Ertugliflozin - Insulin Before and After

HollyWoozle

HollyWoozle

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www.farandride.com
Our mini with EMS has had around a month of Ertugliflozin, a very small dose (half what he was meant to have because I am a moron!), after a bout of winter lami. His resting insulin (not a fasting test) was 207 when tested a month ago and it's now 63. 🙌 Our vets seem to use 32 as the cut-off ideally. We'll be talking to them on Monday about the plan moving forwards.

I just thought I'd share here in case people search about the drug. We've had no negative side-effects and he is looking so much better and more comfortable.
 
I'm going to pop my EMS Appy back on it this Spring. She's muzzled but that's never enough when the grass is sweet.

Relieved to hear your Shetland responded so well.
 
My horse has tested at 75, and vet has suggested ertugliflozin.

Could I ask whether either of you (or anyone else) have found more cost effective sources for it online? If so, where?
The financial side effects are considerable o_O
 
My mare is on Invokana, a daily dose caused her blood fat levels to rise, but using it every other day has fixed that and is keeping her glucose low (I think it was about 40 at last blood test)
 
teacups said:
My horse has tested at 75, and vet has suggested ertugliflozin.

Could I ask whether either of you (or anyone else) have found more cost effective sources for it online? If so, where?
The financial side effects are considerable o_O
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I think you may struggle with this, as it's not licensed for use on horses (it's a human diabetes drug) so vets are only allowed to prescribe it off-label, but are unlikely to issue a prescription for it for you to purchase elsewhere, as the 'elsewhere' would likely need to be a human pharmacy not animal, and they probably wouldn't be keen on fulfilling a vet prescription. (to any knowledgeable people who are cringing at the way I've worded my post, please forgive me if I've messed up my terminology. It's been a long week and I'm very tired)
 
JenJ said:
I think you may struggle with this, as it's not licensed for use on horses (it's a human diabetes drug) so vets are only allowed to prescribe it off-label, but are unlikely to issue a prescription for it for you to purchase elsewhere, as the 'elsewhere' would likely need to be a human pharmacy not animal, and they probably wouldn't be keen on fulfilling a vet prescription. (to any knowledgeable people who are cringing at the way I've worded my post, please forgive me if I've messed up my terminology. It's been a long week and I'm very tired)
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Yes, I understand the wording perfectly, and was coming to that same conclusion.

The usual online vet medication sites don’t have it.

Another question: is there a reason most people seem to have it as a paste rather than a tablet? The obvious reason I can think of is to be able to vary the dose…any others? Apart from ‘how to get it into the horse’ reasons ; )

ETA invokana is good value compared to the £6 a day for ertugliflozin I was told it would cost.
 
HollyWoozle said:
I must be honest and say I’ve no idea what it costs as my parents bought the pony (against my advice 🤣) and pay all his costs. I will see what they’ve paid for it but they definitely bought via the vets.
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That made me laugh. It would be interesting to hear what the cost is at your vets, though!
 
teacups said:
Yes, I understand the wording perfectly, and was coming to that same conclusion.

The usual online vet medication sites don’t have it.

Another question: is there a reason most people seem to have it as a paste rather than a tablet? The obvious reason I can think of is to be able to vary the dose…any others? Apart from ‘how to get it into the horse’ reasons ; )

ETA invokana is good value compared to the £6 a day for ertugliflozin I was told it would cost.
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I have a prescription from my vets and buy tablets. Easy to hide in food whereas the paste was awful to manage - its very thick so hard to get into a syringe let alone the horse!
 
teacups said:
Yes, I understand the wording perfectly, and was coming to that same conclusion.

The usual online vet medication sites don’t have it.

Another question: is there a reason most people seem to have it as a paste rather than a tablet? The obvious reason I can think of is to be able to vary the dose…any others? Apart from ‘how to get it into the horse’ reasons ; )

ETA invokana is good value compared to the £6 a day for ertugliflozin I was told it would cost.
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I had 100mg tablets, and they were easy enough to snap in half for the smaller doses 🤷‍♂️

I hadn't seen it on any vet med sites, I'm assuming that's because it's licensed only for humans, but then I didn't look very hard. Obviously, some ARE selling it as SEL managed to get some.

I've spent a bit of time browsing facebook in the last couple of days, and the Laminitis groups are often near the top of my newsfeed - there seem to be quite a few recent posts sharing experiences of serious side effects (mortality!) of ertigliflozin, so many are preferring canagliflozin (Invokana). However this is purely anecdotal comments based on a few posts, so whilst it may be a start point for researching, I'm not claiming it as fact! 😂
 
Blimey, well I can confirm that Domino isn’t dead yet at least. 🙈 We have the paste and he has the tiniest, weeniest dose as he’s so small and actually it’s quite a loose paste and we just squirt a measure into a small piece of hollowed carrot.
 
We’ve our pony on Invokana, and get the prescription filled at the local chemist- £58 for 30 tablets and he gets half a day, so just under £1/day for him. Well worth it for the improvement in his quality of life!
 
SEL said:
I have a prescription from my vets and buy tablets. Easy to hide in food whereas the paste was awful to manage - its very thick so hard to get into a syringe let alone the horse!
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Cherryblossom said:
We’ve our pony on Invokana, and get the prescription filled at the local chemist- £58 for 30 tablets and he gets half a day, so just under £1/day for him. Well worth it for the improvement in his quality of life!
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That sounds quite promising, and a bit more positive. Thank you for that - will discuss tablets as an option with the vet.
 
HollyWoozle said:
Blimey, well I can confirm that Domino isn’t dead yet at least. 🙈 We have the paste and he has the tiniest, weeniest dose as he’s so small and actually it’s quite a loose paste and we just squirt a measure into a small piece of hollowed carrot.
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My vet did say ertugliflozin is more popular for smaller horses and ponies - cheaper!
Hope Domino continues to enjoy his carrots & bounce onwards and upwards (perhaps upwards is the wrong phrase to use when talking horses 🤣 ).
 
JenJ said:
I had 100mg tablets, and they were easy enough to snap in half for the smaller doses 🤷‍♂️

I've spent a bit of time browsing facebook in the last couple of days, and the Laminitis groups are often near the top of my newsfeed - there seem to be quite a few recent posts sharing experiences of serious side effects (mortality!) of ertigliflozin, so many are preferring canagliflozin (Invokana). However this is purely anecdotal comments based on a few posts, so whilst it may be a start point for researching, I'm not claiming it as fact! 😂
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Interesting to hear about invokana, thank you. Will take a look. Social media does tend to be full of alarmist anecdotes - sometimes difficult to work out what is reliable & what is not. But it is as you say still useful information & a starting point.
 
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teacups said:
Interesting to hear about invokana, thank you. Will take a look. Social media does tend to be full of alarmist anecdotes - sometimes difficult to work out what is reliable & what is not. But it is as you say still useful information & a starting point.
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I did ask my vets last time there was a flurry from the US laminitis page of panic over the new drugs

You need to blood test beforehand to check blood fat levels. If they're OK but the horse loses weight rapidly on the drugs then you need to re-test immediately. Ideally vets like to test after a month but I'm on my 2nd year with my big Appy so vet has agreed 2 months at my risk. I haven't heard any UK mortality stories.

Mine also has type 1 pssm and the impact on her muscles on the drugs is phenomenal. That stiffness totally goes and her bilateral hind end lameness isn't really noticeable - vet investigations struggled to pin it down so at least i know it's muscular / pssm related
 
Thank you, that is also interesting. My vet did mention that if I was going to look it all up I’d read about the blood fat issue. He said the first sign would be the horse going off its food. Mine is so keen on his food that that would be a very obvious and immediate cause for alarm 🤣
 
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