# Stopping Prascend in Cushings horse



## AnShanDan (13 May 2016)

Just trying to find out if anyone has any experience of doing this.

Horse in question is mid 20s, has had slowly increasing ACTH levels for several years despite prascend being increased to 2.5 tabs per day now. Most recent bloods were over 300 and owners now saying they will stop the prascend because of the cost and "let nature take it's course". Horse is retired obv. but fine in himself, hairy but happy, eats well and is active in the field.

I wonder if it would be better to just pts now while he is relatively well than put him through unmedicated cushings but maybe the prascend isn't actually helping much and he may be OK for a while?


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## Crackerz (13 May 2016)

AnShanDan said:



			Just trying to find out if anyone has any experience of doing this.

Horse in question is mid 20s, has had slowly increasing ACTH levels for several years despite prascend being increased to 2.5 tabs per day now. Most recent bloods were over 300 and owners now saying they will stop the prascend because of the cost and "let nature take it's course". Horse is retired obv. but fine in himself, hairy but happy, eats well and is active in the field.

I wonder if it would be better to just pts now while he is relatively well than put him through unmedicated cushings but maybe the prascend isn't actually helping much and he may be OK for a while?
		
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Would they consider trying something like Vitex? 

I know my old boy would go downhill and suffer pretty quickly if i took him off his medication....


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## ester (13 May 2016)

I was talking about this with a vet friend yesterday and how many other things there might be going on other than the symptoms we see. 
It obviously isn't well managed if ACTH levels keep increasing and I would PTS before I took him off the meds tbh.


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## AnShanDan (13 May 2016)

It's a slightly tricky situation, the horse was bought years ago by parents for a then young girl. The girl is now an adult but her parents still help her out financially with the horse, they are not keen to pay for his medication any more, and are applying pressure to the daughter (who is devoted to the horse) to stop the meds. 2.5 tabs a day costs them about £75 a month which is not nothing I guess.
I'm just worried he suffers but not sure if the prascend is actually doing that much.


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## EQUIDAE (13 May 2016)

He will deteriorate much quicker off the meds - although they appear not to be working they will be still slowing the progression. It is far kinder to PTS than stop them meds and let nature take its course - the side effects of the end stage tumour are not nice.


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## Crackerz (13 May 2016)

I would definitely PTS before i ever considered taking my boy off of Prascend


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## ester (13 May 2016)

It might not look like the prascend isn't doing very much but I would imagine he will end up mightily sick without it. The fair thing to do would be to PTS.


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## AnShanDan (13 May 2016)

You are all confirming what I thought


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## splashgirl45 (13 May 2016)

ester said:



			I was talking about this with a vet friend yesterday and how many other things there might be going on other than the symptoms we see. 
It obviously isn't well managed if ACTH levels keep increasing and I would PTS before I took him off the meds tbh.
		
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I query the comment about not being well managed.  my mare has been well managed, is tested twice yearly and her acth levels have steadily risen over the last 5 years even though her prascend has been increased each time. she is now on 4 tablets daily and I agree I would never take her off meds even though the cost is crippling me but would PTS if stopping meds was the only other option. I think it would be wrong to let nature take its course as this would probably lead to laminitis and pain..


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## JillA (13 May 2016)

The knowledgeable people on The Laminitis Site have found research which indicates that a suitable Prascend dose isn't dependant on the animals weight nor the level of ACTH. Worth reducing the dose and seeing if it still controls the symptoms?


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## fatpiggy (13 May 2016)

AnShanDan said:



			It's a slightly tricky situation, the horse was bought years ago by parents for a then young girl. The girl is now an adult but her parents still help her out financially with the horse, they are not keen to pay for his medication any more, and are applying pressure to the daughter (who is devoted to the horse) to stop the meds. 2.5 tabs a day costs them about £75 a month which is not nothing I guess.
I'm just worried he suffers but not sure if the prascend is actually doing that much.
		
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Mean people who should have thought it through before they bought a pet of any description.  Sooner or later you are going to be faced with vets bills that come with old age, or PTS bills.  You either take the financial hit or you call it a day.  To "let nature take its course" is cruel.  You might just as well say, my horse has got a broken leg, I'll let nature take its course.    I was devoted to my horse too but that didn't stop me doing the right thing by her when her quality of life was not as good as I wanted it to be and another wet muddy winter would have been too much for her.


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## ester (13 May 2016)

splashgirl45 said:



			I query the comment about not being well managed.  my mare has been well managed, is tested twice yearly and her acth levels have steadily risen over the last 5 years even though her prascend has been increased each time. she is now on 4 tablets daily and I agree I would never take her off meds even though the cost is crippling me but would PTS if stopping meds was the only other option. I think it would be wrong to let nature take its course as this would probably lead to laminitis and pain..
		
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I guess I meant at 2.5 tabs a day, so they are going to need to increase it really and if they don't want to carry on with the 2.5....


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## Boulty (13 May 2016)

In this position if she can no longer afford the meds (or if she feels they are bringing more side effects than benefits) then if she does have to stop them it may be worth trying vitex agnus castus instead.  It may make no difference but there's a vague chance it might so may be a preferable option to no treatment at all.  It may also be worth tapering the dose down and seeing if a lower dose may still bring enough control to give good quality of life (possibly with the agnus castus used alongside?) but would advise her to discuss it with vet before doing anything.  I'm guessing that if the horse does deteriorate then should be PTS rather than have him suffer?


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## AnShanDan (13 May 2016)

The horse appears well in himself, he does have a hairy coat and some muscle wastage, but he is 25 or 26 and retired, so not surprising really. Other than that he enjoys life, as far as I can judge. He walks briskly out to the field in the morning, trots off looking sound and often won't be caught. He eats everything he is given and lies down every night.  I've had old horses that were clearly nearing the end of their lives and they slow down a lot, which he hasn't.
If he were mine, I'd have no hesitation in keeping him on the prascend, but he's not, so I have to work with what the owners decide. I just wondered if anyone had actually taken a high ACTH horse off prascend and what happened? Obv. you'd assume they will go downhill quickly, but is there evidence of that?


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## supsup (13 May 2016)

I haven't had personal experience taking a horse off prascend. I think what is probably most likely to give you a clue how the horse may react is to look at the symptoms the horse showed before it was diagnosed with Cushings. If the horse was diagnosed because it showed symptoms (other than "old age") that worried the owner enough to consult a vet, then I'd expect those symptoms to return, possibly worse. If that included laminitis/hoof problems, I don't think I'd risk taking the horse off medication, and would PTS instead. Even if the symptoms didn't include laminitis, but had me worried for other reasons (weight loss, depressed mood...) I'd question the quality of life the horse would have if it redeveloped those symptoms.

If the Cushings was picked up on a routine blood test, but the horse didn't really have any worrying symptoms, I might be more inclined to see how it does without the medication, but I'd be ready to PTS at the first sign of deterioration.

In the end, for an old retired horse with the only alternative being PTS, I think I'd be guided as much by the horse's symptoms (or lack thereof) and quality of life as I'd be by blood tests. So, tapering the dose down slowly and seeing how the horse responds (with the vet's agreement) might be an option.


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## ester (13 May 2016)

AnShanDan said:



			I just wondered if anyone had actually taken a high ACTH horse off prascend and what happened? Obv. you'd assume they will go downhill quickly, but is there evidence of that?
		
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 I'm not sure of any but am not sure that I'd want my horse to be the experiment either on that.


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## Crackerz (13 May 2016)

ester said:



			I'm not sure of any but am not sure that I'd want my horse to be the experiment either on that.
		
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This. 
If a horse has symptoms bad enough to notice in the first place, high chances are they will be worse further down the line


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## Bradsmum (13 May 2016)

I do have experience of taking a horse off Prascend. She is my 30-something year old companion pony who is retired. She showed no signs of cushings other than not keeping weight on during the winter but I had her tested and like every horse over 20 it seems she came back positive.  She was put on 1 tablets a day, re- tested and the dosage increased to 1 1/2 a day.  She became very depressed and we reduced her dosage for a while and gradually increased it but she was so unhappy.  She was eating fine but very lethargic. I decided to take her off her meds and was ready to make that final decision if she showed any adverse signs.  She hasn't. She has never shown signs of laminitis, she maintained her weight this winter, she is happy and lively and I am now managing her grass intake carefully.  I will make the decision to pts if I feel she is in any way deteriorating but until then I have a happy pony.  I should add that i feed her Agnus castus in her feed  - I have no idea whether this is actually beneficial but it seems to work for her.


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## ester (13 May 2016)

It would be interesting to know what her score was Bradsmum 

(fwiw I have a 23 yo who as yet has not tested +ve)


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## AnShanDan (13 May 2016)

supsup said:



			I haven't had personal experience taking a horse off prascend. I think what is probably most likely to give you a clue how the horse may react is to look at the symptoms the horse showed before it was diagnosed with Cushings. If the horse was diagnosed because it showed symptoms (other than "old age") that worried the owner enough to consult a vet, then I'd expect those symptoms to return, possibly worse. If that included laminitis/hoof problems, I don't think I'd risk taking the horse off medication, and would PTS instead. Even if the symptoms didn't include laminitis, but had me worried for other reasons (weight loss, depressed mood...) I'd question the quality of life the horse would have if it redeveloped those symptoms.

If the Cushings was picked up on a routine blood test, but the horse didn't really have any worrying symptoms, I might be more inclined to see how it does without the medication, but I'd be ready to PTS at the first sign of deterioration.

In the end, for an old retired horse with the only alternative being PTS, I think I'd be guided as much by the horse's symptoms (or lack thereof) and quality of life as I'd be by blood tests. So, tapering the dose down slowly and seeing how the horse responds (with the vet's agreement) might be an option.
		
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Very good point. He was originally diagnosed because I suggested it!! He had had an ongoing intermittent lameness which turned out to be a chronic abscess/corn. He was also not losing his coat so readily in the spring. Since then his foot care has been drastically improved, he has not had any further issues with his feet.
So difficult to decide what to say to them, when it is not my money. He is such a lovely old boy too.


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## ihatework (13 May 2016)

AnShanDan said:



			The horse appears well in himself, he does have a hairy coat and some muscle wastage, but he is 25 or 26 and retired, so not surprising really. Other than that he enjoys life, as far as I can judge. He walks briskly out to the field in the morning, trots off looking sound and often won't be caught. He eats everything he is given and lies down every night.  I've had old horses that were clearly nearing the end of their lives and they slow down a lot, which he hasn't.
If he were mine, I'd have no hesitation in keeping him on the prascend, but he's not, so I have to work with what the owners decide. I just wondered if anyone had actually taken a high ACTH horse off prascend and what happened? Obv. you'd assume they will go downhill quickly, but is there evidence of that?
		
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I own 2 horses with cushings.
1 older one who is pretty typical, he is on 2mg a day, ACTH reasonably well controlled but he does have other symptoms. I wouldn't take him off medication, he is teetering on the edge of PTS anyway.

The other is a younger, slightly more complicated horse. He was diagnosed at 7 and over the course of a few months we started and increased his prascend with little change in ACTH. Furthermore he became so lethargic and depressed that it just wasn't fair to keep him on prascend. I withdrew the drug and he was immediately a much happier horse. He does have other niggly things going on and my gut feeling is his ACTH was being pushed up by stress cortisol. He is out on loan at the moment as a hack, last test he had off prascend was 50 which is about half what it was. He has had a couple of abcess and a flair up of an old injury in that time. I'm very concious we will probably reach a time when its not ethical to keep him going.

After all that id say your situation very much like my old retired horse. I'd PTS rather than withdraw the medication


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## ester (13 May 2016)

ihatework said:



			I own 2 horses with cushings.
1 older one who is pretty typical, he is on 2mg a day, ACTH reasonably well controlled but he does have other symptoms. I wouldn't take him off medication, he is teetering on the edge of PTS anyway.

The other is a younger, slightly more complicated horse. He was diagnosed at 7 and over the course of a few months we started and increased his prascend with little change in ACTH. Furthermore he became so lethargic and depressed that it just wasn't fair to keep him on prascend. I withdrew the drug and he was immediately a much happier horse. He does have other niggly things going on and my gut feeling is his ACTH was being pushed up by stress cortisol. He is out on loan at the moment as a hack, last test he had off prascend was 50 which is about half what it was. He has had a couple of abcess and a flair up of an old injury in that time. I'm very concious we will probably reach a time when its not ethical to keep him going.

After all that id say your situation very much like my old retired horse. I'd PTS rather than withdraw the medication
		
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I don't think I have ever seen him stressed in current home, the most he manages is a wander over to say Hi to Frank!  That's interesting about him as I didnt' realise he was off meds. He certainly doesn't look terribly symptomatic atm anyway.


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## ihatework (13 May 2016)

ester said:



			I don't think I have ever seen him stressed in current home, the most he manages is a wander over to say Hi to Frank!  That's interesting about him as I didnt' realise he was off meds. He certainly doesn't look terribly symptomatic atm anyway.
		
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No he doesn't do 'stressed' lol. But I think it's amazing what the stoic ones can hide from you. He is certainly a happier horse on less work, bute and no prascend


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## paddy555 (13 May 2016)

AnShanDan said:



			Just trying to find out if anyone has any experience of doing this.

Horse in question is mid 20s, has had slowly increasing ACTH levels for several years despite prascend being increased to 2.5 tabs per day now. Most recent bloods were over 300 and owners now saying they will stop the prascend because of the cost and "let nature take it's course". Horse is retired obv. but fine in himself, hairy but happy, eats well and is active in the field.

I wonder if it would be better to just pts now while he is relatively well than put him through unmedicated cushings but maybe the prascend isn't actually helping much and he may be OK for a while?
		
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I don't see it as a choice of keep on prascend or PTS. You have no way of knowing what will happen if he stops prascend. If he deteriorates badly he can be PTS immediately however he may well be OK. The test results as far as I can see mean very little. What is important are the symptoms. I don't test mine. I tested twice and the test results were total rubbish compared to his symptoms. I have heard of so many similar results. I work totally on the symptoms. If you stop and they start deteriorating then there is little choice but what if they don't? PTS a horse with a reasonable quality of life unnecessarily? 

Have the owners considered targeting the prascend at certain times of the year ie to cope with the seasonal rise? that would reduce the cost and may keep the horse healthy. I don't see reducing or stopping prascend as a cruelty issue as some seem to  but as a management issue to establish what is the lowest dose the horse can have a good quality of life with. That is how I look after both of my cushings horses. My 28yo mare is on only half a tablet. My younger horse started cushings with very very severe symptoms, he was not far off PTS. That was 4 years ago and I have reduced him from 1.5 to 1 over the early part of the year very successfully. He looks totally fantastic on that and is ridden 7 days a week.


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## _HP_ (13 May 2016)

JillA said:



			The knowledgeable people on The Laminitis Site have found research which indicates that a suitable Prascend dose isn't dependant on the animals weight nor the level of ACTH. Worth reducing the dose and seeing if it still controls the symptoms?
		
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This


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## ester (13 May 2016)

I think it is more if you decide to stop the prascend you have to understand that if that is your decision you might have to be prepared to PTS fairly swiftly. If they are not prepared to do that or put the horse back on prascend if it deteriorates then .. 
There won't be any research on stopping it because, well, no one would get ethics approval for it!


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## _HP_ (13 May 2016)

Boulty said:



			In this position if she can no longer afford the meds (or if she feels they are bringing more side effects than benefits) then if she does have to stop them it may be worth trying vitex agnus castus instead.  It may make no difference but there's a vague chance it might so may be a preferable option to no treatment at all.  It may also be worth tapering the dose down and seeing if a lower dose may still bring enough control to give good quality of life (possibly with the agnus castus used alongside?) but would advise her to discuss it with vet before doing anything.  I'm guessing that if the horse does deteriorate then should be PTS rather than have him suffer?
		
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Agnus Castus may help with some clinical signs but that's all....it won't stop the degeneration


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## AnShanDan (13 May 2016)

Thank you everyone, lots to think about and discuss with owners.


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## Bradsmum (13 May 2016)

ester said:



			It would be interesting to know what her score was Bradsmum 

(fwiw I have a 23 yo who as yet has not tested +ve)
		
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Originally her score was high, I think around 200 and it rose to 250.  Can't remember exactly as I took her off her meds about 2 years ago. I have to say I have no regrets as she perked up straight away and has remained the same and is interested in everything going on that she can poke her nose into.


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## CazD (13 May 2016)

My companion pony has cushings. She  is now approx 28.   Since she's had cushings she wont eat anything other than grass or hay, regardless of what it is and whether or not the prascend tablet is in it or not.  She's no longer on any medication because of the impossibility of getting her to take it.  So far she's coping OK apart from being a bit hairy. She's still able to do the occasional canter round the field with her mates.  Obviously she will be pts if she deteriorates but so far so good.


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## Becks01 (18 May 2016)

I started to feel like the side effects of the Prascend were worse than the few Cushing's symptoms my boy did have...I trialled reducing the dose and he was better than he'd ever been. I lost him in the end anyway due to a combination of reasons and I decided it was the right time to PTS. However if that hadn't happened I was going to investigate the Vitex Agnus Castus route...


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