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The starting dose is 2 µg pergolide/kg (dose range: 1.3 to 2.4 µg/kg) body weight. Studies from the published literature cite the most common, average dose as 2 µg pergolide/kg with a range from 0.6 to 10 µg pergolide/kg (0.25 mg to 5 mg total daily dose per horse). The starting dose (2 µg pergolide/kg) should then be titrated according to the individual response as determined by monitoring (see below). Starting doses are recommended as follows:

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Life long treatment is anticipated for this disease. Most horses respond to therapy and are stabilised at an average dose of 2 µg pergolide/kg body weight. Clinical improvement with pergolide is expected within 6 to 12 weeks. Horses may respond clinically at lower or varying doses; it is therefore recommended to titrate to the lowest effective dose per individual based on response to therapy, whether it is effectiveness or signs of intolerance. Some horses may require doses as high as 10 µg pergolide/kg body weight per day. In these rare situations, appropriate additional monitoring is advised.

Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25% of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d = 5.8 cm) ascending aorta. Retroperitoneal fibrosis improved with pergolide cessation and corticosteroid treatment. This is the second case reported in the literature, of a patient who had double valve and ascending aorta replacement surgery because he suffered from this rare but serious adverse effect of dopamine agonists used for managing Parkinson's disease.

Retroperitoneal fibrosis (RPF) describes a chronic inflammatory process of the retroperitoneum, with eventual fibrosis and entrapment of the ureters and other retroperitoneal organs, which can produce obstructive uropathy and renal failure [1, 2]. Rarely, is RPF related to drugs overt autoimmune disease and chronic infection, such as tuberculosis [1, 3]. In fact, retroperitoneal or pleural fibrosis, the so called "serosal fibrosis" secondary to pergolide has been reported by many authors [4, 5]. Apart from the above mentioned serosal fibrosis, another consequence of ergot dopamine agonists, such as pergolide, is heart valve regurgitation. Van Camp G et al [4] reported the development of moderate-to-severe heart-valve regurgitation in 15 of 78 patients treated with pergolide for Parkinson's disease. The changes mediated by the 5-HT2B agonist are closely connected to the serotoninergic receptors expressed on cardiac valvular fibroblasts [6, 7]. In fact, pergolide and cabergoline have high "affinity" for the 5-HT2B serotonin receptors, which are expressed in heart valves and might mediate mitogenesis and, in turn, the proliferation of fibroblasts. The latter process causes fibrotic changes such as thickening, retraction, and stiffening of valves, which result in incomplete leaflet closure and clinically significant regurgitation [7]. Fortunately, heart valve replacement will only be necessary in a few of these patients.

Prascend is supplied as small tablets and is the veterinary licensed form of the drug pergolide, which has been used for some time to treat Cushing's Disease in horses. This is a hormonal disease where the pituitary gland in the brain fails to work properly, resulting in an overproduction of natural steroid hormones in the body. This gives rise to a variety of clinical signs, the most common being a longer, paler and curly coat. Affected horses often appear depressed and lose weight despite seeming to eat more. They often drink and urinate excessively too. Cushing's disease results in a depressed immune system, so parasite infestations and bacterial infections often develop. Cushing's disease is seen most often in older ponies. Vets can perform blood tests to confirm the diagnosis. Prascend is unable to cure Cushing's disease, but it helps to control symptoms and improves the quality of life. Prascend tablets need to be given daily for the rest of the horse's life.

Rood and Riddle Veterinary Pharmacy welcomes you to place your prescription order online by using our website. However, to have the order fully processed and filled, your veterinarian will have to provide a prescription for the medication(s) you would like to order.

It has been reported that pergolide tablets may cause eye irritation, an irritating smell, or headache when PRASCEND Tablets are split or crushed. PRASCEND Tablets should not be crushed due to the potential for increased human exposure and care should be taken to minimize exposure when splitting tablets.

Pregnant or lactating women should wear gloves when administering this product. It has been reported that pergolide tablets may cause eye irritation, an irritating smell, or headache when PRASCEND Tablets are split or crushed. PRASCEND Tablets should not be crushed due to the potential for increased human exposure and care should be taken to minimize exposure when splitting tablets. Store this product separately away from human medicinal products and handle this product with care to avoid accidental ingestion.

The use of PRASCEND in breeding, pregnant, or lactating horses has not been evaluated. The effects of pergolide mesylate on breeding, pregnant, or lactating horses are not known; however, the pharmacologic action of pergolide mesylate suggests that it may interfere with reproductive functions such as lactation. PRASCEND is approximately 90% associated with plasma proteins. Use caution if administering PRASCEND with other drugs that affect protein binding. Dopamine antagonists, such as neuroleptics (phenothiazines, domperidone) or metoclopramide, ordinarily should not be administered concurrently with PRASCEND (a dopamine agonist) since these agents may diminish the effectiveness of PRASCEND.

To report suspected adverse reactions, to obtain a Safety Data Sheet (SDS), or for technical assistance, contact Boehringer Ingelheim Animal Health USA Inc. at 1-888-637-4251. For additional information about adverse drug experience reporting for animal drugs, contact the FDA at 1-888-FDA-VETS or online at 041b061a72