Pergolide ends and Prescend begins..OMG please read.

[Bryndu]

Bit long...sorry.

My Sec A gelding was diagnosed Cushings in 2009 and began a course of Pergolide, and eventually stabilised at 2 x 50 micrograms given once a day (50 micrograms = 0.05 milligrams). This costs me £28.55 for 100 tablets making a total cost for the year of £208

I had heard that Pergolide was being withdrawn from circulation and that we would now all have to use a drug called Prascend .

So armed with my repeat prescription, I headed to my local Pharmacist and asked him about the withdrawal of Pergolide from the market. He said he had heard nothing about this from any of his publications or indeed the GMC press. He said he would find it difficult to believe it was being withdrawn as it is used to treat Parkinson’s Disease in humans.

So, off to the vet to get 3 repeat prescriptions...and the bombshell....

Pergolide is NOT being withdrawn, however no tests have never been carried out on the human Pergolide to see it’s effect on horses, so a company as I understand it has researched Pergolide and it’s effects on equines and come up with a registered product called Prascend. This drug is produced by Boehringer-Ingelheim, who also produce Pergolide for human use and when I went on to their website earlier today are still producing Pergolide in human tablets.
Now by law (and I stand willingly to be corrected) if an equine equivalent drug is available, vets may not prescribe a human drug. So, up until now, there has been no equivalent equine Pergolide and that is why we have been using the human drug. I should like to point out I am not in any way having a pop at the manufacturer.

Nothing wrong with that I hear you say......until you hear the price. 150 tablets of Prascend costs £150.
Now, my Sec A falls within the 200 – 300 kg weight bracket and the recommended dose for this bracket is ½ a 1milligramme tablet. (Taken from the Prascend website today). Therefore it will cost me £1000 per year to treat my pony instead of the present £208

Another worry is that my pony is on a VERY low dose, which does not seem to be catered for by the 1milligramme tablet, and I am concerned about the effects this may have on my pony. I must at this point stress, that I have an extremely caring and understanding veterinary practice who will oversee the transition to this drug, and in whom I have every faith, but at the moment even they do not have all of the answers.

Now some of you may be thinking...well..he is an old pony he has had a good life...perhaps now would be the time to consider putting him to sleep.
Well if he was aged I would do this, however he is just 9 years old, and whilst his Olympic career is in tatters (LOL!) he still has a good competition career going on.

I am concerned this new dosage may affect my pony

I am concerned at the massive cost increase implications for giving my pony this drug

I am concerned that both Pergolide and Prascend tablets appear to contain pergolide mesylate, so why is there a need to change to an equine tablet and not just re-brand existing drugs if equine clinical trials have already taken place. (I am not a Chemist or Pharmaceuticals expert so there may well be a reason for this).

I am concerned that many horse and pony owners faced with this massive increase in costs will have their equines put to sleep with the possibility of another hike in costs from the manufacturer due to making a drug for limited customer demand.

I would be interested in other people’s thoughts/opinions on this.

I am not about to start any sort of campaign, but what started as a good Friday, has turned in to a bad weekend.

Bryndu

 

[mystiandsunny]

If the drugs are of equal strength, and using the new one will cause the dosage to skyrocket, perhaps the answer is to grind the tablet (mortar and pestle), then split the resulting powder by the correct number of feeds/days to get the correct dosage?

 

[barbann]

Hope this isn't the case as my Arab has 3x25 micrograms per day. I haven't heard anything about this from my vet and I recently had another batch from him. If it is correct it'll be yet another case of "let's rip off the horsey community as they've all got loads of money" ....ha-ha..NOT!

 

[lauraandjack]

Welcome to the crappy world of medicines licensing.

This is happening to many drugs in the veterinary world - I'm sure it's because the drug companies have got wind of the fact that they can make a tidy profit by "rebadging" human drugs under a veterinary label and charge more for them!

Pergolide is just one of a number of drugs that have been affected by this. And unfortunately under current UK medicines regulations your vet's hands are tied, they are obliged to supply Prascend rather than generic pergolide.

A former colleague reckoned he had encountered a number of owners who had ended up having to have their pets put to sleep because they could no longer afford to keep on treating since he became unable to prescribe generic products for them.

Apparently this is progress!

 

[mulledwhine]

GRRRRRRR, this makes me so crosss.

If you look on any equestrian medcial shelf, you will see that at the least they are double the price of the human equvilent.

Horse Savlon !!!!!!!!
Horse Iodine !!!!!!

WTF, they take advantage as far as I am concerned.

I found this out many years ago when my old dog had kennel cough, and my vet said ' you can give her this which is £12 or go to boots and get kids cough syrup which is about £2' luckily my vet is very honest and fair

 

[lhotse]

I would research as to whether you can buy it online, seems you can buy pretty much anything these days.

 

[Ali2]

Welcome to the crappy world of medicines licensing.

This is happening to many drugs in the veterinary world - I'm sure it's because the drug companies have got wind of the fact that they can make a tidy profit by "rebadging" human drugs under a veterinary label and charge more for them!

Yep - and if they get a patent on the new indication then that allows them to charge a premium because they are sole providers with no competition for at least a decade from generics.

It does suck on an individual basis but when it comes down to it pharma companies are there to make a profit for their shareholders and need to fund ongoing R&D to ensure a continuous pipeline. I don't know how the profit margin on a rebranded drug, which should require less development and testing, compares with a novel drug.

Just reread. If you stick with your current dose, which you know is working for you, then you'd actually only need 37 tablets per year which would work out significantly cheaper for you. I would seriously consider the suggestion made above to split the dose. If you ground the tablet and mixed it very well with a known quantity of a carrier (not sure what you would use, bran, micronised linseed?) then you could aliquot it out to give a daily 100 µg dose, thereby getting 10 doses from 1 tablet.

I hope you can sort this out its obviously a worry for you

 

[0ldmare]

Yes I can confirm all this, just went to get a new lot of pergolide and had to get prascend. Vet charged about £260 for 160 x 1mg tablets ( )

In your case, if you can't get the 0.5 mg I would definitely crush the tablets and split into 2 doses.

 

[sueeltringham]

I split the 1mg tablets and it worked well. You can use a very sharp knife, score the tablet and then press with knife. Alternatively we also ground up in pestle and mortar, collected powder on a folded paper, shake paper and then 'cut' the powder into equal proportions. We then wrapped each dose in seperate paper sachets. Sounds fiddly, but it wasn't so bad -OH is a pharmacist so I gave this job to him!

 

[Bennions Field]

think the reason for change was discussed on here recently, not certain but thought it was due to the dreaded european regulations, rather than just drug company involvement, the drug was originally licenced for human use by Eli Lilly, but went generic some time ago, i originally had to buy celance as it was origninally branded for humans and it was expensive. thankfuly just after my pony was diagnosed around 6 years ago it went generic (ie anyone with a licence to manufacture) was allowed to make it. hence the drastic drop in price then.

check with your vets, i am not sure, but they may be allowed to write a prescription for the generic name. you could then go to your local pharmacy and have it dispensed as 'pergolide'??? there was a law brought in a while back allowing pharmacies to dispense vets prescriptions not just human ones. its worth a try if it keeps the cost down

best of luck, i know it has a great result for some neddy's, unfortunately my little man is no longer with us, and is very sadly missed :-(

 

[Puppy]

Nothing wrong with that I hear you say......until you hear the price. 150 tablets of Prascend costs £150.
Now, my Sec A falls within the 200 – 300 kg weight bracket and the recommended dose for this bracket is ½ a 1milligramme tablet. (Taken from the Prascend website today). Therefore it will cost me £1000 per year to treat my pony instead of the present £208

Hmmm, I'm not sure about your maths there. If it's £150 for 150 tablets, then the tablets are £1 each. If your pony has half of one per day then it's 50p per day, and therefore £182.50 per year.

However, I do agree that this is frustrating and more expensive for those of us with cushings horses - I have one myself on 1mg per day. My advice is to shop around for price as your vet practice is likely to be more expensive than a chemist - as was the case with pergolide.

 

[learningcurve]

Hmmm, I'm not sure about your maths there. If it's £150 for 150 tablets, then the tablets are £1 each. If your pony has half of one per day then it's 50p per day, and therefore £182.50 per year.

However, I do agree that this is frustrating and more expensive for those of us with cushings horses - I have one myself on 1mg per day. My advice is to shop around for price as your vet practice is likely to be more expensive than a chemist - as was the case with pergolide.

Thats what I thought, my shettie has cushing but fine without medication at the moment, but I had worked out the cost at 50p per day based on half a tablet.

 

[Puppy]

For me, the most expensive thing about keeping a cushings horse (And mine is a solid 16.2, whose not the best of doers) is keeping them on alternative forage and off the grass all spring/summer/autumn. My girl can eat 16kgs of haylage per day no problem, work that out over a year!

I'm having her blood tested on Monday to see just how she's doing on the 1mg per day (started last march) but I am somewhat expecting (due to her winter coat still being quite curly), that she will have her dose slightly upped.

 

[Clava]

My vet told me this would happen last summer. A company has basically got the patent / license (patent is probably not the right word) to sell the new drug so Pergolide could no longer be used. he then implied that if I'd won the lottery I might start using the new drug, but I had already decided to manage my ponies cushings as best I can without medication.

 

[smiggy]

Your vet might be able to work round the regs on the fact that your pony is already stabilised on pergolide and also that the formulation of prascend (ie the dose stength of tablet) is not suited to your horse.
Its a judgement call on his part but might be worth having a chat with him

 

[Bryndu]

Thanks all for your interest.

Re the money thing - I was trying to point out, but I don’t think I was very clear..sorry!.. that I would have to be using a higher dosage as that was the new recommended for his weight category, therefore would this affect my chap adversely?

Monkst01 – Really sorry to hear you lost your beastie.

Smiggy re : 'Your vet might be able to work round the regs on the fact that your pony is already stabilised on pergolide and also that the formulation of prascend (ie the dose stength of tablet) is not suited to your horse.
Its a judgement call on his part but might be worth having a chat with him'

This is a good call and something worth persuing – thanks.

Clava – re : 'I had already decided to manage my ponies cushings as best I can without medication.'

I am interested in your comments, are you able to expand?

Ihotse re: 'I would research as to whether you can buy it online'

My research so far indicates that:

A. It can only be purchased online with a prescription.....but I am still investigating this.
B. At present they are being sold by the 1mg tablet at between 86p and 84p ex vat an p&p.

At the moment I have not told my pony!!!!

Bryndu

 

[MagicMelon]

I hadn't heard this??? When does Pergolide go off the market? I currently have my cushings pony on it, it already costs a fortune.

 

[Clava]

I can only expand by saying I give him NAF cushionaze, keep him fit and very careful about lammi and diet and will clip to control hair growth, he's a companion really (but could do more if I had a rider for him) and I don't necessarily expect him to live into old age, but symptoms are mild at present.

 

[Bryndu]

I can only expand by saying I give him NAF cushionaze, keep him fit and very careful about lammi and diet and will clip to control hair growth, he's a companion really (but could do more if I had a rider for him) and I don't necessarily expect him to live into old age, but symptoms are mild at present.

Thanks Clava.

 

[Bryndu]

I hadn't heard this??? When does Pergolide go off the market? I currently have my cushings pony on it, it already costs a fortune.

I have 3 repeat prescriptions and then my vet says they will have to prescribe Prascend. So it is Feb now so I expect I shall start in June sometime.

Bryndu

 

[glenruby]

I can see this is distressing and considering we are seeing the benfits of treating ponies/horses with Cushings more and more these days - thus allowing them a longer more comfortable life, I do fear this will stop.
For the record - it is EXACTLY the same drug as the human one. Just re-packaged as the equine one. This info came directly from the reps. I did ask about the different dose sizes but forget the answer Im afraid.

 

[Bryndu]

I can see this is distressing and considering we are seeing the benfits of treating ponies/horses with Cushings more and more these days - thus allowing them a longer more comfortable life, I do fear this will stop.
For the record - it is EXACTLY the same drug as the human one. Just re-packaged as the equine one. This info came directly from the reps. I did ask about the different dose sizes but forget the answer Im afraid.

Thanks for this.
You would think it would be in the vets' best interest to get the drug companies to keep the price low as there are going to be an awful lot less customers for them if everyone decided along the PTS route.
I have to say, whilst grooming my boy today.....I was thinking about his future.....living without the drug is not an option for him......living without my boy ...is.
Worrying times......
Bryndu

 

[glenruby]

Im afraid vets have no influence over drug companies. I really cannot understand why the drugs industry is allowed to work in such a way as to have NO competition where other areas of the economy this is rarely allowed. (if you catch my drift...)
Drug companies have us vets over a barrel just as they do our clients. Im actually not sure what our price is (though I gather its not a huge increase) but a colleague told one of my clients the other day that it would be approx 30-50p daily for her pony(on the lowest dose).

 

[Bryndu]

Im afraid vets have no influence over drug companies. I really cannot understand why the drugs industry is allowed to work in such a way as to have NO competition where other areas of the economy this is rarely allowed. (if you catch my drift...)
Drug companies have us vets over a barrel just as they do our clients. Im actually not sure what our price is (though I gather its not a huge increase) but a colleague told one of my clients the other day that it would be approx 30-50p daily for her pony(on the lowest dose).

I know...it is all so worrying.....my vets are actually distraught at the fact this is going to happen and they are powerless to do anything about it....it is all so frustrating...arrgg!

Bryndu

 

[smiggy]

Again nothing to do with vets, we just get struck off if we dont follow the rules!
There is a petition signed by many vets against the new regulations. Many of us have also written to our mps and get a standard non committal answer back, actually don't think they quite grasp the issue.

 

[brighteyes]

How long before Prascend is available as a generic? And I'd be quite prepared to go 'underground' to get Pergolide, if I needed to.

There is absolutely no reason for the price difference for the veterinary version. Having a sick pony is bad enough without some stupid legislaton and opportunist manufacturers forcing your hand over the decision not to continue treatment purely on the grounds of cost Really makes me furious.

 

[Puppy]

Thanks for this.
You would think it would be in the vets' best interest to get the drug companies to keep the price low as there are going to be an awful lot less customers for them if everyone decided along the PTS route.
I have to say, whilst grooming my boy today.....I was thinking about his future.....living without the drug is not an option for him......living without my boy ...is.
Worrying times......
Bryndu

Really?! For 50 pence per day? How very sad

My mare will cost at the very least £1 per day on this new brand of medication, (plus about £750+ pa in forage because she can't have grass ), and I can't say I'd consider PTS because of that.

I also think it pretty obvious that the vets have no say in this.

 

[MurphysMinder]

My pony's pergolide dose has just been increased to 2 x 1000mg tablets per day. The vet has given me a x 3 repeat prescription to keep her on it as long as possible but after that it is going to cost me a heck of a lot more to keep her on Prascend. She has been a useless field ornament for years but guess I will have to bite the bullet and find the money from somewhere.

Incidentally the last couple of times I have gone to chemists for Pergolide the pharmacist has told me it is increasingly hard to get and is being phased out, so not sure if it is going to still be available to people either.

 

[TarrSteps]

This has been coming down the pipeline for some time and has also been a concern to people in North America so it's not, at least not primarily, anything to do with the EU regs specifically. (The complications of "off label" usage are international. Basically drug companies are there to make profits and if they see a niche in the market they can exploit, they will. )

I am interested though, generally human pharmaceuticals here are VERY inexpensive relative to in North America, even considering the exchange rate. Are they subsidised somehow? Perhaps through the NHS? (Canada also has socialised medicine but it doesn't extend to prescriptions unless the patient falls into very specific groups.) Is this related to the problem somehow, in that obviously the health care system cannot be subsidising (or even controlling) medications for non-humans at least if veterinary options are available? As I said, I have no idea but sad as it is to the individual horse people affected, it would make sense.

Right, have just done a bit of looking and Peroglide is being withdrawn voluntarily for human use by the FDA in the US - is that also the case here? That would explain the "shortage". I guess in some ways it's good they didn't decide to stop making it entirely but presumably the drug companies are looking to "make up" the loss as a human drug against the continuing market as a equine drug. Not good.

 

[glenruby]

Bright eyes - it will be 10years before the generics can come out.

Tarrsteps - Yes the FDA have removed pergolide from the market in the US and I think Canada has too. As there are only approx 200people in the UK who are currently on the drug it is expected that the UK will follow suit in the near future - hence Boehringer applying for the licence. Most of those who used the human drug were horses.