Cushings and Pergolide...

ImogenBurrows

ImogenBurrows

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Hi all,

This is a pretty popular topic and I've been reading with great interest the threads about Cushings diagnosis, treatment and most worringly (for me anyway) the dose rates of pergolide given.

I have diagnosed and treatment a lot of ponies and horses with Cushings over the years, most of which have been controlled pretty successfully I'm happy to say. However, the doses of Pergolide I've used vary between 250mcg up to and MAXIMUM of 1mg daily. I've not ever found the need to go higher.

I have read a number of people who have horses on prescribed doses 4, 5 and 6 mg of Pergolide!:eek:

I was so shocked by this that I actually rang had a chat with an internal medicine specialist about the dose range...he was pretty shocked too.

Those of you who have Cushings horses and ponies, especially those on the wackingly high doses....please can you give me some feedback?

I really would love to know about how the diagnosis is being made, how the Cushings disease is being monitored, are these cases actively laminitic, and is the treatment useful in your opinion or are you finding the doses going up and up despite still having high ACTH levels.... and are the side effects to your treatments??

Come one folks, please help and :confused: and :( vet out!!!


Thanks a lot
Imogen :o
 
Hi Imogen,

I agree! I have been pretty shocked when I read about some horses being on what I would deem as very large daily doses. Having said that it really does seem to vary widely case per case as to what should be prescribed.

My 23 year old girl is only on 1/2mg per day after testing positive for Cushings at the beginning of this year (no laminitis) Initially the vet started her on 1mg daily but this proved too much for her (she is 14.1 NF x TB) and sent her into a almost trance like state, she forgot where her stable was and her field also, very strange to witness! :eek: and she went completely off her food which is VERY unlike her.

So the vet swiftly decreased the dosage to 1/2mg and this seems to suit her perfectly and she has no noticable side effects.....she is like a 5 year old again :) and this was confirmed with a blood test to check her levels and her level was now in normal range. She will be tested every year or earlier if I or the vet feels its necessary and the meds adjusted accordingly.

Interestingly in my new yard there are a few oldies on Pergolide and its seems the dosage varies, one 12.2 is on 2mg a day :eek: and a 16.3 is on 1mg per day....I guess they determine the best dosage by blood tests after the horse has been on the drug for a certain period of time :confused: (this was the case with my sweet girl anyway)

Sadiemay
 
My mare (who went down with Laminitis, which was the first we knew about her Cushings problem) is on 1mg per day. She was completely zombie for a few days and off her food for about a week, but subsequently seems to have recovered on both fronts. I'm keen for her to be tested again soon to see if the level is right.

I've read that a high (too high) dose of Pergolide can actually make laminitis worse!
 
Hi Imogen, I've got the 14.3 NF mare (aged 19) who is currently on 2mg a day. She was diagnosed back in May after a loss of topline and reoccurent bouts of a "colicky type" thing. The vet thought it very unlikely she had cushings but it came back positive after a blood test. Her ACTH levels were initially 171 and she was started on 1mg, after a month she was re-tested (at Liphook) and her levels had gone down to 97 so the vet increased her dosage to 2mg. The ACTH levels are now at 39 and my vet is happy to keep the doseage at 2mg. She will be retested in January and is "touch wood" doing well I think and is ridden regularly.
 
Hi Imogen, I was surprised as well as I have a welsh sec A diagnosed around a year ago. she has never displayed laminitis but I became suspicious when I monitored her drinking, she seemed depressed, had fat pads above her eyes and stores fat very easily in her crest and pads on her back. Her ACTH levels were 523 and she was started on .25mg for a few months which perked her up no end. she then became a touch lethargic and grumpy again so we upped the dose by half a tablet therefore to .375. She has been great ever since but I do manage her strictly as a laminitic and she is in full work, coping with a week of PC camp in the summer and mounted games training up to and including Championships. I constantly feel she is too fat though and cannot seem to get the excess weight off. I'm intending to have her blood checked again if her state changes but am happy with the dosage at present....
 
PS, forgot to add , she is only 13 and I've just rechecked the vet report and the level really was 523...surely this is excessively high? Any advice would be appreciated
 
PS From me too - my mare had an ACTH of 583. Am now rather scared as she seems to be v high compared with the others except forderough. She's 15.1hh and 19 years old
 
I cannot remember the exact figure but its something like anything under 120 is considered normal and anything above is considered abnormal and an indication of Cushings.

Sadies orginal ACTH level was I think just over 140 and now with the pergolide is down to mid 50's. I am sorry but I cannot remember the exact figures but the above is a rough indication of what my vet told me.

I hope this helps somewhat. I am due to speak with my vet next week so I will clarify with him what the exact figures were. But basically you want the level to be as low as possible and within "normal" range once established on the pergolide.

Sadiemay.

Edited to add: I am not sure how relevent the orginal levels are, I wouldnt worry too much my vet said that in my case we had diagnosed Sadies onset of Cushings early hence the relatively low level but in most cases horses ACTH levels are alot higher (several hundred even up to nearly 1000 in some cases) upon diagnosis. And that the main thing is that the levels are brought down through use of pergolide/other meds.
 
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Thanks for all the posts to date - really interesting. I asked my boss today at work and the highest dose he's used in 2mg in a big horse. I'm just really unfamiliar with the higher ends. I'm hoing some more people who have horses on the really big doses may post....
come on folks don't be afraid!!! :D
 
I've no experience of cushings but this thread is really interesting. I really hope more reply, especially those with horses on high doses.
 
I have a 13.2 welsh section B gelding who is 22 years old and has just been diagnosed as having cushings.

He does not have any of the classic symtoms such as a thick coat etc and looks in excellent condition and no where near his 22 years.

He has had 3 very mild boughts of laminitus this year having never suffered before which led me to getting him tested.

My vet perscribed 1mg of pergolide per day, he said this was a low dosage and a pony of this size could have up to 2mg.

After 5 days of being on pergolide he had a "funny turn" one morning as i arrived at the stables and turned the lights on he seemed to be wobbly on his legs and not quite himself but recovered quickly.

The next morning i arrived to a much worse case - as i approached his stable he woke up and appeared to have a fit. He threw himself against a wall and then to the floor with his eyes rolling and did not have any control (nearly giving me a mild heart attack!). My first thought was that he had colic but after a couple of minutes apart from being slightly shaken he was absolutely fine and looking for breakfast!

I phoned my vet immediately who said he would look into it but did not beleive there could be any connection between the "fits" and the pergolide. I stopped giving the pergolide on friday - against my vets advise to carry on with it.

The next day he had another mild seisure in the morning, but not anywhere as bad.

I have not given any pergolide since and the last two mornings he has been absolutely fine. I have the vet coming again tommorrow to discuss any alternatives?

Has anyone ever heard of this being a side effect of pergolide before?

I am worrying myself sick!!
 
Wow - sorry you had to witness that kind of episode - scary stuff!!!

No I haven't ever witness that kind of side effect....1mg in a substantial pony is a high, but recognised dose...:confused:

It initially was used a treatment for Parkinson's disease in humans - and I can't find any reference to seizure activity there either.

Bear in mind that as the new equine licensed drug is on sale we all have to use that rather than the generics....:(
 
my shetland has been on pergolide for 6 weeks, he also had a fit about 2 weeks ago, which my vet said is due to the tumour in the pituitary gland pressing against his brain, some horses have one fit and never again, others fit more often, one horse on my yard went blind after a fit, she had had cushings for years and was very old. so far my pony is fine, but still on pergolide, and he has started eating again and looking much happier.
 
Hi I have a 14.2 Arab mare who has been diagnosed with Cushings due to physical symptoms (long coat that doesn't shed properly, excess drinking and a bout of laminitis despite being slightly underweight. She is on 1mg Pergolide and the improvement has been dramatic with no side effects at all (touch wood).

Please could someone explain further about testing for ACTH levels. Is this where they are injected with steriods? I would like to test her and see if the Pergolide could be reduced.

Many thanks
 
For those of you worried about giving your horses Pergolide I would be thinking 2 things:

1) The dosage is too high and consider liasing with your vet to decrease. The reason I say this is that my 14.1 mare was prescribed 1mg initially and she became very lethargic and almost in a trance/zombiefied like state and wobbly on her feet. The vet put this down to a too high dosage and she is now on 1/2mg dosage and it suits her MUCH better.

The effects of too high a dosage were very visible and in my mind extreme que me having heart failure! With regards to testing I plan on having my mare tested every 6 months to check her ACTH levels are still within normal range and asjust the pergolide accordingly if needs be or pursue other treatment if deemed necessary. The ACTH levels can be done with a simple blood test that is sent chilled to Liphook for example, your vet can advise on this. But I have to say I am suprised at the high doses prescribed to some horses :confused:

2) If you dont want to give Pergolide full stop then there are some apparently effective supplements available that help with the symptoms and management of the pituitary gland, one the most well known being NAF Cushinaze, there have been some very positive reveiws of this supplement so its worth a look I reckon.

Or Chaste Berry is supposed to be effective also. Also I heard there is a new drug specifially for Equines for the treatment for Cushings called Prascend. As I understand its basically Pergolide but specifically for horses. It might be more easily tolerated in some horses than Pergolide which is essentially a human drug, I dont know though as I have not investigated it further as my old girl is doing fine on her 1/2 mg of Pergolide but it might be worth a look?

Sadiemay
 
minime said:
Hi Imogen, If you get time could you read up on my stallion who is having problems. I am afraid it is a bit long and I have received all sort of advice some good some very bad. I was reading about cushings and wondered if it could be his problem.
Thanks
http://www.horseandhound.co.uk/forums/showthread.php?t=402543&page=5
Click to expand...

I remember the thread in veterinary, but I've been away for the last few days so haven't had chance to post!
I agree with those about the body condition issue in the first piccie :p and often the crest does flop over due to obesity - but in your second set of photos he has obviously lost weight and the crest doesn't look that big. What did you vets say about the crest when they felt it? And didn't you post these bloods on a separate thread that I commented on?
Have you tried stripping some of the weight out of the mane as suggested??

It would confuse me too....don't think Cushings is on the differential list TBH but you can always test and check. Due to the weight issue I'd say that metabolic syndrome is more possible.

HTH
Imogen
 
Hi, my 14.2 16yr arab gelding was diagnosed with cushings 5 weeks ago. He had become very lethargic when been schooled (only symptom). I had tried giving him a holiday, changed feed, changed his routine - nothing. So took him to vets for blood tests to see what was going on and it came back as cushings. His reading was 92. Anything 49 and under is normal - as per my vet. The vet prescribed Prascend 1mg a day - couldn't give me pergolide. I asked if I could start on 0.5mg a day and work up if need be. She agreed. I had read about chaseberry and found Vitex 4 Equids which was supposed to be good natural medication for cushings so started on that too 40ml a day.

Just had second lot of bloods done this week and his reading had gone up to 107:eek: I am taking him off Vitex for time being and putting him on 1mg of Prascend - back for more bloods in 4 weeks.

The good thing is that he is taking his tablet - my friends part bred is 19 and on pergolide ( she can continue to get this from same vets as me as she was diagnosed before the law changed?) but he refuses to take treats as he is worried the horrible tasting tablet is in it:( Has the taste changed now it's a horse drug?
 
Have been reading this post with lots of interest but up until now havent posted as been lurking! I am finding this post very infomative and interesting. As I am studying for a degree in equine science and think of doing my final project on Cushings and the current treatments and the effectivness.
I feel it is very encouraging that people are disscussing this as clearly over the years treatments have changed and veiws and opinions are also changing. And i find it even more encouraging that it was a vet that started this. Well done
 
My Shetland mare went rapidly downhill this time last year. She had a classic Cushings coat, lost most of her top line, had a Cushings belly and was colicking repeatedly with signs of laminitis. We gave her Pergolide as we had nothing to lose and no time to get her tested -she was on deaths door. I did also try Agnus Castis for a while, but she completely refused any food with it in and I hated syringing it into her everytime. We noticed no change anyway.
After starting Pergolide, she improved slightly after a week, more so after 10 days and within a month was putting on weight and eating like she'd never eaten, showing a new lease of life and a new coat. The change was remarkable. She had a 5oo mcg dose per day. She was fab into spring and summer and we had a brilliant summer attending PC rallies and camp.
Sadly a few months ago she went into decline again. I increased her Pergolide in agreement with my vet to 750 mcg with a good improvement in her Cushing symptoms (amount of lethargy, drinking, slight lamnititis, etc.) her diet was very tightly controlled with access to soaked hay, a feed balancer and fast fibre and very restricted turnout on a mud patch. Sadly she declined again (although I upped her pergolide to 1mg temporarily) with strong digital pulses and laminitis after only an hours turnout with virtually no grass. We made the decision to have her pts before she declined further.

There's a lot of experience on a US forum for equine metabolic syndrome and Cushings (http://pets.groups.yahoo.com/group/EquineCushings/). Over there, Pergolide seems to be started gradually to avoid the 'veil' side effects. They suggest starting with a 500mcg dose and increasing it in 250mcg amounts over a period of a few weeks. If side affects/not eating happen then the dose is decreased for a few days.

I don't have experience of higher than a 1mg dose, but I considered that was quite high for a mini Shetland who only weighed about 150Kg. We think she'd had Cushings for a very long time.
Don't forget that Pergolide is only part of the treatment. Management on a very strict diet is extremely important. Hope my experiences help.

Sue
 
It's so hard knowing what to do.

My mare was diagnosed about 10 years ago, but with hindsight she'd had it for years before that. She's now at least 30 (exact age unknown, possible much older) and although she's retired now, she's still going strong, so there is hope.

I started her out on Hormonise (soluable monks pepper) as she wouldn't eat the neat berry. That resulted in a rapid turnaround - to the extent that when I went home to my mum's for xmas, I was thinking I'd have to make 'the decision', but when I came back she was galloping and bucking and kicking. I've never gone down the pergolide route - we thought we'd try the 'small guns' first and then still have the 'big guns' in reserve should we need them. As it was she didn't need them.

However, the biggest thing that turned her condition around was getting her a small pony mate. She took the young rescue pony under her wing, taught him the ways of world domination, and they're still a right old team (even if he does get a clip round the ear every now and then from his ol' gran). I haven't actually given her any supplementation for ages, and touch wood no more laminitis. Our vet thinks she's a legend, as every other horse that was diagnosed when she was is now dead. He also thinks there's something in the fact that improving her psychological stimulation (her happpiness, for want of a better word) improved her condition so much, and its certainly led him to take a more hollistic approach to some of the other cases he deals with. The medication is helpful, certainly, but there is a bigger picture at work here.

The old bat is still cushingoid - she has a coat on her like a yak - but she is a sharp as a die and her metabolism is relatively stable.
 
Thanks to everyone who has posted replies to give their experiences - this is really what I was looking for.

I am glad to hear so many positive experiences with treatment, I personally believe it is a very beneficial treatment as as I said in the OP, my experience of managing cases using pergolide is good.

I don't necessarily think that if your horse has Cushings (or signs suggestive thereof) you need to rush into treatment. As the above post says, some horses do very well with environmental management, usually the ones vets see and diganose get treated as there may be an associated problem - or we probably wouldn't be there in the first place!:p

I'd like to post a photo similar to that of one of my client's ponies...this one had Cushing's - I think although no tests were done and the owner did not have the horse on treatment. He coped very well!!
Cushings_long_haircoat.jpg


Secondly, I would like to comment on my OP.

It has been brought to my attention by members of my profession that my OP was poorly worded, so much as to say it has been a hotly debated and controversial topic of conversation in other veterinary forums.

I fear that my OP has done two things that I certainly did not intend and as such would like to put the record straight.

It has been pointed out that the OP could be interpreted in such a way to suggest that I do not approve of vets that had chosen to prescribe the higher levels of pergolide for certain cases.

This is NOT the case. Each veterinary surgeon managing each individual case will have the benefit of examination, lab results, a full history etc and will make a clinical decision for treatment based on all this information. I know of references supporting higher levels of Pergolide doses in specific cases. I do NOT consider use of these doses to be negative - I would feel sure that they are indicated as they have been prescribed.

As such, colleagues may have felt this thread undermined their decisions to use higher doses, and for this I sincerely apologise. The intention was purely to find out owner's experiences so that I, as a vet, will be able to discuss risks etc with my own clients should I need to use these higher doses in the future. As I have no experience with use of these dose levels, I personally felt your opinions matter.

It was also pointed out that veterinary surgeons have a code of professional conduct to stick too and that by undermining other veterinary surgeons decisions or knowledge, could compromise this.

I will be posting another thread to clarify my own feelings regarding my contributions on this site to avoid future controversy I hope!

Happy posting.
Imogen
 
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Deedee1990 said:
Have been reading this post with lots of interest but up until now havent posted as been lurking! I am finding this post very infomative and interesting. As I am studying for a degree in equine science and think of doing my final project on Cushings and the current treatments and the effectivness.
I feel it is very encouraging that people are disscussing this as clearly over the years treatments have changed and veiws and opinions are also changing. And i find it even more encouraging that it was a vet that started this. Well done
Click to expand...

I very much agree with DeeDee1990 on this. And have too found this post very informative and intresting. It is always useful as an owner to hear other people veiws and opions on things.
What a shame it is vets themselves that seem not to be embracing discusion. from an owners perspective I do not feel any vets have been undermined. More vets should be willing to come on here to give thier views too if they feel that strongly about it.
Well done Imogen for this thought provoking and very intersting thead.
 
I agree I think Imogen has done a great job. My friend who also just diagnosed 6 mths ago and I where saying only this week about how little information is given to owners when your horse is diagnosed and it's a shame vets don't hand out information leaflets on things like cushings- giving you all the facts.

Imogen just wondering if you know how much testing has gone on with Prascend, my lad is becoming depressed and ratty. He has been on Prascend 6 weeks now. My friends horse is on Pergolide and really happy and back to himself. As I posted earlier his aeth range has gone up and we are now on 1 full tablet a day. It's awful to see him so sad. Do you think it's possible he would react better to Pergolide?
 
Have people had much luck with agnus castus for cushings?

I have a friend with an old horse that has been diagnosed but not treated. The horse gets very hot and its feet and coat grow like wild fire - it has just been started on agnus castus - too early to see if its made a dfifference yet.
 
Prascend is Pergolide - same chemistry, the only difference is that the makers of Prascend have gone off and jumped through the hoops to get it approved as a medicine for horses, so it jumps up the cascade. The stuff is probably made on the same production line, costs the same to make, but the drug companies are getting more money through it being the only licensed product.

There's quite a few drugs that are the same formulation (and are made by the same factory) which have different meat withdrawal periods/ status as regards being given to Equines without the relevant bits of the passport being signed off. Might be Domesedan/equivalent...
 
I know Prascend contains Pergolide but there must be a difference lots of horses in fact most of the ones on Pergolide start to refuse tit bits scared it's going to contain the tablet - it's amazing some of the length's people have to go to to get the tablets down. Where as I haven't heard one person have problems getting Prascend down. Something is different somewhere. I know the Pergolide smells and taste's of nothing to humans (my friend took one so see how bad it tasted as she is really having to come up with inventive ways to get the tablet down)
 
impy01 said:
I know Prascend contains Pergolide but there must be a difference lots of horses in fact most of the ones on Pergolide start to refuse tit bits scared it's going to contain the tablet - it's amazing some of the length's people have to go to to get the tablets down. Where as I haven't heard one person have problems getting Prascend down. Something is different somewhere. I know the Pergolide smells and taste's of nothing to humans (my friend took one so see how bad it tasted as she is really having to come up with inventive ways to get the tablet down)
Click to expand...

I've not had reports from my clients that they have had issues giving pergolide or prascend tbh. There will be a different formulation of pill as one is for humans and one more for horses....but no active ingredient difference to my knowledge.

On a different note...the prascend won't cause a difference in depression/mood vs the pergolide that I can think of....:confused:

If the ACTH levels are still high despite the 1mg dose then may be other treatments are worth considering? Not every case responds perfectly to the pergolide...and other treatments are available, but are used less commonly due to usually lower response rates...discuss that with your vet maybe? This may be a case that does need higher doses?

Regards,
Imogen
 
EstherYoung said:
It's so hard knowing what to do.



However, the biggest thing that turned her condition around was getting her a small pony mate. She took the young rescue pony under her wing, taught him the ways of world domination, and they're still a right old team (even if he does get a clip round the ear every now and then from his ol' gran). I haven't actually given her any supplementation for ages, and touch wood no more laminitis. Our vet thinks she's a legend, as every other horse that was diagnosed when she was is now dead. He also thinks there's something in the fact that improving her psychological stimulation (her happpiness, for want of a better word) improved her condition so much, and its certainly led him to take a more hollistic approach to some of the other cases he deals with. The medication is helpful, certainly, but there is a bigger picture at work here.
Click to expand...
This is my feeling very strongly. A horses mental health and feeling of security is so important imo.

Imogen, I greatly respect you posting on here and I'm sad to read how your OP has been read by some other vets. However, code of conduct or whatever, no one is beyond question and instigating a hot debate that causes people to think more is a good thing imo.:)
Thankyou for taking the time and effort to post, I much appreciate it as I'm sure many others do. :)
 
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