Treatment for the PPID horse; no Prescend

[StormyDay]

Some of you probably have seen my posts about my 25YO PPID positive gelding who struggles to keep weight on. Prescend was a hard no this year; I may try again next spring but TBH his attitude changed SO much on it I have a hard time justifying it. He is a crabby, funny, weird dude; on Prescend he was sad and tired.

In Europe they seem to be trying several different treatments. Has anyone tried these? How did it go?

Trilostane: apparently this doesn’t cause appetite loss. It’s more expensive though. I can get it compounded.

Chasteberry: mixed results on studies on if it works. Doesn’t seem particularly expensive though so maybe it’s worth a try. Has anyone used it and at what dosage?

resveratrol: if I’m understanding it correctly, it’s used as an anti-inflammatory in hopes that lowers cortisol levels.

cyproheptadine: also mixed results in studies. I don’t quite understand how an allergy med will affect dopamine.

Metformin: this is more for symptom control than treatment of PPID. But since his only symptom is muscle/weight loss, maybe controlling his sugar level would help that.

Thoughts?

[Renn_aissance]

My vet spoke with New Bolton several years ago about trilostane, as she had used it successfully in her small animal practice and had seen some of the research on it from the early 2000’s in the UK and NZ. It does not seem to have had any more recent research on horses. It acts on cortisol, not on ACTH directly, which may be why it wasn’t well studied. We didn’t pursue it for my horse because at time of testing his cortisol was fairly well controlled.

Cabergoline is the other medication that you might hear of, but either New Bolton or my vet (don’t recall which) advised that if the horse does not respond well to pergolide, the mechanism is similar enough that the horse also likely will not respond to cabergoline. It’s also more complicated to administer. I don’t know if the side effect profile is the same.

I have my horse on resveratrol via his joint supplement. Antioxidants and omega-3 fatty acids do have some pretty good research on them for reducing cortisol levels, which as I understand it is what is associated with the general physiological “everything is so much more complicated” with Cushings horses (increase in inflammation, increased risk for soft tissue injury, immunosuppression, etc.) On this note, two things:

• I did see a correlation between starting a highly bioavailable omega-3 fatty acid source (vs. flax) and reduced ACTH and cortisol levels over a year. This did not persist for longer than a year but the horse’s Cushings symptoms remain well-controlled. I use Mad Barn W3, KER has another one with marine sourced omega-3’s.
• Auburn Labs APF is another supplement with adaptogens (and some antioxidant ingredients.) I have no idea if it works for Cushings symptoms or not- the research I’ve read on adaptogens is not exactly medical-grade. However, APF has a lot of anecdata behind its use in combating pergolide veil (especially the inappetance,) so if you try pergolide again for your horse in the spring, I’d put him on this at the same time and see if he feels more like himself.

[StormyDay]

We tried APF with no change. However, I started it after we started Prescend so maybe loading up first would help.

[SmlHpy1]

What does of Prascend? My guy was initially on one tab. He looked drugged - stoned. Depressed. I hated it. His ACTH is controlled with half tab. And he seems his normal self on that does. I’m with you though - I don’t know if I’d medicate if my horse reacted that way on half tab. I hated it. My guy is also in he skinny category. The weight gain is a struggle. Good luck! If you have success report back.

[JB]

I’d give Cabergoline a try. Yes, it’s the same type of drug, but I know of enough horses who don’t do well on pergolide in any form, but do well on Cabergoline, that it’s worth a trial. He’s also just as likely to not do well since it is still the same kind of drug

CTB manages symptoms, not the underlying disease, so not what I’d do unless it’s a last resort to at least make his remaining years more comfortable, even if it’s not as many years

APF Pro seems to work well for the appetite issue, the “pergolide veil”, but I’ve not seen real reports of it managing symptoms of the actual disease

@StormyDay

Metformin: this is more for symptom control than treatment of PPID. But since his only symptom is muscle/weight loss, maybe controlling his sugar level would help that.

If he’s not also IR, it’s not going to impact that, as not all PPID horses are also IR/EMS

@StormyDay

We tried APF with no change. However, I started it after we started Prescend so maybe loading up first would help.

what dose did you start with?

If you started with the whole 1mg then start with 1/2 or even 1/4. With his reaction I’d start with 1/4. If he’s fine after 2 weeks, add another 1/4 at the opposite end of the day. If he’s fine there, see if he’ll tolerate 1/2mg once a day. If so, then add 1/4 at the other end of the day, then 1/2mg twice a day, and then see if he’ll be able to take a whole 1mg once a day

I would definitely make sure he’s getting plenty of Omega 3. If he’s not on enough grass, then I’d add a good marine-source O3 like Renn suggested. It’s really important to have a good balanced of O3:6 to control inappropriate inflammation. Marine-based O3 is just much more bioavailable than plant-based, as the horse doesn’t have to convert ALA into DHA and EPA

[StormyDay]

@JB

I’d give Cabergoline a try. Yes, it’s the same type of drug, but I know of enough horses who don’t do well on pergolide in any form, but do well on Cabergoline, that it’s worth a trial. He’s also just as likely to not do well since it is still the same kind of drug

CTB manages symptoms, not the underlying disease, so not what I’d do unless it’s a last resort to at least make his remaining years more comfortable, even if it’s not as many years

APF Pro seems to work well for the appetite issue, the “pergolide veil”, but I’ve not seen real reports of it managing symptoms of the actual disease

@StormyDay

Metformin: this is more for symptom control than treatment of PPID. But since his only symptom is muscle/weight loss, maybe controlling his sugar level would help that.

If he’s not also IR, it’s not going to impact that, as not all PPID horses are also IR/EMS

@StormyDay

We tried APF with no change. However, I started it after we started Prescend so maybe loading up first would help.

what dose did you start with?

If you started with the whole 1mg then start with 1/2 or even 1/4. With his reaction I’d start with 1/4. If he’s fine after 2 weeks, add another 1/4 at the opposite end of the day. If he’s fine there, see if he’ll tolerate 1/2mg once a day. If so, then add 1/4 at the other end of the day, then 1/2mg twice a day, and then see if he’ll be able to take a whole 1mg once a day

I would definitely make sure he’s getting plenty of Omega 3. If he’s not on enough grass, then I’d add a good marine-source O3 like Renn suggested. It’s really important to have a good balanced of O3:6 to control inappropriate inflammation. Marine-based O3 is just much more bioavailable than plant-based, as the horse doesn’t have to convert ALA into DHA and EPA

We started on a 1/2 a tab every other day for two weeks. He ate okay on that. When we went up to 1/2 tab every day he started to become more picky. Stayed there for two weeks. The full tab was way too much and even though I tried to stick it out it just didn’t get better. He lives on a grass pasture (we have no back teeth) so probably getting enough omega 3 in the summer months.

[Pico_Banana]

I had to start with 1/4 tab with my gelding. We started with a half tab and he flat out refused to eat grain for about 2 weeks, even after I pulled the Prascend altogether. Next attempt I put him on APF (which he also didn’t like, but I managed to get it in him - you can even syringe it if you have to) and then started with 1/4 tab. Did that for 2 weeks. Then did 1/2 tab, then 3/4 tab, then full tab. About 2 weeks for each change. APF the entire time. Once I got him to a full tab, I used up the APF I had and then stopped it.

I continue to break the tabs in half and hide them in his grain, just to be on the safe side.

And this is a big, 16.3 warmblood. He’s a sensitive guy, what can I say?

But good luck to you!!!

[JB]

@StormyDay

We started on a 1/2 a tab every other day for two weeks. He ate okay on that. When we went up to 1/2 tab every day he started to become more picky. Stayed there for two weeks. The full tab was way too much and even though I tried to stick it out it just didn’t get better.

If it were me, I’d drop it until he returns to normal, then go with the 1/2mg every other day for 2 weeks again, then assuming you didn’t do this, go with 1/4mg twice a day and see how that works, then increase by 1/4mg every other day, etc

Depending on how many pills you have left, it might be worth getting a compound for, say, 15 days worth since you really should try to get through this compound in 30 days or so, to start again. It’ll be much easier to do 1/4mg dosing

[SmlHpy1]

Did you test him at the 1/2 tab? It’s possible you could have stopped there.

[Marla_000]

I’ve used SmartPak’s Smart Pituitary with some success on
A horse who could not tolerate
Prascend. It was better than nothing.

[StormyDay]

@SmlHpy1

Did you test him at the 1/2 tab? It’s possible you could have stopped there.

No, we did not. Maybe next year. I can’t risk him not having some weight on him going into winter

[Renn_aissance]

Totally understood. You have a 25-year-old and you are making all your decisions based on what will give him best quality of life, knowing that quantity is what it is for a horse of such vintage. I understand why you would decide not to treat given the cost of the side effects for him.

I do think it’s worth a try to put him back on the dose he can tolerate once you get into the spring. Even if it doesn’t solve all of life’s problems for him, a little bit of ACTH control plus all the cortisol control measures you’re asking about might combine to make a meaningful difference in his symptoms.

[2tempe]

My vet also suggested I try Smart Pituitary- she said it has helped some of her Cushings patients. My mare was on 1 prescend per day and acting like maybe we should up the dose, but this was a cheaper option, lol. It seemed to help and she was on it for maybe 8 months or more. Then she refused to eat it in her grain. I stopped it because she needed the grain intake and is not at a place where I feel comfortable that they would dose her daily. One thing in feed is fine, but… Anyway, its been 6 months or more since stopping the supplement and she’s still at one Prescend/day. So who knows?

[Kirikou]

I did Chasteberry on a 26 yo pony who couldn’t tolerate Prascend either.
He also would get recurring abscesses so I had him on Smart Lamina as well which seemed to help with those.
As others had said supplements did not “cure” anything just masked the symptoms for the time he had left. But for what it’s worth he was more “lively”/cheerful, back to his-nickering-for-his-breakfast-every-morning-when-he-saw-the-kitchen-lights-go-on - self for his last 6 months. At that age it is a bit of a balancing act: quality of life vs. quantity.
I would perhaps try again a lower Prascend dose in the Spring but for now, Chasteberry or Smart Pituitary may be worth a try? Good luck to you and your guy!