Question about pergolide dosage increase, was Re: Morgan Mare Diagnosed with EMS and PPID


abberdoo@...
 

Question around increase in pergolide.   My vet had me giving Abbey a 1.1mg capsule and .5mg of powder since I needed to use it up as that is what I was given to begin with, but switched to capsules per advice in this forum.  I am running out of the powder, so I wanted to at least get the .5mg in capsule form to keep her at the same amount, but my vet does not have it available.  I was going to order from Chewy, she suggested we bump her up to 2mg, so I was going to order the .8mg capsule since they didn't have .9mg in stock, which would get her to 1.9mg.   They, of course, need approval from my vet who is out on calls and won't be around the rest of the day.  I probably have about 3 days left of the powder (I tried contacting my vet earlier so this wouldn't be the case, it's taken days to get this far with her)...  since she isn't around, she suggested I just give her two of the 1.1mg capsules daily, so she would be going from 1.6mg to 2.2, which isn't a huge jump, but should I be concerned about over medicating her?   Since she was just diagnosed in late June, we have never re-tested her to see how this dose is even working for her.  We did retest her insulin mid-July and she was at 21.23 (10-40 reference interval), down from 115 the first time we tested her in June.  I'm just worried about giving her too much/too little and the effects that could have on her.  Any advice would be much appreciated.
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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 


 

Oops, Lori, I wrote up a response and then lost it so this one is bound to be shorter.

First of all, 2.2 mg of pergolide vs 1.9 mg will not be an issue.  But I would suggest you get a prescription for Prascend until you can do the blood testing to tell you if that’s an adequate dose.  Then you can switch to compounded pergolide, knowing what dose should work because the Prascend will maintain its effectiveness until the packet is opened.  The fact that your vet is making the capsules for you concerns me.  Do I understand that correctly?  She may be making the capsules from the same powder we warned you against using.  Not because there was anything wrong with it initially but because she may not have the appropriate situation for maintaining its stability.

One and one-half tablets of Prascend will be the same as about 2 mgs of compounded so that’s where I’d start.  If you test in the middle of the rise (Sept 21) you will see how well controlled she is at the peak but if you increase the dose then, it may well not be as effective as increasing it after the rise has finished in December.  So, when to test is your choice.

Please let me know if that didn’t answer your question.
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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
 


abberdoo@...
 

Thank you Martha,  I realize my question was very long and confusing, short version, she is on 1.6mg total right now of powder + capsule, I honestly don't know if the vet put the powder into the capsules herself, I do know the powder was compounded at a pharmacy in South Carolina because the label has their name on it.  If I were to guess, I would say the pharmacy put the compounded powder into the capsules, I can't imagine she would do that herself but you never know.  So, if I gave her the 2.2mg of pergolide (two capsules), she would be going up by .6mg.  I wonder if it would be okay to try that for now and have her tested in September to see how she is fairing on that dose?  

I really wouldn't mind getting her on Prascend as you suggested, but getting my vet to answer me and help me is like pulling teeth these days.  She's super busy and does not have help really, just a part time admin person.  

On another note, I keep wanting to mention that I see you live in Vermont, I am from there, born and raised and miss it very much!   I can't imagine soaking hay in the winter there, how do you deal with that?  We are thinking of moving back and that is one of my biggest concerns.  Or maybe you have found hay that you don't need to soak?

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Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 


 

Hi Lori, who misses Vermont.  That sounds like a plan.  When I purchase compounded pergolide, my vet has prescriptions on file for my horses with the compounding pharmacy and they ship it directly to me and charge me directly.  Then I am responsible for caring for it.  The only time I need to communicate with my vet is when I want testing done or a prescription change.
I have an old barn here and I can close the doors.  The frost free spigot is inside the barn and I have a drain to an underground tank aways away.  If that overflows it goes into a drainage ditch.  With a place to close up to get out of the wind, a water source and a means of disposal, soaking is quite doable.  On the other hand, I rarely need to soak local grass hay.  I’m soaking some now to make sure my little guys get plenty of water.
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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
 


abberdoo@...
 

Thanks Martha,  That is a great idea to get the prescriptions on file, that would make this so much easier.   I love old VT barns, your setup sounds perfect.  

--
Lori J in NC 2022
Abbey's Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=276850 


Sherry Morse
 

Lori

If you have the OK from your vet to order from Chewy (or wherever) the usual procedure is you place the order and specify the vet's contact information and they will contact the vet to get the prescription information.