# Pergolide ends and Prescend begins..OMG please read.



## Bryndu (4 February 2011)

Bit long...sorry.

My Sec A gelding was diagnosed  Cushings in 2009 and began a course of Pergolide, and eventually stabilised at 2 x 50 micrograms given once a day (50 micrograms = 0.05 milligrams). This costs me £28.55 for 100 tablets making a total cost for the year of £208

I had heard that Pergolide was being withdrawn from circulation and that we would now all have to use a drug called Prascend .

So armed with my repeat prescription, I headed to my local Pharmacist and asked him about the withdrawal of Pergolide from the market. He said he had heard nothing about this from any of his publications or indeed the GMC press. He said he would find it difficult to believe it was being withdrawn as it is used to treat Parkinsons  Disease in humans.

So, off  to the vet to get 3 repeat prescriptions...and  the bombshell....

Pergolide is NOT being withdrawn, however no tests have never been carried out on the human Pergolide to see its effect on horses,  so a company as I understand it has researched  Pergolide and its effects on equines and come up with a registered product called Prascend. This drug is produced by Boehringer-Ingelheim, who also produce Pergolide for human use and when I went on to their website earlier today are still producing Pergolide in human tablets. 
Now by law (and I stand willingly to be corrected) if an equine equivalent drug is available, vets may not prescribe a human drug.  So, up until now, there has been no equivalent equine Pergolide and that is why we have been using the human drug. I should like to point out I am not in any way having a pop at the manufacturer.

Nothing  wrong  with that I hear you say......until you hear the price. 150 tablets of Prascend costs £150.
Now, my Sec A falls within the 200  300 kg weight bracket and the recommended dose for this bracket is ½ a 1milligramme tablet. (Taken from the Prascend website today). Therefore it will cost me £1000 per year to treat my pony instead of the present £208

Another worry is that my pony is on a VERY low dose, which does not seem to be catered for by the 1milligramme tablet, and I am concerned about the effects this may have on my pony. I must at this point stress, that I have an extremely caring and understanding veterinary practice who will oversee the transition to this drug, and in whom I have every faith, but at the moment even they do not have all of the answers.

Now some of you may be thinking...well..he is an old pony he has had a good life...perhaps now would be the time to consider putting him to sleep.
Well if he was aged I would do this, however he is just 9 years old, and whilst his Olympic career is in tatters (LOL!) he still has a good competition career going on.

I am concerned this new dosage may affect my pony

I am concerned at the massive cost increase implications for giving my pony this drug

I am concerned that both Pergolide and Prascend tablets appear to contain pergolide mesylate, so why is there a need to change to an equine tablet and not just re-brand existing drugs if equine clinical trials have already taken place. (I am not a Chemist or Pharmaceuticals expert so there may well be a reason for this).

I am concerned that many horse and pony owners faced with this massive increase in costs will have their equines put to sleep with the possibility of another hike in costs from the manufacturer due to making a drug for limited customer demand.

I would be interested in other peoples thoughts/opinions on this.

I am not about to start any sort of campaign, but what started as a good Friday, has turned in to a bad weekend.

Bryndu


----------



## mystiandsunny (4 February 2011)

If the drugs are of equal strength, and using the new one will cause the dosage to skyrocket, perhaps the answer is to grind the tablet (mortar and pestle), then split the resulting powder by the correct number of feeds/days to get the correct dosage?


----------



## barbann (4 February 2011)

Hope this isn't the case as my Arab has 3x25 micrograms per day.  I haven't heard anything about this from my vet and I recently had another batch from him.  If it is correct it'll be yet another case of "let's rip off the horsey community as they've all got loads of money" ....ha-ha..NOT!


----------



## lauraandjack (4 February 2011)

Welcome to the crappy world of medicines licensing.

This is happening to many drugs in the veterinary world - I'm sure it's because the drug companies have got wind of the fact that they can make a tidy profit by "rebadging" human drugs under a veterinary label and charge more for them!

Pergolide is just one of a number of drugs that have been affected by this.  And unfortunately under current UK medicines regulations your vet's hands are tied, they are obliged to supply Prascend rather than generic pergolide.

A former colleague reckoned he had encountered a number of owners who had ended up having to have their pets put to sleep because they could no longer afford to keep on treating since he became unable to prescribe generic products for them.

Apparently this is progress!


----------



## mulledwhine (4 February 2011)

GRRRRRRR, this makes me so crosss.

If you look on any equestrian medcial shelf, you will see that at the least they are double the price of the human equvilent.

Horse Savlon !!!!!!!!
Horse Iodine !!!!!!

WTF, they take advantage as far as I am concerned.

I found this out many years ago when my old dog had kennel cough, and my vet said ' you can give her this which is £12 or go to boots and get kids cough syrup which is about £2' luckily my vet is very honest and fair


----------



## lhotse (4 February 2011)

I would research as to whether you can buy it online, seems you can buy pretty much anything these days.


----------



## Ali2 (4 February 2011)

lauraandjack said:



			Welcome to the crappy world of medicines licensing.

This is happening to many drugs in the veterinary world - I'm sure it's because the drug companies have got wind of the fact that they can make a tidy profit by "rebadging" human drugs under a veterinary label and charge more for them!
		
Click to expand...

Yep - and if they get a patent on the new indication then that allows them to charge a premium because they are sole providers with no competition for at least a decade from generics.

It does suck on an individual basis but when it comes down to it pharma companies are there to make a profit for their shareholders and need to fund ongoing R&D to ensure a continuous pipeline.  I don't know how the profit margin on a rebranded drug, which should require less development and testing, compares with a novel drug.

Just reread.   If you stick with your current dose, which you know is working for you, then you'd actually only need 37 tablets per year which would work out significantly cheaper for you.  I would seriously consider the suggestion made above to split the dose.  If you ground the tablet and mixed it very well with a known quantity of a carrier (not sure what you would use, bran, micronised linseed?) then you could aliquot it out to give a daily 100 µg dose, thereby getting 10 doses from 1 tablet.  

I hope you can sort this out its obviously a worry for you


----------



## 0ldmare (4 February 2011)

Yes I can confirm all this, just went to get a new lot of pergolide and had to get prascend. Vet charged about £260 for 160 x 1mg tablets (  )

In your case, if you can't get the 0.5 mg I would definitely crush the tablets and split into 2 doses.


----------



## sueeltringham (4 February 2011)

I split the 1mg tablets and it worked well.  You can use a very sharp knife, score the tablet and then press with knife.  Alternatively we also ground up in pestle and mortar, collected powder on a folded paper, shake paper and then 'cut' the powder into equal proportions. We then wrapped each dose in seperate paper sachets.  Sounds fiddly, but it wasn't so bad -OH is a pharmacist so I gave this job to him!


----------



## Bennions Field (4 February 2011)

think the reason for change was discussed on here recently, not certain but thought it was due to the dreaded european regulations, rather than just drug company involvement, the drug was originally licenced for human use by Eli Lilly, but went generic some time ago, i originally had to buy celance as it was origninally branded for humans and it was expensive.  thankfuly just after my pony was diagnosed around 6 years ago it went generic (ie anyone with a licence to manufacture) was allowed to make it.  hence the drastic drop in price then.  

check with your vets, i am not sure,  but they may be allowed to write a prescription for the generic name.  you could then go to your local pharmacy and have it dispensed as 'pergolide'???   there was a law brought in a while back allowing pharmacies to dispense vets prescriptions not just human ones.  its worth a try if it keeps the cost down

best of luck, i know it has a great result for some neddy's, unfortunately my little man is no longer with us, and is very sadly missed :-(


----------



## Puppy (5 February 2011)

Bryndu said:



			Nothing  wrong  with that I hear you say......until you hear the price. 150 tablets of Prascend costs £150.
Now, my Sec A falls within the 200  300 kg weight bracket and the recommended dose for this bracket is ½ a 1milligramme tablet. (Taken from the Prascend website today). Therefore it will cost me £1000 per year to treat my pony instead of the present £208
		
Click to expand...

Hmmm, I'm not sure about your maths there. If it's £150 for 150 tablets, then the tablets are £1 each. If your pony has half of one per day then it's 50p per day, and therefore £182.50 per year. 

However, I do agree that this is frustrating and more expensive for those of us with cushings horses - I have one myself on 1mg per day. My advice is to shop around for price as your vet practice is likely to be more expensive than a chemist - as was the case with pergolide.


----------



## learningcurve (5 February 2011)

Puppy said:



			Hmmm, I'm not sure about your maths there. If it's £150 for 150 tablets, then the tablets are £1 each. If your pony has half of one per day then it's 50p per day, and therefore £182.50 per year. 

However, I do agree that this is frustrating and more expensive for those of us with cushings horses - I have one myself on 1mg per day. My advice is to shop around for price as your vet practice is likely to be more expensive than a chemist - as was the case with pergolide.
		
Click to expand...

Thats what I thought, my shettie has cushing but fine without medication at the moment, but I had worked out the cost at 50p per day based on half a tablet.


----------



## Puppy (5 February 2011)

For me, the most expensive thing about keeping a cushings horse (And mine is a solid 16.2, whose not the best of doers) is keeping them on alternative forage and off the grass all spring/summer/autumn. My girl can eat 16kgs of haylage per day no problem, work that out over a year!  

I'm having her blood tested on Monday to see just how she's doing on the 1mg per day (started last march) but I am somewhat expecting (due to her winter coat still being quite curly), that she will have her dose slightly upped.


----------



## Clava (5 February 2011)

My vet told me this would happen last summer. A company has basically got the patent / license (patent is probably not the right word) to sell the new drug so Pergolide could no longer be used. he then implied that if I'd won the lottery I might start using the new drug, but I had already decided to manage my ponies cushings as best I can without medication.


----------



## smiggy (5 February 2011)

Your vet might be able to work round the regs on the fact that your pony is already stabilised on pergolide and also that the formulation of prascend (ie the dose stength of tablet) is not suited to your horse.
Its a judgement call on his part but might be worth having a chat with him


----------



## Bryndu (5 February 2011)

Thanks all for your interest.

Re the money thing - I was trying to point out, but I dont think I was very clear..sorry!.. that I would have to be using a higher dosage as that was the new recommended for his weight category, therefore would this affect my chap adversely?

Monkst01  Really sorry to hear you lost your beastie.

Smiggy re : 'Your vet might be able to work round the regs on the fact that your pony is already stabilised on pergolide and also that the formulation of prascend (ie the dose stength of tablet) is not suited to your horse.
Its a judgement call on his part but might be worth having a chat with him' 

This is a good call and something worth persuing  thanks.

Clava  re : 'I had already decided to manage my ponies cushings as best I can without medication.' 

I am interested in your comments, are you able to expand? 

Ihotse re: 'I would research as to whether you can buy it online'

My research so far indicates that:

A. It can only be purchased online with a prescription.....but I am still investigating this.
B. At present they are being sold by the 1mg tablet at between 86p and 84p ex vat an p&p.

At the moment I have not told my pony!!!!

Bryndu


----------



## MagicMelon (5 February 2011)

I hadn't heard this??? When does Pergolide go off the market?  I currently have my cushings pony on it, it already costs a fortune.


----------



## Clava (5 February 2011)

I can only expand by saying I give him NAF cushionaze, keep him fit and very careful about lammi and diet and will clip to control hair growth, he's a companion really (but could do more if I had a rider for him) and I don't necessarily expect him to live into old age, but symptoms are mild at present.


----------



## Bryndu (5 February 2011)

Clava said:



			I can only expand by saying I give him NAF cushionaze, keep him fit and very careful about lammi and diet and will clip to control hair growth, he's a companion really (but could do more if I had a rider for him) and I don't necessarily expect him to live into old age, but symptoms are mild at present.
		
Click to expand...


Thanks Clava.


----------



## Bryndu (5 February 2011)

MagicMelon said:



			I hadn't heard this??? When does Pergolide go off the market?  I currently have my cushings pony on it, it already costs a fortune.
		
Click to expand...



I have 3 repeat prescriptions and then my vet says they will have to prescribe Prascend. So it is Feb now so I expect I shall start in June sometime.

Bryndu


----------



## glenruby (5 February 2011)

I can see this is distressing and considering we are seeing the benfits of treating ponies/horses with Cushings more and more these days - thus allowing them a longer more comfortable life, I do fear this will stop.
For the record - it is EXACTLY the same drug as the human one. Just re-packaged as the equine one. This info came directly from the reps. I did ask about the different dose sizes but forget the answer Im afraid.


----------



## Bryndu (5 February 2011)

glenruby said:



			I can see this is distressing and considering we are seeing the benfits of treating ponies/horses with Cushings more and more these days - thus allowing them a longer more comfortable life, I do fear this will stop.
For the record - it is EXACTLY the same drug as the human one. Just re-packaged as the equine one. This info came directly from the reps. I did ask about the different dose sizes but forget the answer Im afraid.
		
Click to expand...

Thanks for this.
You would think it would be in the vets' best interest to get the drug companies to keep the price low as there are going to be an awful lot less customers for them if everyone decided along the PTS route.
I have to say, whilst grooming my boy today.....I was thinking about his future.....living without the drug is not an option for him......living without my boy ...is.
Worrying times......
Bryndu


----------



## glenruby (5 February 2011)

Im afraid vets have no influence over drug companies. I really cannot understand why the drugs industry is allowed to work in such a way as to have NO competition where other areas of the economy this is rarely allowed. (if you catch my drift...)
Drug companies have us vets over a barrel just as they do our clients.  Im actually not sure what our price is (though I gather its not a huge increase) but a colleague told one of my clients the other day that it would be approx 30-50p daily for her pony(on the lowest dose).


----------



## Bryndu (5 February 2011)

glenruby said:



			Im afraid vets have no influence over drug companies. I really cannot understand why the drugs industry is allowed to work in such a way as to have NO competition where other areas of the economy this is rarely allowed. (if you catch my drift...)
Drug companies have us vets over a barrel just as they do our clients.  Im actually not sure what our price is (though I gather its not a huge increase) but a colleague told one of my clients the other day that it would be approx 30-50p daily for her pony(on the lowest dose).
		
Click to expand...

I know...it is all so worrying.....my vets are actually distraught at the fact this is going to happen and they are powerless to do anything about it....it is all so frustrating...arrgg!

Bryndu


----------



## smiggy (5 February 2011)

Again nothing to do with vets, we just get struck off if we dont follow the rules!
There is a petition signed by many vets against the new regulations. Many of us have also written to our mps and get a standard non committal answer back, actually don't think they quite grasp the issue.


----------



## brighteyes (5 February 2011)

How long before Prascend is available as a generic?  And I'd be quite prepared to go 'underground' to get Pergolide, if I needed to.

There is absolutely no reason for the price difference for the veterinary version. Having a sick pony is bad enough without some stupid legislaton and opportunist manufacturers forcing your hand over the decision not to continue treatment purely on the grounds of cost _*Really*_ makes me furious.


----------



## Puppy (5 February 2011)

Bryndu said:



			Thanks for this.
You would think it would be in the vets' best interest to get the drug companies to keep the price low as there are going to be an awful lot less customers for them if everyone decided along the PTS route.
I have to say, whilst grooming my boy today.....I was thinking about his future.....living without the drug is not an option for him......living without my boy ...is.
Worrying times......
Bryndu
		
Click to expand...

Really?! For 50 pence per day? How very sad  

My mare will cost at the very least £1 per day on this new brand of medication, (plus about £750+ pa in forage because she can't have grass ), and I can't say I'd consider PTS because of that. 

I also think it pretty obvious that the vets have no say in this.


----------



## MurphysMinder (5 February 2011)

My pony's pergolide dose has just been increased to 2 x 1000mg tablets per day.  The vet has given me a x 3 repeat prescription to keep her on it as long as possible but after that it is going to cost me a heck of a lot more to keep her on Prascend. She has been a useless field ornament for years but guess I will have to bite the bullet and find the money from somewhere.

Incidentally the last couple of times I have gone to chemists for Pergolide the pharmacist has told me it is increasingly hard to get and is being phased out, so not sure if it is going to still be available to people either.


----------



## TarrSteps (5 February 2011)

This has been coming down the pipeline for some time and has also been a concern to people in North America so it's not, at least not primarily, anything to do with the EU regs specifically.  (The complications of "off label" usage are international.  Basically drug companies are there to make profits and if they see a niche in the market they can exploit, they will.  )

I am interested though, generally human pharmaceuticals here are VERY inexpensive relative to in North America, even considering the exchange rate.  Are they subsidised somehow?  Perhaps through the NHS?  (Canada also has socialised medicine but it doesn't extend to prescriptions unless the patient falls into very specific groups.)  Is this related to the problem somehow, in that obviously the health care system cannot be subsidising (or even controlling) medications for non-humans at least if veterinary options are available?  As I said, I have no idea but sad as it is to the individual horse people affected, it would make sense.

Right, have just done a bit of looking and Peroglide is being withdrawn voluntarily for human use by the FDA in the US - is that also the case here?  That would explain the "shortage".  I guess in some ways it's good they didn't decide to stop making it entirely but presumably the drug companies are looking to "make up" the loss as a human drug against the continuing market as a equine drug.  Not good.


----------



## glenruby (6 February 2011)

Bright eyes - it will be 10years before the generics can come out. 

Tarrsteps - Yes the FDA have removed pergolide from the market in the US and I think Canada has too. As there are only approx 200people in the UK who are currently on the drug it is expected that the UK will follow suit in the near future - hence Boehringer applying for the licence. Most of those who used the human drug were horses.


----------



## Bryndu (6 February 2011)

TarrSteps said:



			This has been coming down the pipeline for some time and has also been a concern to people in North America so it's not, at least not primarily, anything to do with the EU regs specifically.  (The complications of "off label" usage are international.  Basically drug companies are there to make profits and if they see a niche in the market they can exploit, they will.  )

I am interested though, generally human pharmaceuticals here are VERY inexpensive relative to in North America, even considering the exchange rate.  Are they subsidised somehow?  Perhaps through the NHS?  (Canada also has socialised medicine but it doesn't extend to prescriptions unless the patient falls into very specific groups.)  Is this related to the problem somehow, in that obviously the health care system cannot be subsidising (or even controlling) medications for non-humans at least if veterinary options are available?  As I said, I have no idea but sad as it is to the individual horse people affected, it would make sense.

Right, have just done a bit of looking and Peroglide is being withdrawn voluntarily for human use by the FDA in the US - is that also the case here?  That would explain the "shortage".  I guess in some ways it's good they didn't decide to stop making it entirely but presumably the drug companies are looking to "make up" the loss as a human drug against the continuing market as a equine drug.  Not good. 

Click to expand...

Hi TarrSteps,
Blimey....we are all being given so much conflicting information about Pergolide..will it/won't it be withdrawn......arrgh..
As far as my pharmacist is aware this is not happenening here, although I have asked if he would let me know, but I think I will also do some Interweb searching.
Re the prescription charges....I live in Wales and we do not pay for human prescriptions, they are paid for by the Welsh Assembly Govt. but we do pay for animal prescriptions available only in the 'human' form. The £28.55 I pay for the 100 x 50microgrammes may well be less than if I were to buy 1mg...I do not know, maybe another poster could supply this information.

Bryndu


----------



## Bryndu (6 February 2011)

Puppy said:



			Really?! For 50 pence per day? How very sad  

My mare will cost at the very least £1 per day on this new brand of medication, (plus about £750+ pa in forage because she can't have grass ), and I can't say I'd consider PTS because of that. 

I also think it pretty obvious that the vets have no say in this.  

Click to expand...

Hi Puppy.
Sorry if I gave the wrong impression...my 'git' is staying in this world even if I have to sell my body to pay for his prescription...I was just pointing out that maybe some people will not have the choice with this option.

Bryndu


----------



## Bryndu (6 February 2011)

I must say a big Thank You to all who have responded so far.

A question:
As an ordinary member of the public who has NEVER complained etc. to a higher authority...do you think in your opinion..that it might be worth me taking this further?
I know I said at the beginning I had no hidden agenda...but reading your replies...would it be worth me fighting my Sec A's corner as he clearly can't...or would I be on a hiding to nothing?

Arrgh... I feel so HELPLESS.

Bryndu


----------



## glenruby (6 February 2011)

In all honesty, I dont think it will make an ounce of difference Im afraid.


----------



## jendie (6 February 2011)

If you have a friendly pharmacist he may be able to get you a tablet splitter which will cut the tablets much more accurately than you could managed with a knife.


----------



## TarrSteps (6 February 2011)

Bryndu said:



			I must say a big Thank You to all who have responded so far.

A question:
As an ordinary member of the public who has NEVER complained etc. to a higher authority...do you think in your opinion..that it might be worth me taking this further?
I know I said at the beginning I had no hidden agenda...but reading your replies...would it be worth me fighting my Sec A's corner as he clearly can't...or would I be on a hiding to nothing?

Arrgh... I feel so HELPLESS.

Bryndu
		
Click to expand...

I can't see who you'd complain TO, to be honest.  I can't see the government stepping in to subsidise medications for horses or to somehow force the makers to control the price on "humanitarian" grounds.  As above, the drug is hardly used for people anymore so there's very little impetus to keep it on the market in its current form.  And, frankly, I wouldn't imagine the equine market for that particular drug is so large that the drug company would care much either way - they'll set their price and people will either pay or they won't.


----------



## Ella19 (6 February 2011)

Some vets are keeping the 250mcg in as they agree splitting the 1mg tablets is difficult. Perhaps discuss this with your vet?


----------



## Britestar (6 February 2011)

What you are all missing is the bit of info that is, the reason BI have brought out Prascend is that 'human' pergolide may stop being manufactured in the near future. It is a very 'old' drug, and most cases of Parkinson's are treated with more 'modern' drugs, meaning there are only a few people left taking it, and as they die (sorry, fact of life) it will become uneconomical for them to produce.

Should Pergolide stopped being made, because the drug companies don't see it as viable to manufacture, then it would disappear altoghether, leaving you will absolutley nothing to give the cushings horse.

At least by making an equine version it remains available. My own horse has half a 1mg tablet daily.

At my vets, the cost between the 2 isn't that much different TBH. Maybe try chatting to your Vet to negotiate a discount, they would often rather do that than have you take your business elsewhere.


----------



## Kellys Heroes (6 February 2011)

I've noticed this with our 17 yo who's just been diagnosed with Cushings - we had one pack of Pergolide, on which she improved unbelievably...and have now just started on Prascend. 

However, it's much more expensive and whilst I haven't read through the whole thread (sorry for any repeats!) I have been told that the human medication may be being withdrawn - the laws have also changed in that vets can no longer use human medication when there is an equine/canine equivalent available. (or something along those lines!) It is the same with our GSD - although it changed many years ago, for her atopic dermatitis we cannot be prescribed cyclosporin - it's Atopica. Much more expensive, the same drug and same method of treatment, just a specific canine drug! We pay about 4 pounds a tablet (she is on one tablet every day).

I'll be keeping a close eye on this thread...I think whilst it might not make any difference to the available drugs, getting in touch with the higher authorities might highlight the fact that many horse owners are concerned at a) the massive price change and b) the fact that many of their horses were ill for a long period of time before being diagnosed with Cushings and that whilst Pergolide was making a significant difference, people are wary to start changing meds and what not.
K x


----------



## Bryndu (6 February 2011)

Ok...I have scared myself silly on the Interweb with the fact that Pergolide is being withdrawn due to the affects it has on the human heart (see below):
(Sorry..when I post this I don't know if the links will work)

Taken from http://neurotalk.psychcentral.com/thread10250.html

The British study showed that patients taking pergolide were 7.1 times more likely to develop heart valve damage than those who took other treatments. Patients taking the highest doses of the drug had a 37 times greater risk.

It would seem that the last study, (and as far as I can see the only study..but I stand to be corrected),
made into the  affect of pergolide on equine s for Cushings was 2007, http://ultimatehorsesite.com/articles/ei_cushings.html 
..and I cannot find any reference to any suggestions that it is a cause of heart problems in horses..... does that mean it does or does not affect the equine heart?

The drugs now being used to treat Parkinsons in humans, (which is what Pergolide was used for) are to be found at:
www.parkinsons.org.uk/about_parkins...s/drug_treatment_for_parkinsons/levodopa.aspx

Now heres the question.....

If we were to say that as Pergolide is being taken off the market due to the high percentage of heart valve damage in human,  it would be seen as an unacceptable risk to continue to use Pergolide in equines as research into heart valve damage in equines does not appear to have been carried out....and as there is no equine alternative to the products listed on the website above...would we be justified in asking for one of the newer human treatments available?

Bryndu.


----------



## Britestar (6 February 2011)

Bryndu said:



			If we were to say that as Pergolide is being taken off the market due to the high percentage of heart valve damage in human,  it would be seen as an unacceptable risk to continue to use Pergolide in equines as research into heart valve damage in equines does not appear to have been carried out....and as there is no equine alternative to the products listed on the website above...would we be justified in asking for one of the newer human treatments available?
		
Click to expand...

For a start, there is no evidence that it will affect horses the same as humans. After all it is being used for a totally different problem in humans.

Thats leads onto the question whether you could use a 'newer' drug, just because those drugs treat the same problems in human doesn't mean to say they will aslo be effective for cushings horses.

Drugs have varies side effects, the most well known one is Viagra, in actual fact that drug was and still is used for hypotension and its other effects were discovered later! 

Maybe there is another drugs out there that can be used for cushings, but obviously studies would need to be done, and that in turn will push the price of that medication up.


----------



## glenruby (6 February 2011)

Firstly, Parkinson's disease and Equine Cushings are NOT the same thing. However insufficient levels of Dopamine are common to both. Im not sure of the different dopamine agonists and how suitable they are for Cushings however.  There are other treatments for Cushings but most of them either do not give a satisfactory clincal result or vary s to how effective they are in different horses.

And no, in the absence of research I dont believe its an unacceptable risk. People were more than happy to use it off licence for years (and the heart effects are known for a few years now). Also there is a much lower incidence of heart disease/attacks in equines than in humans(in general).  The average Cushings horse will probably get Pergolide for less than 5years whilst humans would usually be on the drug for far far longer. Untreated Cushings will usually result in the early death of the horse (either directly or through laminitis) whereas Parkinson's disease doesnt really kill people.


----------



## Bryndu (6 February 2011)

Thanks Brightstar and Glenruby.

It was worth a try and I really DO appreciate your concise replies.

I don't know the first thing about 'trialling drugs' and can only comment on the amazing affect Pergolide has had on my pony......and he shall continue to have the drug for as long as he is able, although I know he shall not be with me for as long as we both would wish

Bryndu


----------



## norfolk_grump (7 February 2011)

Hi Brydu,

Pergolide does cause valve fibrosis as per the links you posted, when used in the treatment of Parkinson's, importantly, the dose used for the treatment of Parkinson's is huge in comparison to that used in pituitary problems. 

There is a more modern drug used in humans (cabergoline) but as this is also ergot based, theoretically can cause similar problems. Patients on cabergoline will have a yearly echocardiogram as a sort of security blanket for the doctor who prescribed it. 

I'm not sure if cabergoline is licenced to be used in animals, nor its cost (try the BNF via google for price), there are still a few patients on Pergolide so I think it is still being produced


----------



## Bryndu (7 February 2011)

norfolk_grump said:



			Hi Brydu,

Pergolide does cause valve fibrosis as per the links you posted, when used in the treatment of Parkinson's, importantly, the dose used for the treatment of Parkinson's is huge in comparison to that used in pituitary problems. 

There is a more modern drug used in humans (cabergoline) but as this is also ergot based, theoretically can cause similar problems. Patients on cabergoline will have a yearly echocardiogram as a sort of security blanket for the doctor who prescribed it. 

I'm not sure if cabergoline is licenced to be used in animals, nor its cost (try the BNF via google for price), there are still a few patients on Pergolide so I think it is still being produced
		
Click to expand...

Thank you for this norfolk_grump.

Bryndu


----------



## Sadiemay (9 February 2011)

Hi there,

I have just equired with my new vet practice about Prascend as I will run out soon of the Pergolide my old vets prescribed. 

I was expecting it to be mega bucks as I have read its very expensive compared to Pergolide. However I was pleasantly suprised when the receptionist said is was 158GBP for 160 1mg tablets.  

Granted, its alot more than I was paying for Pergolide (Pergolide was something like 70GBP for 100 tablets including the cost of getting the vet to write a prescription so I could get it from a pharmacy)

The cost really does seem to vary between vets as someone posted at the beginning of the thread that they paid 260GBP for 160 tablets (I think) 

Now that is where my grumble lies, that the cost of drugs/medicine varies so much. Its not fair at all.

Sadiemay


----------



## Sadiemay (9 February 2011)

Sorry I meant to say to Bryndu.....

Am I right in thinking your pony is on 0.5 mg a day?  If so then 160 1mg tablets will last your pony 320 days, which is around 11 months  

So say worst case scenario and you have to pay around 200GBP for the 160 tablets its still a hell of alot better than the 1000GBP a year you thought you may have to spend.

Ignore me if I got the wrong end of the stick 

Sadiemay


----------



## fatpiggy (9 February 2011)

Oh the joys of prescription medicines for animals! I could write a book on the subject   My mare has epilepsy and her main drug is phenobarbitone.  When she started on it back in 1998 I could have the human product and 1000 tablets cost about £17 including VAT. Back then that was a months supply. Over time she has gradually needed more and more and now she needs 2000 tablets per month plus potassium bromide - without the bromide I would need to double the phenobarb.  She had only been on the drug for 6 months when my vet warned me about the new Cascade system being foisted on them by Brussels which meant I could no longer use human phenobarb as there was a licenced animal equivalent produced for dogs.  Trouble was 1000 tablets cost well over £100.  He managed to negotiate a deal with the company whereby I order 5000 tablets and pay for 4000 which obviously is a big help but still means my drug bill is around £200 per month for her epilepsy plus another £70 or so for metacam - she can't have any other antiinflammatory due to the drugs blocking each other.  The drug company can basically charge what they like as they have the only licence - the drug costs pennies to produce in reality. Vets refuse to prescribe on the grounds of cost and I certainly know of other horses which have died or been put down and never got the chance of treatment.  My girl has gained (so far) 12 extra years of happy, productive life and I've lost £30K in the process. But what else could I have done?


----------



## Bryndu (9 February 2011)

Sadiemay said:



			Sorry I meant to say to Bryndu.....

Am I right in thinking your pony is on 0.5 mg a day?  If so then 160 1mg tablets will last your pony 320 days, which is around 11 months  

So say worst case scenario and you have to pay around 200GBP for the 160 tablets its still a hell of alot better than the 1000GBP a year you thought you may have to spend.

Ignore me if I got the wrong end of the stick 

Sadiemay
		
Click to expand...

Sausage..I wouldn't ignore anyone who has taken the time to read and reply to this post..thank you.

My pony is on microgrammes not milligrammes which is my problem. Microgrammes is a much smaller dosage and my problem is going to be getting the amount he requires in to small enough 'dust' to administer.
Interestingly, my vet phoned for a chat yesterday and she had spoken to the drug company as she does not feel happy at giving my boy half a 1 milligramme tablet as this would be way too much of a dose for him. He is only 9 years old and was diagnosed at 7 so is at the beginning of Cushings, whereas it would seem most of the treatment in high doses is to treat the advanced stages of Cushings in older horses. The drug company basically said 'you are on your own'....hey ho!
I am off to my pharmacist tomorrow to see what tye of equipment is available to 'break up' his Prascend into manageable 'bits'. I am hoping there are some sort of weighing scales.

Bryndu


----------



## Bryndu (9 February 2011)

fatpiggy said:



			Oh the joys of prescription medicines for animals! I could write a book on the subject   My mare has epilepsy and her main drug is phenobarbitone.  When she started on it back in 1998 I could have the human product and 1000 tablets cost about £17 including VAT. Back then that was a months supply. Over time she has gradually needed more and more and now she needs 2000 tablets per month plus potassium bromide - without the bromide I would need to double the phenobarb.  She had only been on the drug for 6 months when my vet warned me about the new Cascade system being foisted on them by Brussels which meant I could no longer use human phenobarb as there was a licenced animal equivalent produced for dogs.  Trouble was 1000 tablets cost well over £100.  He managed to negotiate a deal with the company whereby I order 5000 tablets and pay for 4000 which obviously is a big help but still means my drug bill is around £200 per month for her epilepsy plus another £70 or so for metacam - she can't have any other antiinflammatory due to the drugs blocking each other.  The drug company can basically charge what they like as they have the only licence - the drug costs pennies to produce in reality. Vets refuse to prescribe on the grounds of cost and I certainly know of other horses which have died or been put down and never got the chance of treatment.  My girl has gained (so far) 12 extra years of happy, productive life and I've lost £30K in the process. But what else could I have done?
		
Click to expand...

Blimey fatpiggy.....I am REALLY sorry to hear about your girl....and having read your post...I feel quite humbled.....you have greater costs for the same amount of hassle.

Best wishes
Bryndu


----------



## fatpiggy (9 February 2011)

Thanks Bryndu - I try not to think about the cost TBH!  I would probably do exactly the same all over again, although I admit I didn't think the old girl would live as long as she has (she's 28 this year) as the drugs are supposed to knacker the liver. She was routinely tested just over a year ago and her liver was functioning completely normally.

There is one trick you could try - if you could get the vet to say that the new drug is unsuitable for your pony, he might be able to still prescribe pergolide.  A friend of mine is a pharmacist and she knows of someone's dog with epilepsy which still gets the human phenobarbitone because the vet "says" it is allergic to one of the components of the animal medicine.  

Animal owners are really held to ransome over their pets, aren't they?  Good luck with your chap.


----------



## Bryndu (10 February 2011)

Thanks fatpiggy....

Update...visited pharmacist today..he says he may be able to get Prascend from his animal medicines supplier a bit cheaper so he will look in to this...as Teaso says...every little helps!!!  However.....isn't there ALWAYS a 'however', he would need a prescription...havn't spoken to vets yet, we shall have to wait and see if they feel this is acceptable...

He is also sourcing some crushing and weighing equipment and he thinks it will be easy to get the 50 x 2 microgramme dose my pony requires using this method...

Folks....things may just be looking up......
Will keep you informed.

Bryndu


----------

