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Any Reason NOT to give Pergolide for Cushings Horse? ACTH 127?

Horse Care
#1

I am starting a new thread because this is not about my horse who is doing well on Pergolide and Thyro-L to control his Cushings and IR.

Very coincidentally, my good friend’s 30 year old horse has been diagnosed with Cushings. He was extremely lame and could barely walk and was immediately put on Bute and Ace (reason for Ace was to dilate blood vessels?). This was prescribed by a vet on call for my friend’s regular vet who was out of town. This on call vet also did blood work and ACTH came back at 127. My friend has not asked for the Insulin results at this point.

This particular horse is 30 years old and has had the outward usual Cushing’s signs for years. Thick wavy coat that does not shed, so he is body clipped over and over. Tends to be heavy all over – between about an 8 body condition. Has always been sluggish and has become more so.

Xrays were taken and he has a slight (7 degree) rotation in one foot and even less in the other.

The regular vet got back from his trip and has only told her to get Soft Ride boots, but has said there is no need to do Pergolide as he doesn’t really think it helps.

What do the smart COTH folks have to say about this? I was quite surprised as everyone here urged me to get my horse on Pergolide as quickly as possible and my horse’s ACTH was only 39.7 (Insulin 43.3). My horse had also had an acute laminitis attack and was also put into Soft Ride boots. So why Pergolide for my horse and not for hers?

What questions should my friend ask about why no Pergolide?

SCM1959

#2

I’d be getting a new vet.

ok to add questions - “how many Cushings horses have you treated?”

“What should we do to treat the laminator? Because obviously it hurts.”

4 Likes
#3

Firstly, I know this isn’t about your horse but you should get the horse re-tested as there’s generally no need for Thyro-L once a horse is well established on pergolide and diet control is enough to manage the IR.

As for the friends horse, horses with IR can also develop a thick coat and struggle to keep weight on so it’s really up to your friend to ask her vet for a test and to get a second opinion if her vet refuses.

3 Likes
#4

Unfortunately, the are bad vets out there who give bad advice. It sounds like your friend has one.

There are some articles about Cushing’s on the aaep site, and perhaps your friend would be willing to read?

https://aaep.org/horsehealth/equine-endocrinology-cushings-disease-and-metabolic-syndrome

https://aaep.org/horsehealth/equine-cushings-disease-equine-pituitary-pars-intermedia-dysfunction

2 Likes
#5

@AllHorse - my horse has only been on the Thyro-L and Pergolide for a couple of weeks (began September 5). My veterinarian will be re-testing at 6 weeks to see how much he has improved. She has told me that the Thyro-L will not be for always (and that is good because my horse thinks it is poison).

My friend’s horse has no problem keeping weight on … he is at least a body score 8, so if anything he is too heavy.

He may or may not be IR, but his Cushings test is more than positive. I am concerned, with an ACTH of 127, why does the vet say no Pergolide? My friend is feeling overwhelmed and does not know what to do. I told her I would ask on COTH if there may be a reason not to give Pergolide.

@S1969 - Thank you. I also think she needs to switch over to my (new!) vet, but the regular vet is her next door neighbor, so there is that. This regular vet has treated a lot of Cushing’s horses. I have no idea why he would say no Pergolide. Her horse is on Bute and Ace for his pain. I think the Ace has been stopped, but I am not sure. I looked up Ace for laminitis and found mixed opinions, but the on call vet told my friend to give it to her horse, so she did.

I told my friend, that with my new and still limited understanding of Cushings, the Pergolide helps to suppress the extra cortisol being released by the pituitary gland and it is the excess cortisol that causes all of the problems. With an ACTH of 127, it seems very obvious to me that the horse needs something to get that number back to normal range (9-35). I am very sure that Bute alone will not do that.

SCM1959

#6

every case is different … if the vet can not explain the ‘whys’ he is not doing his job
and/or
if the vet is not getting the job done … he should be replaced immediately

  • anytime a person is uncomfortable with a ‘professional’
    best to gather previous documentation and test results and move on Ӣ IMHO
1 Like
#7

Has the horse been on Prascend before or is this all a whole new ball game? My 25 Morgan mare has Cushings and we attempted Prascend with her- even with 2 a day, it wasn’t doing anything for her and she was miserable. My vet said a small percentage of horses just can’t tolerate it. She is on a fairly large list of supplements plus Equioxx and it seems to be doing the trick. She was on the medication for almost 2 years and this spring, after we had stopped and switched to the supplements, was the first year in a while where she shed out to a normal coat. Plus she’s back to being the bossy witch of the field (aka her old self). She’s fully retired so my goal with her is simply to keep her comfortable and happy.

1 Like
#8

@tabula rashah - this horse has never been on Prascend. He has taken Equioxx for 2 years because of ringbone, but that is all he is on. The Equioxx was stopped when the on call vet had my friend use Bute and Ace for the acute laminitis.

SCM1959

#9

Then I definitely agree Prascend would be the normal starting point from there

1 Like
#10

Your friend needs to ask her vet why he’s making the decision, since he ran the test he must have been looking for something to base his treatment suggestion on
ACTH levels are higher in the late summer to Fall season months
Pain from a laminitis attack will also give a false high reading

Maybe the vet wants to get the horse through the laminitis attack and into another season then do another test?

#11

When a vet thinks in direct opposition to all the research out there, for years (decades even), I find it really scary. Pergolide (brand Prascend) is proven to slow the growth of the pituitary and help manage the symptoms of Cushing’s. How a vet “think” that doesn’t help makes me :eek:

The fact that this horse has had in-your-face symptoms for years, means the Prascend may not be able to help a lot at this point, not like if he was recently diagnosed because of just-developing symptoms. But it really is sending that horse down a fast path to more frequent major laminitis episodes if he doesn’t get on it.

I would also just start feeding this horse as if he’s IR, because he may well be.

4 Likes
#12

Any other health issues with this 30 yr old horse?

#13

No. None at all. The ringbone is the only thing he has been treated for long term. Several years ago, another horse kicked him and he was on stall rest until he recovered, but that is all.

SCM1959

#14

I have three horses that have Cushings… Two are on Prascend and doing well. The third could not tolerate Prascend at any dose. He is arthritic but not showing any sigs of laminitis. He is not IR.

#15

But you did at least try your third horse on Prascend, right? This horse has all the outward symptoms, plus an ACTH of 127.

Doing nothing does not seem like the best choice. He already has a slight rotation in one front foot. The other one looks okay for now. This bout of laminitis was quite mild. Why in the world would the horse not be treated with Prascend if for nothing else to ward off another bout of laminitis?

My friend is going to question her vet very thoroughly. She is also thinking about getting a second opinion.

SCM1959

2 Likes
#16

A 2nd opinion would be a good idea; although in lieu of that, I’d simply insist on trying Prascend. It would be a very odd vet that would refuse to prescribe Prascend even if they didn’t think it was the only option. I’ve never heard of a vet that doesn’t think it works. It’s not like an OTC remedy or herbal supplement. It works.

Not sure what the post above means by the horse “not tolerating” it means specifically - it can affect the appetite, but most horses can get past that to a significant degree. And/or it’s better than they would be without it - even if they eat less. For my very affected pony - it’s Prascend or dead. There is nothing else I can do.

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#17

Several vets’ opinions involved
more than one horse
noted Ӣ

if a horse can not get past the appetite issue
and
there is no improvement noted

  • a vet will advise: discontinue the Prascend

it does not work for all horses/ ponies Ӣ

I have ‘lived’ this ^ above situation ”¢ with 2 horses as well as first hand knowledge with friends’ horses

not interested in arguing with you

In my equine life experiences over Years … it is not always continued as per vet recommendation ”¢

Yes, should be tried as should all medical intervention that may help - IMHO

2 Likes
#18

[QUOTE=S1969;n10483191
Not sure what the post above means by the horse “not tolerating” it means specifically - it can affect the appetite, but most horses can get past that to a significant degree. And/or it’s better than they would be without it - even if they eat less. For my very affected pony - it’s Prascend or dead. There is nothing else I can do.[/QUOTE]

The horse never got past it affecting the appetite. We tried three times trying to get him up to at least one tablet daily without any luck. My vet suggested that cyproheptadine could be tried as an alternative.

#19

Well it can happen but it’s not the norm. I would not forego trying it on a horse diagnosed with Cushings because many have no issues whatsoever, some have moderate issues, and some more serious. But you never know until you try.

My pony has severe Cushings; every fall I consider euthanizing him (in that mode at the present time) and then he rallies. Without Prascend he would be dead. If he’s still eating enough to keep him close to a normal weight and comfortable on his feet, I consider it good enough. But it definitely affects his appetite for grain, for some reason. He eats hay normally.

1 Like
#20

Big Fat Reason: It often works marginally, if at all, and is uncomfortably expensive for the average owner. Your vet is honest; there are also vets out there rubber-stamping scripts for this lately without having even tested the horse for genuine article Cushing’s first. Lameness, losing muscle, winter coat coming in earlier, you name it they’ll Perg first and “see if it helps.”
Gotta wonder what that company is handing out in perks to prescribers.

BTW, at 30 it’s not at all abnormal for a horse to run a heavier than usual coat, and laminitis can result from a winding-down metabolism, sweet late-season grass, or too-rich feed. BTW, on the day y’all find a pill that cures Old Horse Syndrome, tell me 'cause I want to buy some too!

Not every case of Old Horse means he has a pituitary tumor. In fact, if we’re seeing THIS many metabolically-driven tumors, in the interest of PREVENTION (vs. treatment) we need to be looking really hard at what’s in the feed bags. Maybe (like we’re finding out with diabetic humans), all that soy and wheat middlings and molasses as primary ingredients isn’t the positive choice it seemed a few years ago for an animal wired by nature to eat GRASS or grass-based pelleted substitutes.

Don’t know what you’re feeding, but I’d try an alfalfa or grass hay based pellet and see if he does better on that.

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