Pergolide ends and Prescend begins..OMG please read.

TarrSteps said:
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Right, have just done a bit of looking and Peroglide is being withdrawn voluntarily for human use by the FDA in the US - is that also the case here?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. :(
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Hi TarrSteps,
Blimey....we are all being given so much conflicting information about Pergolide..will it/won't it be withdrawn......arrgh..
As far as my pharmacist is aware this is not happenening here, although I have asked if he would let me know, but I think I will also do some Interweb searching.
Re the prescription charges....I live in Wales and we do not pay for human prescriptions, they are paid for by the Welsh Assembly Govt. but we do pay for animal prescriptions available only in the 'human' form. The £28.55 I pay for the 100 x 50microgrammes may well be less than if I were to buy 1mg...I do not know, maybe another poster could supply this information.

Bryndu
 
Puppy said:
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 :rolleyes:), and I can't say I'd consider PTS because of that. :confused:

I also think it pretty obvious that the vets have no say in this. :( :(
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Hi Puppy.
Sorry if I gave the wrong impression...my 'git' is staying in this world even if I have to sell my body to pay for his prescription:)...I was just pointing out that maybe some people will not have the choice with this option.

Bryndu
 
I must say a big Thank You to all who have responded so far.

A question:
As an ordinary member of the public who has NEVER complained etc. to a higher authority...do you think in your opinion..that it might be worth me taking this further?
I know I said at the beginning I had no hidden agenda...but reading your replies...would it be worth me fighting my Sec A's corner as he clearly can't...or would I be on a hiding to nothing?

Arrgh... I feel so HELPLESS.:(

Bryndu
 
Bryndu said:
I must say a big Thank You to all who have responded so far.

A question:
As an ordinary member of the public who has NEVER complained etc. to a higher authority...do you think in your opinion..that it might be worth me taking this further?
I know I said at the beginning I had no hidden agenda...but reading your replies...would it be worth me fighting my Sec A's corner as he clearly can't...or would I be on a hiding to nothing?

Arrgh... I feel so HELPLESS.:(

Bryndu
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I can't see who you'd complain TO, to be honest. I can't see the government stepping in to subsidise medications for horses or to somehow force the makers to control the price on "humanitarian" grounds. As above, the drug is hardly used for people anymore so there's very little impetus to keep it on the market in its current form. And, frankly, I wouldn't imagine the equine market for that particular drug is so large that the drug company would care much either way - they'll set their price and people will either pay or they won't.
 
Some vets are keeping the 250mcg in as they agree splitting the 1mg tablets is difficult. Perhaps discuss this with your vet?
 
What you are all missing is the bit of info that is, the reason BI have brought out Prascend is that 'human' pergolide may stop being manufactured in the near future. It is a very 'old' drug, and most cases of Parkinson's are treated with more 'modern' drugs, meaning there are only a few people left taking it, and as they die (sorry, fact of life) it will become uneconomical for them to produce.

Should Pergolide stopped being made, because the drug companies don't see it as viable to manufacture, then it would disappear altoghether, leaving you will absolutley nothing to give the cushings horse.

At least by making an equine version it remains available. My own horse has half a 1mg tablet daily.

At my vets, the cost between the 2 isn't that much different TBH. Maybe try chatting to your Vet to negotiate a discount, they would often rather do that than have you take your business elsewhere.
 
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I've noticed this with our 17 yo who's just been diagnosed with Cushings - we had one pack of Pergolide, on which she improved unbelievably...and have now just started on Prascend.

However, it's much more expensive and whilst I haven't read through the whole thread (sorry for any repeats!) I have been told that the human medication may be being withdrawn - the laws have also changed in that vets can no longer use human medication when there is an equine/canine equivalent available. (or something along those lines!) It is the same with our GSD - although it changed many years ago, for her atopic dermatitis we cannot be prescribed cyclosporin - it's Atopica. Much more expensive, the same drug and same method of treatment, just a specific canine drug! We pay about 4 pounds a tablet (she is on one tablet every day).

I'll be keeping a close eye on this thread...I think whilst it might not make any difference to the available drugs, getting in touch with the higher authorities might highlight the fact that many horse owners are concerned at a) the massive price change and b) the fact that many of their horses were ill for a long period of time before being diagnosed with Cushings and that whilst Pergolide was making a significant difference, people are wary to start changing meds and what not.
K x
 
Ok...I have scared myself silly on the Interweb with the fact that Pergolide is being withdrawn due to the affects it has on the human heart (see below):
(Sorry..when I post this I don't know if the links will work)

Taken from http://neurotalk.psychcentral.com/thread10250.html

‘The British study showed that patients taking pergolide were 7.1 times more likely to develop heart valve damage than those who took other treatments. Patients taking the highest doses of the drug had a 37 times greater risk.’

It would seem that the last study, (and as far as I can see the only study..but I stand to be corrected),
made into the affect of pergolide on equine s for Cushings was 2007, http://ultimatehorsesite.com/articles/ei_cushings.html
..and I cannot find any reference to any suggestions that it is a cause of heart problems in horses..... does that mean it does or does not affect the equine heart?

The drugs now being used to treat Parkinsons in humans, (which is what Pergolide was used for) are to be found at:
www.parkinsons.org.uk/about_parkins...s/drug_treatment_for_parkinsons/levodopa.aspx

Now here’s the question.....

If we were to say that as Pergolide is being taken off the market due to the high percentage of heart valve damage in human, it would be seen as an unacceptable risk to continue to use Pergolide in equines as research into heart valve damage in equines does not appear to have been carried out....and as there is no equine alternative to the products listed on the website above...would we be justified in asking for one of the newer ‘human’ treatments available?

Bryndu.
 
Bryndu said:
If we were to say that as Pergolide is being taken off the market due to the high percentage of heart valve damage in human, it would be seen as an unacceptable risk to continue to use Pergolide in equines as research into heart valve damage in equines does not appear to have been carried out....and as there is no equine alternative to the products listed on the website above...would we be justified in asking for one of the newer ‘human’ treatments available?
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For a start, there is no evidence that it will affect horses the same as humans. After all it is being used for a totally different problem in humans.

Thats leads onto the question whether you could use a 'newer' drug, just because those drugs treat the same problems in human doesn't mean to say they will aslo be effective for cushings horses.

Drugs have varies side effects, the most well known one is Viagra, in actual fact that drug was and still is used for hypotension and its other effects were discovered later!

Maybe there is another drugs out there that can be used for cushings, but obviously studies would need to be done, and that in turn will push the price of that medication up.
 
Firstly, Parkinson's disease and Equine Cushings are NOT the same thing. However insufficient levels of Dopamine are common to both. Im not sure of the different dopamine agonists and how suitable they are for Cushings however. There are other treatments for Cushings but most of them either do not give a satisfactory clincal result or vary s to how effective they are in different horses.

And no, in the absence of research I dont believe its an unacceptable risk. People were more than happy to use it off licence for years (and the heart effects are known for a few years now). Also there is a much lower incidence of heart disease/attacks in equines than in humans(in general). The average Cushings horse will probably get Pergolide for less than 5years whilst humans would usually be on the drug for far far longer. Untreated Cushings will usually result in the early death of the horse (either directly or through laminitis) whereas Parkinson's disease doesnt really kill people.
 
Thanks Brightstar and Glenruby.

It was worth a try and I really DO appreciate your concise replies.

I don't know the first thing about 'trialling drugs' and can only comment on the amazing affect Pergolide has had on my pony......and he shall continue to have the drug for as long as he is able, although I know he shall not be with me for as long as we both would wish:)

Bryndu
 
Hi Brydu,

Pergolide does cause valve fibrosis as per the links you posted, when used in the treatment of Parkinson's, importantly, the dose used for the treatment of Parkinson's is huge in comparison to that used in pituitary problems.

There is a more modern drug used in humans (cabergoline) but as this is also ergot based, theoretically can cause similar problems. Patients on cabergoline will have a yearly echocardiogram as a sort of security blanket for the doctor who prescribed it.

I'm not sure if cabergoline is licenced to be used in animals, nor its cost (try the BNF via google for price), there are still a few patients on Pergolide so I think it is still being produced
 
norfolk_grump said:
Hi Brydu,

Pergolide does cause valve fibrosis as per the links you posted, when used in the treatment of Parkinson's, importantly, the dose used for the treatment of Parkinson's is huge in comparison to that used in pituitary problems.

There is a more modern drug used in humans (cabergoline) but as this is also ergot based, theoretically can cause similar problems. Patients on cabergoline will have a yearly echocardiogram as a sort of security blanket for the doctor who prescribed it.

I'm not sure if cabergoline is licenced to be used in animals, nor its cost (try the BNF via google for price), there are still a few patients on Pergolide so I think it is still being produced
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Thank you for this norfolk_grump.

Bryndu
 
Hi there,

I have just equired with my new vet practice about Prascend as I will run out soon of the Pergolide my old vets prescribed.

I was expecting it to be mega bucks as I have read its very expensive compared to Pergolide. However I was pleasantly suprised when the receptionist said is was 158GBP for 160 1mg tablets.

Granted, its alot more than I was paying for Pergolide (Pergolide was something like 70GBP for 100 tablets including the cost of getting the vet to write a prescription so I could get it from a pharmacy)

The cost really does seem to vary between vets as someone posted at the beginning of the thread that they paid 260GBP for 160 tablets (I think) :eek:

Now that is where my grumble lies, that the cost of drugs/medicine varies so much. Its not fair at all.

Sadiemay
 
Sorry I meant to say to Bryndu.....

Am I right in thinking your pony is on 0.5 mg a day? If so then 160 1mg tablets will last your pony 320 days, which is around 11 months :)

So say worst case scenario and you have to pay around 200GBP for the 160 tablets its still a hell of alot better than the 1000GBP a year you thought you may have to spend.

Ignore me if I got the wrong end of the stick :o

Sadiemay
 
Oh the joys of prescription medicines for animals! I could write a book on the subject :( My mare has epilepsy and her main drug is phenobarbitone. When she started on it back in 1998 I could have the human product and 1000 tablets cost about £17 including VAT. Back then that was a months supply. Over time she has gradually needed more and more and now she needs 2000 tablets per month plus potassium bromide - without the bromide I would need to double the phenobarb. She had only been on the drug for 6 months when my vet warned me about the new Cascade system being foisted on them by Brussels which meant I could no longer use human phenobarb as there was a licenced animal equivalent produced for dogs. Trouble was 1000 tablets cost well over £100. He managed to negotiate a deal with the company whereby I order 5000 tablets and pay for 4000 which obviously is a big help but still means my drug bill is around £200 per month for her epilepsy plus another £70 or so for metacam - she can't have any other antiinflammatory due to the drugs blocking each other. The drug company can basically charge what they like as they have the only licence - the drug costs pennies to produce in reality. Vets refuse to prescribe on the grounds of cost and I certainly know of other horses which have died or been put down and never got the chance of treatment. My girl has gained (so far) 12 extra years of happy, productive life and I've lost £30K in the process. But what else could I have done?
 
Sadiemay said:
Sorry I meant to say to Bryndu.....

Am I right in thinking your pony is on 0.5 mg a day? If so then 160 1mg tablets will last your pony 320 days, which is around 11 months :)

So say worst case scenario and you have to pay around 200GBP for the 160 tablets its still a hell of alot better than the 1000GBP a year you thought you may have to spend.

Ignore me if I got the wrong end of the stick :o

Sadiemay
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Sausage..I wouldn't ignore anyone who has taken the time to read and reply to this post..thank you.

My pony is on microgrammes not milligrammes which is my problem. Microgrammes is a much smaller dosage and my problem is going to be getting the amount he requires in to small enough 'dust' to administer.
Interestingly, my vet phoned for a chat yesterday and she had spoken to the drug company as she does not feel happy at giving my boy half a 1 milligramme tablet as this would be way too much of a dose for him. He is only 9 years old and was diagnosed at 7 so is at the beginning of Cushings, whereas it would seem most of the treatment in high doses is to treat the advanced stages of Cushings in older horses. The drug company basically said 'you are on your own'....hey ho!
I am off to my pharmacist tomorrow to see what tye of equipment is available to 'break up' his Prascend into manageable 'bits'. I am hoping there are some sort of weighing scales.

Bryndu
 
fatpiggy said:
Oh the joys of prescription medicines for animals! I could write a book on the subject :( My mare has epilepsy and her main drug is phenobarbitone. When she started on it back in 1998 I could have the human product and 1000 tablets cost about £17 including VAT. Back then that was a months supply. Over time she has gradually needed more and more and now she needs 2000 tablets per month plus potassium bromide - without the bromide I would need to double the phenobarb. She had only been on the drug for 6 months when my vet warned me about the new Cascade system being foisted on them by Brussels which meant I could no longer use human phenobarb as there was a licenced animal equivalent produced for dogs. Trouble was 1000 tablets cost well over £100. He managed to negotiate a deal with the company whereby I order 5000 tablets and pay for 4000 which obviously is a big help but still means my drug bill is around £200 per month for her epilepsy plus another £70 or so for metacam - she can't have any other antiinflammatory due to the drugs blocking each other. The drug company can basically charge what they like as they have the only licence - the drug costs pennies to produce in reality. Vets refuse to prescribe on the grounds of cost and I certainly know of other horses which have died or been put down and never got the chance of treatment. My girl has gained (so far) 12 extra years of happy, productive life and I've lost £30K in the process. But what else could I have done?
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Blimey fatpiggy.....I am REALLY sorry to hear about your girl....and having read your post...I feel quite humbled.....you have greater costs for the same amount of hassle.

Best wishes
Bryndu
 
Thanks Bryndu - I try not to think about the cost TBH! I would probably do exactly the same all over again, although I admit I didn't think the old girl would live as long as she has (she's 28 this year) as the drugs are supposed to knacker the liver. She was routinely tested just over a year ago and her liver was functioning completely normally.

There is one trick you could try - if you could get the vet to say that the new drug is unsuitable for your pony, he might be able to still prescribe pergolide. A friend of mine is a pharmacist and she knows of someone's dog with epilepsy which still gets the human phenobarbitone because the vet "says" it is allergic to one of the components of the animal medicine.

Animal owners are really held to ransome over their pets, aren't they? Good luck with your chap.
 
Thanks fatpiggy....

Update...visited pharmacist today..he says he may be able to get Prascend from his animal medicines supplier a bit cheaper so he will look in to this...as Teaso says...every little helps!!! However.....isn't there ALWAYS a 'however', he would need a prescription...havn't spoken to vets yet, we shall have to wait and see if they feel this is acceptable...

He is also sourcing some crushing and weighing equipment and he thinks it will be easy to get the 50 x 2 microgramme dose my pony requires using this method...

Folks....things may just be looking up......
Will keep you informed.

Bryndu
 
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