Starting Pergolide/Prascend

3/17/2014

Your horse has been diagnosed with PPID and you are about to start treating him/her with Prascend or pergolide. Here are some of the most frequently asked questions regarding Prascend/pergolide.

Important sources of information:
NOAH data sheet for Prascend
www.ecirhorse.org -pergolide

Q. My horse has been prescribed 1 mg of Prascend per day, do I give him the full 1 mg on the first day?

A. No. The Equine Endocrinology Group, made up of the leading experts on PPID, now recommends introducing Prascend gradually "by giving partial doses for the first four days or by administering half the dose morning and evening". EEG Recommendations for the Diagnosis and Treatment of PPID Table 6.

The ECIR group has been recommending introducing the dose of pergolide slowly for years:
"Whether increasing or decreasing dosage or just starting pergolide for the first time taper at a rate of 0.25 mg every three days." www.ecirhorse.org -pergolide.

When prescribed for humans with Parkinson's Disease, pergolide is always introduced very gradually - see Pergolide Dosage and Administration - Pergolide - www.drugs.com. Why assume this should be any different for horses?

Generally the initial amount given should be 0.25 mg, slowly built up in 0.25 mg increments to reach the prescribed dose. The urgency of reaching full dose and the horse's reaction to pergolide will dictate how quickly the prescribed dose is reached - this must be discussed with the prescribing vet. Splitting this between morning and evening would be next to impossible - good results are usually seen when the dose is given once a day and slowly built up.

Your vet should be able to obtain a pill cutter from Boehringer Ingelheim to help you split pills into 0.25 mg - see Splitting Prascend Tablets.

Q. What is the "Pergolide Veil"?

A. The "Pergolide Veil" is a phrase given to the side effects of inappetence and depression commonly seen when a horse starts on pergolide/Prascend.

Research carried out for the FDA New Animal Drug Application for Prascend in 2011 found that of horses with PPID given a starting dose of 1 mg Prascend, 33% had a decreased appetite at one or more meals, that was usually transient, and 10% of horses that had not previously shown signs of lethargy became lethargic - details here.

Q. Can the "Pergolide Veil" be avoided?

A. As above, when pergolide is introduced slowly (in 0.25 mg increments building up over several days), the "Pergolide Veil" seems to be experienced less (anecdotal).

The ECIR group has found that using adaptogens such as APF at the same time as introducing pergolide can also help reduce the incidence of these initial side effects. APF can be bought in the UK from ForagePlus.

It can be concerning when horses go off their feed when starting pergolide, particularly if they are already underweight. One owner reported success when her horse (who was ill with a suspected bacterial infection and had lost a significant amount of weight) was given Periactin (cyproheptadine) as an appetite stimulant for the first couple of weeks while starting on Prascend (the horse had previously been tried on Prascend and had gone off feed). No side effects of either Prascend or Periactin were seen.

Q. Does it matter what time of day I give Prascend/pergolide?

A. No. There is currently no recommendation for giving Prascend/pergolide at any particular time of day - this was confirmed by Dr Marian Little in The Horse.com's Ask the Vet Live Managing Horses with PPID in February 2014 - see notes.

Q. Should pergolide/Prascend be given once or twice a day?

A. Once a day, usually. The NOAH data sheet for Prascend says "The product should be administered orally, once daily." This is confirmed by the Equine Endocrinology Group Recommendations for the Diagnosis and Treatment of PPID - Table 6 - Prascend should be given "q24h orally", that is once every 24 hours by mouth.

Q. What is the difference between pergolide and Prascend?

A. Pergolide is the name of the drug, i.e. the active ingredient (pergolide mesylate).
Prascend is the only form of pergolide that is currently licensed for use in horses. It is made by Boehringer Ingelheim and comes in 1 mg tablets, which can be easily broken in half.

27 Comments

Jane Rutledge

7/20/2015 10:30:59 am

Is Prascend better metabolized if given on an empty stomach (one hour before feeding) than giving it at the same time as the AM feeding?

Sandra Peard

7/9/2017 12:06:09 am

What is the best way to change the time of day I give the 1 tablet to my pony? I want to give it mornings rather than evenings, thank you

Andrea

7/9/2017 08:36:04 am

Here's the data sheet for Prascend, but there doesn't appear to be any information specific to your question:
http://www.noahcompendium.co.uk/?id=-447750

However, it says that "if a dose is missed, the next scheduled dose should be administered as prescribed" which suggests that it might be best to leave more than 24 hours rather than less than 24 hours between the doses if you are changing the time that you give the tablet.

You might ask the vets at Boehringer Ingelheim though Talk About Laminitis: https://www.facebook.com/talkaboutlaminitis/ to confirm this.

You might consider giving the evening dose as late as possible for a couple of days before changing to morning, and the first couple of morning doses as early as possible.

Laura Mollrich

8/11/2017 07:53:02 pm

My 20-year old, 17.1hh Dutch Warmblood gelding has been on compounded Pergolide since 2007. Started out at 1 mg and is currently at 3.5 mg capsules. His July 2017 Cornell labs show his ACTH at 27.02 (9-35 pg/Ml). Historically, his ACTH rises (8/17/2016 went up to 45.) Dressage friends are telling me that I should switch to Prascend? I've heard that this can make a horse very jumpy/spooky which I do not want. He's extremely athletic. Should I just continue to keep him on the compounded Pergolide?

The Laminitis Site

8/31/2017 12:56:24 pm

Hi Laura,

We are not aware of any reason why Prascend but not compounded pergolide should make a horse jumpy/spooky, but here are a couple of possible theories:

Research has shown that compounded pergolide is not always at the stated potency when tested - see "how stable is pergolide" under Pergolide: http://www.thelaminitissite.org/p-q.html.

Therefore it might be possible that compounded pergolide was not at the declared potency by the time it was given to a horse. So if a horse was taking supposedly 3 mg of compounded pergolide that was 50% below the declared potency, so only actually contained 1.5 mg pergolide when it was given to the horse, and that horse was swapped onto the same dose (3 mg) of Prascend, that would represent a large increase in the dose of pergolide, and increased excitability is (rarely) reported as a side effect of a high dose of pergolide.

Along the same lines, one of the effects of treatment with pergolide/Prascend is often a reduction in lethargy - it's not unusual for owners to report their horse returning to being a bit excitable or sharp to ride, often forgetting that their horse had been like this before perhaps years of becoming quieter because of the excess PPID hormones. So if compounded pergolide was not at full potency, and changing to Prascend increased the actual dose being given to the horse and reduced clinical signs, an increase in excitability might be a reflection of treatment efficacy and getting on top of the PPID - if this was the horse's nature before it developed PPID.

Another, we suspect fairly unlikely possibility (as the amounts used are so small), is that a horse could be allergic to one of the excipients used in Prascend (the bulk that makes up the tablet in addition to the pergolide). The excipients listed on the UK VMD SPC are: Croscarmellose sodium
Ferric oxide red (E172)
Lactose monohydrate
Magnesium Stearate
Povidone K30
See https://www.vmd.defra.gov.uk/ProductInformationDatabase/Default.aspx.

Any change in medication should be discussed with the horse's vet. It may be possible to test the potency of the compounded pergolide currently being used to check that it is at the declared potency, to help guide a change over to using Prascend.

Donna H

12/20/2017 04:40:48 pm

Will an increase in dose ,Stop my horse from getting Laminitis. She is a 20 yr old, 14hh native pony who has been on Prascend 1x 1mg for 5 months with little improvement signs. She was good all Summer but since Autumn , has had Laminitis several times. Help . . . . . please . . . . Thanks

The Laminitis Site

12/24/2017 09:53:36 am

Hi Donna

There are several factors to consider for your mare:

Her laminitis is caused by insulin dysregulation (ID). ID can be due to the excess hormones produced as a result of PPID, and/or because the diet is too high in sugar/starch, the horse is overweight, or not getting enough exercise (obviously a horse with laminitis won't be exercising), i.e. the reasons that cause laminitis in horses with EMS.

Any horse with endocrine laminitis (due to PPID & EMS) should be managed for EMS, with a low sugar/starch diet that provides good levels of protein, minerals, vitamins and essential fatty acids, and if the horse is at all overweight, a steady weight loss programme must be started, as being overweight is likely to increase insulin resistance.

The different insulin tests may help differentiate between hyperinsulinaemia from PPID alone, and insulin resistance. If a fasting resting insulin test is above normal, this suggests that a horse has a chronic high level of insulin, regardless of what it has been eating, and you should check that PPID is being controlled by the correct dose of Prascend (you should do this anyway). If a fasting resting insulin test is normal, but a fed resting insulin test or an oral sugar test are above normal, that may be more suggestive of insulin resistance and a high insulin response to food eaten, in which case controlling the sugar and starch in the diet, and losing any excess weight, are likely to be particularly important.

You say that she has been on 1 mg of Prascend for 5 months. Has her ACTH been checked regularly during that time, and returned to normal? Many horses will require an increase in their Prascend dose during the seasonal rise, which peaks August to October, but may not end until around Christmas, when the dose can often be lowered back to the spring/early summer level. Autumn laminitis is often a sign that PPID is not fully controlled. It is now recommended that horses with PPID have ACTH tested in August, to help check whether their hormones are under control as they go into the seasonal rise. See http://www.thelaminitissite.org/news/seasonal-rise-in-pituitary-hormones-2016. It’s important to remember that the correct dose of Prascend is the one that controls the clinical signs and blood hormone levels. Although recommendations for starting doses are based on the horse’s weight, this is very much a guide, and the correct dose is individual to each horse and doesn’t depend on weight or ACTH levels. Starting treatment at the start of the seasonal rise is often going to be challenging in the first year, as just as you seem to be getting control, hormone levels can increase because of the seasonal rise, and you can often feel as if you are playing “catch up” all the time but not quite getting on top of the PPID. Hopefully now that we are pretty much out of the seasonal rise, you will be able to establish your horse’s baseline Prascend requirement, and be ready to test, monitor and respond with an increased dose if necessary from the end of July/start of August next year.

Unfortunately testing ACTH may not give an accurate picture of how well a horse’s PPID is controlled, as it is the other hormones: CLIP, beta-endorphin and alpha-MSH, which are thought to be more involved in producing the clinical signs of PPID, and the ACTH level may not accurately reflect the levels of these other hormones. Until better hormone testing is available, it is important to closely monitor clinical signs as well as blood ACTH levels, and base Prascend dose adjustments on both clinical signs and blood results. See Table 6: https://sites.tufts.edu/equineendogroup/files/2017/11/2017-EEG-Recommendations-PPID.pdf.

Another thing that must be considered is whether her feet have been fully realigned and are correctly supported following laminitis. Sometimes it is thought that a horse has “new” laminitis, when it is foot pain from uncorrected rotation from previous laminitis that is causing symptoms of laminitis. X-rays should always be taken following laminitis, and should continue to be taken until they show that the feet are fully realigned at ground level and the new hoof wall at the toe is growing down parallel to the pedal bone. See http://www.thelaminitissite.org/articles/laminitis-and-the-feet.

You may find this article and links helpful: http://www.thelaminitissite.org/articles/laminitis-ems-or-ppid-start-here

For individual help and for help with realigning trimming and looking at x-rays, you might like to join Friends of The Laminitis Site: http://www.thelaminitissite.org/join-friends-of-tls.html.

Risemary

2/22/2018 04:56:33 pm

My lively 27yo 14.1 hh Connemara cross gelding had his dosage increased to 4 mg per day a couple of years ago, after I had his blood re-tested when I noticed a change in his behaviour and the arrival of supra orbital fat pads. He has been fine on this very high dose. Over the last winter I have reduced the dosage first to 3.5mg and then to 3mg per day and he seems absolutely fine on the lower dose which he has been on for a couple of months. Is it possible that his body is so full of the drug that he can cope with the lower dose over winter?

The Laminitis Site

3/7/2018 10:30:39 am

Thank you for sharing your horse's experience with pergolide.

Andy Durham suggested in a 2015 webinar that, for some horses, it may be that a higher dose of pergolide is needed initially to bring the PPID under control, and that that dose may then be able to be reduced. This hasn't been proven by research yet, but Hal Schott found that horses kept on a low dose of pergolide showed greater improvement after 2.5 years than after 6 months, so there does appear to be a long-term effect - see p19 https://sites.tufts.edu/equineendogroup/files/2013/10/Equine-Geriatric-Workshop-II-DRH-2014.pdf.

This long-term improvement may be due to a reduction in hyperplasia and hypertrophy of pars intermedia (PI) cells, i.e. the opposite of what happens when PPID is left untreated. In untreated horses, the lack of dopamine causes PI cells to produce more hormones, and this in turn leads to an increase in the number and size of the hormone-producing cells - basically the "factory" is expanded to cope with the increased production. Treatment with pergolide acts to replace the missing dopamine, so reducing the output of hormones. It seems logical that, with reduced production of hormones, the "factory" will become smaller again, and with a smaller "factory", less hormones will be produced.

It is common for horses to need a higher dose of pergolide through the seasonal rise, so from around July to November (or August to October in earlier cases), and for the dose to be able to be reduced around December and through the winter/spring. It is currently recommended that ACTH should be tested in August, to check for PPID becoming uncontrolled and giving the opportunity to increase the dose of peroglide as the horse heads towards the peak of the seasonal rise (end Sept/start Oct), with one other test around 6 months from then, so around Feb/March to check for control outside of the seasonal rise. As you are clearly doing, monitoring clinical signs may be more important than ACTH levels, as so many factors other than PPID can increase ACTH (and for this reason testing the other hormones raised in PPID would seem to be a good idea - unfortunately not currently available commercially).

Testing insulin is also important, particularly when a horse is showing signs associated with insulin dysregulation, such as filled supraorbital hollows, and treatment for EMS - low sugar/starch mineral balanced diet, weight loss if necessary, exercise if able - is important alongside pergolide treatment for horses with PPID and insulin dysregulation.

JANE ROBERTS

7/16/2018 09:26:14 pm

I have a mare who foaled 2 weeks ago who I am convinced has PPID. I am about to arrange for her to be tested - however I have heard conflicting reports about whether Prascend should be prescribed to lactating mares, some saying it should not be used, others saying it is safe to start once the foal is 30 days old and milk established. Please can you advise ?

The Laminitis Site

7/17/2018 08:38:02 pm

Prascend (pergolide) will suppress prolactin and therefore milk production, and the current data sheet states that it should not be used during lactation - see http://www.vmd.defra.gov.uk/ProductInformationDatabase/ - go to page 8 of P to find Prascend, see point 4.7:
"Lactation: The use is not recommended in lactating horses, in which the safety of this product has not been demonstrated. In mice, reduced body weights and survival rates in the progeny were attributed to the pharmacological inhibition of prolactin secretion resulting in lactation failure."

More information under Mares: http://www.thelaminitissite.org/m.html

Sharlene Kelley

8/24/2019 05:21:05 pm

Is there ever an instance of a horse going totally off Prescend after it has been started? My 25 yo Morgan mare is being started at 1 mg. daily--in August. Is there a chance she could be taken off the drug, say maybe, after Christmas?

The Laminitis Site

9/2/2019 08:40:31 am

If a horse has been diagnosed with PPID, then it will have PPID for the rest of its life and will require treatment. Treating with Prascend/pergolide may do 3 things: replace the missing dopamine and reduce the clinical signs of PPID, reduce and possibly even reverse the increase in the size and number of the pituitary cells linked to PPID, and potentially protect the dopamine-producing neurons in the hypothalamus and slow the progression of the disease.

The seasonal rise happens from around mid July to mid December, that's when PPID hormones are at their highest, so clinical signs are likely to be at their worst too. Many horses have an increase in their dose of Prascend/pergolide during this time, and the dose is able to be reduced around December.

Research by Hal Schott II has found that giving horses with PPID a low dose of Prascend (i.e. less than is needed to control their clinical signs and/or blood hormone levels initially) seems to increase control of PPID after 3-4 years. So a steady low dose may be effective in the long-run, if not straight away.

With what we know at the moment, a horse with PPID should be treated all year round, but the dose may be able to be quite low (perhaps 0.5 to 1 mg), at least outside of the seasonal rise, particularly if serious clinical signs of PPID like laminitis and infections aren't seen.

Danielle Lindgren

2/4/2020 07:23:48 pm

We have just started our 16-year-old Gelded Welsh Cob 14.2 hands on prascend for chronic laminitis, he has been tested for Cushings but has normal ACTH levels, and his regular bloods have come back perfect. But we have been struggling for over 12 months with chronic laminitis. It’s like every time we feel like he’s just about better he comes down with another bout of laminitis, around every four weeks he gets to about 85 to 90% better and then lame again with another bout of laminitis. We tried many different variations of diet.. always including vitamin and mineral supplements, Cen oil and salt. We started him on .25 mils of compounded pergolide four days ago, is there any evidence or experiences of this helping with chronic laminitis?

The Laminitis Site

2/6/2020 10:26:04 am

Whether pergolide can help reduce the incidence of laminitis will depend on whether a horse has PPID and whether that PPID is causing insulin dysregulation. If PPID is driving insulin dysregulation, then treatment with pergolide/Prascend (at the correct dose for the horse) should help reduce the insulin dysregulation, alongside management for EMS/insulin dysregulation (low sugar/starch diet with adequate levels of protein, minerals, vitamins and essential fatty acids, weight loss if necessary and when able, exercise).

PPID can be difficult to diagnose in the early stages. If resting ACTH is normal but you suspect PPID, you could try a TRH stimulation test (outside of the seasonal rise).

Could those 4 week intervals tie in with when he is trimmed – either some time from being trimmed when feet are likely to have longer toes and heels, or sensitivity after trimming? Without a full history it is difficult to comment, but very often in cases we see that appear to have recurrent laminitis, the feet have not been fully realigned and/or not correctly supported/protected, and if recent x-rays haven’t been taken and show perfect realignment, that’s where we’d suggest starting.

Presumably insulin, and perhaps also glucose and/or adiponectin have been tested. If his insulin is normal when tested after he’s been eating his normal diet, that may suggest that there is something more than high insulin causing his discomfort, and again we would want to rule out rotation, thin soles, frog or any other sensitivity in the feet.

Lucy

7/29/2020 03:57:52 pm

Can prascend be used for goats with laminitis?

The Laminitis Site

7/29/2020 07:06:21 pm

As far as we know, no. Pergolide/Prascend is a treatment which replaces missing dopamine in horses with PPID, it isn't a direct treatment for laminitis in horses.

We don't have any experience of laminitis in goats, but to our knowledge goats do not get PPID and do not have laminitis caused by pituitary hormone dysfunction, therefore treatment with pergolide (as Prascend or BOVA pergolide paste) would not be beneficial.

Here are a couple of articles about laminitis in goats - it seems that treating the underlying cause and correcting the feet are most important:
https://www.msdvetmanual.com/musculoskeletal-system/lameness-in-goats/laminitis-in-goats
https://franklinvets.co.nz/2019/08/14/patrick-the-goat-with-laminitis/

Susie

1/20/2021 10:08:54 pm

My 16 year old warm blood has been on Prascend since September. The symptom was excessive urination. This has increases again so we are moving her from 1gm to 1 1/2 gm. I was told these needed to be given at different times preferably 12 hours. I can find nothing to support this.

The Laminitis Site

1/20/2021 11:37:32 pm

Hi Susie

Is excessive urination the only clinical sign (of PPID) that your mare is showing? If yes, have you had other causes of PU/PD (excessive drinking and urination) eliminated - see http://www.thelaminitissite.org/p-q.html#PU/PD.

Was her ACTH above normal when she started Prascend, and has it improved with treatment at 1 mg? Have you had glucose tested (before and after starting Prascend)?

The full prescribed dose of Prascend should be given once a day - it should say this in the data sheet that came with your Prascend tablets, otherwise see: https://www.noahcompendium.co.uk/?id=-447753.

There has been some research looking at how long pergolide stays in the blood, which has suggested that perhaps twice daily dosing may help to maintain blood levels, but at the moment this is not recommended.

Sharon Goadby

2/24/2021 11:33:31 am

Hi
my mare is a 28 year old Warmblood and has been dealing with Cushings for a while now. She currently takes 2 tablets a day. She was recently a little lame and the vet suspected her levels may have risen. Her count is 107. I am concerned about raising the levels of her medication as this can be linked to loss of appetite and depression. I do, however need to get a handle on this. I'm interested to read one of the comments stating sometimes it is worth raising the dosage for the short term to get on top of the issue and then perhaps reduce. Any advice welcome x

The Laminitis Site

2/27/2021 09:16:55 am

Hi Sharon

Laminitis is not just linked to PPID. If a horse has PPID and laminitis, it is insulin dysregulation (ID) that causes the laminitis, and this can be for the same reasons as EMS - too much sugar/starch in the diet, being overweight/putting on weight, not enough exercise, plus less usual reasons e.g. taking corticosteroid medication, or exacerbated by systemic inflammation/inflammatory disease.

So don't just look at her PPID if she has become foot sore, ensure her ID is well controlled too, and test insulin.

However, an ACTH of 107 pg/ml does suggest that her PPID may not be fully controlled, if there was no other reason for her ACTH to be high - see http://www.thelaminitissite.org/ppid-faq/does-a-high-acth-result-mean-my-horse-has-ppid. If you are in the northern hemisphere, this is the time of year when ACTH should be at its lowest.

Although there is little research, it can be worth "playing around" with the pergolide dose a bit, for example if you give it in feed, try giving it away from feed, in either a very small feed (treat sized) or by hand in a treat if she will take that, or by syringe into the mouth. We don't yet know the effect of food on absorption of pergolide.

Some experts suggest that giving pergolide twice a day rather than once may be more effective, although the data sheet still recommends once a day, and again more research is needed.

Generally horses show signs of going off their feed or depression when they are first given pergolide, and mostly only when they are started on the prescribed dose rather than it being introduced gradually. As long as any increase is done gradually, ideally in 0.25 mg increments, side effects are rare. We do notice that some horses show side effects (most commonly diarrhoea, also going off feed) if the dose becomes a bit higher than seems ideal for them - some needle-phobic horses are managed according to this, so if they start to show signs that they aren't tolerating the dose well, it is decreased slightly. It is well accepted that the dose of pergolide is likely to need adjusting according to clinical signs and blood results, always trying to use the lowest dose to control these, but also increasing the dose to control signs and hormone levels when necessary. Research has also shown that giving a low dose for a long time (3-4 years) has brought PPID under control in horses that weren't fully controlled for the first couple of years. Unfortunately PPID is a very complicated disease and very individual to each horse, so there are few rules and you really do have to monitor your horse closely and adjust the dose accordingly.

There are also other options for giving pergolide - if you are in the UK or Australia Bova molasses flavoured (but molasses free) pergolide paste can be given if a horse is not doing well on Prascend. This comes in 0.2 mg increments so is easier for slowly increasing and decreasing the dose. Pracend and Bova pergolide should be able to be used in combination to achieve increments smaller than 0.5 mg.

Dawn Jennings

2/27/2021 03:14:33 am

My horse was just tested for cushings (PPID) but he has been on Prascend because of former laminitic issues from being insulin resistant. The results showed my horse does not have cushings, so the vet is suggesting we discontinue Prascend. Could Prascend possibly skew the results of a test for cushings or is it customary to do the testing for cushings while horses are on this medication? I just want to make sure Prascend wouldn't have influenced the test results.

The Laminitis Site

2/27/2021 08:59:00 am

Hi Dawn
Pergolide (Prascend or Bova pergolide paste) would be expected to lower ACTH in a horse with PPID, so yes, being on pergolide when blood was taken for ACTH testing could definitely show a lower ACTH result than if he wasn't taking pergolide, if he has PPID.
For a diagnostic test, a horse should not be taking pergolide. A horse should be weaned off of pergolide slowly and not given pergolide for at least 1 week before ACTH is tested for diagnosis of PPID. As your vet has suggested discontinuing Prascend, you could do that and then test again once all the pergolide has left his system.

PPID testing can be a resting ACTH, which can often be normal in the early stages of PPID, or a TRH stimulation of ACTH.
PPID is very rare in horses aged less than 10.
PPID should be diagnosed on clinical signs and history as much as blood results.
See also:
http://www.thelaminitissite.org/articles/pituitary-pars-intermedia-dysfunction
http://www.thelaminitissite.org/articles/is-it-ppid-or-is-it-ems

As your horse has had laminitis, it is important to monitor his insulin levels. It is insulin that suggests laminitis risk, ACTH has no relationship with laminitis risk. You can also assume that he had insulin dysregulation at the time of his laminitis (assuming he wasn't already seriously ill (sepsis related laminitis) or seriously lame (supporting limb laminitis) - both of which are rare), so he should be managed for ID/EMS with a low sugar/starch diet, weight loss if necessary and a return to exercise once his feet are fully realigned (confirmed by x-rays), well supported and stable.

For individual help you might like to join the Friends of TLS support group on Facebook: http://www.thelaminitissite.org/join-friends-of-tls.html

rena

3/3/2021 12:57:42 pm

My horse is a 23 year old Cushings TB gelding doing quite well with his daily 1mg of Pergolide. Should I increase his Pergolide around August 1st to prevent further laminitis? Very concerned about potential lameness.

The Laminitis Site

4/27/2021 03:43:25 pm

Many horses with PPID do well with an increased dose for the seasonal rise, with the dose dropping down again around November/December.

Ideally test ACTH twice a year to check for control of PPID, with one of those tests around the start of August, to help guide an increase in pergolide dose for the seasonal rise, and monitor clinical signs carefully.

PPID doesn't necessarily increase the risk of laminitis.
Horses with PPID may be in 1 of 3 categories for laminitis risk:
1. No insulin dysregulation (ID), therefore no increased risk of laminitis;
2. ID due to EMS (ID caused by being overweight, too much sugar/starch in the diet, not enough exercise, but not directly due to PPID hormones - these horses have EMS and PPID). For these horses, control laminitis risk through diet, weight control and exercise.
3. ID due to PPID hormones - these horses have PPID + ID. For these horses, control excess PPID hormone output and therefore laminitis risk through PPID treatment (pergolide).

The distinction between 2 and 3 is unlikely to be quite that clear, as a horse with chronic hyperinsulinaemia from excess PPID hormones is likely to also develop insulin resistance and therefore have insulin levels increased by sugar and starch in the diet, and all horses with ID are likely to need some control of weight and sugar/starch in their diet, but being aware of these distinctions may help to focus treatment.

All horses with PPID should have insulin tested to assess their laminitis risk. ACTH has no proven association with laminitis risk, and it is suggested that it may be the hormone CLIP that is produced in excess in horses with PPID that may cause ID and increase the risk of laminitis in some horses with PPID. Unfortunately at the moment CLIP cannot be tested commercially.

Lynn Woody

4/6/2021 08:02:50 am

My horse has just been diagnosed with PPID, no laminitis. He has excessive sweating, fatigues easily, grows a long and curly winter coat and reacted to his vaccinations last year. He is losing some topline. He is in good weight. My question is when would I most likely see a difference from having him on Prascend? A week, month, more?

The Laminitis Site

4/27/2021 11:11:59 am

When you see improvements will depend on the clinical signs seen, and on the dose of pergolide being correct, but as a rough guide, you might expect to see improvements in attitude and activity, reduced PU/PD (excess drinking and urination) and reduced sweating (if excess hair isn't causing sweating) within 30 days of starting treatment, plus reduced ACTH (basal or response to TRH) results and reduced glucose and insulin IF increases were due to PPID hormones.
It may take up to a year (with the correct dose) to see improvements in hair coat shedding, top line and pot belly, reduced infections, and reduce laminitis [again only IF laminitis was due to PPID hormones - if laminitis was due to PPID hormones, a decrease in laminitis risk should be seen within 30 days, therefore further laminitis may be due to uncorrected rotation in the feet].

The EEG has a guide to treatment expectations in Table 5 here:
https://sites.tufts.edu/equineendogroup/files/2019/12/2019-PPID_EEGbooklet.pdf

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