Q. My 18-year-old gelding was just diagnosed with Cushing’s disease (pituitary pars intermedia dysfunction, or PPID) after a mild bout of laminitis at the start of the month. The vet has prescribed Prascend, but he will not eat it. I’m at my wits’ end. Do you have any suggestions on how to get this medication into him?
A. I’m sorry to hear about your horse’s recent battle with laminitis. We often think about laminitis only in the spring, when grasses are high in sugar, but fall laminitis is common in older horses with undiagnosed or poorly controlled Cushing’s. This is because of the seasonal rise of adrenocorticotropic (ACTH) hormone released from the pituitary in response to day length, which in turn can result in elevated cortisol and insulin. While this rise occurs in all horses, it can be particularly significant in horses with PPID, pushing their levels well out of normal range.
Veterinarians treat PPID with the drug pergolide, and the FDA-approved form is called Prascend. Unfortunately, pergolide is not very palatable and appetite suppression is a common side effect. A good trick for helping avoid appetite suppression when starting the medication is to introduce the drug very slowly. Pracend comes in 1 milligram tablets, and most horses start on one tablet a day. Consider starting with just a quarter of a pill and increasing the dose by a quarter of a pill every few days. Owners report to me that they see fewer initial side effects, including being less picky, when they start this way.
The other trick is to find a better way to give the medication. This is where things can get complicated, as you have found out. You need to find a carrier in which to hide the tablet that will mask the taste. Some owners are lucky enough that their horses will take the tablet in a small handful of grain. Others carve out a piece of carrot or apple and put the tablet inside. This doesn’t work for everyone, though. I caution against putting the tablet into a bucket of feed, as it is very small and it would be impossible to know whether your horse ate the medication this way.
Some other ideas include putting the tablet into the middle of a pitted prune or date. Some horses like Fig Newtons, and you can hide the tablet in the gooey center. One company even makes a pill pocket for giving medications, designed specifically for horses with PPID. The outer shell is like a large alfalfa pellet, and you press the tablet into its soft center.
Another trick is to put the tablet into empty gelatin capsules before putting it into your carrier. This will hide any smell and also prevents the tablet from interacting with the carrier and potentially impacting its taste. If all these ideas fail, many people end up dissolving the tablet in a small amount of water in a syringe and then dosing the horse with it directly. This might not be an ideal long-term solution but can get some horses over the hump. The key is to stick with it and not to give up. It might take several weeks to win your horse over and for his or her pituitary system to even out, resulting in more appetite and less pickiness about medications.