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when to start pergolide


millionairess1989
 

At what point should Pergolide be started? My IR/RAO gelding Jack's ACTH just came back at 64.4. His test in October 2017 was 28.9. Would I expect to titrate up to 0.5 mg or 1 mg, starting at 0.25 mg?

His breathing has been a little better with the slightly cooler, less humid temps. He's still needed a few doses of Albuterol here and there.
--
Jennifer in Middle TN  2010
 Mill 31 yrs Arabian-PPID, IR & Pacemaker Dependent
Jack 21 yrs TN Walker- IR & RAO

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Millionairess

https://ecir.groups.io/g/CaseHistory/album?id=831

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Jack-TN%20Walker


Sherry Morse
 

Hi Jennifer,

Were he mine I would start him ASAP.  If you want to try him at .5mg you should plan on testing him 3 weeks after starting to see if that dose is controlling his PPID.  If he's still showing an elevated level at that point you'd want to titrate him up to 1mg and see how he does with that.



millionairess1989
 

Thanks Sherry. I'll do that. When should I retest after seasonal rise to see about possibly lowering the dose? It's been about 10 years since I started Mill on pergolide and I've forgotten some of what I did. She's on 23 mg and going up to 24.
--
Jennifer in Middle TN  2010
 Mill 31 yrs Arabian-PPID, IR & Pacemaker Dependent
Jack 21 yrs TN Walker- IR & RAO

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Millionairess

https://ecir.groups.io/g/CaseHistory/album?id=831

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Jack-TN%20Walker


Sherry Morse
 

Hi Jennifer,

If you were to start him on pergolide/prascend now and test in 3 weeks we'll be on the tail end of the rise so that should give you an indication if he's being controlled or not.  I believe the only way you could tell if he doesn't need it the rest of the year would be to stop after the rise is over (mid-November) and then test him again at the beginning of next year to see what his level is at that point.




millionairess1989
 

Hi Sherry,

At what level ACTH does the group generally recommend starting pergolide? I know Jack needs it, but is it anything over 35 during seasonal rise or a certain number? Does it matter if symptoms are present or not? We've been doing a bit more testing at the vet hospital at which I work so I'm curious. 

Does time of day matter for the blood draw (ie 4 hours after eating) if we're just doing ACTH and not insulin & glucose?

Thanks,
--
Jennifer in Middle TN  2010
 Mill 31 yrs Arabian-PPID, IR & Pacemaker Dependent
Jack 21 yrs TN Walker- IR & RAO

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Millionairess

https://ecir.groups.io/g/CaseHistory/album?id=831

https://ecir.groups.io/g/CaseHistory/files/Jennifer%20and%20Jack-TN%20Walker


Eleanor Kellon, VMD
 

If they are above the upper limit of the seasonal rise and symptomatic we would generally suggest starting. If asymptomatic and insulin normal, retest after the rise.  Time of day doesn't matter but fasting can significantly decrease ACTH.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cindy Giovanetti
 

What is the upper level of the seasonal rise?

 

Oden’s ACTH bloodwork just came in at 45.  (Reference range 9-35.)  He’s asymptomatic but his insulin isn’t normal either (45 pg/ml) (which is actually good for him, and he was off Metformin when tested).

 

Cindy

 


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Maxine McArthur
 

Hi Cindy 
Could you please check the test result for the current ACTH reference range on this recent test? The 9-35 pg/mL you mention would usually be the range for outside the seasonal rise, which is now. That current reference range will tell you the upper limit for the rise. Also, could you please check the insulin units? 

And if you could pop those results into your case history, that would be really helpful. 
--
Maxine and Indy (PPID) and Dangles (PPID)

Canberra, Australia 2010
ECIR Primary Response

https://ecir.groups.io/g/CaseHistory/files/Maxine%20and%20Indy%20and%20Dangles 
https://ecir.groups.io/g/CaseHistory/album?id=933

 


Sherry Morse
 

Hi Cindy,

You can check the weekly and monthly levels here: https://liphookequinehospital.co.uk/wp-content/uploads/Seasonal-Changes-in-ACTH-Secretion2.pdf.  At 45 he's higher than we'd like to see for a horse on Prascend or Pergolide but it's within the expected level for a seasonal rise in a non-PPID horse.





Cindy Giovanetti
 

Thanks.

 

He’s not on Prascend or Pergolide.

I’ve seen this website, but it’s in the UK and we’re in Texas.  Still useful?

Cindy

 

 

_._,_._,_


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Cindy Giovanetti
 

The test was run a week ago.  Yes, I know we’re in the seasonal rise.  It’s the first time my vet could come out because, unfortunately, he had Covid.  L

The reference range is on the current Cornell lab work for ACTH is 9-35. Oden’s ACTH is 45 pg/mL.

 

His insulin is 46 ulU/mL

 

Cindy


 


--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Eleanor Kellon, VMD
 

Cindy,

That reference range is for the non-rise months. The 45 at this time of year is normal.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Cindy Giovanetti
 

Oh, thank God!!
_._,_._,_
--
Cindy, Oden, and Eeyore, North Texas
On ECIR protocol since 2/19
https://www.facebook.com/LifeWithOden/
History: https://ecir.groups.io/g/CaseHistory/files/Cindy%20and%20Oden
Photos:  https://ecir.groups.io/g/CaseHistory/album?id=91125


Eleanor Kellon, VMD
 

I should add that some horses benefit from pergolide during the rise even when their results are within the expected range - specifically horses that have EMS and their insulin is pushed too high during the rise.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001