Planning to start Cabergoline, questions


Joy
 

Good morning, 

I have a question about starting Cabergoline.  Common sense tells me I should wait until after seasonal rise (don't want to rock the boat right now when things are going fairly well), does that sound like a good plan or am I being over cautious?

Also, do I just stop her CP (compounded pergolide) and start the Cabergoline injections or is there a period of overlap to titrate?  From what I'm reading in all the studies on file on this forum I gather that Cabergoline and Pergolide share the same receptors so wonder if it's no big deal to make the switch (I should mention I failed High School Chemistry, didn't get past the first day, so if I missed something please let me know).

Emmy's ACTH was 38.4 on Sept. 8, at that time she had been on 16 mg CP (financial "ouch!") for 10 days.  I Hope to be increasing another 2 mg in the next few days.  I recently had to change vets because it became a fight to get the amount of CP needed to control her ACTH.  The new vet seems so much more cooperative.

As always, thank you all for your help.
--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy/
https://ecir.groups.io/g/CaseHistory/album?id=85584


Eleanor Kellon, VMD
 

Joy,

You could change during the rise but we have no indication that cabergoline is any more effective (or not) during the seasonal rise so you won't be able to titrate your dose until after the seasonal rise.

Just for the record, it's no big deal to make the switch. You can give the cabergoline injection the day after your last pergolide dose.  Some horses have less side effects with cabergoline, some have more - but the side effects are the same for both drugs.

If things are fairly well right now, my inclination would be to up the pergolide as planned and ride out the seasonal rise until December then make the change. The 38.4 in September isn't terribly high but may be considerably higher by now. We are right on the brink of the peak rise. You should do a repeat ACTH in December and use that to make your decision.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Joy
 

Thanks so much Dr. Kellon.  I should mention clinical signs are intensifying at this time as well.  I'll increase pergolide and plan for Cabergoline when it all blows over in December.
--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy/
https://ecir.groups.io/g/CaseHistory/album?id=85584


 

Hi Joy,
From my experience, I would suggest you pretreat with APF before starting cabergoline.  My horse had never exhibited a veil while using pergolide, except perhaps a faint one when first started, so I did not pretreat.  His ACTH was above normal but not super high.  Instead there was a remarkable veil which would have been a bit frightening had I not recognized what it was.   
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo
 


LJ Friedman
 

When you say financial ouch at 16 mg, isn’t the price of cabergoline  much more expensive than that? I know every horse is different, I was using 20 mg with jesse before I switched to Cabergoline  because  his vet did not want to go any higher.. I do regret that I did not push him to go higher on the 20 mg. I never liked  cabergoline and i had to use higher doses with more frequency and suppllier had issues with Chinese supplier too
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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

 


Joy
 

The problem is the former vet won't prescribe more than 8 mg, but also gave me a standing 2 mg script so I can increase that for seasonal rise.  

The more pills the lab has to handle the more expensive.  The  8 mg dose is $3.60/day, four of the 2mg/day is $4.68 for a grand total of $8.28 per day, so yes ouch.

From what I understand Cabergoline is $281 or about $5.63 per day (10 day dose).  So even if the vet charges a 50 % mark up, I'm still better off.

Emmy's ppid was never really controlled on just 8 mg so I suspect even after this seasonal rise i would need to keep her on a fairly high dose.

Also reading the studies on cabergoline in the ECIR group files, it would appear, correct me if I'm wrong, that cabergoline does a really good job at keeping things on an even keel.

With Emmy's recent IR diagnosis, I need consistent ppid numbers so I can focus on IR stuff.

BTW Emmy was rescued as a Cushings horse back in 2018 when all I knew about PPID was "you just need to give her a pill everyday".  How far we've come!

Sadly, we've made the decision that if Emmy turns down the path of laminitis, the journey ends.  In the meanwhile we'll be doing all we can to prevent that.

Lol. Are you sorry you asked?

--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy/
https://ecir.groups.io/g/CaseHistory/album?id=85584


Eleanor Kellon, VMD
 

Hi Joy,

Regarding side effects (not that you asked!) some horses have more on pergolide and some more on cabergoline - no way to tell ahead of time. Also, not all horses will respond adequately to the 1 mL/5 mg dose. Some need more. I'm not trying to discourage you, just give you the facts.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."


Joy
 

I appreciate that.  I may not need to switch if the new vet will let me have a larger dose of CP in one or two capsules.  Getting prices and wish list together. Exploring all options. 

Thanks so much for your help.  This group is a blessing.

Joy




--
Joy and Emmy
WI, Feb 2019
https://ecir.groups.io/g/CaseHistory/files/Joy%20and%20Emmy/
https://ecir.groups.io/g/CaseHistory/album?id=85584


LJ Friedman
 

another thing you can do is  just get a script Or have them call him. And you make the payment yourself , no mark up. I never paid a mark up through my vet for cabergoline  I always went direct with payment via supplier BET
--
LJ Friedman  Nov 2014 Vista,   Northern  San Diego, CA

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