Vet is suggesting temporarily stopping Prascend, which scares the @#$& out of me

[ljc]

I have two welsh ponies, 22 &21, who were diagnosed with PPID two years ago. They each started on 1/2 mg of Prascend and their dosage has gradually been increased as their clinical signs and testing warranted. They’d been on 1.5 mg until last month, when we upped dosage to 2 mg (transitioning through 1 3/4 for a few days). Unlike past increases, which immediately reduced clinical signs (excessive urination, drinking water, hair growth) this time there was zero improvement and in fact, they began peeing more.

After consulting with the vets at Cornell, this was their recommendation. Two more weeks at the current dose (just in case it’s taking longer than normal for improvement), then stop ALL Prascend for 4-6 weeks to see if that might kickstart their systems, and then start with1 mg. And go from there.

I very carefully manage these ponies. They get tested twice each year (the ACTH stimulation test), or when their clinical signs worsen. They are on dry lots except for 2-3 hours a day of grazing, with grazing muzzles. They get a low-sugar grass hay and beet pulp without molasses. They’ve been on Quiessence since their diagnosis. So far, neither has ever shown any signs of laminitis (which, of course, is my nightmare). I clip them every 2-3 months. Both are 100% sound and in perfect weight. Neither is Insulin resistant.

I’m petrified that stopping Prascend will trigger laminitis and be the beginning of the end.

The Cornell vets (and my vet) agree that the maximum dosage either pony should ever receive is 3 mg. I don’t want to unnecessarily increase their dosage but since upping it to 2 mg has done nothing, it seems another strategy would be to up it again, maybe to 2.5 and see what happens. Right now the major issue is housekeeping - taking out multiple muck buckets of wet bedding each day from their stalls. (I use as a normal baseline one full muck bucket). Honestly, I think I could better handle the housekeeping aspects if I knew they were on the maximum dosage and would remain that way until their time comes.

Any thoughts?

[RedHorses]

I attended a talk about PPID given by one of Boehringer Ingelheim (not sure I got that right, but the company that makes Prascend) a few years ago. One of the things he said was that if your horse’s symptoms are well controlled by Prascend and you stop giving it, it can be more difficult to regain that control and often means a larger dose when going back on the drug.

So, could you reach out to the company directly and explain the situation and ask for advice?

The vet did say they were learning more about PPID all the time - who knows what they have learned in the last five years.

[ljc]

@RedHorses

I attended a talk about PPID given by one of Boehringer Ingelheim (not sure I got that right, but the company that makes Prascend) a few years ago. One of the things he said was that if your horse’s symptoms are well controlled by Prascend and you stop giving it, it can be more difficult to regain that control and often means a larger dose when going back on the drug.

So, could you reach out to the company directly and explain the situation and ask for advice?

The vet did say they were learning more about PPID all the time - who knows what they have learned in the last five years.

That is another fear of mine. I wonder what used to happen to horses/ponies showing for multiple weeks back when pergolide/Prascend was banned. They’d be going on and off it all the time.

[S1969]

Why are you increasing the dosage at this time if they are in good health and perfect weight? I would be hesitant to change anything just because of one test result, if that’s the reason you are doing it. Especially at this time of year when you know the fall rise will affect their bloodwork results.

My pony would definitely be laminitic immediately if we stopped the Prascend. I don’t think he would manage 4-6 weeks without it. I recently switched from hand feeding him pills to syringing them because he would spit them out sometimes and he was symptomatic.

[SLedbetter]

OP: i am currently having the same issue with my mustang. Same age, same time frame after diagnosis, and same symptoms. We recently increased his dose to 2 mg per day, and I haven’t seen much change. Putting a call into the vet this next week for suggestions. I would be hesitant to stop his meds as well,

[ljc]

@S1969

Why are you increasing the dosage at this time if they are in good health and perfect weight? I would be hesitant to change anything just because of one test result, if that’s the reason you are doing it. Especially at this time of year when you know the fall rise will affect their bloodwork results.

My pony would definitely be laminitic immediately if we stopped the Prascend. I don’t think he would manage 4-6 weeks without it. I recently switched from hand feeding him pills to syringing them because he would spit them out sometimes and he was symptomatic.

Their pattern has been consistent. They do well in terms of clinical signs on a certain dosage, then slowly their urine increases until I’m taking two-three soaking wet buckets of bedding from each stall (instead of one) and they grow out their clip jobs in two weeks instead of two months and they drink much more water. We actually did the last test at the very end of July and got results in early August.

I feed Prascend in a tiny piece of carrot. I poke holes in both ends with a screw driver and stick each pill in one end. Works great.

[findeight]

Get another opinion. Calling the drug company won’t help, they cannot dispense veterinary advice nor should they as there is a conflict of interest on their side.