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Author Topic: Metabolic Disorder Issues and Test Results  (Read 1453 times)

OldnOrnery

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Re: Metabolic Disorder Issues and Test Results
« Reply #45 on: October 29, 2014, 10:05:25 pm »

Hi, Judy. I've been following  your saga on the ECIR Yahoo Group. That's a great place to get the straight scoop. I joined two years ago when my 20 yo RMH was diagnosed with PPID after becoming suddenly lame and foot sore early in October.

Pergolide was used for many many years to treat humans with Parkinson. It is NOT a new drug. Around 2007, it was withdrawn from the human market because studies showed that at high doses (10 mg for a 150-200 lb human) over a long period of time, some people developed heart valve problems.

Prascend is pergolide. The primary difference between it and compounded pergolide is this: after some vets had been using compounded pergolide to treat PPID for about 10 years and after a study was finally published showing that it can control PPID by controlling ACTH, a German drug company did some math and got FDA approval for its form of pergolide -- 1 mg tablets in little sealed packages.

There are issues with the longevity of all pergolide. It loses potency when exposed to heat over 77℉ and below...37, I think. It loses potency quickly when exposed to moisture (the reason for Prascend's packaging). So if you get it compounded, you need to get it powdered, in capsules, store it within the temperature range, keep it dry, and refill every 30 days. It is absolutely untrue that compounded pergolide is ineffective. I know for a fact based on my own experience  that 6 mg of compounded pergolide works exactly like 6 mg of Prascend, only at a fraction of the cost.

The study the drug company did was not especially thorough. A high percentage (40%?) of the the PPID horses treated with only 2 mg of pergolide/1000 pound horse did NOT improve. If they'd bothered to check with the the ECIR Group, they'd know that equines vary a lot as to the dose they need to control symptoms. Rather than test further since some horses didn't get better and even had to be euthanized, their great idea was to tell the FDA that horses only needed 2 mg of pergolide if they weigh 1000 pounds. They priced accordingly.

The problem is that PPID is a progressive degenerative disorder caused by a growth on a certain part of the pituitary gland. Like Parkinson's in humans, over time, to control symptoms (the worst being laminitis, but IR, anhidrosis, long coat and a bunch of systemic disorders), the dose of pergolide needs to be increased. Oops. FDA-approved Prascend labels dosage only up to 2 mg for a 1000 lb horse, up to 4 mg for really big horses. So what happens when the PPID advances and 2 mg doesn't keep ACTH under control? Let them founder, apparently.

One lesson from the ECIR Group is that if you control PPID early, before advanced Cushings makes your horse look like a yak, before your horse gets laminitis every fall, then you can start at a lower dose and keep the dose relatively lower over a longer period of time. If you don't get a diagnosis until PPID is advanced, like when your horse grows a long coat that doesn't shed out, when the body type sets in (loss of top line, pot belly, muscle atrophy), then you start out needing a higher dose to control ACTH, and PPID advances faster.

There are members of the ECIR Yahoo Group who treated their horses with compounded pergolide for 10 years.

There are more and more studies of laminitis now, with metabolic disorders known to be a major cause. And that has brought much more attention to PPID and IR, sometimes called Equine Metabolic Syndrome. Most vets don't have the time to read all kinds of vet studies to bring themselves up to speed; instead, they get their info from...the German drug company.

I've been told so many whoppers by the numerous vets I consulted that I just shake my head. One said PPID horses don't get anhidrosis, they get hyperhydrosis. My mare doesn't sweat. Another said that since my horse's ACTH wasn't controlled on 2 mg of Prascend, the only thing to do is to add cyproheptadine - - a drug shown in a published study NOT to improve PPID by controlling ACTH and that she offered me at $100 for a 3 week supply. And the latest vet told me that after the horse isn't controlled on Prascend, you just put it down.

Sorry for the rant. This is an issue near and dear to me. I want to treat my horse. There's a lot of life left in that old mare.
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Ozhorse

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Re: Metabolic Disorder Issues and Test Results
« Reply #46 on: October 30, 2014, 12:51:39 am »


"Strength to your arm"

Keep fighting the good fight, you have done a fabulous job.
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