Drug instead of Prascend (or in addition to) for PPID

[NaturallyHappy]

Hi all! One of the horses in my care came back w high levels of ACTH in spite of being on 2.5 tablets of Prascend a day. There was a thread a while ago in which a couple of other drugs were mentioned. One was cyproheptidine (sp?) and I thought the other also started w a “c”. I asked my vet about it; he had not heard of it. I tried searching for the thread, but didn’t find it. Does anyone, by chance, know what that drug was? I am going to research it if I can figure out what it is. Thank you very much for your(g) help.

Thankfully, his insulin test results were good.

[keh]

Cabergoline. I believe it’s a biweekly IM injection. I heard a side effect is muscle soreness, but overall it’s been said to be an effective alternative. Hope this helps!

[NaturallyHappy]

Yes, it does!!! Thank you!!!

[4horses]

Vitex Angus castus is reported to help as well.

http://www.laminitis.org/Vitex%20trial.html

[prunebey]

I’m in a similar situation. My non-IR mare’s ACTH came back sky high a couple weeks ago, so we’re moving up to 2.5 pills a day. It’s ironic considering she’s looking pretty dang good right now for being a 30-something, cushingoid old bat with melanoma lol. I wish the alternative wasn’t a shot because she does NOT like getting poked. Would definitely be easier for me than shoving pills down her throat everyday or hoping she actually eats them in her feed when I can’t be there.

[JB]

@4horses

Vitex Angus castus is reported to help as well.

It may help symptoms, but it will interfere with pergolide, and will do nothing to manage the actual cause of the disease. That study was done a long time ago, and a lot more is known hthese days.

[keh]

Lmk if you try it. I’m couldn’t find a lot of info & I’m curious if it’s a practical alternative.

[NaturallyHappy]

@keh, I certainly will. I’m hoping to speak w my university veterinary contact (as opposed to my local vet who thinks I’m nuts for testing more than once a year; I really want to know what is happening w insulin and ACTH) to get her perspective on this. The one w the high ACTH looks better than ever. He’s almost completely shed out this year so I was shocked when his numbers were higher than in December!!!

[Renn_aissance]

@NaturallyHappy

The one w the high ACTH looks better than ever. He’s almost completely shed out this year so I was shocked when his numbers were higher than in December!!!

Same over here. My vet and I were shocked b my guy’s spring numbers because he looks fantastic. He went from low equivocal to the worst labs of his life.

Cabergoline works on the same mechanism as pergolide. If a horse is not or has stopped responding to pergolide, cabergoline is not likely to be useful.

My vet had asked New Bolton about adding trilostane to the pergolide (used in dogs, studied some for horses in the UK; no effect on ACTH, lowers cortisol). The guidance sje got is that at this point we treat the symptoms and not get aggressive about the biochemistry. So… we are staying on his current dose of two pills a day and since he’s not symptomatic, I look at him and not his bloodwork.

This sucks.

[NaturallyHappy]

Thank you for this information. And yes, it does indeed.

[HappyHorsey]

Interesting thread! Seems to be a trend because I also have a PPID guy whose numbers were really high this year but the horse looks and feels great. Our vet also agrees that at this point we treat the symptoms, but they were also fine with increasing to 2 or 3 pills of Prascend. I know some don’t like to increase past 1 pill, but I’ve seen 2 or 3 pills help a lot of horses.

[NaturallyHappy]

Thank you for this information. It really helps. My local vet is one who says one pill is plenty and gives me a hard time over testing more than once a year. I pay my bill immediately so…. I hope yo speak s the university vet this week. I will report what I learn.

[Renn_aissance]

@HappyHorsey

Our vet also agrees that at this point we treat the symptoms, but they were also fine with increasing to 2 or 3 pills of Prascend. I know some don’t like to increase past 1 pill, but I’ve seen 2 or 3 pills help a lot of horses.

My vet doesn’t tend to prescribe more than 2 pills for most horses around the 1200lb range because her experience has been that beyond that dose the side effects start really impacting quality of life. Based on my horse’s response to 2 pills I’m inclined to trust her judgment on that one.

[NaturallyHappy]

Do you know what those side effects are???
Edited to add I’m familiar w those; was wondering if something else pops up on an increased dose.

[Renn_aissance]

Inappetance and depression. My horse responds well enough to APF that I can manage the inappetance but the last time I asked the vet about a dopamine infusion she didn’t think I was funny.

[NaturallyHappy]

Thank you- mine is on 2 1/2 pills right now. We never experienced those problems, even in the beginning. I’m thankful for that.

[ladipus]

@NaturallyHappy my 35yr old Wb with PPID has been on 4 tablets prascend/day and we recently added Cyproheptadine

[NaturallyHappy]

@ladipus, thank you SO much. I’m so grateful to everyone who is chiming in on this thread💗.

[keh]

I also appreciate the input. My horse’s numbers are still high, despite being on 2.5 pills. He looks great though & has had zero laminitis episodes.
He sheds well & doesn’t have the typical potbelly shape, or cresty neck.

I’m curious to those that “treat the symptoms & not the numbers”, what symptoms are you using to gage efficacy of dosage?

I’m reluctant to increase the dosage ($$$) when it feels like I’m just chasing the number.

[NaturallyHappy]

@keh, mine was 44.4 in January of 23. NOW it is 84.4. He is shedding well and has no pot belly. I may still have to body clip him, but I’m not sure. I do not understand…