me go on .75gm of pergolide and planned to have me
drop to .5gm and then .25 gm. My horse started growing winter coat on .75
gm and, for other reasons, I switched vets. The new vet said that .75 gm
was low and thought he should be on 1 or 1.25 gm. At 1.25 he started to
shed the winter coat and is now doing fine on 1gm (with also some thyroid).

Dex suppression test - The first vet was very against this test because she
had seen 2 horses founder right after the test and one had to be put down.
Second vet also thought test was risky and likes the BET lab tests. More
and more articles mention this risk, yet some vets don't believe it elevates
their cortisol enough to throw them into founder. Maybe just coincidences,
but too scary for me. I'm happy with the BET tests and monitoring his
condition visually.

Take care, Makyla & 4-legged friends


belindavet@...
 

Dear List,
Dr. Divers at Cornell Large Animal Clinic did some of the early research on
this whole condition. He recommended to me that I use a dose of either
pergolide or cyproheptidine that will keep the insulin levels at or below 60
U/ml, if possible, and to try to gauge alot by the horse's general appearance
and attitude. Sometimes the insulin levels start at upwards of 3-400; in
these cases I am happy to get it down below 100 on the first retest.If
subsequent retests show higher insulin levels, I consider chsanging meds or
increasing doses.(Yes, Kay, I did get the results you sent me and I am
concerned about Sadie's higher insulin levels.)

I have found that the ACTH levels vary tremendously, and so I assume the
cortisol levels do as well and would be less reliable in checking progress.In
my patients, ACTH invariably seems to go up on early retests, but goes down
after long periods on meds, like 1-2 years. I avoid the dexamethazone
suppression tests, because these animals can already have high cortisol
levels. Dexamethazone is a corticosteroid. Founder has been reported, but I
have never seen it, following dexamethazone administration. We use it for
many things in medicine, and I have never had a known bad experience, but I
try to be especially careful with these fragile individuals.

These equids may also have a problem in that cortisol levels may be
independent of ACTH levels (the hormone from the pituitary that stimulates
the adrenal gland to secrete cortisol). As you can tell by the responses on
this list, every one of these patients is different.

It is believed that the excessive drinking and thirst are related to high
cortisol levels that cause electrolyte loss from the kidneys with
corresponding increased urine flow. After some time, the electrolyte loss,
especially sodium chloride, can cause a loss in the salt gradient in the
kidneys which is necessary to concentrate urine. Thus, more water is lost
and urination can become even more excessive. Access to salt would be
essential to re-establish this gradient as the horse's symptoms dissipate.
If you are beginning to medicate your horses, I wouldn't worry too much about
too much salt eating if the horse has continuous access to lots of fresh
water (that is, absolutely can not run out of water!). It probably will stop
in the near future.

Hope this is helpful; this is a very complicated disease and a lot of answers
to your questions are not yet known.

Belinda S. Thompson DVM
Pine City Veterinary Clinic
Pine City, NY
belindavet@...


belindavet@...
 

Mary G.,
Feel free to add my reply as a file. I do not consider myself an expert on
this subject, but I am trying to stay as up to date and ask as many questions
as time permits me.

Belinda S. Thompson DVM
Pine City Veterinary Clinic
Pine City, NY
belindavet@...


rich goldy <rmgoldy@...>
 

Dr. Thompson, This is really good info. Would you consider adding this
as a file in our groups file page?
Thanks,
Mary G.
************************************************************************
belindavet@... wrote:




[eGroups] My Groups | EquineCushings Main Page | Start a
new group!

Dear List,
Dr. Divers at Cornell Large Animal Clinic did some of the early
research on
this whole condition. He recommended to me that I use a dose of
either
pergolide or cyproheptidine that will keep the insulin levels at or
below 60
U/ml, if possible, and to try to gauge alot by the horse's general
appearance
and attitude. Sometimes the insulin levels start at upwards of 3-400;
in
these cases I am happy to get it down below 100 on the first retest.If

subsequent retests show higher insulin levels, I consider chsanging
meds or
increasing doses.(Yes, Kay, I did get the results you sent me and I am

concerned about Sadie's higher insulin levels.)

I have found that the ACTH levels vary tremendously, and so I assume
the
cortisol levels do as well and would be less reliable in checking
progress.In
my patients, ACTH invariably seems to go up on early retests, but goes
down
after long periods on meds, like 1-2 years. I avoid the dexamethazone

suppression tests, because these animals can already have high
cortisol
levels. Dexamethazone is a corticosteroid. Founder has been reported,
but I
have never seen it, following dexamethazone administration. We use it
for
many things in medicine, and I have never had a known bad experience,
but I
try to be especially careful with these fragile individuals.

These equids may also have a problem in that cortisol levels may be
independent of ACTH levels (the hormone from the pituitary that
stimulates
the adrenal gland to secrete cortisol). As you can tell by the
responses on
this list, every one of these patients is different.

It is believed that the excessive drinking and thirst are related to
high
cortisol levels that cause electrolyte loss from the kidneys with
corresponding increased urine flow. After some time, the electrolyte
loss,
especially sodium chloride, can cause a loss in the salt gradient in
the
kidneys which is necessary to concentrate urine. Thus, more water is
lost
and urination can become even more excessive. Access to salt would be

essential to re-establish this gradient as the horse's symptoms
dissipate.
If you are beginning to medicate your horses, I wouldn't worry too
much about
too much salt eating if the horse has continuous access to lots of
fresh
water (that is, absolutely can not run out of water!). It probably
will stop
in the near future.

Hope this is helpful; this is a very complicated disease and a lot of
answers
to your questions are not yet known.

Belinda S. Thompson DVM
Pine City Veterinary Clinic
Pine City, NY
belindavet@...

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