# Side affects of Prascend



## Twigben (8 August 2013)

Hello

My 16.2hh 17.5 year old Warmblood was diagnosed in June with Cushings with ACTH levels of 46.  He was on 1 tablet of Prascend a day which in 4 weeks brought the levels to 26 but displayed symptoms of a little loss of appetite and was majorly spooky.  Vet saw him and said it could be a reaction to the Prascend and to lower the dose to half a tablet.  After a month on half a dose the spooking did seem to have got better but then at the w/e at a ODE he became almost glazed over before the SJ really lethargic in the SJ to the point where he was almost stopping and then climbing the SJ fences.  Cut a long story short we retired XC and got the show vet.  

This horse does have neurological problems (simlar to shivers but the vets have never been able to fully diagnose) and was also exhibiting some wobbly hind leg movements and almost tripping over his feet.

The vet at the show said she thought it could be the Prascend making him lethargic etc but that the neurological signs were unsual.  My normal vet thought he may have had a bout of colic.

I am non the wiser.  He seems a little dull and still incredibly spooky to the point where he will almost fall over he spooks so badly and seems to be on constant watch for "danger".

Has anyone else had similar symptoms on this drug?

I do wonder if with ACTH levels only slightly over the "normal" range if he should even be on this drug - but I want to do the best for him.

Thanks in advance.


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## flintfootfilly (8 August 2013)

I only have one mare on prascend, and I've not seen that as a side effect at all.  Maybe it's worth checking his ACTH again to see if a change in dose is needed?

Shivers-type movements can be associated with systemic muscle disease (like EPSM) but for movements to happen correctly, it needs the nerves, ligaments, tendons and muscles to all be functionally correctly, so anything that affects any of those might be a potential cause.

Interested that you mention lethargy too, because this (or rather lack of energy, reluctance) can be associated with muscle problems too.

May be a long shot, and it's something close to my heart because of problems I'm having with my gang, but what is his diet - what forage, what feed, how much etc, including how much of which balancer or vit/min supplement?

How long have you had him?

Just wondering whether it could be a selenium deficiency (but others will know that I suggest this for a lot of things, but especially when vets don't find another cause, it's certainly worth checking out - easy enough to test forage for selenium and get an idea of whether it's low (anything below 0.1mg/kg DM in the forage) or adequate).

Sarah


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## Twigben (8 August 2013)

Hello thanks for your reply.  I have had him for 5 years.  He is on HiFi light, sunflower oil and soya oil, soaked Alfa Pellets, Benevit and Cortaflex and when needed electrolytes.  He has had this diet for a number of years now.  He is normally in at a night with soaked hay and out in the day but we have switched it the last few weeks as it has been so hot and the flies are so bad!

The soil they are on is chalk and so the grass is not great - we feed hay from the fields so nothing comes in from other suppliers unless i treat him v occassionally to haylege.

I would hope that the Benevit would have the adequate amounts in - perhaps he does need extra vitamin E and selenium?


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## JillA (8 August 2013)

I would join the  Yahoo ECIR group and ask on there - they have a host of experience with pergolide in al its many forms


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## Rjd84 (8 August 2013)

Ive recently done a lot of research into Prascend as my horse has just started 1 tablet a day after ACTH levels of 68 and chronic laminitis. Other than Lami, he had no other symptoms of Cushings at all, and i understand that it can present very differently in individual horses. Some have mentioned on previous cushings/Prascend/Peroglide threads than the benign tumour on the pituitary that causes the cushings can cause other neurological symptoms, such as minor fits or seizures, and twitches or shivers. Just a possibility?


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## lornaA (8 August 2013)

My mare is on pracend and has been for 2 years now.  Her cushings seems well under control but I don't know how she would be to ride as she is retired. She is on one tablet a day and it has made a massive difference to her. Unfortunately like the previous poster says the tumour that causes cushings can cause neurological problems and personality changes or behavioural changes as the tumour gets more advanced .


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## Zuzzie (8 August 2013)

I have experience of Cushings with 2 of my horses - neither of which displayed any side effects.  However, my other gelding (non Cushings) caught a virus in January and got extremely lethargic.  I had him blood tested which confirmed a virus.  During his recovery he was showing signs of anemia with low muscle enzymes.  Six months later he is now coming back into work, slowly.  I would recommend you get your horse's ACTH levels tested again and also take a sample for virus testing.  Good luck.


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## lornaA (8 August 2013)

I meant to say that my mare was started on 2 a day but it severely affected her appetite so we went down to half then increased to 1 and at that point she was tested and it was found that 1 was enough to control it for her.


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## flintfootfilly (8 August 2013)

Just checked Feedmark Benevit - it uses inorganic selenium (sodium selenite) rather than selenium yeast.

If this was my horse, I would:

- change to a balancer with selenium yeast (Blue Chip has more selenium yeast than any other "traditional" balancer that I've been able to find)

- have a comprehensive blood test (to include muscle and liver enzymes) and ask for a copy of the full blood report for your records.  Check whether anything is high or low.  If muscle enzymes are even marginally high, it can be significant.  For example, the lab my vets use has a reference range of up to 225 u/l for creatine kinase, CK, the main muscle enzyme.  World experts in equine muscle stuff (Beth Valentine, Stephanie Valberg) recognise anything about 350 as being indicative of muscle disease.

The bloods should give you an idea whether there's anything underlying his lethargy which can't immediately be seen on the outside of the horse - eg infection, compromised liver, muscle etc.

Third thing I'd do would be to have the grass analysed for minerals, to include selenium.  I use Sciantec at Cawood, Selby for mine, and they are quicker than others I've used in the past.  Selenium of less than 0.1mg/kg dry matter is deficient.

Those things might help guide you as to whether it's anything like I'm thinking.  If it is and you choose not to change the diet, the signs will gradually become more pronounced.  I had one mare who could not trot more than a few strides without grinding to a halt.  She can now trot fine, but it's just her canter that can't be sustained at the moment.  We're still a work in progress!

Good luck with getting to the bottom of things.

Sarah


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## fabian (8 August 2013)

I have a little mare with Cushing's who became increasingly spooky and irrational on Prascend to the point where we have had to discontinue it. Off the medication, she is the perfect lead rein pony who I would trust around the tiniest of tots but on it she swings between being dull and lethargic to dangerously spooky and impossible to catch. I have worked with several other Cushing's horses who had no adverse reactions to the drug. All I can say is that every horse is different and some simply do not seem to tolerate it well.


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## Nudibranch (9 August 2013)

My old mare had no side effects from Prascend (pergolide) and in fact it did nothing but good for her. However I have heard of plenty who have had issues. As his levels are pretty low, have you considered agnus castus? I'm not normally into herbal remedies particularly, but I believe  quite a few people on here have had success with it. Might be worth trying if he's borderline for Pergolide.


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## Cargou (10 November 2016)

Hi!
I know it's been a While since you posted that...
I would like to know what happened with your horse?
My main broodmare just got diagnosed for Cushing so I started her on Prascend 1 mg and within a week she stop eating and drinking. She lost a lot of weight in a couple of days. I decided to give her half a pill instead and she started drinking and eating again. After 8 days on Prascend, she started showing neurological sings. At first I thought it was weakness due to the non eating episode... I had the vet to look at her anyway and she could not say what it is. Just like your vet said... It is something neurological with some wobbly moves but we don't know what it is. She also said that she doesn't think it's because of Prascend.  We did a blood test and we gave her a dose of butasone because we thought it could be a bad fall in the muddy field...
I'm waiting for the results but yesterday I decided to stop Prascend. This way I'll figure if it comes from the pill...

Please let me know what happened with your horse. 

Thanks


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## JillA (10 November 2016)

You really need to join ECIR (Equine Cushings and Insulin Resistance) Yahoo group - full of knowledgeable experienced people, including Dr Eleanor Kellen who is just about the best there is.


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## QuantockHills (10 November 2016)

My 13 year old was diagnosed with Cushings in June 2015. The only symptom he had was very lethargic and excessive drinking. We started on 1 tablet and it seemed to perk him up for a short while but then he went down hill again. We tried for 12 months with increasing the tablets and re-testing. His last blood test came back at over 350 and that was on 3 tablets a day..... he developed narcolepsy and started to have quite a few very wobbly episodes and my vets advised not to ride him anymore. He would spend several hours in the field stood in the same place each day and had no energy. It was heart breaking to watch so i decided (with the vets full support) to stop the tablets (as they weren't working anyway) and I let him have a month in the forbidden fat field and then had him PTS. Sadly, Prascend isn't always the miracle cure and not all horses do well on it. I lost my boy only 15 months after his diagnosis and he was only just 14 and had been with me since he was 3.


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## JillA (10 November 2016)

JillA said:



			You really need to join ECIR (Equine Cushings and Insulin Resistance) Yahoo group - full of knowledgeable experienced people, including Dr Eleanor Kellen who is just about the best there is.
		
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Found the link  http://ecirhorse.org/index.php/ecir-group-inc


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## leggs (10 November 2016)

on the Dutch forum i'm on (very active forum ) there is a long topic on PPID, we have discovered that it is best to start peroglide/prascend  with a loading dose because many horses will go off their food, become lethargic etc. 

It is advised to start on 1/4 tablet for large horses, or even 1/8 for 2 weeks, then double that dose for another 2 wks until you are on the normal target dose.

Also take into account that we're just coming out of the "seasonal rise" in which the ACTH levels are peaking.  Some people give a higher dos in these months (sept/oct)


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## Micky (10 November 2016)

Please look at the dedicated websites ecir group or the laminitis site for correct information..(ie cushings ppid is Not a tumour!!)... 
The veil..when the horse has too much prascend in the beginning..half the dose for a couple of weeks, then up to correct dose...re jig his diet..see websites for weight loss, weight gain etc...
Lethargy is one of many signs of ppid..
It will take a good while for your horse to feel on top form again, so take it easy on him...it took my horse a year and half to become totally 'normal' again..but some of that was due to getting his feet aligned properly. He lost a ton of weight and really looked poor...I'm now back out doing dressage hacking pleasure rides etc and he's fab...but you have to be patient and adjust his lifestyle and mange him slightly differently now..so gem up as much as you can (with factual stuff) to give him the best you can..good luck


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## Boulty (10 November 2016)

I've had similar bizarre side effects after altering Prascend dose.  Horse started jumping at absolutely everything (he can be very daft and spooky anyway but this was ridiculous even for him) , bashing himself on walls and gates as if he couldn't judge the distance properly and generally going into his own little world where he didn't acknowledge people as he normally would and generally seeming a bit off.  He also went totally off hard feed for about a month no matter what I did.  Ultimately he started showing early laminitis signs and so ended up on box rest and started eating more normally again.    We couldn't 100% say it was down to us fiddling with his Prascend dose as there were a few other factors that we think also played their part.  Looking back I think I stopped it for a couple of days then restarted.  He'd now at the dose we were trying to get him onto when he started being odd and doing ok and showing no further weird signs


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## applecart14 (11 November 2016)

Are you sure it isn't just a co-incidence and he has taken a fall onto his neck in the field or pulled back whilst tied up, or got stuck somewhere, thus causing inflammation to his neck bones?  This can then cause calcium deposits to build up impinging the spinal cord and associated nerves and cause neuro signs such as those you are seeing?

My horse has been investigated for the same in the past few weeks.  My current horse had a bad neck injury which resulted in CVM/Wobblers where he was graded 3, nearly 4 on the scale and was sadly PTS aged ten. It is quite common as a result of injury in the field/stable.

I am not doubting what you saying about side effects with Prascend however.  I have been told by two vets and heard second hand from a fellow livery whose vet told her the same that Prascend can have some dreadful side effects and both vets I personally spoke to said they wouldn't advise putting a horse on it that just showed up as having cushings upon test unless the horse also had laminits at the same time.  But I think its more likely your horse is showing neuro signs because he is challenged in this area for some reason and not from a side effect of a drug.  I am not a vet but that is just my own personal point of view and stems from my own experience.


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## _HP_ (11 November 2016)

Prascend not only treats Cushing's but can slow down the progression giving horses many mre years. 
I think many vets/owners are judging it due to incorrect use. It's only relatively recently that people have worked out that it should be introduced slowly to allow the body to adjust and to avoid the side effects.


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## JillA (11 November 2016)

_HP_ said:



			Prascend not only treats Cushing's but can slow down the progression giving horses many mre years. 
I think many vets/owners are judging it due to incorrect use. It's only relatively recently that people have worked out that it should be introduced slowly to allow the body to adjust and to avoid the side effects.
		
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I would never discount it - my old mare had Cushings before pergolide was easily available and it wasn't a pretty sight, she had a really tough time, and TBH I left her too long because she was on the Vitex trial. 
If there are recorded side effects you need to discuss with Boeringher, who produce it, or feed it into a site like ECIR so they can assemble some anecdotal evidence. I would suggest much of it is coincidental with something else, which is why anecdotal evidence is so unreliable, unless it is assembled into a large body of such evidence. Diagnosis by therapy is one way to diagnose PPID, the ACTH test has its drawbacks and to see people generalising a reluctance to use Prascend worries me a lot. As far as I am concerned it is the gold standard of managing the condition.


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## Beausmate (12 November 2016)

applecart14 said:



			I have been told by two vets and heard second hand from a fellow livery whose vet told her the same that Prascend can have some dreadful side effects and both vets I personally spoke to said they wouldn't advise putting a horse on it that just showed up as having cushings upon test unless the horse also had laminits at the same time.
		
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Blimey.  That's rather sad, and I'm so happy my vet is a lot more proactive than that!  Cushing's doesn't just cause laminitis, it has an effect on pretty much the whole horse and why would anyone want to wait for their horse to develop laminitis before giving it something than can help to prevent laminitis? Doesn't make sense to me and it certainly isn't something I would want my horse to go through.

My old horse is on Prascend, his ACTH levels weren't particularly high and the only symptom he showed was weight loss, but he is so so much better, it's as if the clock has been turned back at least five years.  His pal, who is the same age and looks rough, tested only just above average and is being re-tested next month. If he needs it, he will have Prascend too and I will see how he goes from there.

My horse was rather sorry for himself and looked out of it for about a week after starting on one a day.  No other side-effects observed.


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## Achinghips (25 November 2016)

Cushings was once thought to be as a result of a tumour.  It is not a tumour.   It is an enlargement of the pituitary gland.


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## whizzer (25 November 2016)

My horse was put on prascend as soon as he was diagnosed,he had no typical,classic signs was just obviously not 'right' & had massive weight loss,we only did the free test as I wanted to rule it out. For me no question of not medicating as he clearly wasn't managing without. Had a 160 reading so not huge,diagnosed 6 months ago & readings slowly coming down. 
I introduced prascend slowly,didn't seem to have any side effects except loss of appetite,he's a horse that really struggles with eating & keeping weight on anyway so the diagnosis was a bit of a nightmare really & he hates being stabled & separated from his mates,will stress himself into gastric ulcers,so I've just left him out on loads of grass with his mates. He's refused food all summer & will only eat now it's colder,plus the only thing he's considering eating at the moment is fast fibre,although I've been able to sneak some omega rice in this week. I can't follow ideal cushings management as none of it suits him & I can't risk gastric ulcers as well if he gets upset so I'm biting the bullet to keep him happy & hoping the cushings stays under control...


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