Skipping Pergolide Doses


larkstabatha
 

Happy Thanksgiving Everyone!  I messed up and did not order my Pergolide refills in time for the holiday weekend.  My mail order, compounding pharmacy is closed today and Friday.

I did do multiple searches with quotes and the plus sign, but did not find an answer to this question:  Rather than skipping dosing two days in a row of their pergolide, would it be better to skip one day to make the medication I have on hand last longer?

Thanks very much, Sally
--
Sally in Big Park, Arizona/April 2013

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie 

  

 

 


 

Can you find a veterinarian who sells Prascend? 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


larkstabatha
 

Good thinking Cass, but not a viable option for me in my current situation.
--
Sally in Big Park, Arizona/April 2013

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie 

  

 

 


Kirsten Rasmussen
 
Edited

Hi Sally,

I would give the full dose for as many days as you can, even if it means skipping 2 days, because splitting the dose means you have more days where ACTH isn't controlled.

It does take some time for pergolide effects on ACTH to go away, which is why we recommend waiting at least 3 weeks after stopping pergolide to pull blood in horses that may need a diagnosis confirmed.  There is a Mcfarlane paper in our files that shows the average change in ACTH over that time after stopping pergolide in 6 horses (Fig. 1).  While it does appear to climb gradually after 2 days with no pergolide, it wasn't until day 14 that ACTH was found to differ 'statistically significantly' from baseline.  Those were the average values, but horses appear to respond differently.  More specifically, after stopping pergolide ACTH increased by 50% at 2 days in 3/6 horses, and after 10 days in 6/6 horses.

There are lots of other good observations in this paper that we often mention in the group:
- justification for dosing 1x a day and not splitting the dose
- when stopped, pergolide clears quickly but effect on ACTH is much slower
- TRH stim while on pergolide shows a decrease in ACTH but it is not statistically significant
- aggressively titrating pergolide in early fall is needed to regulate ACTH thru the rise

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


larkstabatha
 

Thank you Kirsten... Glad to be aware of the McFarlane paper information.  

Perhaps we are talking about two different things?  I was asking about skipping a day as opposed to splitting the dose.

If I skipped a day, being this coming Monday, my horse and donkey would be getting their normal Pergolide dose on Sunday, Tues and Wed Eve (after my UPS overnight delivery brings the refill).  Other option would be to give them a normal dose on Sunday, Monday, and they would go without from Tuesday morning to Wed evening... resulting in a longer consecutive period of time without the medication in their system.

Please forgive me if I am being daft in re-asking this question given the information that you have already shared with me.

Thanks so much, Sally
--
Sally in Big Park, Arizona/April 2013

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie 

  

 

 


 
Edited

It seems to me, Sally, that they would be missing a single dose, regardless of which one it is.  I would just do whichever is more convenient.  I don’t think either would be an issue.  Like Cass, I keep Prascend, with its longer shelf life, on hand for similar situations .

*Or there may be some confusion because I read that you give pergolide in the evening.  If that’s not the case, I see your point but still think it doesn’t matter which you choose.
--
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


 
 


larkstabatha
 

Thanks everyone!
--
Sally in Big Park, Arizona/April 2013

https://ecir.groups.io/g/CaseHistory/files/Sally%20with%20Tabby%20and%20Maisie